When babies are born, they are completely dependent on their caregivers to make sense of this new world that they have come into. From making sense of bodily needs like hunger and thirst, babies slowly learn to express them to their caregivers with the hope that their needs will be met. These go beyond just physical needs to emotional needs like love, affection and cuddles. By the age of 7-8 months, the baby has learnt to cry when hungry or thirsty; smile to express joy; be angry when the mother is not being attentive, and thus we begin to observe the emergence of a mind – one that has feelings, the beginnings of intentionality and recognition towards ‘what’ feels comfortable and ‘what’ doesn’t. To state it simply, the baby has successfully begun developing life in the world – a unique, personal journey of mental health.
Mental health, in simple words, is a measure of our state of mind. A combination of our feelings and thoughts that can be used to describe our mental wellbeing at a given moment in time. Mental health is progressively emerging within the public domain in India (finally!) as an area that has historically faced stigma, and dismissal with regards to its status as an essential component of well-being. While the increased conversations are reducing the negativity and stigma around it and helping people talk about their struggles and seeking help, the conversations almost always talk about ‘illnesses’ that need to be ‘treated’ or ‘cured’. The popular understanding of mental health considers ‘anxiety’ and depression’ as synonymous to mental health. In other words, the terms ‘mental health’ and ‘mental illness’ are more often than not, used interchangeably. However, this, in my opinion, is highly misleading and a distinction needs to be made clear.
Our minds are continuously dealing with the world, exposing us to experiences which leave an impact on us, changing us continuously. In this way, mental health reflects the totality of our experiences – both positive and negative, thus influencing who we are and how we express ourselves. Mental health does not mean an ‘absence of problems’, but instead having the emotional ability to deal with what comes your way, called ‘resilience’. It is the overall functionality of our ability to process all feelings and emotions that we have. This approach normalises the range of negative experiences that are part of being human. Anxiety for instance, by itself, is a normal human reaction, that all humans experience from time to time in certain situations. It tends towards becoming problematic when it becomes a chronic state of being, or becomes enhanced, seriously interfering with our ability to function and carry out our day to day activities responsibly. It is also concerning if our anxiety decreases our ability to solve problems and make decisions in our lives. It thus represents a very small part of the entire repertoire of human feelings that disturb mental health, forcing individuals towards taking some action to broaden their existing coping toolbox, or else compromising their mental health.
A few examples can help us understand this better. A child who experienced an early loss of a parent continued with his life like before, going to school, performing well academically. However, the difficulty in working through his grief owing to his untimely loss interfered with his expression of it, forcing him into moments of utter loneliness and isolation from time to time across many days. He faced problems socially as he could connect to his friends superficially in the moment, but wasn’t able to make strong, long-lasting connections over time.
Another individual, a young adult, who has stressful relationships at work, may continuously feel like a victim, just like when she felt when being ‘bullied’ in school. She feels helpless about any pursuit to change her circumstances because she’s always been told ‘It’s okay, bullying is part of life’, thus dismissing her pain since childhood, and forcing her towards tolerating the rage that ensues within. Parents who have children with special needs deal with a range of challenges from frustration, exhaustion, confusion and grief, in their day to day life, often depleting them of their emotional resources. Another major shift I have noticed nowadays is that many people feel a sense of shame about their bodies. These ‘body image concerns’ have become a common theme, specifically in the younger age group that is more exposed to social media and other platforms that may impact their perception of the ‘perfect body’. One can find them putting in a lot of effort – both financially as well as mentally in developing what they come to believe is an ‘ideal body’. This is specifically alarming when seen in young children and adolescents who are still developing, and tend to establish extreme hatred towards their changing bodies, often moving between magnifying awareness of their bodily ‘imperfections’, and a complete lack of care.
We all would know at least one person whose life seems to somewhat fit into one of the above experiences. We, as a society, are guilty of dismissing many such stories, thinking ‘these things happen to everyone. Just get over it’. We continue to feel uncomfortable about discussing challenging experiences like grief, failure, divorce and the emotional storms that these situations evoke within our internal worlds. It is undeniable, however, that such significant life events are often responsible for altering the very fabric of our being – which direction these changes take us towards is unique for every individual, determined on a number of factors such as genetics, past experiences in significant relationships, and previous life circumstances. Society plays a huge role in determining how we are able to express ourselves and thus our struggles.
