By Sudarshan R. Kottai
Edited by Namitha Sadanand, Senior Editor, The Indian Economist
The recently launched National Policy on Mental Health defines mental health problems as “a range of difficulties, ranging from psychological distress affecting a larger number of people, to mental illness and mental disability affecting a smaller segment of the population.”
I am very skeptical about the word ‘distress’ used in the definition as it subsumes every individual, projecting them as patients of one mental health problem or the other. There is no individual who doesn’t experience “distress” at some point of time, except the dead. We are human beings. Negative emotions do occur to us, they do have functions and positive outcomes. When we are sad, we tend to be more alert and more justified and fair in dealing with people. Recall and recognition memory is enhanced during periods of sadness. Bad is also sometimes good and the road to mental health is not about being completely free from distress. Suffering is inevitable, said, Buddha. It is all about how we combat distress.
With the advent of the Movement for Global Mental Health, all of us are constantly bombarded with phrases like “Mental illness is a brain disorder”, “Depression is the second largest global burden”, “One in every four people suffers from mental illness” and the like.
The notion of ‘politics of power’ has lead to a fuller awareness of the reflexive relationship between language, knowledge and power. Distress, depression and mental illness are obviously areas of human experience and action in which language, knowledge and power are played out. The way language is used affects people’s thinking strongly which in turn affects the way people behave, bringing power into the equation. By equating mental illnesses to brain disorders, depression gains equal status with other physical disorders like Tuberculosis. But the fact is that no conclusive physical causes have been found for any mental disorder, ranging from the common to the severe. The evidences are inconclusive and contradictory, at times.
The usage of the term “burden” is significant. It startles everyone, and the ‘fight or flight’ response to it is the most likely. The mental health policy is an after effect of this discourse by the WHO and the Global Mental Health Movement. Burden also implies the need to spend more on mental health and subsequently, eyes an untapped ‘market’ for drugs.
As a result of widespread dissemination of these taglines through popular media, common people are constantly on the search for symptoms of mental illness believing what popular discourse tells them- every one in four of us is mentally ‘ill’, and the illness can be treated like a physical disorder.
The spotlight on mental health globally has brought out the standard toolkit to assess mental disorders in alien cultures and has produced epidemiological results to show that the Global South is bereft of mental health services and that there is an imminent need to scale up mental health services.
In practice, scaling up of mental health services in the Global South is nothing but increasing access to psychotropic drugs whose efficacies are still being hotly debated in the Global North. As a clinical psychologist, I had been to community mental health programmes where the sole focus has been on distributing medicines.
Even if the patient tells the psychiatrist that the reason for his depression is because he doesn’t have money for a square meal, say, most of them would prescribe antidepressants. The disadvantaged people’s attention is deflected from the deprived socio-politico-situation in which they are in, towards their supposedly compromised brains. Poverty is individualized as a defect in their brain. In this context it is to be remembered that the governments of many states in India had sent a team of psychiatrists to prevent farmer suicides-a knee-jerk response-without paying attention to the macro level agrarian crisis and consequent widening of social inequalities.
In the research article titled ‘The medicalisation of ups and downs: The marketing of the new Bipolar Disorder’ published in the journal Transcultural Psychiatry a few months back, Joseph Monerieff explains the evolution of bipolar disorder, which was rarely diagnosed in earlier days to its current form which encapsulates any form of emotional turbulence; be it negative or positive. Due to the increasing coverage in the media about bipolar disorder, people self-diagnose and seek psychiatric services-essentially, drugs. The marketing of bipolar disorder by terming it, in Joseph Biederman’s words, ‘a disorder with a neural basis in the brain and the category of pediatric bipolar disorder’ has increased the chances of patients being saddled with a wide range of psychiatric medicines ranging from mood stabilizers to antipsychotics. Medicalization of emotional turmoil without acknowledging social disadvantages or pressures give rise to the ‘biochemical self’ that can compromise agency, he points out.
Derek Summerfield in his research article titled “How scientifically valid is the knowledge base of Global Mental Health” published in the British Medical Journal examines how local knowledge has been sidelined, and Western psychiatry has been applied without taking into consideration the context in which the distress occurs. He calls it medical imperialism. Psychiatric literature talks more about cultural similarities than differences in order to signify the universal applicability of Western biomedical psychiatry. We are reminded of the fluidity of psychiatric diagnosis in the form of sudden appearance and disappearance of psychiatric disorders in the Western cultural documents known as ICD-10 and DSM-V.
All local idioms of distress and human experiences are translated into psychiatric categories. Thiongo calls it, ‘a colonialisation of the mind’. China Mills calls it ‘Psychiatric Imperialism’ whereby psychiatry is exported to the majority world by economic and political forces allied to Western power. As the sale of psychotropic drugs have been saturated in the Western countries due its controversial evidence base, the lens has now turned towards the East, to persuade people in the Global South to take pills and cure life’s ills.
The ground reality is neo-colonialisation in a different form of psychiatry, silencing an individual’s world and finding pharmacological solutions to social problems. The medical hegemony in the field of mental health promoted by the Government of India explicitly expressed by sidelining and discriminating against clinical psychologists and psychiatric social workers on the basis of pay and perks can be read with these developments.
After organ transplantation was hailed as a grand revolution by medicine, it is now causing negative repercussions in social dynamics including poverty, power, role of the state etc. Stricken by poverty, many have started selling kidneys, leading to kidney tourism. For many people, body organs have become commodities worldwide, with anthropologists calling this phenomenon ‘commodification’.
Now, exaggerated attention is being shed towards the brain in the name of mental illness, discounting profusely the world in which the brain exists and operates. There are many ways to cope with distress. Foremost and the most important is the exertion of agency and the revitalization of indigenous systems like religious healing without resorting to making our distress an illness to be ‘treated’. It is high time we thought beyond our individual body; the political and social body argue to better understand the politics engulfing us, and eclipsing realities.
Sudarshan R. Kottai studied his M.Sc in Applied Psychology from Pondichery University and his M.Phil Clinical Psychology from LGBRIMH, Assam. He is a recent RCI registered Clinical Psychologist .He is currently pursuing his PhD in Psychology at Indian Institute of Technology, Hyderabad. He is passionately involved in bringing to the fore sensitive issues related to human mental life such as sexuality. He also follows issues related to Public Administration that has direct consequences to human life in general and human mentation in particular. Solitary activities like travelling, listening to music, reading literature and spending time with animals are sources of immense contemplations for him. Sudarshan R Kottai can be reached at [email protected]