A Wake-Up Call on Indian Mental Health
By: Pulkit Sharma
Published on: October 24, 2014

Dr According to official data provided by the National Commission on Macroeconomics and Health, 6.5% of the total Indian population suffers from various mental health disorders including schizophrenia, bipolar disorder, depression and anxiety. Whether it was the mental health act of 1987 or the recent mental health care bill of 2012, the plight of mental health patients seems never ending. This huge segment of population continues to suffer relentlessly due to various factors. Firstly, there is a stigma associated with mental illness in India and it impedes the diagnosis and treatment of individuals suffering from psychiatric and psychological disorders. Secondly, there is a severe shortage of qualified and experienced mental health professionals in India.

As a country thatcontinues to struggle to provide basic medical care to its population the neglect of mental health issues does not come as a surprise. The Indian government probably has more severe problems to address such as poverty, sanitation and AIDS before it can commit to a comparatively esoteric area such as mental health. Yet, I have a feeling that India has not acknowledged the potential of good mental health for dealing with several basic issues that our country struggles with. While working as a clinical psychologist in Delhi, I feel that a deeper awareness of mental health and its implications can help us in growth and development.

Self-esteem and aggression:An important component of mental health is self-esteem. All of us want to feel good about ourselves and most of what we do and say is geared towards protecting and enhancing our self-esteem. Based on their life and personal histories people can derive self-esteem in both constructive and destructive ways.A person with sound emotional health derives self-esteem constructively. The various problems that a society faces at any given point of time are also reflective of destructive ways of acquiring self-esteem at an individual and cultural level. Aggression in its various manifestations including domestic violence, antisocial behaviour, road rage, sexual assault, group and ethnic violence is a one of the destructive ways to acquire a strong sense of self. Individuals, who indulge in aggression lack empathy for others, have an extremely fragile self-esteem, poor emotional control and difficulty in tolerating pain. Through the act of violence, they feel in control and powerful and are able to eject their negative emotions. Such individuals can be helped with some psychological treatment where by working on their self, the need to control and exploit others can be reduced and a capacity for healthy and reciprocal relationships can be developed. The government has been trying to come up with stringent punishments and strict laws to control aggression but nothing really has changed. The idea that an aggressor can be mentally ill sparks of an ideological debate where people feel that the accused should not go scot free under the alibi of insanity. I agree that it will be an injustice to the victim if insanity is used as a defence and we surely need stricter laws to deter the aggressors but only stringent punishment is insufficient to transform the aggressor.

Sexual health:Another area that can benefit from mental health inputs is AIDS awareness and control. People working for reproductive and sexual health in India face unique challenges. The biggest challenge is non-compliance. Many a times people indulge in unprotected sexual behaviours not because they lack awareness but because the idea of taking a risk excites them, makes them feel omnipotent and helps them in getting rid of painful emotions. Even when given proper sex education these people rarely renounce their risky behaviours. They believe that they are too powerful and though the risk may be there for other people, they will come out unscathed. Often, people with a fragile self use omnipotence as a defence mechanism- they carry a false belief that they are special and this gives them an exaggerated confidence. Psychological work can help them overcome deep sense of shame and vulnerability which exists behind this defence.

Drug abuse:In a similar manner, individuals using addictive substances derive an artificial high from it which helps them deny painful self-states. The Indian government has been showing a strong resolve to end smoking by imposing bans and fines but results have been hardly encouraging. This is so because addictive substances serve an important function for the addict and in order to quit it the person needs to develop psychological resources to tolerate and manage painful self-states. Focussing on emotional health of addicts and helping them cope with negative emotions can help them in quitting drugs.

Communal violence:Our country has experienced communal and group violence on several occasions. Though the violence stops, it scars and traumatizes the psyche of the person. The person's self feels shattered, ashamed and torn and there is a strong wish for revenge to restore the sense of self. This trauma is passed on to the future generation as well if the person has not been able to deal with it. The second generation feels victimized and develops a wish for revenge which forms the basis for continuation of violence and trauma. An important part of rehabilitation of victims is to help them come to terms with trauma so that they deal with the loss, are able to restore their sense of self and do not pass the burden on to the future generations. In India, people have not been able to work through their individual and collective trauma and this leads to continued intergroup tensions.

Mental health is simply not a mere absence of chronic and severe psychological disorders in asylum-seekers; it should include the so-called normal people of the entire nation. Only by building more mental health hospitals and half-way homes, training more mental health professionals is not sufficient for improvement of mental health of our country. India therefore needs to comprehend the deep meaning of mental health.India's mental health policy needs to undergo a massive transformation. Mental health is a state of inner well-being where the individual has a good feeling about who they are and can cope with various stressors without undue difficulty. We need to do a lot of rethinking about how we canhelp people build a strong sense of self at both an individual and collective level. Although, mental and emotional health may seem to be an esoteric concept, sound minds can become catalysts in resolving important individual, interpersonal and social problems in our country. It is time India wakes up to the need for mental health and well-being.

Pulkit Sharma is Clinical Psychologist & Spiritual Therapist in private practice at Pondicherry (Puducherry), near Auroville. Email:- info@thepsychologistindia.com