Lend me your ears

Truth be told

Picture this scenario. You’re sitting with your family, watching TV. The usual rambunctious debate, this time about a heinous domestic crime. Everyone blames everyone else. Finally, as always, politics swamps the issue.

Your family carries on the debate. If only the son had been more sensitive, his parents more hands-on. If only the women had had more freedom. Why didn’t society step in at the right time? You join the ‘if’ parade, merrily heaping blame. And then you suddenly stop and think: Good God, look at me! Look who’s talking!

My 2012 play, ‘Cast Party’, dealt with something like this. People watch a play and sympathise with the victim, rage against the perpetrator. Among them is someone  guilty of a similar, more severe, crime. The last person we point fingers at is ourselves! Because we never see ourselves as we are.

The thought led me further. Do we go around carrying a desperate — and probably unnecessary — cross of guilt? Do we dissociate ourselves from our “crimes”? Where do we find redemption? Where do we draw the line between culpability and self-righteousness? Can we actually mend relationships if we voice our concerns? It was appropriate, pondering these questions, both in terms of actual relationships and those of my fictional characters. It was also timely. World Mental Health Day is right behind us. Its theme: Dignity in Mental Health.

Who do we turn to for help? There’s a bit of a paradox here. People who know you well have better access and judgment. But, being involved, they tend to add past and present layers to what may be a singular problem. They may bring others into the equation, going beyond the focal area.

 You need an objective listener. Someone who listens well. Perhaps someone trained to listen. And finally, you and your listener can dust yourselves off and walk away from each other without shards of commitment sticking to you.

Consider the clinically depressed. The layperson dismisses depression. “Don’t worry, you’ll get better in a couple of days. Have a hot cup of coffee and plenty of exercise.” But those who suffer depression know it’s insufferable. The expert knows it’s a disease like any other, curable if treated right.

The bottom line is evident. You can’t fight your mind’s demons all by yourself. You need an expert, a trained one, an objective one. Doctor of the mind? Counsellor? Why, for heaven’s sake, I’m not crazy! In the West, it may be fashionable and routine to bandy your counsellor’s name. In India, you stay away as long as you can, and if you do consult one, you don’t go around advertising it. It’s like thinking we’re the only ones in the world with problems, everyone else is so happy and well-adjusted.

So I decided to ask the experts. Are people now more open to seeking help? What’s the equation between the sufferer, the expert, and public perception? I chose three people I know well. Experts, very different from each other.
I’ll leave you with them.
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More than 30 years ago, I took my mother to an allergist, and  discovered an amazing fact. The doctor was actually a trained sexologist. He used his allergy expertise mainly to retain his practice. He couldn’t function as a sexual medicine practitioner alone. Decades later, he’s one of the most respected sexologists in the country, taken on his own terms, with newspaper columns, conference papers, and a very successful practice.

The one fact we all like to hide is that we have sexual problems. In fact, we’d like to hide that we have sex at all. Despite the fact that the three-letter word is blown out of proportion on medical signboards, cinema posters and quackery centres. So, how has awareness grown since the last time we met? Has society come to terms with discussing sex?

“Yes,” says Dr Narayan Reddy. “There is some change in attitudes. Earlier, people were hesitant and shy to approach doctors to resolve sexual problems. Nowadays, that hesitation has reduced to a great extent. The media has played a great role in bringing about this attitudinal change. However, there’s a clear-cut lakshman-rekha between personal life and public expression.

“Sexual response is psychosomatic in nature. Sex involves two individuals. The interaction between them determines the quality of sex life. Hence, the patient/couple get counselling from me.”

Dr Reddy conducts training programmes for health professionals through the Council of Sex Education and Parenthood (International), a national association for sexual health. He teaches in medical colleges and the psychology departments of arts colleges. He also conducts awareness programmes for teachers and students.

Rape and sexual intimidation are grave threats today. Personal insecurities spill into society, spreading harm and danger. Can you, as counsellor, find a role there as well?

“Yes, every counsellor has a role in dispelling insecurities arising out of ignorance. I write in about six different vernacular media apart from English, clearing myths, doubts and offering scientific information. I thereby hope to empower people to lead a happy life, full of sexual health.”

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We became friends, starting our literary journey at the same time. Already a very successful psychiatrist and counsellor, he branched off into non-fiction, becoming a bestselling author. I nailed the psychological aspects in Maria’s Room, only after he’d read and cleared my novel.

I ask Dr Vijay Nagaswamy if, as writer and counsellor, he finds one activity helps the other.

“I’ve always been a ‘narrative’ sort of person, and for me, certainly, writing and psychotherapy do help each other. The fact that through the process of counselling I had to work to simplify, without dumbing down, certain complex psychological concepts has helped me in my writing. And the fact that when I write I get the canvas to crystallise certain thought processes helps when it comes to counselling.”

What’s your experience in attitudes to counselling, especially in conservative cities (for instance, Chennai)? Have you seen a pattern of change?

“Cities like Chennai have always used conservativeness as a smoke screen. But, that apart, resistance to professional counselling is a pan-Indian — in fact, pan-Asian — phenomenon, largely based on the belief that ‘elders’ are best placed to give advice. It’s only in recent times that people have discovered counselling isn’t advice, but a guided process of self-discovery imparted by a trained and neutral professional. As a result, more and more people are beginning to seek professional help. From a time when nobody wanted to see a counsellor (for this could be an impediment in getting your sister married off), today we live in an age where people pick counsellors based on Google ratings. So, I guess we’ve come a full circle.”

