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Wednesday, April 01, 2020

The Silent Killer

The recent suicides by adolescents in the Tricity are a warning bell we cannot afford to ignore.

Written by Chahat Rana | Chandigarh | Updated: February 17, 2020 11:24:03 am
The Silent Killer Between January 2015 and December 2019, police data recorded a total of 81 suicides committed by adolescents alone in Chandigarh.

The recent suicides by adolescents in the Tricity are a warning bell we cannot afford to ignore. The Indian Express met up with some mental health professionals, and found that a significant number of youngsters, some as young as six, suffer from some form of depression or anxiety that needs medical intervention.

IN JANUARY 1998, David Foster Wallace, the acclaimed American writer and academic, wrote a short semi-autobiographical story titled “The Depressed Person”, which took an unflinching look at the unceasing emotional pain suffered by a depressed individual. In the essay, Wallace claimed that the pain of the eponymous ‘depressed person’ was compounded by the “impossibility of sharing and articulating this pain” and was a contributing factor in depression’s “essential horror”.

Wallace committed suicide by hanging himself in the patio of his house in 2008, after attempting to articulate his long-drawn battle with depression in a two-page long letter. “Suicide is the last resort, it is nowhere near the beginning of the development of a mental health disorder, it is the ultimate manifestation of the disease. For someone to take such a drastic step, the person must have been battling the disease for years without telling anybody, probably since an early age,” claims Dr Nitin Gupta, a Chandigarh-based psychiatrist.

Closer home in Chandigarh, it seems many young people have suffered this ‘unceasing pain’ in silence before resorting to this last escape from their constant battle with mental illness. Between January 2015 and December 2019, police data recorded a total of 81 suicides committed by adolescents alone in the city. Most recently, a 17-year-old boy suffering from depression ended his life by shooting himself with his father’s pistol inside his bathroom at home. The boy had allegedly been depressed since his mother passed away in 2005.

“More than anything else, it is this absolutely misguided understanding that to be strong means to remain quiet and suffer your mental trauma in silence, which causes irreparable harm. For years I suffered my illness in silence, appearing to be perfectly happy on the outside, before finally getting diagnosed,” says Sharmita Bhinder, who was diagnosed with bipolar disorder in her middle age, though she suspects she had it since high school. “There were times I considered suicide, but I might not have gone through those phases had I received the treatment I needed earlier,” rues Bhinder.

Early onset

Dr Gupta, the psychiatrist, claims the youngest child he has treated with depression is a six-year-old. “It is prevalent in very young children, adolescents and adults alike, but the problem with children battling mental health issues is that they are incapable of articulating what they are going through like an adult might be able to,” claims Dr Gupta.

The symptoms of depression in younger children are often psycho-somatic, which means they often manifest through physical pain or agony. “They don’t understand their mental state and have no vocabulary to convey it, so children usually come to us with stomach aches or constant headaches that cannot be pathologically traced to a disease in the body,” explains the psychiatrist. Apart from pains, the doctor claims that children with mental health issues, especially depression or anxiety, tend to avoid going to school, and cling on to their parents or guardians more than other children. “They also have low esteem and avoid all social interactions. Furthermore, their sadness or malaise manifests through general irritability,” claims Dr Gupta.

Regardless of the symptoms, which might vary from person to person, the doctor explains that all clinically depressed persons have a chemical imbalance in their brain. “The levels of certain neuro transmitters, including norepinephrine and serotonin, are imbalanced in the depressed person’s brain,” says the doctor. “Though the causes for the onset of depression can be various stressors, including an unhealthy family environment, academic stress, or sometimes nothing that can be pinpointed, the manifestation of this in the body is an imbalance in chemicals in the brain,” explains the doctor.

