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Understanding Trauma Therapies

By Scherezade Siobhan


You can read Part 1 of this piece here

 

In Poetry and Memory, James Applewhite writes - “Memory is always allowing itself to be used, but won’t be coerced; there are better strategies than head-on pressure. Memory has its own processes and its own selectivity. Scenes, faces, bits of story that rise up spontaneously are thus more likely to have an emotive significance than those memories we might deliberately call up.”

Trauma can often batter dissension into the reservoir of memory. The recognition of triggers can emit a flood which then tries to uproot the mindfulness of the present moment and replaces it with a past incident or phase of time that seems interminable.

Trauma survivors have to often adapt ways in which the waves of remembrance are not coercive and damaging. As mentioned in my last article, there are standard and direct therapeutic ways to heal from trauma, however we also have at our disposal a combination of alternative healing methods that can supplement direct therapeutic interventions to create a more holistic experience of wellness. Personally, I am a little aversive to using the term “alternative” because I find it to be a placeholder for marginal and do not wish exclusionary tactics in healing. However, for the purpose of discussion, I am using “alternative” as a term that indicates niche and emergent.

ALSO READ: LIFE BEYOND TRAUMA: A THERAPY GUIDE

1. Trauma Sensitive Yoga is an evidence based treatment for complex trauma and complex Posttraumatic Stress Disorder, developed at the Trauma Center in Brookline, Massachusetts, since 2003 and part of the Justice Resource Institute since 2006. TCTSY is used with children, youth, and adults throughout the United States, Canada, Europe, Colombia, Mexico, Israel, Japan, Australia, and New Zealand. Yoga is a meditative approach to exercising connectivity between mind and body. These exercises allow the participants to feel more rooted in their current moment and develop a dialogue with their own bodies. This can be beneficial for trauma survivors when trying to reestablish a way to be attentive to their physical presence in the world without feeling imperceptible. When participating in TSY, one has to be mindful of choosing a qualified trainer who will be able to provide guidance both for the bodily and the cognitive awareness that ensues.

2. Somatic Bodywork – Somatic therapy is centered in the belief that the mind and the body aren’t disparate or uncoordinated chapters in a person’s life story. This form of therapeutic intervention disputes a common and arbitrary bifurcation between the body and the mind. The locus of strength is an assemblage of ways that orient the mind and the body to be better friends to each other and allowing space for that to occur. In trauma relapses, a client often oscillates between states of dis-regulation (arousal, hypervigilance, sudden shock, freezing, continued panic & anxiety as well as physical pain & numbness) and regulation (restoration to a calmness, awareness of self and environment without threat perception).

Somatic therapy designs itself around a kind of enablement where a person is provided resources and learns how to steer their dysregulated states towards regulated states. Peter Levine, a renowned trauma specialist, often speaks about how experiencing any kind of trauma can lead to a person dissociating from their physical self particularly when the recall/relapse of the original traumatic event occurs.
This form of intervention can take various shapes and routes including dance & music therapy, guided imagery meditation, progressive muscle relaxation et al. Finding someone whom you can engender a trusting and comfortable interpersonal relationship is crucial to somatic therapies.

3. Expressive Therapy – Despite the success rate of most conventional trauma therapies, there tends to a considerable percentage of dropouts on account of PTSD avoidance syndrome and the clear fact that a lot of regular talk therapy involves long-term commitment which might seem excessive or insurmountable to a survivor in the beginning.

In order to ease oneself into seeking help, expressive therapies can be viewed as pragmatic gateways and are fairly uncomplicated. Expressive therapy can employ art and writing as channels for necessary self-expression which helps validate personal experience and feelings. Expressive therapy is less goal-focused and more process-oriented where the task of creating is infused with primacy rather than the outcome. This also speaks directly to the uniqueness and personal healing preferences for a lot of folks. From bibliotherapy to experiential camps & horticultural group therapy, there is a wide array of choices for anyone who is interested to pursue this further.

4. Animal-aided therapy – Guide dogs have been helping folks with disability for a while now. However, a lot of people are not familiar with the fact that therapy and emotional support dogs/animals can help alleviate daily symptoms of post-traumatic anxiety. Trained animals can offer unconditional support and love which in turn can provide a resonant foundation on which someone surviving trauma can build their self-regard. The more functional aspect of having a therapy animal or spending time with one is their ability to help navigate difficult phases or moments including depressive lows or a generalised form of loneliness. A recent study in the US indicated that veterans who spent time in equine therapy showed a massive dip in suicidal ideation. Animal-aided therapy shows real progress when helping people rebuild trust in themselves and their immediate surroundings.

It is always advisable to seek professional inputs before creating the blueprint for your own healing path. A little bit of research and prior knowledge can be fruitful in determining what is the right course of action that largely meets your specific needs.

Alternative therapies are best engaged with when in combination with a more mainstream form of intervention that allows a wider net of support during self-work. Your own self-awareness plays a crucial role as well, for e.g. if your trauma involves an incident with a wild animal, it would be wise to not immediately gravitate towards animal-aided therapy because it might trigger you further. On the other hand, if you have always found solace in the company of dogs and cats, then it might work best for you.

Trauma is an unfortunate reality in the world we inhabit, however it doesn’t need to become our stamped destiny. As the poet Hafiz once wrote –

“Awake, my dear
Be kind to your sleeping heart. 
Take it out into the vast fields of light
And let it breathe.”


ALSO READ: MORE IN OUR UNDERSTANDING THERAPY SERIES


Scherezade Siobhan is an award-winning Indo-Rroma Jungian scarab turned psychologist, mental health advocate, community catalyst, and a writer. She is the founder of The Talking Compass -- a therapeutic practice that provides in-person, at-home and online counselling for people who need help with emotional and mental health. She is the creator and curator of The Mira Project, a global dialogue on women’s mental health, gendered violence, and street harassment. Send her puppies and cupcakes at nihilistwaffles@gmail.com

 

Disclaimer: Material on The Health Collective cannot substitute for expert advice from a trained professional

If you would like to share your story, do write to us here or tweet us @healthcollectif
 

Your Stories: The Anxious Hat

By Jessica Xalxo

 

There had been a moment that morning. Just one.

A single ray of sunshine had pierced the otherwise outwardly aesthetic room. Almost shooting at my head, as its golden tendril reflected off of the walls, before losing its novelty and direction. A single yellow spot amidst the black and white of my living squarespace.

It was there. I had felt it. Basked in it even. Hah!

 And then like a thought unchased, with no heed for a request, it was gone. Just like the person who ghosts on you.

It had been courteous enough to leave a replacement. A substitute in abundance. For it had left not just one thought but a myriad coiling sentences, nestled in my head, latching themselves to the crook of my brain. In the mellow afternoon light, it had placed in the once haloed spot a hat.

 What a common yet largely unused accessory -- even in the tropical weather of the city -- and oft, unspoken of too.

Had it known it was going to be draughty outside? Perchance. That wouldn’t be a wild guess, given the temperament of the weather lately. But it did not know me well. I did not wear hats, and this one, it did not sit well.
 


