Mental Health in India: Looking Through a Filter of Colonialism and Casteism
Image by Tumisu from Pixabay
India has to grapple with both caste and colonisation to get a holistic understanding of mental health issues, stigma, treatment and community interventions.
The ‘Mental Health in India’ series on The Chakkar will look at various gaps in conversation regarding mental health issues in the country, from the effects of history, to current cultural speed-bumps, solutions for coherent policies for the future, and much more.
It is no secret that Indians carry a lot of shame and stigma around mental health issues. In recent weeks, there has been repeated digs into the death of actor Sushant Singh Rajput and into his private life. Yet, many people have been unable to accept or understand his crippling and serious diagnosis, proving that we find it much easier to blame a villain—or in Rajput’s case, a girlfriend—rather than in the delve in the collective responsibility we are to have towards those suffering.
I believe, however, that the stigma towards mental health often steeps from India’s long tradition of the caste system and our colonial history.
Looking at oneself as inferior is something that most inhabitants of colonised countries experience. The British/European way of life has been painted as “better”, and thus ideas of badness and weakness are internalised. For example, E.J.R. David’s piece on Filipino mental health shows the internalised colonial mentality as it manifests in disliking one’s looks, one’s cultural ways, and thinking of the “provincial” Filipinos as backward compared to westernised Filipinos. It is not a stretch to imagine that this is the case in India too, where we often tend to look down on our rural and tribal populations.
We need a mix of the new and the old, the eastern and the western, and it has to be grounded in visions of empathy and community integration. Our solutions need to be multi-pronged, like having more professionals per person, making treatment accessible and safe across caste, class, gender, age and other divides.
Our ideas of “madness” and “abnormality” are actually quite western. Before the advent of colonialism, we did not lock up people who manifested signs like ‘hearing voices’. It was given a more spiritual tone. Secondly, the mind and body were conceptualised as connected. This idea of the mind being cut off from the body and the environment and the problem being solely inside the brain, is a colonial one.
Recently, The Swaddle published an IGTV video on how ritual healing practices, which may be seen as violent, often are an exceptional space for women to exist on their own terms. Such practices do not find acceptance in western/colonial ideas of mental health or its treatment. Sudhir Kakkar, in his famous book Shamans, Mystics and Doctors, makes a similar claim, about how the ritual healing practices of India respond to the relational and cultural needs of the Indian patient, which are more central to their healing than they would be someone located in a more individualistic-value-based country. A famous post about the Rwandan prescription for depression on under the blue door talks about how the western ideas of mental health treatment did not have traditions important to African healing, such as music, outdoors, dance and community. The common element, therefore, is that all colonised countries seem to regard mental health and its solutions from a heavily colonised lens.
We can see how the western and colonial thought has become a part of how we as Indians think of mental health, illness and its treatment. An analysis published on the World Economic Forum, for example, suggests the stigma from respondents about giving responsibilities to those with mental health challenges. This stigma is rampant with misconceptions, with exclusion, beliefs that those who suffer do so from a lack of will power, that they are violent, that they should be kept at a distance, and so on. An excerpt from the above article adds:
While there exists widespread sympathy towards sufferers, with more than 75% of participants stating they would always feel sympathetic towards them, they also exhibit feelings of fear (14% would always be fearful), hatred (28% feel hatred sometimes or always), and anger (43% feel angry sometimes or always) towards people with mental illness. More than a quarter admitted that they would always be ‘indifferent’ towards people with mental illness.
In a first-person account, Margarita Tartakovsky wrote about facing stigma about mental health as an Indian-origin person, and how she moved forward.
The other big driver of stigma in the Indian context, which doesn’t have an exact parallel to African countries (which often have their own unique race/class complexities) is the caste system. The caste-system has historically led to deprivation, abuse, exclusion, lack of inclusion and opportunities, and of course, poverty. While there haven’t been too many studies focused on the effect of caste on mental health stigma, the connection on poverty and mental illness are quite clear. For example, migrant labourers—who often comprise of those from Dalit or Bahujan castes—have suffered silently with mental health issues. A well-known advocate on social media, Divya Kandukuri (or @anticastecat as she is known on Instagram) wrote of her experience of discrimination in her piece about mental health and caste identity. Kandakuri also speaks of how mental healthcare is often inaccessible to people from Dalit and Bahujan castes due to various reasons, including a steep price, of a therapist unaware of caste issues, or to accessibility problems like language. Her efforts to bridge these gaps prompted her to start her foundation, Blue Dawn.
A study published in 2015 on BMJ Open by a group of collaborating authors highlighted the role of poverty and caste in mental health and its stigma in India. The study concluded:
Public stigma and multidimensional poverty linked to SMI (severe mental illness) are pervasive and intertwined. In particular for low caste and women, it is a strong predictor of poverty. Exclusion from employment linked to negative attitudes and lack of income are the highest contributors to multidimensional poverty, increasing the burden for the family. Mental health professionals need to be aware of and address these issues.
India has to grapple with both caste and colonisation to get a holistic understanding of mental health issues, stigma, treatment and community interventions. It is too easy to say, “Let’s go back to our pre-western understanding”, but that may ignore the impact of the caste-system. Therefore, we need new imaginations regarding how we think of mental health. We need a mix of the new and the old, the eastern and the western, and it has to be grounded in visions of empathy and community integration. Our solutions need to be multi-pronged, like having more professionals per person, making treatment accessible and safe across caste, class, gender, age and other divides, introducing multiple levels of treatment—right from barefoot community counsellors up to specialists—and having a robust awareness campaign. And of course, this would mean way more mental health budget allocation than the current 0.05%.
This is a huge task, but silver linings have emerged. Take the example of uniquely hopeful idea of the Dawa Dua project, under which mental health professionals work within the premises of a Dargah, in collaboration with the Dargah priests, to help give treatment to those whose ailments may not be only spiritual in nature. In order to have unique solutions for our unique contexts, we need ideas that break the barriers of hierarchy and othering in the service of healing and community.
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Sadaf Vidha (she/her) is a therapist and researcher with five years of experience. She is interested in cross-disciplinary understanding of human behavior at the intersections of mental health, sociology, social justice and economics. In her free time, she likes to read, paint, bake and play with her cats. You can find her on Instagram: @shrinkfemale and Twitter: @randomwhiz.