A study conducted under the supervision of Dr N K Goel, who heads the department of Community Medicine in the Government Medical College and Hospital in Sector 32, to measure the prevalence of stress, anxiety and depression in government school students showed that an alarmingly high number of children suffer from mental health issues in the city. The study showed that out of all the children interviewed, more than 65 per cent children have mild to severe forms of depression, and more than 80 per cent suffered from varied levels of anxiety. The study also found a co-morbidity of 40 per cent between depression and anxiety. The researchers behind the study claim that their findings showcase only the ‘tip of the iceberg’, as many more children yet to be surveyed might have undiagnosed mental illnesses as well.

Another study conducted by the Department of Community Medicine at GMCH-32 examined the levels of depression and anxiety in the students of Panjab University between the years 2012 and 2014. It revealed that almost 60 per cent of the students surveyed had mild to severe forms of depression. Most alarmingly, 86.5 per cent of the students surveyed were found to have mild to severe levels of anxiety. “These were conducted a few years back. I reckon the levels must have risen, and without adequate support, awareness or treatment of mental health disorders, most suffer in silence, until things truly get out of their hands,” rues Dr Goel.

Stigma and silence

Apart from the pain of the disease itself, those suffering from depression or other forms of mental health issues, have to tackle crippling levels of stigma and taboo, which ultimately lead to them keeping their suffering to themselves. Shriya Nawani, a graduate from Panjab University who runs an organisation dedicated to creating mental health awareness called ‘Sunahri Soch’, claims she had symptoms of schizophrenia and depression since she was three years old. “But my illness was diagnosed only when I was sixteen, until then I suffered alone, without any support from anyone,” says Nawani, who got her mental illness under control after she began seeking adequate treatment.

“At a young age, I was witness to abuse at home, my parents used to fight a lot. This trauma of mine snowballed into full-blown schizophrenia eventually, making it next to impossible for me to function in daily life. Instead of getting me proper medical help, my parents took me to get jhaad- pooch done and indulged in other such superstitious practices to ‘cure’ me,” says Nawani.

Schizophrenia is a chronic and severe form of mental health disorder, which often leads to the patient suffering from a dissociation from the reality around them, leading to hallucinations and constant confusion and disorientation. Often those afflicted with schizophrenia also undergo depression due to the severity of the disease. “There were times in school where everything was so hazy to me, and I just couldn’t understand what was going on around me, but I got no help from anyone until things took a severe turn and I was finally diagnosed after a decade of suffering in silence,” Nawani says.

Sharmita Bhinder, who suffers from bipolar disorder, a personality disorder wherein an individual undergoes a phase of emotional highs or hypomania, followed by a depressive phase characterised by extreme sadness and emotional lows, says she wasn’t diagnosed for years at end, because no one believed the mental pain she was going through. “It started perhaps with the trauma I felt after both my parents passed away when I was just 16. I was diagnosed decades later though, after I had a family of my own with children, and a business to run,” Bhinder adds.

Bhinder says that the most harmful misconception about depression and emotional pain is that it will manifest in explicit ways. “Just because I would rather cry alone in a bathroom and literally bang my head in frustration because I felt so much internal pain, rather than cry in front of others and scream and shout, people thought I was completely fine and happy,” Bhinder says. “In fact, when I tried to share what I was going through, even my closest friends would dismiss my agony and said that I will manage because I was successful and academically brilliant and seemed to have a perfect hold on my life from the outside.”

A class 12 student in the city, who has recently been diagnosed with depression, shares both Bhinder’s and Nawani’s experience with social stigma and people’s inability to extend emotional support to those who quietly suffer from a mental illness. “Even after I was diagnosed, my parents keep dismissing the issue. They ask me to stop taking the medicines because they believe I am completely ‘normal’. As if having depression makes you abnormal,” says the student. He adds that he is pained to see the extent to which his parents try to hide the fact that he regularly goes to a psychologist for therapy. “They told some guests once, that I had gone to meet a psychologist for some research I was doing for school. It’s suffocating, even though I am getting adequate treatment and they are paying for it, they don’t even want me to utter the word ‘depression’ out loud,” he rages.