Photo by Velizar Ivanov on Unsplash

It was a black hat, a fedora, I think. Its felt encompassed most of the top of my head and half of my ears, so that when I put it on, the thrum of the world ceased at once. The only voice I heard was my own. My own words, my own thoughts, my own fantasies, my own reassurances and my own validations. And as my hair rose to meet the hat’s roof, as if joining with the fabric, my head accepted this gift like it had no choice. But really, it did. It, no, I always did. Didn’t I? Alas, meeting the fate of most good thoughts, my mind shied away from tracing this one to its very end.

It was a safe space, really. The fedora. A singular pocket of existence, with as many avenues of imagination as the hair follicles on my young flaking scalp. If I could store all my thoughts in this hat, especially those that corresponded with its colour, these thoughts, would they be contained? I might not even have to speak them. No soul would ever know the expanses, the tall worlds my mind built with my predictions of the speech and movements of the world, not always true but all too real to me.

ALSO READ: ANXIETY DISORDERS IN INDIA

What relief, I chimed to myself. But what kind of justice would that be, really? A shaky resounding laugh escaped me, taking several breaths with it. The sighs slowly failing as they tried to keep up with my mind and the conclusions it was arriving at. There would still be the comprehending to do. Thoughts and thinking held each other by the hand. And that was where all the trouble lay after all. At least, this way, no one else would know. This could be my safe space.
 

And thus, I became one with the fedora. These were my thoughts after all. Contained. Within me. How destructive would they be?

The hat was boundlessly snug. I could close my eyes and never leave the seemingly infinite folds in its abyss of darkness. So many velvet corners of granite coolness to settle into and be lost in -- forever. All sights and smells beyond reach and amiss here in this dream of night. Oh no, waking would be unbearable. The thought of raising the shutters and my body off the bed - that might have been where the misery lay after all.

 And then, I heard it. The hat. It was speaking!

There was a small congregation forming within the hat. Voices! All mine. Murmuring at first, then slowly gaining in octave, and rising, to a lilting cacophony of screams, as they curled, in smoky wisps, around my heart.

THERE IS SO MUCH TO BE DONE. SO MUCH. TOO MUCH.

ALL THINGS THAT I DON’T WANT TO DO WITH A FEW EXCEPTIONS.

ALWAYS A FEW. SOMETIMES TOO LITTLE TO MATTER.

TO BE DONE, MUCH THE SAME.

I WON’T FINISH DOING THEM.

 

 In that moment, I realised I was Atlas. There would never be an escape for me. The hat could only be my requiem, not repose.

Breathe, I reminded myself. Think of something else. Anything else. Try and come up with a new thought to replace every old cycle of notion. Engage your mind with mint ideas. Think. Jump. Again and again. Anything could be better than this. This did work, it always did. For a few spells of time. Until it didn’t. And then the hat’s call was too potent to not heed.

]The tasks of the day seemed insurmountable. Nevertheless, I would do them. And sincerely so. I always tried, didn’t I? What good was that in a globe of millions of actions - I did not know. But what if I couldn’t? What if I couldn’t complete my tasks? I would fail and then there would be too much and too many to lose. More than I could bear.

 

Will she still talk to me if I don’t submit my part of the Gender Project on time?

      I’m way behind on my writing projects and she probably sees it as a lack of commitment.

                  Why can’t I work at a normal pace like the others? My ass will be fired soon.


I am going to die alone and if I don’t work before then, I will die alone and broke.


             Am I even worthy of realising my dream?

                                                                          Is my dream even for me?

                           The whole team is going to realise I’m a sham sooner or later.

I take too long to get a simple task done.

                                                                               Sincerity is not the same as results.

           Maybe it is that most tasks don’t interest me. No, that’s definitely it.

                                But some things must be done anyway.

                                   Get yourself together, you’ve always had a healthy if not crazy work ethic.

It’s work or the void, you have a choice.

         Occupy a space.

                                There are those exams that need to be given too. Correction : re-exams.

                                                                         Everybody’s going to give up on me.

               I don’t know if I can do this.

I am too scared to find out.

                                  Oh Lina also requested me to set up a blog page for her tourism business.

                                                 I have to call up Aunt Priscilla.

When was the last time I caught up with Tasneem? She must hate me now.

                                                              I am overly saturated in one field.

            Dad thinks working from home isn’t work.

                                                                                   I am too dead to want a social life.

I am definitely going to be fired tomorrow.

                      My parents are getting older and nearing retirement. I need to step up more.

             YOU COMPLETELY FORGOT ABOUT PRIORITISING COLLEGE ONCE AGAIN!



Image by rawpixel.com

 

I took off the hat as I felt the voices forming a vice like grip around my throat, clenching my scream. The voices would subdue me. Unless...unless, I did something.

Quick! Jumping from the bed and onto the creamy marble floor, I fumbled to find my slippers and made my way to the white desk that sat beside the bedroom window. I dipped my hand into the pen stand, telling myself to ignore the sheath of dust on the pen I had selected. They were all the same anyway. Where was the time to dust when there was so much to be done? I would probably be found smothered by a dust bunny if and when I lived alone. That is if I ever lived to save up enough to move out.

Focus! I screamed at myself. There’s work to be done.

ALSO READ: HOW BULLET JOURNAL HELPED ME DEAL WITH ANXIETY AND WHY I WILL NEVER FORCE IT ON YOU

I laid the voices of the hat out on to the board. To write them. Quantify them. Give them basis and ground. I had found work to be a saviour back when the thoughts had gotten bad. It had helped me rewire and adjust to the new normal. But the thoughts never ever did leave me. Not for too long.

I translated the voices into 8 tasks for my to-do list. Okay, 8 and a half. Some were filler tasks - though I treated them all the same. Each task would take some time of their own, but each was do-able. I could do them. I would do them. And I would make it through.

 After all, I had even taken off the hat. Acknowledged its existence. Parted with it. Or at least, I had tried. Now, it was only up to my mind to contain the thoughts. No escape or considerations of a final void. Recovery was better than requiem. Maybe.

 I turned to look at the bed, wanting, no needing so badly to wrap myself in the comforting shroud of my bedsheet.

“Just brush your teeth and eat your breakfast,” I said aloud. Speaking to myself again. I only ever spoke multiple authoritative sentences to myself anymore, in stark contrast to my outward social and pliant self.

Put one foot in front of the other. A smile when in doubt. A call should you collapse, but maybe not. What if nobody answers? Those who tell you to call when you need them are being courteous. Don’t actually take them up on the offer. How could they possibly help you? You’ll lose the people you have if they learn of the real you. Just be where you’re most comfortable and not bothersome, but still, try to push the ante - you’ve to get somewhere in life and you could start with getting out of this. This doesn’t have to be your everyday reality. But it is, isn’t it? Will every day be like this? It will.

 Mom would hate me when she realised that I hadn’t been able to get myself to go to college. Again. I couldn’t. How could I tell her that? Maybe once the early morning stopped feeling like a second vacuum and college another concrete social obligation of sharing space, I’ll want to go. I’ll have to want to go. Tomorrow, I will. Please, please do, I beg myself, crying mutedly as I shuffled, taking questioned steps to the bathroom.

 “We could seek professional help, you know?,” I heard one last whisper from the hat as it sat, taunting and perched on my space.

 “Oh honey, nobody believes that you are real, and nobody will believe me about you.” Nobody.

 Till date, I live varied renditions of the hour on repeat.


--

The Anxious Hat is fictionalised narrative, based on personal experience. The author wished to let people know what it is like to live with anxiety and to repeatedly question one's every thought and action. She experiences extreme anxiety and only recently reached out for professional help. Her days are changing with recurrences but no looped repeats.

