Mental Healthcare for Young Women in Indian Metros

Photo by José Martín Ramírez C on Unsplash

It is 7 p.m. on a weekday evening, and long lines of vehicles snake interminably across the choked lanes of Hyderabad’s busy IT corridor. They are carrying hundreds of thousands of tired working professionals home after a long day. ‘Home’, to most of these young professionals, means a paying guest facility or an apartment shared with other 20-somethings like them.

People have always moved out of their hometowns in search of better opportunities elsewhere. Migration to cities for higher education and better employment is by no means a recent phenomenon. What is new, however, is that more young women are stepping out to live on their own than ever before.

The benefits of more and more young women taking up higher education and embarking on careers are indisputable. Young women today have a greater degree of economic and social freedom and mobility than ever before. Economically empowered young women are initiating social, cultural and political change, and are fast emerging as an entirely new demographic—independent and differentiated from the caste-based groupings which have traditionally influenced Indian politics.

India’s metros find themselves in a curious twilight. They accommodate and empower young women who contribute immensely to fuelling the local economy, but at the same time, they are still little more than overgrown villages, with deeply entrenched systems of patriarchal oppression. Young women in cities may appear free, but any one of them will be able to relate tales of how patriarchal constructs continue to rule their lives, from being evicted from rented apartments simply because a male friend came over, to constantly having to ward off queries about how their families have “let” them step outside the home to study or work.

Young women unmoored from the support networks they grew up with often create new, more authentic networks, which truly see them for who they are, devoid of the burdens of inherited identities. However, these connections can be extremely transient—rootlessness is what defines urban living, and new friends can often move away quickly, never to return, in pursuit of a new career opportunity, a second degree, or a relationship.

We already know that this environment is taking an immense toll on young people. Young women are especially affected, with suicide being the leading cause of death for Indian women between the age of 15-49. So what happens when these isolated, struggling, young women reach out for help?

“You think the hard part is getting over the stigma of accepting you have a mental health condition and need a psychiatrist,” says Pearle, a 26-year-old media professional. “And then you realise it was only the first step; the easy one.”

“I remember struggling with depression and panic attacks since I was 14 or so, but I think I sank into my worst and longest depressive phase around a year back,” Pearle recalls. “I can’t really tell you what triggered it, exactly. I expect it was a combination of factors—practically everyone in my friends’ circle had moved away; I had spent three years in my present role at work and I was no longer feeling challenged enough; I was tired of the toxic relationships I kept getting into and had decided to give myself a long break from dating. I think that was what it was—the constant drama I had surrounded myself with for years had finally stopped, but when it did, I saw that I had nothing without it. Life was a gaping void; just empty.

“I wouldn’t admit to myself that anything was wrong, however. Not even when I stopped caring about what I wore and how I looked, and unwashed laundry piled up for weeks. I was just constantly tired, so I didn’t care about anything. I crept into bed as soon as I got home from work, at 6 or 7 in the evening, and woke up at 8, sometimes 9 am. Even with 14 hours of sleep, I was still tired. I struggled to get out of bed every single day. I started taking naps at work as well, to cope. It’s not like being awake led to anything interesting, anyway. The few hours I was awake, I was so bored! Just…existing…it bored me. I was so bored and apathetic that one time, when I was awake, I held a knife and seriously contemplated slashing it across my wrist, just so I could finally feel something. I told this to a friend from work, thinking nothing of it, but she was horrified and alarmed. She saw that I was sinking, even if I didn’t, and cajoled me into going to a psychiatrist.

“I resisted for weeks, though. Depression wasn’t something that happened to people like me—it happened to skinny girls in movies who had been dumped by the love of their lives, after which they spent all their time wearing black and crying in the rain. I was doing none of that—I was just bored and tired. So I went on a vacation, I visited my parents back home in Kolkata. My mood did lift on occasion. So it couldn’t be depression, right? Depression was all-or-nothing; you never felt anything but sadness if you were depressed. That’s what I thought at the time, anyway.

“I finally did go to a psychiatrist with my friend after she insisted repeatedly. I didn’t have high hopes from it; I didn’t really care. That’s what I thought, anyway. After a 45-minute session with this psychiatrist, who supposedly had a Master’s degree in psychiatry, in addition to a degree in medicine, and worked at one of the premier mental hospitals in one of India’s largest metros, I was a blubbering, trembling mess. That’s how damaging and brutal he was.”

What did he do, exactly?

