The mind is a minefield. It does unimaginable things to you. With living no longer an easy undertaking, and pressure to perform in boardrooms and classrooms quite high, preserving mental health is the key to success. In an interaction with TNIE, eminent consultant psychiatrist and sexologist Dr Sandip Deshpande fields a series of mind-bending questions. Excerpts:
Mental health is a broad subject. How can one ascertain if a feeling of sadness or distress needs psychiatric help?
Feeling sad or a little anxious is normal. It is not the same as depression or clinical anxiety. The World Health Organisation (WHO) has laid out the criteria for distress to be qualified as an illness: If the feelings and symptoms in question remain for more than two weeks, and cause disability – for instance, not being able to focus on work or daily activities – then it qualifies as mental illness. The same sort of discretion is to be maintained to discern a habit from addiction. The affected person must know how to differentiate.
People often resort to Google to understand their symptoms. Is that, and the resultant self-diagnosis, a concern?
Yes and no. I’m happy that these online tools are at least prompting people to seek help. Google does a good job of providing helpline numbers to people who take their potential suicidal ideation to the platform. But self-diagnosis can be dangerous.
Is hypochondria the logical endpoint of this obsession?
Yes, that is the earlier term for what is now commonly known as health anxiety. Patients quite often come to me with extreme distress. Often, having read up on something, they psychosomatically manifest the associated symptoms. This is a distressing loop that often bleeds a lot of money as well, leading vulnerable people to fall prey to scams.
Mental health is not a new invention, but a new discovery. A lot of destigmatisation has followed since, but are we using this to forsake our mental resilience and fortitude?
The jury is out in terms of whether people are increasingly getting distressed or if there is an overdiagnosis. In the 1970s, WHO found that India and Nigeria did very well in terms of dealing with mental illness, which took them by surprise, given how under-resourced a country we were then. The crucial variable was the family unit. Families then were inclusive; they would take someone in mental distress along with them (as opposed to delegating care to facilities or ostracising them). But now, we are becoming increasingly nuclear, in terms of the family unit. Genes play a good role; we are blessed with some good genes. We now have the resources to tackle the crisis.
How do doctors themselves fare?
I was part of the Doctors for Doctors (Drs4Drs) campaign. We found that doctors are three times as likely to take their own lives, compared to a regular individual. They are often not good as patients.
What is the progress of sex education in Indian schools?
Sex education in India has faced long-standing resistance. The Adolescent Education Programme (AEP) by CBSE in 2007 faced opposition from some groups, claiming it would promote condom use. A Joint Parliamentary Committee, headed by Venkaiah Naidu, concluded that India needed moral education rather than sexuality education. Despite this, experts stress that the focus should be on age-appropriate Sexuality and Relationship Education, starting with parents talking to children at home and supplemented by schools.
How should sex education be implemented effectively?
Education should be age-appropriate, starting with discussions about the human body and relationships. It should not be a one-off school session, but continuous discussions at home and school. Examples include explaining pregnancy to young children in simple terms and using events like the Nirbhaya cases to teach adolescents about boundaries, consent and expectations. We should try and educate children, boys in particular, about expectations, dos and don’ts. Kerala has been a positive example in implementing such education.
What are the consequences of a lack of sexual education?
The absence of comprehensive sexual education leads to teenage pregnancies, misinformation from the internet, pornography exposure, and difficulties in adult sexual relationships. Even married adults may face sexual dysfunction due to a lack of awareness about their own bodies and communication about desires.
How important is compatibility between a therapist and a patient?
Compatibility, or rapport, is critical in therapy. Psychological treatment depends heavily on trust. Patients should seek therapists with expertise and experience, and both parties must feel comfortable. This process can be instantaneous or take time. AI-assisted tools are now being developed to help match patients with compatible therapists.
What drives people to commit violent crimes, such as murder of a partner?
Violent crimes can stem from delusional disorders, where one partner falsely believes the other is unfaithful, leading to impulsive acts. Some cases involve confirmed extramarital affairs, often uncovered via technology, triggering violent reactions. Premeditated crimes also occur, sometimes with the partner involved. Psychiatrists categorise offenders as sad (emotional/mental health issues), mad (serious mental illness like delusions or schizophrenia), or bad (criminal intent).
What factors contribute to long-lasting and healthy relationships?
Studies in Western contexts, which can be adapted to the Indian perspective, suggest that couples who remain together for decades often share common interests that keep them engaged with each other, they have mutual respect for personal space, allow each partner to grow individually, and effective boundary management with extended family, ensuring family pressures do not interfere.
There is a perception that India has a high number of people with mental health issues but there is a shortage of experts to deal with it...
Not anymore. There were 200 MD seats some 20 years ago, but now the number has gone up to 1,800, but we are still short, given our large population. Nimhans has come up with Tele MANAS which was initiated in Karnataka and has now been rolled out in several states. The Karnataka government has emerged as the flag-bearer with its District Mental Health programme and a psychiatrist in each district. Now the government is set to establish Taluk Mental Health centres, and rope in ASHA workers to tell people about mental health services. Early identification is happening, and treatment is free. I guess we are moving in the right direction.
Does stress and anxiety at the workplace and competition in the professional sphere impact people’s and students’ performance?
Some stress is really good. No stress would make me lazy. When I know my exams are in three weeks, I will sit up and take notice. When it crosses a certain level, stress does the opposite and impacts performance. The pendulum has swung the other way due to competition and race, and impacted mental health. The Supreme Court has taken note, and a committee is looking at students’ mental health.
Suicides among medical students are a big worry. I am sure everybody knows how there is a lot of pressure among medical aspirants in Kota and other places. Suicide among medical students is a big worry. That's why the government wants to set up wellness centre in the educational institutions. The same needs to be replicated at workplaces.
How do we know we have reached the threshold level?
Everyone needs to know their own threshold level. You look at telltale signs like tiredness, slowness at work, facial expression, downcast mood, looking under the weather, not taking care of personal hygiene, not eating well and others. There are studies indicating that a person has expressed but worded it differently. If a person says, ‘I don’t think it’s worth living’, these are signals. Ten per cent of the population in the past one week in Bengaluru has said they have become ‘tired of life’ and they can be helped by friends and colleagues. Next comes the death wish, and this is a passive thought. Some tragedy happens far away, and people wish to be there and among the victims. This is a worrying sign, and if it goes beyond, like suicide attempts and plans, then most definitely they need help.
Can you speak about the pandemic of loneliness?
Society has become very wired and we are connected with some 500 people on social media. In reality, we have fewer people to talk to. With my patients, I tell them to be part of groups and socialise. In Bengaluru, there is a lot of activity happening. Students in colleges have a lot more opportunities, and the idea is to tell them to be part of groups and express themselves.
What are the simple ways to deal with stress and anxiety before we approach an expert?
Understanding why one is getting stressed is important -- is it due to not addressing issues with my partner, someone is unwell in the family, or the boss might not be treating me well. For this, one can talk to somebody, go for long walks, do relaxation exercises, take a holiday break or listen to songs. However, what is to be done when some things don’t change? For instance, I treated a man whose father was suffering from fourth stage liver cancer. He was feeling guilty thinking his father took a lot of stress and got cancer. He went into clinical depression and needed treatment. He was in denial, but we helped him move towards acceptance.