**

WHAT IS ANXIETY

Anxiety is often seen as a mental disorder that can be easily dealt with because it’s normalised and stereotyped in everyday interactions. However, for those battling the actual disorder and not tiny jolts of anxiousness now and then, it can be a very debilitating mental state to live with. Especially when they can’t bring themselves to seek help or to let people know how serious their anxiety is. Imagine living the story on repeat without any external help.

Therapy, breathing exercises, meditation and certain other techniques do go a long way in aiding one to manage their anxiety. Please do try and access help.  

**

Jessica Xalxo is a student engaged in the fields of gender, peace, writing and education. She has authored the Red Elephant Foundation’s “Speaking Our Truth: A Curriculum on Non-Violent Communication.” She is also the Assistant Editor at One Future Collective and a Writer at SheThePeople.TV. You can tweet to her @IriscopeX.



Disclaimer: Material on The Health Collective cannot and does not claim to substitute for expert advice from a trained professional. Share your stories with us, if you like -- Tweet @healthcollectif or mail us right here

 

 

How Bullet Journal Helped Me Deal with My Anxiety & Why I Will Never Force It on You

By Rajashree Gandhi

It has been over a year since I started using a bullet journal. It feels like possessing an extra mind that works towards a better ambience for the existing one.

A simple Google search suggests how massive a trend bullet journaling is. It has benefited a variety of people, including mental health survivors. This essay is part enthusiastic recommendation, part mindful warning. Bullet journal gave me tools to deal with anxiety specific behaviours. However, like every other trending lifestyle/idea, it has the potential to induce other anxiety specific behaviours in many people.

While it hasn’t fixed all my problems, or transformed me into a warrior who’s slaying at life, it does help me in identifying the negative loops and patterns that hold me captive. I can then loosen their grip on me and gravitate towards things I have always wished to try but was afraid to pursue.

A Note on Productivity Internet and Mental Health

Have you found yourself troubled by the aggressive, intimidating, White-dominated shit-hole that is Productivity Internet? Here is where a plethora of articles, apps, and videos mask themselves as well-intended, angelic agents of self-improvement. However, the language and tone is burdening, apolitical and often very gendered. It is particularly insensitive to mental health survivors and those with chronic sickness. It puts the entire onus to lead happy, productive, successful lives on the reader without ever questioning capitalism and allied systems of exploitation. Productivity Internet is the last place I had ever imagined to find a life-changing solution.

But here’s the thing, bullet journal changed my life, and is completely capable of failing to change yours. I share my experience without denying you your own, with a gentle nudge to give it a shot.

What is a Bullet Journal:

To put it simply, bullet journal is the holy union of a blank notebook and a black pen. It’s not something one can rush out to buy or download, but has to be set up, much like how we set up our room according to our needs and wants.

A part of Bullet Journal’s genius is that a digital product designer, Ryder Carroll, chose to design an analogue organiser inspired by his own learning disability. Caroll’s 2015 video is the only reference one needs to get started with bullet journaling.

Photo Courtesy: Rajashree Gandhi

The Bullet Journal Community

Today there’s a large and growing online community of bullet journal junkies who share new ideas to build on the basic system Caroll created. Unlike their spreads (pages in the bullet journal) which are very artsy and colourful, Caroll keeps it simple and minimalistic. This should encourage those of us who are not exactly artists, nerds or full time lifestyle bloggers. While it can be soothing to add colours to the pages, not doing so is as legit, and also saves time. Having said that, maintaining even a basic Bullet Journal requires time and patience, something which I lacked.

ALSO READ: The Phantom Pain Monster: My Battle with PTSD and Fibromyalgia

And yet, every time I grumbled, “I don’t have time for this,” I asked myself, “What am I doing with all the time I keep saving?” – a worthwhile self-investigation to conduct in this age of machines and applications. I have lost uncountable hours to negative mental patterns, regretful behaviours and procrastination. If something can help me handle a fraction of that, I would like to offer it my time and energy. Even the best designed apps need updates and Bullet Journal is no different.

How is Bullet Journal Different From Calendars, Diaries and Apps?

Bullet Journal can be personalised and adapted to suit oneself. It provides structure to the long to-do lists we keep making as a prelude to panic. Yet, it doesn’t cage us like calendars and dated diaries.

We live in a thriving digital world. But (and I guess science can back this up) we’re likely to be more relaxed, focused and creative while using pen and paper while planning, as opposed to using the various flickering, distracting screens of our connected devices. If your mind is housed by tireless anxiety, paper can provide the calm, quiet, tactile contact you seek desperately, without leaving your eyes, neck and back feeling tensed.  

Keeping a diary has been a historical practice, one of privilege over those who couldn’t read/write and had to sustain with oral narratives. As school children, we are encouraged by teachers and parents to maintain a diary, without being explained why. I never followed, but I have enjoyed making unusual lists on empty bills. I scribbled on the back pages of the cutesy notebooks I have collected over the years, too scared to ‘spoil’ them with my thoughts, some of which felt unworthy, mediocre and ugly. Bullet journal gave me both: structure and motivation. It delivered on its promise: track the past, organise the present and prepare for the future.

Journaling Through Anxiety Specific Behaviours

Anxiety is like juggling various extremes. I’m either completely scattered and distracted, responding to every stimulus that comes my way or I stay fixated on one tiny and irrelevant detail until my muscles ache.
Writing my thoughts, tasks, goals into the daily, monthly and future logs of the bullet journal helped me slow down the trains of my thought. Anything that doesn’t have a dimension of time was put into collections, for example: I have two pages kept aside for planning my workshops and another two for all metaphors or poetry elements that pop in my mind in the middle of other work. Titling these pages and entering them into the index reduces a whole lot of mental labour later.

For those who can remember all this orally or keep ‘mental notes’, both my thumbs hereby rise up for you. But me, I need to write down the smallest task on most days. Obvious acts like taking a bath and taking pills may be easy for many, but mental health often causes you to forget basic tasks or their motivations. Outsourcing the mental load to checklists and trackers frees up abundant space for creativity and commitments.

‘How We Spend Our Days is How We Spend Our Lives’

Anxiety is non-stop self-doubt, guilt, confusion wherein we headline every little instance of failure and downplay our biggest achievements. Coupling to-do lists with done lists, as suggested by a bullet journal junkie, helped me understand where my time flies, and the umpteen things I do get done without knowing it.

Unlike other planners, bullet journal allows recording all the efforts outside professional commitments, like health, finances, hobbies, family. I realised how life is made richer by performing emotional labour for our loved ones, by creative articulation of our politics, cooking, cleaning, acts of self-care, and is not limited to what the employer/institution demands of us. Our failures at work/studies cannot define us for too long if we take into account the numerous things we do to make ourselves/others happy.

Anxiety is not completely isolated from other behaviours: sleeping, eating, drinking water, social media activity etc. To find out one’s own patterns, triggers and situations that lead up to anxiety and panic attacks, one needs data. Making trackers for mood, food, exercise, periods and bowel movements at different points helped me identify linkages and what I need to do/not do to stay healthy.

Sorting The Grain from The Chaff

The most common response I get from my ‘normal’ friends is, ‘Tu itna sochti kyu hai?’/‘Why do you overthink everything?’ It frustrates me because I can’t seem to stop and to be very honest... nor do I want to.