In the changed and informed world of today, what is the basic role that a counsellor plays? Is there a specific economic profile you find in your clients/ patients? Not in terms of affordability alone, but also being open to the idea of sharing one’s problems.

“Given that the levels of psychological awareness have increased substantially in recent times through mass media sensitisation (even vernacular media actively report on behavioural issues), I don’t believe economic criteria apply any more to seeking help. In fact, bar those who’re struggling for physical survival, most other economic groups are comfortable seeking counselling when they find the need to do so. It’s just that their expectations differ. Those who are less psychologically aware and less well-off, expect the counsellors to be ‘professional elders’ and provide solutions, while those at the other end of the spectrum expect the counsellor to empower them to enhance their lives. The majority falls somewhere in between.

What is the role of patriarchy in the cases you encounter?

“It’s always pervasively present, often in the foreground. Considering that almost every aspect of our lives is in some form or another impacted upon by patriarchy or our reactions to shaking off its tentacles, this cannot be surprising. However, the most interesting development, as I see it, is that young people are willing to table issues relating to patriarchy. Even if they aren’t able to arrive at definitive conclusions, they’ve at least started addressing it.”

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When I first met Amrita Clements, she was less than a year old. I’ve watched her transform from a child with a mischievous smile to an amazing provider of solutions, loved and respected by her clients (in this case they’re not referred to as patients). She studied and practiced in the US before moving to Mumbai.

Where do you find the difference between counselling in the US and Mumbai? I’m talking more about your approach and the response. How have you been able to make a difference in attitudes towards counselling?

 “One big difference I’ve noticed here is people reacting to my age. In America, to be a licensed therapist and to work in a Mental Health agency, you have to have at least a Master’s degree. So they trust you even if they’re twice your age. In India, I spend the first session trying to convince them how my qualifications and experience, rather than my age, will help them. We don’t value qualifications as much in the counselling field. People can even do a counselling ‘crash course’ here which lasts a week or two, and then practice.

“In India, people first visit a psychiatrist and then a counsellor. In the US, it’s the other way around. Indians tend to place doctors on a pedestal, and are more willing to try therapy if recommended by a doctor.

“In Bombay, there’s still stigma attached to Mental Health and counselling, and you need to be seriously ‘crazy’ before seeking help. But I’ve definitely noticed this outlook slowly, but gradually, changing as celebrities are talking about it openly (like Deepika Padukone). As my practice grows, I see more people coming in through word of mouth and old clients than just referrals from psychiatrists. This means my clients are starting to be more open about the fact that they see a therapist. When you try something and it works, and you see its benefits, you’re more likely to share it without shame and embarrassment.

“Being a marriage and family therapist, I work a lot with couples. A big difference between America and India is our arranged marriages. Unlike  America, helping couples resolve conflicts, improve communication, break patterns and rekindle lost love doesn’t necessarily work in arranged marriages in India. It’s difficult to rekindle love when there wasn’t love to start off with in a lot of marriages. Here, I need to help partners then express their individual definitions of marriage, and work together to create a joint definition which can be a sort of guideline to help them flourish as individuals within the marriage, and help the marriage flourish too.”

How hard does it get on the counsellor? What is the burden on you, and how much does your training help relieve this?

“I believe being a therapist can be such a hard job, but a fulfilling one. One of the biggest struggles is not seeing change immediately sometimes and learning how to celebrate the small changes even if they seem insignificant. It’s also challenging to sit in the unknown with a client. As humans, we tend to gravitate towards familiarity and shy away from change because the unknown scares us even if it may be good or healthy.

“My training has helped me tremendously in understanding and coming to terms with my own ‘baggage’ and my own story and making meaning and sense of my story before I try to understand someone else’s. Most of my graduate program was spent in understanding who I am and how I operate, and what I value, and how different factors have shaped and influenced me, because all of this will in turn influence how I do therapy. Hence, as therapists, we have to be very mindful of counter-transference.

“Also, how to create boundaries with clients. In my disclosure form, I’m very clear that I refrain from doing therapy via texts or emails. This helps clients to refrain from reaching out to me during the week and to use their support system instead, which we build in therapy. Helping create healthy boundaries helps me have a life outside of therapy. It helps me acknowledge and understand where my client’s story ends, and mine begins.
“Also, my training has stressed on the value of self-care and how, in my profession, to help others one must learn how to help ourselves.”

Without going into confidential specifics, what are the more common problems, and do you see a pattern there?

“India is changing. People are trying to keep up by trying to adopt western values while trying to hold on to their own culture and traditions. I think our country is currently having an identity crisis, which in turn is influencing and affecting individuals, relationships, marriages and families. One big change is that of gender roles. With women being more empowered, they’re choosing to work. This change plays out a lot in marriages and relationships — distribution of household chores, increased pressures, previous generations not understanding this change in roles. Also, fighting for independence as the nuclear family slowly replaces the joint family.

“The most common problems I see are depression stemming from loneliness, and anxiety from increased pressures from society to perform, as we place more value on success.” What is the change in attitude you predict in the coming years?

“I believe mental health awareness is now starting to grow in India. People are seeing the value in therapy and taking care and nurturing the mind, creating space and time for healing, just like you would if you fractured your leg. Also, maintenance counselling may eventually grow in popularity as people realise one can seek help even before a crisis.”