— Reema Ahmad 

(The Indian Express has launched a new series of articles for UPSC aspirants written by seasoned writers and scholars on issues and concepts spanning History, Polity, International Relations, Art, Culture and Heritage, Environment, Geography, Science and Technology, and so on. Read and reflect with subject experts and boost your chance of cracking the much-coveted UPSC CSE. In the following article, Reema Ahmad, Mental Space Psychologist, discusses the significance of a holistic understanding of mental health.)

How physically or mentally healthy or ill we are depends on a tangle of visible and invisible factors. The World Mental Health Day, observed every year on October 10, draws our attention to the significance of mental well-being. Founded in 1992 by the World Federation for Mental Health, this day aims to increase awareness, dispel misconceptions, and mobilise support for mental well-being. 

There was a time in ancient human history when symptoms of mental illnesses across various cultures were misunderstood as demonic possession, the result of magic spells and sorcery as well as divine wrath. Remedies in the Neolithic era ranged from mystical to brutal practices like chanting, potions, prayers as well as incarceration, chaining, trephining or worse. 

Evidence of a deeper understanding of mental health first appeared in records left by the ancient Egyptians, Persians, Arabs, Chinese and Indians from about 1500 to 500 BCE. These describe mental health issues as ‘illnesses of the soul’ and prescribe therapies like fresh air, movement, music and painting.  

Segments from the Vedas describe treatments like bheshaj (medicine), yam and niyam (behavioural control), asan and pranayam (physical activities) for conditions like psychosis, epilepsy, sleep disorders, and aggression. The first mental hospital of the world was founded in Baghdad in 792 CE. Apparently the rest of the world took time to catch up.

The European world has had the most influence on modern psychiatric treatments and psychology. It has gone through its own journey of understanding mental illness through the ages. From ancient beliefs of supernatural wrath to the theory of imbalance in the four ‘humours’ propagated by Greek thinkers Socrates and Galen who advocated treatments as varied as cupping, blood-letting, leeches and enemas, to the widespread establishment of mental asylums from the 14th century onwards, our understanding of mental health has kept changing.

Historically speaking, a lot of the stigma that continues to surround conversations on mental health dates back to the European Middle Ages. The establishment of the first mental asylums in India in the mid and late 18th century followed the arrival of the British. In the beginning, these asylums were meant only for Europeans but they later started accepting Indians. 

The cultural shift from following a more spiritual approach to mental illness by seeking divine intervention to this idea of madness that had to be punished or isolated is possibly an offshoot of colonialism in India.

However, in the 20th century, the work of Austrian neurologist and psychiatrist, Sigmund Freud created a ripple with the introduction of psychoanalysis and talk therapy which form the basis of a lot of modern treatments like cognitive behavioural therapy. 

The attention Freud’s work received led to other developments like psychosurgery, electroconvulsive therapy and psychopharmacology all over the world including pre- and post-colonial India. These developments were based on the biological model of mental illness where biochemical imbalances are seen as the cause of mental illness. 

As groundbreaking as these new therapies were, they are tinged with horrible histories of forced psychosurgeries (like lobotomies) and the unscrupulous use of shock treatment in clinics and asylums, especially on women who were seen as ‘problematic’. This painful history of forceful admissions and treatments that disregarded the comfort or consent of patients still echoes the fear that describes our hesitation and anxiety in going to see a psychiatrist or counsellor to this day. 

The introduction of drugs like Lithium, Valium and Prozac in the early, mid and late 20th century completely changed the landscape of mental health treatment. These drugs made previously uncontrollable conditions like psychosis and schizophrenia manageable, drastically reducing the need of inhumane treatments or asylums. 

At the same time, this change reduced mental health to an approach where a pill could fix issues and larger social, cultural and family units could absolve themselves of the responsibility to create better environments. Over time, especially in countries like India where the drug industry largely remains unregulated and medicines are often available easily for a price, it also created complex problems like drug overuse, over prescription and addiction which were made worse by the global boom in pharmaceutical industries.

The largely western clinical approach to mental health followed globally relies heavily on label inducing diagnosis and symptomatic medication can lead one to believe that mental health is somehow an enclosed space in our brain and bodies – like an organ that needs to function well in order for us to be healthy. While that is true of some conditions, it is not the whole truth. 

