Why we need to talk: A look at the prejudices against psychotherapy in India

Seven years ago when my pediatrics professor at medical school asked me to stay home and “write tragic tales like Chetan Bhagat” because my diagnosed clinical depression involved the death of a lover, I knew it wouldn’t be easy. Apart from the fact that Chetan Bhagat didn’t write tragic tales, my professor clearly had no idea what depression does to a person, and what it inevitably entailed – an endless wait.

Many people mistake depression (clinical or not) to mean plain sadness. It seems to be a choice, a way of romanticising one’s life, a way of drawing attention to oneself. After the emergence of social and digital media, it is also about writing sad poems or pressing the recrafted “like” button a tad bit longer till the “sad” emoji pops up below a status. Depression is about Instagram-ing the dark night, or twittering a sad line from one of Neruda’s poems. Gone are the days when mental health issues were a taboo, now everyone talks about it. But with no understanding again of what it actually means to have or suffer from clinical depression or any other psychological ailment.

In the last few years of my practicing as a psychotherapist in India, I have seen Facebook becoming a venting therapy ground, and have also found more than eighty percent of my clients coming to me with an attached self diagnosis of being clinically depressed, suffering from Attention-Deficit/Hyperactivity disorder, schizophrenia and even Alzheimer’s. Once, an IPS officer walked into my clinic with his son and asked me to prescribe him a mood stabiliser because he was certain his son had bipolar disorder. When I asked him to step out so I could talk to my client, his son, he said he did not feel the need for him to go through any talk therapy because he didn’t believe in it. Apparently, he had taken him to a few counselors for two to three sessions and it did not work out. He said he only believed in drugs and salts.

More than just drugs

As a medical doctor I do not discount the efficacy and potency of psychiatric “medicine” or chemical compounds, yet I prefer to place equal importance on psychotherapy as an independent intervention in working with mental health issues. It is important for us to understand the true meaning of whatever tag we are using to brand our illnesses. Say, “depression” the commonest by virtue of its ubiquitous usage in everyday life, everyday lingo. For starters, it may begin with a simple one-line correction: Depression is not just sadness. Period.

Depression is not about what you see, post, comment on Facebook, Instagram, Twitter. It is a real disease that needs to be worked upon. Like any other physical ailment it needs to be examined, inspected, dissected and operated upon. This sadly cannot happen solely by drugs. One would invariably need to sit down, talk about it with a qualified expert, and get to the root of it.

The beginnings of talk therapy

For many medical students it might come as a surprise that Sigmund Freud did not invent the term “psychiatry”. Before Johann Reil came up with the word in 1808, a mental health professional was called an “alienist” – a not so favorable title for a medical professional. In spite of being a neurologist – someone who had practice traditional drug based interventions – Freud believed in the potential and working of the unconscious mind. The base for psychoanalysis, the most influential personality theory invented by Freud, lay in the working of the unconscious and making the patient aware of the meaning of his symptoms. For once the patient is aware they find it easier to release their unexpressed emotions, and catharsis can happen. Fortunately today, building on the foundations of psychoanalysis, we have many other forms of drugless interventions that can be broadly categorized under the umbrella of “talk therapy”. Which, clearly my pediatrics professor or the IPS officer had no inkling about.

However, it does not surprise me that many people, well educated and “progressive”, have such skewed notions not only about mental health, but also about psychotherapy as a reliable method of treatment. On the eve of World Mental Health day when I wrote to an editor of a major daily asking if I could write about the “talking cure” focusing on the need and emergence of therapy in India, his response came as a real disappointment. I was rejected on the grounds that his friends in college who suffered from various mental illnesses remained “sane” only by virtue of taking medication and drugs. He said that if he published a piece on therapy – which was already assumed to be in opposition to drugs – he would be doing disservice to a lot of people he knew. Clearly it meant that I, through my article, was there aiming to shame people who popped pills and therefore, downplayed the importance of medicines.

Having said that, during my own journey of popping antidepressants during medical school, I was sent to Cognitive Behaviour Therapy, where the therapist not only asked me to look at calendars of naked women to cure my sexual orientation, but also asked my mother to confiscate my phone and delete the numbers of all my male friends. Information and skill do not help a person kill his or her prejudice. Therefore the dearth of regressive minds in informed circles – be it at a clinic or at an editorial desk – is an absolute myth.

Change can only happen when we begin to talk. When we allow ourselves to talk about it, when we acknowledge and embrace our problems as integral parts of our personalities. And this can only happen with the discovery and deliverance of “perspectives”. While reading self-help books, cooking, or posting on social media websites can be therapeutic for many, it perhaps will not help one to have an objective attitude or understanding of his or her issues. That can only happen at the table of a skilled professional, a therapist.

Gaurav Deka is a writer, medical doctor and clinical psychotherapist in Delhi.