Kaneenica Ninawe is a clinical psychologist working in King Edward’s Hospital in Mumbai since 2011. She recently completed her Phd in Health System Studies from TISS. This interview with Sukanya Sharma has been edited for clarity.
Q: What kind of problems do patients come to you with?
Largely people come with a diagnosis of their own, and the others are just trying to know what the possible diagnosis could be for what and how they are feeling.
- A lot of them may have issues with self-esteem
- A lot of them will have inter-personal conflicts (sometimes because of their personality, sometimes because of their mental illness)
- Sometimes there are social issues. For example: We look at a lot of patients coming from the lower socio-economic strata. For such patients, coming in to seek therapy is difficult as some of them are daily wage earners, and for them to skip work and come in for medication is not a viable option — it is an economic burden to come to the hospital.
Q: Do patients generally check themselves in or they are referred by someone?
Largely they are referred by someone, like their partner or their parents. They are not willing to come because they don’t consider this (mental health) as a problem per se, so they have to be directed. There are very few people who come by themselves, although patients who suffer from depression or OCD have been seen to take that first step by themselves. They want to come seek therapy, because they are so tired of their symptoms that they are willing to get better.
Q: What are the various illnesses people come in for? And any specific age group that comes with a specific problem?
I see a lot of schizophrenia patients because it’s a hospital set-up, so the more chronic and severe cases come here. I also see a lot of bipolar patients, patients going through major depressive disorder, OCD, borderline personality disorders, also some cases of child sexual abuse, bullying in children, marital discord. Since the hospital has a child OPD and adult OPD, we look at cases from all the age groups, and therefore nothing specific. There is also an addiction centre which looks at substance abuse survivors – alcohol, nicotine, gambling.
Q: Are these support groups helpful?
AA (Alcoholics Anonymous) is doing some fabulous work and so is NA (Narcotics Anonymous). But at the end of the day, they are support groups; a peer group. Sure, some people do get help only by attending these group meetings, but a large chunk do require medical help simply because of the kind of dependence that these substances can create – in terms of detoxification, and anti-craving. The approach to getting better is more holistic in some surroundings – (apart from just joining a support group) – there’s detoxification of the patient, we give the regular medicines depending on the diagnosis, therapy is done regularly, a social worker looks into employment and other social related issues, we have yoga groups too.
ONLY medicine or ONLY therapy can only do so much.
Q: Three things to tell a mental health survivor
- You can heal
- You can heal
- You can heal
ALSO READ: Your Stories: Surviving as a Care-Giver
Q: What do caregivers need to be careful of when taking care of a patient?
In general it is not best to use labels – yeh toh pagal hai (S/he is crazy), yeh toh theek hi nai hoga (S/he can’t get better) and so on.
When we look at the whole idea of expressed emotions, we try to explain to caregivers – you have to be as you are. You need not be extra loving and you need not be extra critical also, either (way of being) is not going to be good for the patient. There are caregiver groups that address specific issues and try to psycho-educate them about how to be with a patient. These groups are quite helpful.
Q: Advice to a carer?
They need to take care of themselves as much as they care for the patient.
Q: How comfortable are patients with taking medication for mental illness?
As observed by me, patients that come to public service hospitals are actually more open to taking medication than just going for therapy – the kind of patients that would come won’t take therapy as a solution to their illness. Even when we chart a medical model, we incorporate therapy for the days when they come to pick up their medicine just to make sure that they also attend the counselling session. Most of these patients are daily wage earners, so for them earning takes priority than just coming in for a therapy session.
Q: Are patients embarrassed of the illness?
A lot of people are even embarrassed to say what they are suffering from, and embarrassed to accept their condition. Sometimes our sessions may seem like we are teaching them about illnesses and mental health; it doesn’t follow the conventional therapy part but you have to psycho-educate the patient to sort of build this insight of what is exactly wrong with them, why are they here and how they can get better — because until and unless they don’t build that insight, there’s only so much a therapist can do.
Q: How many patients do you see in a day?
Testing is a long procedure, and every patients takes an hour and a half or two hours at least. Ideally im supposed to only see 4, because that’s how much time I have, but there are times I see 5-6 patients also. Depends on the individual and the session I have with them. Some finish faster, while the others may take longer to open up. I don’t really restrict myself, but I prefer not to do more than 4 or 5, otherwise it gets too tiring for me mentally.
Q: What do you have to do to de-clutter your mind? Do you also go for therapy from time to time?
Counselling and therapy is not a 9-5 regular job per se, so when you leave work, you should just leave work. I don’t think about my patients when I leave from here, what their problems are, however bad they may be, (I’ve heard some real horror stories), but when I leave this space I make sure I disconnect. I choose to not think of myself as a counsellor, I think of myself as only an individual who needs her own time. Of course over a period of years you understand when and how to switch off. And of course there are some days where you are affected; we are human beings after all, so I do sometimes end up talking to my peers, who are also therapists, without really indulging in details or any confidential information. There’s something called a peer supervision, which is what we turn to when some session gets too heavy for us.
Q: Mental health and infrastructure in India: What is lacking?
- Number of therapists to patient ratio is bad and the psychiatrist to patient ratio is even worse. There is no structure, infrastructure for mental health care in rural India
- The way we as a society look at mental illness, understand mental illness and perceive the after-effects of mental illness needs to change.