According to the World Health Organisation, “Mental health is a state of mental well-being that enables people to cope with the stresses of life, realise their abilities, learn well and work well, and contribute to their community. It is an integral component of health and well-being that underpins our individual and collective abilities to make decisions, build relationships and shape the world we live in. Mental health is a basic human right. And it is crucial to personal, community and socio-economic development.” 

Thus, an evolving holistic approach to mental health can open up our understanding even more. It explains health in general, and mental health in particular as an intersection of many visible and invisible factors.

According to this approach, mental health – how we experience it and how it manifests in our behaviour, personality and interaction with the world around us – is a complex reality that is as much influenced by our genetics and ancestry as by a whole web of relational, sociological, economic, political and environmental factors. 

In the simplest terms, how physically or mentally healthy or sick we are depends on a tangle of factors, such as (a) the history of diseases in our family lines, (b) the economic class we belong to, (c) the environment in our workplaces and homes, (d) our relationships, experiences in schools and communities, (e) the availability or lack of resources, and (f) political conflicts, wars and ecological factors like famine, drought, floods and climate change. 

To me, this evolving approach that hopefully becomes more popular meets at the crossroads between compassionate ancient spiritual traditions that perceive all things in existence as interconnected and interdependent and modern medicine that helps alleviate physiological symptoms. There is tremendous possibility and freedom in looking at mental health through this lens.

For instance, more commonly experienced conditions like anxiety, mood swings, mild to severe depression and certain irrational fears or phobias are largely considered to be a result of environment and experiences and may need a combination of medicines, alternate therapies and counselling as well as systemic awareness and change. Some recent studies also link all the above conditions to nutrition, gut imbalances and post pandemic stress.

A recent study, A Comprehensive Analysis of Mental Health Problems in India and the Role of Mental Asylums (2023), published in the National Library of Medicine suggests that 15 per cent of the Indian population grapples with some form of mental health issue.

Another study, Youth & mental health: Challenges ahead (2018), published in the Indian Journal of Medical research states that ‘Recently concluded National Mental Health Survey of India estimates the current prevalence of mental disorders in the age group of 18-29 yr at 7.39 per cent (excluding tobacco use disorder) and lifetime prevalence at 9.54 per cent. 

The prevalence of mental disorders in the age group of 13-17 yr is reported to be 7.3 per cent. Young people also suffer a high rate of self-harm, with suicide being a leading cause of death. About half of all mental illnesses are known to begin by the age of 14 and three-quarters by mid-20s.’

According to another study, The burden of mental disorders across the states of India: the Global Burden of Disease Study 1990–2017 (2020), published in The Lancet, one in seven young and middle aged Indians is affected by mental disorders which are also the largest cause of non fatal disease burden in India. 

Drastically varying economic conditions, pronounced issues of class, caste, low literacy, poor and unevenly distributed medical infrastructure, low funding for research, development and implementation of mental health policies are all factors that make mental health difficult to ascertain and improve in the country.

Globalisation and the post 90s economic boom that led to rapid changes in job markets and created stressful corporate work environments with no separation between personal and professional lives, and long working hours exacerbated existing mental health issues in India. All of these issues have only become more pronounced in the last decade, especially post pandemic as boundaries between work, rest and recreation increasingly blur. 

All pervasive technology that keeps our brains stimulated, speeding paces of living and breakdown of community structures lead to more isolation and increase in symptoms of anxiety and depression in all age groups and demographics across the country. Who we are, what we feel, say, do and how we respond to the many events and people around us is much like a conversation between or a continuum of our internal and external landscape at all times. 

What do you understand about mental health? Is it an enclosed space in our brain and bodies or a complex reality influenced by a tangle of factors? 

How can an evolving holistic approach to mental health, which considers the intersection of genetic, environmental and social factors, help expand our understanding of mental health and its impact on individuals and communities?

How has the shift towards a pill-based approach to mental health affected the responsibility of social, cultural, and family systems in supporting mental well-being?

Conditions like anxiety, mood swings, and depression, which are often linked to environmental and experiential factors, can be effectively addressed through a combination of medicines, therapies, counseling, and systemic change. Comment.

(Reema Ahmad is an NLP based coach and counsellor, a mental space psychologist and author. In the second segment of this series, she will explore mental health as it manifests in Indian workplaces and approaches that can help slow down a growing mental health epidemic.)

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