Tackling a bad case of the blues

LIFE IN THE FAST LANE IS TAKING ITS TOLL AMONG DELHIITES

The movie Rockstar set new standards of creativity associated with a depressed lover. Set in Delhi University, it tried to represent a culture that inspires a ‘different’ kind of students to have an unapproachable muse.

The void it creates gives birth to high level of imagination and takes the world of art a step forward. The individual might be at the risk of collapse, but the humanity at large benefits. India Gate comes to mean an inspiration rather than a mere monument.

A section of experts and psychiatrists the world over argues for not being paranoid about depression as it has a huge potential for creativity. A psychiatrist from a well-known private hospital in Delhi says, “Tanha hoga pahala kavi, aah se upja hoga gaan (the first poet must have been lonely; depression must have given birth to singing).”

However, a majority of psychiatrists and clinical psychologists don’t look at depression in a philosophical way. “Exceptions can’t become the rule. Every depressed person is not creative. Depression doesn’t harm only an individual; it takes a huge toll on the family and caregivers,” says Dr Nimesh G Desai, director, Institute of Human Behaviour and Allied Sciences.

Rohit Manesh, 25, lost his mother two years ago. A bright engineering student, preparing for management entrance, went into depression. His mother was his mentor and the biggest aide in making important decisions in his life. He barely completed BTech last year and left preparation for management altogether. “My brother would not come out of his room for two-three days at a stretch. He would eat once a day and meet close friends sometimes,” says Rohit’s sister.

He was taken to a psychologist, and he improved enough to take up a teaching job. “He goes to his institute regularly, but comes back and locks himself in his room. We see him only for dinner. It is better than before, but far from normal. Our father worries what will we do after he is retired,” says the sister. She adds she can’t think of going to another city for further studies because of her brother’s condition.

“It feels as if all dreams of our family have come crashing down. Everybody has recovered from mummy’s death. But I don’t know if my brother will ever be normal after such depression,” she says.

Depression is the single largest cause of mental disorders in Delhi, apart from other lifestyle disorders such as hypertension. Urbanisation is cited as the main cause of increasing depression in the city.

“It’s not just urbanisation, but the way urbanisation takes place. The West has also been urbanised, but the rate of depression in cities like Delhi is higher because of the form of urbanisation. Working hours are very hectic here,” says Dr Desai.

“Even if there are two or three persons sharing a flat, they do not have time to engage with each other. There is no time to be with one’s social support, except for the weekends. That creates depression among people.”

The fast pace of change that the city is going through has added to the woes. A survey by the directorate of health services of the city government found that 10 per cent of the population in slums suffers from hypertension, leading to other mental disorders.

“It’s not about physical isolation; it’s emotional isolation. Inter-personal contact is falling rapidly. People don’t have time to even pursue their own interests like playing, painting or acting in plays, to do something other than office work,” says Poornima Manchanda, a clinical psychologist in west Delhi. She says even psychologists and psychiatrists are facing emotional troubles and divorce rates among them are also on the rise.

She says the way out is to be less ambitious in going up the career ladder, and take things a little easy. “People have to decide that they won’t work for more than the stipulated hours. It’s better to be a tortoise and win the race rather than be a rabbit and lose out on energy early in life,” she says.

Dr Desai echoes the sentiment. “Prevention is better than cure, always. Delhiites should try and spend more time with other people and increase inter-personal contact. They have to snatch time whenever possible and not wait for a holiday to be with friends and family,” he says.

“It’s also not just about quantity, but quality. Even if you spend half-an-hour with others, spend cheerfully and don’t talk work-related issues. There should be more and more supportive and appreciative interaction,” says Dr Desai.

Lifestyle versus genetics

Mental disorders are of two types — severe and common. The severe ones include largely genetic disorders, primarily controlled by biological reasons. These are schizophrenia, paranoia, bipolar disorder and the likes. Their rates of prevalence don’t change with the place. Be it different countries or cultures, the same proportion of people suffer from them.

The common disorders are dependent on external factors like culture. Rural India has low depression and hypertension rates compared to urban India. In a meta-analysis of many studies, it was found that 60 out of every 1,000 people in India have common disorders. Rural India contributed 49 out of 1,000, while urban India saw 81 out of every 1,000.

“We need to improve quality of mental health services in rural India. However, the most neglected population are the urban poor and we need to do something about it,” says Dr Desai.

Government authorities often say people don’t go to mental health institutions because of the stigma attached to that, and the government can’t do much about it. However, according to a 2009 study by the Indian Council of Medical Research, 77 per cent of urban poor don’t approach a mental healthcare facility although it is geographically in their reach.

The study, conducted in Delhi, Lucknow and Chennai among 10,800 people, showed that the main reason is not stigma — it was reason number three. The first reason was lack of awareness that common mental disorders need medical intervention, while lack of knowledge about availability of government-run facilities to treat it was found to be reason number two.

Govt programmes

According to the national health programme, every district should have one government appointed psychiatrist. But only 127 out of 600 districts have this. Delhi has a high number of psychiatrists in government as well as the private sector. But it is far below international standards.

“We need 6,000 psychiatrists and clinical psychologists in Delhi. But there are only 314 registered mental health doctors. If the government tries to go to the community and spread awareness about available facilities, how will we man them? Even if we start focusing on creating more psychiatrists through our medical colleges, it will take 10 years to have the required workforce,” says a government official.

What is the way out

“Most lifestyle disorders, especially depression, can be handled by a general physician too. We have a module approved by the Indian Medical Association, in which general physicians can be trained in four weeks. It has 12 sessions of one-and-a-half-hour each, making it a total of an 18-hour module,” says Dr Desai.

He says IHBAS has been running this course for many years and it has produced results. People in east Delhi have especially benefited because training has been imparted to general practitioners in that area the most.

“We are trying to push for it for entire Delhi and other cities too, where there are trained and experienced psychiatrists. Some of us can go from here too and conduct the session,” says Dr Desai.