It is ‘over-thinking’ that helps me ideate, wonder, analyse and even write poetry. But the other side of the coin is irrational worry and endless what-ifs, if onlys and flashbacks.

Bullet journal helps me secure my thinking skills as a strength rather than a weakness. Shitty things happened to me like they happen to others, but to interpret them as ‘learning experiences’ was tough until I unpacked them in the pages of my bullet journal. Over-thinking has been replaced with self-guided reflection and deducing key take-aways.

 

Photo Courtesy: Rajashree Gandhi

Unplugged, Yet Connected

By this point, I sound like a complete narcissist or someone who cannot think beyond themselves. It is both true and false. While anxiety leaves you alone with yourself, it peoples your head with voices and manages to disconnect you from yourself. A smartphone doesn’t solve this disconnection, despite being so personal, as it largely hinges on your interaction with the world. Bullet journal helped me unplug from the world and connect to myself, considering one voice at a time. It sculpted parts of my loneliness into solitude and allowed me to reflect without having to share it or get it approved by anyone.

ALSO READ: Overcoming Depression: A Non-Stop Fight

I made wish lists to remember what I want to cook/read, notes to remember what I need to share with my therapist/to note insights surfacing in each session, habit trackers to form new habits. We brush our teeth every day without putting it in any to-do list because our parents trained us for the sake of good dental health. Wouldn’t it be nice to train ourselves to make new habits, of our choice, for our mental health?

Paralysing Fears: Quitting/Failing/Being Judged

Seeing the hype around bullet journal can be triggering for people with anxiety. The fear of failing is a demon that paralyses some into inaction. Further, the should/must vocabulary used in productivity internet burdens the reader. If your anxiety mind is anything like mine, it will trigger you.

There’s never a disclaimer that if a system (be it bullet journal or a fancy diet, workout, art project) doesn’t work out for you, it’s not your fault or failure. Another pit one might fall into is that of perfectionism and compulsive maintenance of the journal. I started to learn hand-lettering so that my journal looks as fancy as the ones I see online, without pausing to ask, do I really want to?

Anxiety also causes fear of being seen/read/judged. The biggest (and the only one as far as I’m concerned) plus a smartphone can offer over a bullet journal is privacy. It is not easy to carry your bullet journal if you’re worried sick of what your judgemental colleagues think of you. Your friends might consider it lame or bougie or boring or whatever. If your family isn’t fancy and liberal, it might not be easy to write about your love life unless you find those lockable notebooks.

Accepting Advice, Rejecting Suggestions

While it can be fruitful to explore various solutions being shared on productivity internet, its better to reject what they suggest: glorification of work stress/being overworked. The internet raves about GTD (getting things done) and gyshydo (getting your shit done), as if calling work shit makes it any nicer/easier. It particularly targets working moms to talk about work-life balance, showing how gendered our ideas of productivity are.

Most people who perform various kinds of intense labour have never needed a productivity solution. It is neo-liberal capitalism, and white-collared jobs that convince us that our ultimate goal is to be not happy, not responsible, but as productive as possible, flaunting our modernity and utility.

It is tempting to indulge in comparison, perfectionism and imposter syndrome while maintaining a bullet journal, but it is honesty, playfulness, patience and curiosity that form the best attitude towards journaling. Viewing the bullet journal as an aide for my anxious mind and not as a revolutionary lifestyle helped me keep it very personal. Perhaps, that is why it continues to feel special and intimate. It fills me with hope to imagine everybody who struggles in their mind finding their own special, intimate systems and solutions.


Views Expressed are Personal.
Rajashree Gandhi is a writer and educator. She conducts Wonderstorms: writing and creativity workshops for school children and young adults. She loves poetry, pickles and female friendships. Find her @raju_tai on Twitter or Insta

Disclaimer: Material on The Health Collective cannot and is not intended to substitute for expert advice from a trained professional.

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Autism Awareness Day: Busting Myths

By Sukanya Sharma

‘People with autism are anti-social

People with autism are stupid’

These are some common myths about autism, Radha Iyer, a parent of a 9 year old with Autism Spectrum Disorder tells The Health Collective. While some people feel that children on the spectrum are incapable of living an independent life, she knows of children who travel independently, and others who grow up to pursue advanced studies, even work at “mainstream” firms. The fact is -- even in urban India today -- there are several myths about the condition.

“One myth I would like to bust about autism is that children with autism are also intellectually challenged. This isn't true. These children may have some exceptionally good skills in certain domains. Some may be very good with calculations for instance, says Kaneenica Ninawe, a clinical psychologist working in King Edward’s Memorial Hospital who has worked with children on the autism spectrum.


ALSO SEE: A SPECIAL COMIC STRIP ON WORLD AUTISM AWARENESS DAY

Some people feel that children with autism are violent. As Iyer explains, Younger children especially “face a lot of sensory issues. (They are) disturbed by loud noises, crowds, light...Some react by jumping around and clapping around, which may seem violent.”

AUTISM SPECTRUM DISORDER IN INDIA

In India, at least one in 89 children aged between two and nine years have been diagnosed with autism, according to a Hindustan Times report last year. To quote from the HT story, “An extrapolation of the data on 2011 census would mean that as many as 2.2 million children and 13 million people in the country live with the condition.”

WHAT IS AUTISM?

Autism Spectrum Disorder is used to describe a development disorder that impairs the ability to communicate and interact. There are challenges with social skills, speech and non-verbal communication, and also certain unique strengths and differences.

As Ninawe tells The Health Collective, “Parents need to be made aware of the signs and symptoms of the disease.

For instance, children with autism may:

  • Have speech difficulties

  • Restricted affect*
    (*Defined as a restriction in range or intensity of display of feelings on the Encyclopedia of Mind Disorders; can include difficulty processing communication or instructions)

  • Limited or no eye contact

  • Prefer playing alone

  • Get upset by minor changes in environment

  • Perform repetitive behaviour like flapping, rocking or spinning, repeating certain words or phrases again and again

  • Refer to themselves in the third person


“If such signs are noticed parents, need to get the child assessed from trained medical professionals as soon as possible for early detection. One needs to understand that this condition is not like other physical illnesses that will be cured. However such individuals can definitely learn to become functional,” Ninawe adds.

Children on the spectrum are sometimes described as in living in a world of their own, and it becomes the job of the caregiver/parent to try to bridge that gap.

Iyer, the mother of 9 year old Kartik, tells The Health Collective,

“We need to be aware of the needs and challenges of the child. And we also have to slowly push him out of the comfort zone. Parents need to understand that these kids need ample amount of time and space to get comfortable with their environment, and therefore patience is the key. Also, the care should start with zero expectation, as the child may feel pressurised otherwise.

Also important to highlight is the fact that Autism Spectrum Disorder doesn’t mean the will to communicate or interact is zero; there are those on the spectrum who are willing to be social, but don’t know the approach to communicate.

 


By Kishore Mohan and Merryn John/ Health Collective

 

IMPORTANCE OF EARLY INTERVENTION

Early intervention is vital to understanding ASD and how to make the environment more comfortable for the child. It forms a base to help children follow and process instructions or communication better.  

ALSO READ: MENTAL HEALTH AND INDIAN POP CULTURE

Parents also have to be watchful of the interests of the child. Assuming that their child is limited to taking up only a certain type of job is equal to limiting choices for them. Let kids explore their environment, and choose their own area of interest.