Nawab (name changed), a gay man is fighting to find acceptance at home with his parents, he suffers in complex ways, fighting feelings of rejection and loss of hope, which might also impact his performance at work, and social relationships. Our personalities are constantly changing as a result of how our minds are interacting with the outside world, affected by both our strengths as well as our uniqueness. We are all continuously faced with feelings of rejection, failure, isolation which can make us feel uncomfortable in an ongoing manner in different degrees and intensity. Technology has added to the complexity of this process, with people actively pursuing a virtual life and using social media as a yardstick to assess their successes and failures in life. It is important to note that many of these experiences, when studied by a mental health professional, may or may not qualify for diagnosable disorders, or mental illnesses. Nonetheless, they represent a range of human experiences associated with compromised mental health due to the many negative feelings that get created and remain unacknowledged within us. They carry the ability to affect how we might feel about our lives, and our potential futures.
This gap in the way we understand and view mental health can create a difference in opinion as well as confusion in many people. This is further aggravated by stigma, social disapproval and the negativity around seeking help for oneself. Here, therapy becomes the healing space to experience these feelings in a safe, non-threatening manner. The emotional cost of not addressing one’s mental health can be seen in problems such as repeating unhealthy behaviours in relationships like choosing the wrong partner, or continuously seeing oneself as unworthy which in turn may affect other aspects of life such as work performance and success. Becoming aware of issues at a level of our thoughts becomes the first step towards dealing with one’s mental health in light of these situations. However, working with a trained mental health professional can make it easier to work through the consequent feelings and make the shift and progress from awareness towards insight, which I define as the moment when the awareness is ‘felt’ for its impact on your quality of life. This step of the therapeutic process is crucial for change to happen. In this way, a mental health professional becomes someone providing an intervention rather than a treatment or cure. An important function served by working with a mental health professional at this stage is that by addressing concerns in the present, one automatically prevents the possibility of issues escalating into a full-blown mental illness.
The issue of seeking help is made complicated in India, wherein, people attach multiple designations, like that of a counsellor, psychologist, psychotherapist, clinical psychologist and a psychiatrist without any legal regulation or clarity on the different meanings they carry. This confusion is increased by the addition of more titles such as life coach, faith healers who promise mental health services without any formalised training or educational background. This is an extremely dangerous situation and might ultimately cause more harm to those suffering as well as the larger profession of psychotherapy, with an increasing number of such pseudoscientists providing negative experiences to those who seek help.
To put things into context, I will share an example of a young female, who had suffered emotional and physical abuse in a romantic relationship, and went to seek help from a lady who called herself a ‘psychotherapist’. This person was not a trained psychologist or counsellor. A common misconception is that mental health professionals just “talk” and “give advice” to their clients. However, the study to become a mental health professional involves being proficient in theories and practice which has been developed over years of research and experience. While talking to clients is key, and even more important skill set of counselling is the ability to effectively listen, and the ability to empathise, skills which are highly nuanced when applied in the consulting room and develop over years of clinical practice. Feeling unheard and annoyed, this girl took 3 years and another abusive relationship before she looked for help again this time from someone qualified to provide it. Such experiences are extremely common across our country and contribute further to the negative ideas around getting help for one’s mental well-being.
The sheer abstractness of mental health concerns, when compared with physical health, make it very difficult to understand since feelings cannot be seen or heard but only felt. It’s funny how we never seek out a surgeon who hasn’t trained in medical school, but we do not check backgrounds of mental health professionals with the same importance. Furthermore, the protocol for an ethical and responsible mental health professional is to have supervision or seek the guidance of a more experienced mental health professional to prevent the possibility of having any personal judgements or blind spots.
A possible solution to this could begin with practitioners clearly stating their training, qualifications, certifications and modality or framework of treatment they use at the beginning, providing clients with the option to get answers to their doubts and a clear understanding of what the process will be like before a financial and mental commitment is made. As a nation, we could benefit from looking at the regulatory models present in developed countries like the UK, across Europe etc. and work towards creating a centralised system which lays the meaning of proper training, and creating a systematised network of professionals on a large scale.
By changing the language we use to talk about mental health, we can begin to change the way we think about mental health. Until now mental health has globally faced a lot of negativity because mental distress is seen as equal to a disease, essentially an approach that medicalises human suffering. Human suffering comes in many forms, such as poverty, and physical disease. Viewing mental health suffering with an equal status as these human dilemmas could thus prove to be crucial to one’s well-being in the long run.
I am proposing a model which allows us to view mental health along a continuum of different life events and stories. Each individual’s story carries within itself its own totality of experiences up to a given moment, affecting how one feels about one’s life in relation to the world he/she lives in. You can be at any point along this continuum as you move through life, navigating your own personal set of achievements and challenges, thus building your unique story along the way. Everyone has a story that shapes their minds. We all have a mind. We all have mental health.