Parental and institutional negligence

Prerna Manchanda, a counsellor at a private school, says what’s truly missing from India in terms of treating children with mental health issues, is the fact that parents are not counselled alongside the children. “With younger children who cannot communicate with their parents about their stressors, which often are derived from the home environment itself, it is absolutely necessary that parents are counselled alongside their wards,” says Manchanda. In her experience, since parents are the closest support system of a young child, it is crucial that they understand how to maintain a suitable home environment for the child to heal.

Nawani claims that an abusive home environment had majorly contributed to her deteriorating mental health. “However, no matter how much my therapist spoke to my parents about my illness, it was hard for them to mend their ways, and they remained a contributing factor to my suffering,” says Nawani. Though her mother eventually understood her condition and extended support, Nawani rues that her father still struggles to understand what she went through or change his behaviour in order to maintain a stress-free environment at home. She adds that she does not blame her parents, because the vocabulary of mental illness evades her parent’s generation, and even when they try to understand, they often inadvertently end up causing more harm than good.

A parent from the city who wishes to remain anonymous, shares how she also struggled with her child going through a mental illness. “For more than six years he remained undiagnosed and in extreme emotional distress. I just didn’t understand what he was going through, but seeing him going through such suffering took a heavy toll on me as well,” claims the parent. She adds that she always wanted to help her child, but was unable to do the right things for him because she never could understand what he was going through. “Everyone around me said he is just being overly weak and emotional, and asked me to dismiss his suffering, until my son himself made the effort to get a diagnosis. “Since the diagnosis, he is getting treatment and is doing so much better. But still, when he has those depressive phases, it breaks my heart because he is such a good child, he does so well in academics and still he has such low self-esteem. I feel helpless and just want to take all that pain away from him,” she says, tearing up with emotion.

“Often our parents or loved ones tell us, you have such a good life, we have given you everything, then why are you still unhappy? But this is an illness, it does not need to have an external cause, it just arbitrarily affects people and is further compounded by external stressors,” says Nawani. Often, depressed persons, especially children, are ridden with guilt and shame, fearful of the agony they cause to close family members and friends, believing that they are a burden, and unable to share their pain with those who are supposed to be their greatest and unconditional source of support and empathy.

“For me, I always got support and understanding from my family, that is how I kept fighting every day,” says a woman who was bullied throughout school. It was her experience with teachers and fellow classmates at school, the first institution that a child encounters, which brought incessant emotional pain and baggage in her life. “I was dyslexic, and when I struggled to get through class, I was mocked and scolded, instead of guided and supported,” claims the woman, who is now 30 years old.

Despite the trauma caused by her isolation at school, the woman never sought support in terms of counselling and therapy, because she had extremely disappointing experiences with her school and college counsellors. “Once I went to the counsellor’s office after being falsely accused of cheating in an exam. My sole friend at school came with me as witness for my innocence and when she tried to give her account, the counsellor began berating her for being under my ‘bad influence’, making me feel even worse about myself,” says the woman. Instead of being a support for students who struggle with school, the woman claims that often counsellors stationed at educational institutions become ruthless disciplinarians and upholders of an archaic sense of morality. “Their job is to be empathetic to the emotional turmoil students go through, not to make them feel worse and ashamed of their unique experience,” says the woman.

“Those who go through depression and other mental illness are fighters and survivors. They battle their illness every day, managing to get out of bed, look their best and go out in the world without letting others know of the pain they go through every day,” says Bhinder. “We are not weak. Instead, we are warriors,” continues an earnest Bhinder, who balances being a mother with owning her own business and dealing with a severe mood disorders every day. “But we need to stop pretending that we are OK, we need to come out in the open and own our narratives. Seeking help is not a weakness. So if you are suffering from a mental illness, I suggest you get out there and seek the treatment you need before it gets too late,” counsels Bhinder.

That is the crux, say doctors as well. Don’t suffer in silence, seek help.

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