Iyer, who volunteers with the Forum for Autism, tells The Health Collective that that people with autism have varied abilities -- some do very well in the fields of art and music. She adds, that some companies also employ people with autism as part of their "diversity hiring" process.** 
 

ADVISORY FOR PARENTS:

  • It's challenging but aim to educate yourselves and update yourselves every day; read, meet other parents/caregivers, speak to professionals, attend support group meetings

  • Start with zero expectations. Taking care of a child on the spectrum can get enormously challenging but one needs to keep working on goals and not get disappointed by failures

  • It is important to have a right team of therapists who help you in this journey of growth. It is important to build a bridge of trust and understanding between the parent and the therapist

  • It is also important to take care of your own mental health. Speak to other parents, share stories of growth and failure. Support groups are a great way to communicate and also give some perspective. Know that you are not alone

  • Encourage others to accept your child the way s/he is. Help remove pressure on yourself and your children

 

How can we change the way people perceive Autism Spectrum Disorder?

Conversation, conversation, conversation.

“The more open you are about your child and the challenges he faces, the easier it is to get help. We need to let go of the 'what will they say/think' attitude. I’ve come to realise that there will always be someone who is ready to help if you are ready to ask,” Iyer says.

Also, we have to start by making the local ecosystem as supportive as possible; which will only start by conversation. In Iyer’s neighbourhood, people who are aware about the challenges of her child come up to help him.

“They include my child in social activities, some make small talk with him, and they are sensitive to the condition - taking baby steps at home, around your local environment helps a lot.”


Views expressed are personal. If you want to share your journey with us, do get in touch via comments or email; tweet us your feedback @healthcollectif.
 

(**This comment was updated on April 3, for clarity and to better convey what the interviewee said, and include "diversity hiring". The original statement was: Iyer, who volunteers with the Forum for Autism, tells The Health Collective about the various jobs that children with Autism have taken up: From being artists, to musicians, to mainstream employees at JP Morgan and Sachs, to pursuing advanced studies in vocational training, these kids have explored it all, thanks to parents who provided them with a safe environment to grow.)

Disclaimer: Material on The Health Collective cannot substitute for expert advice from a trained professional

World Autism Awareness Day

 

 

By Kishore Mohan and Merryn John/ Health Collective

Mental Health in the News: High Awareness, High Stigma in India

 

THE HEADLINE: How India Perceives Mental Health (The Live Love Laugh Foundation)

WHAT YOU NEED TO KNOW: High Awareness on Mental Illness is coupled with High Stigma. The Live Love Laugh Foundation and Kantar Public conducted a study of 3,556 people across 8 Indian cities to understand more about levels of awareness about mental health in India, and attitudes towards those suffering from mental illness. Male and female respondents from eight cities --  Delhi, Kolkata, Hyderabad, Pune, Patna, Mumbai, Bengaluru and Kanpur -- took part in a mix of qualitative in-depth interviews and structured, quantitative interviews, TLLL Foundation says.

The survey found that about 87% of people had a high awareness of mental illness (using at least one term that relates to names and symptoms of mental illness) but also high stigma -- about 62% of participants used derogatory terms to describe those with mental illness.

Source: The Live Laugh Love Foundation
Read more here: 
How India Perceives Mental Health (2018) (Source: The Live Laugh Love Foundation)

 

THE HEADLINE: Dementia Study Links Risk With Fitness Level (CNN)

WHAT YOU NEED TO KNOW: A study published in the medical journal Neurology found that there’s a 88% lower risk of dementia in women with high cardiovascular fitness, or high stamina, than those with moderate fitness.

The 44-year study began in 1968 with a sample of 1,462 women in Sweden, between the ages of 38 and 60. This part of the study involved 191 Swedish women, who were given a cycling test back in 1968 and tracked over the 4 and half decade period.

CNN reports: “The researchers also found that the average age at dementia onset was 11 years older in the "high fitness" group than in the "medium fitness" group, and the most pronounced risk reduction was seen among those with the highest fitness: "High compared to medium fitness decreased the risk of dementia by 88%," the researchers wrote.”

Though it is a small sample size, the results could prompt more research in this field.

Source: CNN (https://edition.cnn.com/2018/03/14/health/dementia-risk-fitness-study/index.html)

Read More: http://n.neurology.org/content/early/2018/03/14/WNL.0000000000005290


 

THE HEADLINE: New Study Elucidates Links Between PCOS and anxiety (Science Daily)

WHAT YOU NEED TO KNOW: A study on mice indicates that there is a sex-specific response in offspring exposed to maternal diet-induced obesity and androgen.

“Maternal obesity and androgen excess induce sex-specific anxiety in the offspring, according to a study on mice. The findings may help explain why children born to mothers with polycystic ovary syndrome (PCOS) have increased risk of developing anxiety later in life,” Science News reports in its summary, of a study done by Karolinska Institutet.

Female mice offspring were more sensitive to androgen exposure, and males to diet-induced obesity. This study could have implications for people, and help explain whether or why children of women with PCOS may be at higher risk of anxiety.   

Source: Karolinska Institutet. "New study elucidates link between PCOS and anxiety." ScienceDaily. ScienceDaily, 23 March 2018. <www.sciencedaily.com/releases/2018/03/180323091054.htm>

 

(Compiled by Sukanya Sharma and Amrita Tripathi for The Health Collective)

The Health Collective is delighted to feature a regular, curated news feed on Mental Health, but cannot independently verify third party content. Feedback is welcome – tweet @healthcollectif with your comments and stories you think we should include.

Mental Health and Indian Pop Culture

Shruti Venkatesh

Here’s what we know: Indian cinema, especially Bollywood, repeatedly misrepresents mental health and illness. And yet, India is not a country completely in the dark when it comes to mental health awareness. So why does its most popular film industry rarely create content which correctly portrays mental health for a general population that is ridden with mental health issues?

ALSO READ: HICHKI AND UNDERSTANDING TOURETTE’S SYNDROME

It is baffling to see that well-educated and socially aware filmmakers are tempted to exploit certain elements of psychological disorders as critical plot elements, but wrap entire movies, without ever shedding any actual light on a given disorder -- like Asperger’s Syndrome in My Name Is Khan, Depression in Anjaana Anjaani or Autism in Barfi.

 

MISREPRESENTATION AND MISINFORMATION

If inadequate representation isn’t enough, there is plenty of misinformation thrown our way in terms of the clinical diagnosis, aetiology (causes), prevention, or even care! For example, in Black, Amitabh Bachchan’s character -- who is meant to be suffering from Alzheimer’s -- is shown to regain his memories. That’s blatantly incorrect, as it is a disorder that progressively worsens, misleading to a general public and potentially harmful, in terms of setting unrealistic expectations. Don’t you think?

Over the years, although there have been movies which have done a better job at representation as compared to the rest (see below for more), the attitudes remain the same.

Kiran Kotrial, a popular screenwriter, tells The Health Collective, “Broadly speaking, there hasn’t been any real change in the representation of mental health in mainstream commercial cinema as words like “paagal” are loosely used and aren’t yet considered to be politically incorrect.”

From normalising discriminatory behaviour, to mocking characters with mental illnesses through supposedly comic roles like in Krazzy 4, to sensationalising psychological disorders, or emphasising the criminality and unpredictability of the mentally ill (like in Darr), or lampooning mental hospitals like in Humshakals... the list goes on. 

The misinformed usage of umbrella terms like “depression” and “schizophrenia” as explanations to mental illnesses only show the large disparities between a DSM criterion and Bollywood’s distortions. Most movies also fail to show clear distinctions between learning or intellectual disabilities and psychotic disorders, leaving the audience bewildered.

ALSO READ: ASK THE EXPERTS: SIX THINGS TO KNOW ABOUT THERAPY

Psychiatrists are also ill-represented, with some performing roles of exorcists or encouraging exorcism, like Akshay Kumar in Bhool Bhulaiya, which gives an impression that mental illnesses translate to supernaturalism. Or you have the situation where the reel-life psychiatrists suggest Electro Convulsive Therapy (ECT) in an ominous manner, like Om Puri in Kyon Ki.

You might think we’re making a mountain of a molehill and you might cite artistic licence, sure… but don’t think that irresponsible representation doesn’t add to the problem of stigma, as people within the industry are well aware.

Fauzia Khan, a Creative Producer, tells The Health Collective, “Mental health is still represented in a highly exaggerated fashion with mainly physical manifestations. The Indian audience has a tendency to be influenced by this representation and feel that the sphere is in black and white. Any real de-stigmatisation is possible only if there is a realistic portrayal and characters suffering from mental illnesses aren’t used as caricatures.”

The most recent addition to this atrocity is the upcoming comedy movie Mental Hai Kya which aims to “bring out the crazy in you as sanity is overrated” and that “crazy is the new normal”.

Really? At a point where mental health needs utmost attention, it is exasperating to see filmmakers choosing problematic titles that are born from loose, derogatory phrases used in Indian languages. To top it all, the movie posters make an absolute mockery of self harm with Rajkumar Rao burning a cigarette on his forehead as he laughs.

 

 

ALSO READ: YOUR STORIES: SELF HARM AND HEALING (TRIGGER WARNING)

A pool of ignorance, Indian cinema rarely allows for healthy discussions regarding mental health. By exaggerating mental illness, film-makers feel that they are able to feed the audience with the right amount of drama, humor and conflict needed to keep them entertained. Mental illness ends up being the excuse for any amount of gore and irrationality shown on screens.  

MAKING A DIFFERENCE

“If our movies, working within the realm of the main storyline manage to convey the pain and experiences of the afflicted person sensibly and interestingly, the audience will surely ‘take home’ some sense and perceive mental health differently and be more sensitised to the travails of one suffering from mental illness”, Kotrial tells The Health Collective.

Fortunately, there do exist a few movies which show a refreshing change in the manner of which mental health has been dealt with like 15 Park Avenue’s depiction of Schizophrenia or Cerebral Palsy in Margarita With A Straw, or Dear Zindagi normalising therapy. Hichki is a movie adapted from the Hollywood movie Front of the Class which itself was based on the book, Front of the Class: How Tourette Syndrome Made Me the Teacher I Never Had. Hichki finally brings to light a much neglected disorder with the plot revolving around a teacher having Tourette’s syndrome.  

Although such films deviate from the usual ignorance, they are still few in number and there is much room for growth. Inducing pity in its audience will not help the cause but portraying empowered and functioning individuals with mental issues will.


Image Courtesy Raw Pixel

THE WAY FORWARD

Popular stars and personalities coming out with stories and personal experiences dealing with poor mental health, like Deepika Padukone speaking about her fight with depression or Anushka Sharma suffering from anxiety, help to draw attention to these issues.

And film-makers can also take a leaf out of the book of our stand-up comedians, who have have begun incorporating relevant discussions into their acts like Sex and Sexability 2.0, which focused on Bollywood’s representation of mental health, disability rights and mental illnesses. Some hugely popular comedians, like Tanmay Bhat and Mallika Dua, also regularly spread mental health awareness through social media.

(Note to the media: Mainstream media in India also needs a corrective, away from a sensationalised or even romanticised portrayal of mental illness. Suicide is almost always sensationalised; the Indian media does not follow a set of guidelines… potentially causing great harm.

Here’s a link to the Samaritans MEDIA GUIDELINES FOR REPORTING ON SUICIDE)

ALSO SEE: WHERE TO GET HELP: CONTACTS AND HELPLINES
 

The content produced and a subtle change in attitudes in the past few years show that mental health (and illness) may finally receive the regard it deserves, yet there is a long way to go. When a country’s media and movie industry has leverage over the mindsets of its general public, it becomes its inherent responsibility to use it to its advantage and bring vital discussions to light.

Disclaimer: Material on The Health Collective cannot substitute for expert advice from a trained professional


About the author: Shruti Venkatesh is an aspiring Clinical Psychologist and Research Assistant at De Sousa Foundation, currently in her fourth year as a student of Psychology. She has been trained in REBT, TA, Forensic Psychology and Clinical Psychotherapy, and volunteers at NIOS and SPJ Sadhana.

 

Ask the Experts: Busting Five Myths About Therapy

By Kamna Chhibber

Undertaking therapy is not an easy decision for most people. Over the years that I have interacted with patients, doctors, friends and family I have recognised the many myths and misconceptions that people harbour about both therapy and therapists. It is not enough to simply say ‘Therapy is helpful and so you must consider it”. We need to break through the myths that surround it.

ALSO READ: SIX THINGS TO KNOW BEFORE ENTERING THERAPY

Through this blog I hope to dispel at least some of the myths which I have come across frequently.

 

  1. “Therapy is like talking to a friend. I can simply go and speak to a friend or family member instead” – Therapy is nothing like speaking to a friend or family member. All our interactions with others have reciprocity associated with them. If you share something, your friend or family member is likely to, and in fact expected to share their own personal experience as well. This is not the case in therapy where the focus is only YOU. Therapists rarely, if ever, engage in personal disclosure. They are trained experts who through years of education and training have developed the skills to be able to tackle the cognitive, emotional, psychological and behavioural issues you may be experiencing. The additional element of confidentiality makes it easy for you to bare all and speak about things that run in the deepest, darkest recesses of your mind without needing to censor anything.

 

  1. “A therapist needs to have similar experiences to be able to help me with my life situations” – The most important experience anyone in therapy is looking for is to be understood. And to be able to understand where another person is coming from, what they may be thinking or feeling and what impact it could potentially have on them, does not require going through the experience yourself. Rather, having the ability to be empathetic is important and is a skill that most therapists possess and are trained to develop. The training that therapists have along with their own trajectory of personal experiences can help them utilise those experiences to guide an understanding of different situations. It is not a must for your therapist to have the same experiences for them to be able to understand you, empathise with you or help you move through a situation.

 

  1. “Therapy is for crazy people. It cannot aid in personal growth” – Most people believe that going to a therapist is warranted only if you have a serious mental health issue or disorder. In fact, the reality is quite the opposite. Therapists play a significant role in helping people cope with stress, determine their growth trajectories, and aid in personal development as well. If there are life situations which you struggle to cope with or you are seeking growth in your personal or professional life then reaching out to a therapist can be rather beneficial.

ALSO WATCH: UNDERSTANDING MENTAL HEALTH

  1. “People who go to therapy are weak” – If you are struggling with something then seeking help for it is not a sign of weakness. It takes courage to be able to state that you may not be able to cope with something or that you need the assistance of another person to help you achieve your goals. It is at times easier to stay stuck in your situation doing nothing about it. Doing something and making the call of reaching out to someone for help is more difficult and is an indicator of the strength of your character. The fact is that most successful people have had coaches and mentors assisting their growth and there is no harm in your seeking the assistance of a psychologist for the same.

 

  1. “All therapists do is listen and not speak. What’s the point of wasting money on venting” – The therapeutic process no doubt begins with listening and asking questions, gently prodding the person to garner a better understanding of the life situations and personality of the person coming for therapy. And to this extent it can seem like therapists only listen. However, this is not the whole process of therapy. Therapy is a collaborative process where the therapist and the client work together to identify problems, personality related variables, aspects of situations which are amenable to change and those which aren’t. They together work to actively problem solve and simultaneously help the client develop the skills required to tackle situations be it related to their emotional or psychological functioning, or decision making and problem solving.


Therapy can no doubt have beneficial effects for an individual. However, sometimes it can take a little while to find the right therapist. Make sure you feel connected to your therapist and feel understood by him or her. If not, then don’t hesitate to reach out and find another therapist who can be a better fit for you.


About the Author: Kamna Chhibber is a Clinical Psychologist, Heading the Department of Mental Health and Behavioural Sciences for Fortis Healthcare. She is a cognitive behaviour therapist, with a particular interest in relationships, trauma, abuse and the impact of personality-related variables on mental health. She has been in practice for the past decade.

Feedback is welcome: Tweet @Kamna_Chhibber @healthcollectif

Coming soon: The next blog in this series would be on 5 things to keep in mind when deciding if your therapist is right for you.

Disclaimer: Material on The Health Collective cannot substitute for expert advice from a trained professional.

 

The Law and You: Trans Persons, Mental Healthcare and the Law

By Vandita Morarka

“People call us hijra, chakka and all sorts of things, no one asks us our individual names or what we want to be called. Terminology doesn't matter when there is no respect,” Surekha*, a transgender woman from a low income community, who self-identifies as belonging to the hijra community tells The Health Collective. These same people use the terms they call us as, as an insult for other people. I can proudly say I am from the hijra community today but others only look at it with disgust and shame.”

(Translated from Hindi; Log toh humein hijra, chakka or bahut kuch bulate hain. Koi nahi puchta ki naam kya hain ya phir hum kis nam se jaane jaana chahte hain. Yeh sab nam toh dur ki baat hain, jab koi adar hi nahi hain, log humein insaan jaise hi nahi dekhte, toh phir naam se kya pharak padhta hain. Jo naam humein dete hain, unhi namon ko aapas main gaali jaise isltimal karte hain. Main aaj garv bol sakti hoon ki haan main hijra hoon kyunki inhi logo ka saath raha hain, aur sab niradar aur gandagi se dekhte hain.)
 

Transgender persons face continued systemic oppression and violence in India. Constant social exclusion has led to their aggravated disadvantaged economic status, in turn lowering access to basic civic rights of housing, sanitation, education and healthcare. Even the National Legal Services Authority v. Union of India (NALSA) judgement, considered a landmark ruling towards establishing the rights of trans persons and providing social welfare schemes targeted at their specific needs, leaves an important aspect of healthcare directly undiagnosed - that of mental health.

The few research studies undertaken on this subject drive home the urgent need for more sustained mental healthcare solutions for trans persons along with dismantling of social barriers and continued discrimination.


Photo Hijras of Panchsheel Park II, New Delhi, 1994by R Barraez D'Lucca, shared under Creative Commons Licence 2.0 
 


TRANS PERSONS AND MEDICAL MENTAL HEALTHCARE STANDARDS 

Whenever one speaks of the mental health of trans persons, somehow the dominant discourse always seems to be on seeing their gender identity as a mental health issue in itself, rather than focusing on other aspects of mental health concerns that can oft be aggravated in trans persons due to societal systems and structural oppression.

Trans persons have constantly been diagnosed as having a “mental illness” and this continues to happen even today. Varied forms of therapy continue to be used by quacks for supposed "treatment". It was only in 2017 that Denmark became the first country to remove the classification of “transsexuality/transgender” as a mental illness.

An earlier change took place in 2013, when “gender identity disorder” was dropped from the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), published by the American Psychiatric Association. A condition called “gender dysphoria” was added to diagnose and treat trans persons. The new diagnosis recognises that a mismatch between one’s birth gender and one’s chosen gender identity is not pathological. It shifts the emphasis in treatment from fixing a disorder to resolving distress over the mismatch.

What does this mean on the ground? Trans persons in the USA are no longer classified as being mentally ill owing to their gender identity. In fact, transitioning biologically, through surgery, is considered as one of the final treatments of gender dysphoria by the American Psychiatric Association. Alongside, there is an increasing call for biological transition to not be seen as the necessary end goal of choosing a different gender identity for oneself than the one assigned at birth within the community.

ALSO READ: THE LAW AND YOU: MENTAL HEALTHCARE IN EDUCATIONAL INSTITUTIONS

Few research studies, especially in India, focus on the mental healthcare needs of trans persons. The National Alliance on Mental Illness, an American Non Profit Organisation has stated that trans persons are at a higher risk of mental illnesses.
In India, a recent study reported that about 54% the trans persons responding to the study questions had the habit of consuming alcohol and 26% of them had severe depression. It also stated that 31% of trans persons in India end their life by committing suicide, and 50% have attempted suicide at least once before the age of 20.

MENTAL DISORDERS AND ILLNESS

According to a study done in Mumbai and referenced here, 48% of hijra participants suffered from psychiatric disorders, ranging from alcohol abuse and dependence to depressive spectrum disorders. None had ever had psychiatric consultations for these issues.

Often the fear of ‘coming out’ and being discriminated against for one’s sexual orientation and gender identity can lead to: depression, posttraumatic stress disorder (PTSD), thoughts of suicide, and substance abuse.

According to the “minority stress” theory, disparities in health are due to stressors from a more dominant culture, ie “For transgender people living in a majority heterosexual culture, minority stress takes the form of discrimination, victimization, harassment, and maltreatment,” to quote from The American Addiction Centre.

Social stigma, discrimination, prejudice, harassment, and abuse are not uncommon in India. Rejection by family or missing family structures and peer support also aggravate this issue, increasing feelings of loneliness and social isolation. Fear of prejudice and stigma can be extremely harmful, especially when one may want to seek treatment. Aside from discordance between gender identity and natal role, there appear to be several socio-cultural stressors for trans persons from hijra communities that predispose them to mental health issues. These include family pressures to conform to gender norms, coming to terms with sexual identity and orientation, and migration to cities with strong hijra communities.

WHAT THE LAW SAYS (AND DOESN'T)

The law doesn’t say much when it comes to specific mental health care needs of trans persons. It is either bundled up with general healthcare, or not addressed at all. The NALSA judgement doesn’t directly refer to any supportive mental health needs of trans persons.

We asked Sourya Banerjee, a lawyer, for his view. “Currently, unfortunately, Indian Law does not even properly take into account the physical well being of trans persons. The only place the currently pending Transgender People's Rights Bill, 2016, even mentions mental health, is the token Section 19 (d), which states: ‘harms or injures or endangers the life, safety, health, or well-being, whether mental or physical, of a transgender person or tends to do acts including causing physical abuse, sexual abuse, verbal and emotional abuse and economic abuse’. This is a token penal section and does not actively aid or help trans persons.”

ALSO READ: THE LAW AND YOU: MENTAL HEALTH IN INDIA 

While The Mental Healthcare Act in India articulates the right of everyone to mental health treatment, without discrimination on the basis of gender, sex, sexual orientation, community, caste, religion, culture, social or political beliefs, disability etc...it doesn't provide specific provisions regarding mental healthcare requirements of disenfranchised groups and communities, including trans persons.

It also doesn't specify where people can go for support against discrimination by mental healthcare practitioners in treatment and care, so it's important to do a reality check on the ground, to assess lacunae in terms of implementation. 

The first step is knowing your rights: Under S.3(i) Part II of the Act, it does state that, “Mental illness shall be determined in accordance with such nationally or internationally accepted medical standards (including the latest edition of the International Classification of Disease of the World Health Organisation) as may be notified by the Central Government.”

Surekha*  tells The Health Collective, “In our community, it is difficult to get general healthcare, forget mental healthcare. We don't even know where to go and what doctor to ask for here.Such care if extremely necessary for us because so many of us are under extreme stress and depression and help is very necessary. We've faced discrimination from the time we were born, have very little access to anything and even living every day can be a struggle, even as part of a community, but where do we go and where do we find the time for this.”
(Translated from Hindi; Mere jaise logon ke liye to yahan sadharan doctor ke jana mushkil hain, mansik ilag toh bahut hi dur ki baat hain. Hum na hi jante hain ki jana kahan hain or na hi ki is bimari ke liye kaunsa doctor hota hain. Jabki aisa ilaj humare liye bahut zaroori hain, hum main se bahut log bahut dukhi rehta hain, har roz ki itni zimidari or kit kit hain. Jab se paida hue hain, tab se humare mere or mere doston ke saath alag vyavar hua hain. Har rooz jina bhi mushkil hain, koi bhi cheezo tak pahuchne ka rasta nahi hain. Jab ki aur logo bhi hain humare saath, phir bhi bahut mushkil hain. Jaye bhi toh kahan, itna waqt bhi toh nahi hain.)

Here’s what she wants people to understand.

“When they need blessings for anything they come to us but otherwise avoid touching us like we carrying some disease. We wish people would understand that this is not something dirty, it is how we feel and how we want to express ourselves and for many of us, there are no options in India outside joining the hijra community if one does not identify with their assigned gender. Several parts of our identity may be performative, but it gives us happiness, why do people have a problem with us being happy?” (translated from Hindi)

(Jab dua chahiye hoti hain, tab humare paas aate hain, apne ghar bhi bulate hain, warna toh koi galti se chuega bhi nahi, aise karte hain jaise humein koi bimari ho. Main or hum sab yahi chahte hain ki log samjhe ki humare jaise hona koi gandagi nahi hain, yeh humari pehchan hain. Aur is samaj main nahi toh aur kahan jayein? Humare jaise logon ke liye is desh main aur koi jagah nahi hain. Haan hum taali bajate hain, aise kapde pehnte hain,hum jaise hain uske kuch aise bahri dikhawa se lagte honge, par humein isse khushi milti hain, Humari khushi se logon ko kya problem hain?)

ALSO READ: MEDIA WATCH: PORTRAYAL OF MENTAL ILLNESS AND SUICIDE 

Banerjee tells The Health Collective, “It is surprising to think that historically Indian culture has always been open and supportive and yet as a developed country, we do not take care of a section of our own citizens. Hopefully, the currently pending curative petition by Naz Foundation before the SC, will finally actively protect the rights of trans persons.”

Support for mental health care needs of trans persons comes in from NGOs and civic society organisations, like the NAZ Foundation, Prothoma, Humsafar Trust, with minimal governmental support. For large scale intervention, action and impact, a national policy framework supported by on ground infrastructural changes and trained human resource personnel is of utmost necessity.


(*Name changed on request)

Views expressed are personal. This post was updated on March 19, 2018 to clarify on provisions of the Mental Healthcare Act. 

Tweet @healthcollectif @vanditamorarka with your thoughts using #RightToMentalHealth


 

Your Stories: Autism Awareness

 


(By Kishore Mohan and Merryn John/ Health Collective)

View older posts »

What It's Like to Live With Anxiety and Depression

Do check out this incredible comic (created by Nick Seluk of The Awkward Yeti). I first saw it on Upworthy and was blown away by it -- like so many others have been. It is reproduced here with the kind permission of The Awkward Yeti.

 

 

This incredible comic was created by Nick Seluk, creator of The Awkward Yeti, based on a story told by Sarah Flanigan, and published on taptastic.com 

It is reproduced here with kind permission from The Awkward Yeti

 

Adolescents, Relationships and Stress

In India, year after year, we are almost inured to stories of students driven to extreme stress by board exams. At times, in the absence of learning coping mechanisms or other ways of releasing these incredibly high levels of stress, a significant number of them choose, tragically to cut short their young lives.


YOUNG SUICIDES

The National Crime Records Bureau report looking at Suicides in India (2004-2014) analyses the 'Percentage Distribution of Suicide Victims by Profession during 2014' to find that 6.1% of suicide victims in 2014 were students. (Another shocking statistic: 15.3% of suicide victims were found to be housewives; find an analysis of the data and concerns about under-reporting here on IndiaSpend)
 


There doesn't seem to be enough attention paid to causes of suicide -- often a web of causes, not just one simple cause.

Nonetheless, many counsellors I had spoken to over the years, including some manning exam helplines for Indian students, mentioned that frequently callers dial in to talk about relationship issues and relationship pressures. It's not just the stress of exams/ Board exam results and the massive pressure we've been socially conditioned to accept as normal, that is.
 

RELATIONSHIP PRESSURE AND ADOLESCENTS

Noted child and adolescent psychiatrist Dr Amit Sen had told me years ago, about how kids are in relationships at ever younger ages -- think tweens or pre-tweens -- and aren't always able to navigate the complications of this; often relationships of course are due to peer pressure.


FROM THE ARCHIVES:
 Dr Amit Sen's own words on the context in India: 

"For the longest time we have found correlations between exam stress and rising depression in adolescents. There is no doubt in my mind that study and exam pressure takes a heavy toll on the minds and well being of teenagers in India. It robs them of other experiences that are vital for adolescent development. Paradoxically, as they begin to slip under the pressure, the system exerts even more pressure.

More recently, we have become increasingly aware of the close relationship between romantic relationship and depression. And indeed, as the article suggests, it is not only to do with break ups but also ongoing/"serious" relationships that often become too complicated for the mid-teens to handle. The cause and effect relationship is,however, not always clear. Its also true that depressed teenagers make themselves more vulnerable and tend to get into messy relationships more easily. A lot depends on the readiness/maturity of the person and clarity about what the relationship means and where the boundaries lie. In India, and perhaps in all places, teenagers often get widely conflicting messages about romantic relationships. This is where life skills and sex education (that is sustained and ongoing) might be preventive/protective of the many ills that plague our children today."

-- This was in response to this article in The Huffington Postwhich, among other things, raised some key points from a startling survey of more than 8,000 American adolescents on issues of depression and romantic relationships.

  

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