“I suppose I was wrong when I said I didn’t care what happened at the psychiatrist’s office,” Pearle sighs. Her voice cracks with strain, even over a year after the incident, as she recounts it. “I didn’t really know what to expect; after all, I had no template for this sort of thing. I grew up thinking all mental illness was pagalpan; madness. I was only just beginning to realise mental illness wasn’t a permanent label, and more of a spectrum, which was liable to shift constantly in life. And this psychiatrist shattered the fragile understanding and self-acceptance which had taken me so long to build.

“He was dismissive; even cruel. He asked me about what I had been undergoing before I came to him, and because I struggled to recollect my behaviours and moods exactly, and couldn’t frame very coherent sentences, he ridiculed me for making a big deal out of nothing. He then went on a rant about how I didn’t have anything to be so gloomy about, because I was still in my twenties, and implied I was merely a hypochondriac. He even said ‘females’ had a tendency to over-exaggerate health symptoms. He constantly cut me off, dismissing every concern I raised as trivial or misguided. The cherry on this cake was that after berating me for close to an hour, he told me off for taking up more of his time than his other patients did, and charged me double the fee!

“When I walked out, I was miserable and shaking. It felt like I had heard all the negative voices—the voices of my family, judgmental friends, my own self-critical voice—all at once, and in the one space I thought was safe for someone like me.”

Horrifying as Pearle’s account is, it seems the norm among Indian mental healthcare providers. Her experience may have been extreme, but her psychiatrist’s attitudes are implicit in the diagnosis and treatment of mental illness in young women.

“There’s definitely a strong bias against single young women,” says Molly, 24. “So many therapists and psychiatrists assume that simply because we are young, financially stable and unattached, we cannot have depression or anxiety. We need to justify what we are feeling with a significant ‘life event’; say, ‘I was abused as a child’, or ‘My boyfriend physically abused me.’ There is little to no recognition of mental imbalances being brought about because of several smaller events building up for years. One expects society at large to be this ignorant; to always expect a dramatic tragedy to have precipitated your symptoms. But sadly, so many of the very people who ought to understand, mental health care providers and professionals, have these attitudes too. Unless you have an ‘event’ to point to as the trigger, don’t expect to be taken too seriously.”

With certified doctors taking dehumanising approaches like these, where does the awareness and education come from?

“Social media!” responds Molly promptly. “We’re seeing a lot of conversations opening up on social media, initiated by sufferers themselves. It’s great to see we are not alone.”

Pearle agrees, saying, “I educated myself on mental health almost solely through Tumblr and Instagram. There is absolutely nothing we learn about this in school and college, and we certainly can’t walk into a public health centre or hospital and pick up an information booklet. I’ve had to educate myself by reading blogs and Instagram posts. It really brought about a change in how I viewed mental health, illness and wellness.”

She pauses, and her tone grows more somber. “All that learning… it still does nothing for the day to day reality of my life, though. It complicates it even further, in fact, because there’s just so much information out there, and I just don’t know what’s right or wrong for me. Should I be taking my meds? Should I ditch it all and go on a raw vegan diet? Maybe it’s because of my poor lifestyle choices that I struggle so much… but then, what else can I do? I worked so hard to get this job and move out of my small hometown…”. Her voice, which has been rising in frustration with each sentence, drops suddenly, defeated. “I really don’t know,” she mumbles.

“I’m confused, and I’m scared I’ll get bad again,” she says, after a long moment. “The first guy I went to was terrible, but now that I had started down this path, I couldn’t not see it to the end. I went to another psychologist I found on the internet. I know from my reading that a psychologist isn’t supposed to prescribe drugs, but he did it anyway. I’ve been taking them for over a year now, even though I don’t much like it. This one doesn’t really sneer at me or anything, but he doesn’t listen to me either. I feel like all he’s doing is shutting me up by prescribing more pills. But I’m too afraid not to take them. I’m too afraid to go back to being what I was. And so I keep taking them.”

The developed world is only just beginning to wake up to the dangers of over-diagnosis, over-treatment and psychiatric drug dependence. In a 2013 study conducted by John Hopkins University, only 38.4% of patients diagnosed with clinical depression were found to actually meet the criteria for a clinical diagnosis. With information on mental illness and wellness being so scarce, and Indian mental healthcare providers often mirroring the same toxic social attitudes that precipitate mental illness in young women, we might be staring at a similar crisis ourselves. How many young women like Pearle and Molly encounter hostile or indifferent mental health care providers, and find themselves trapped into a drug schedule simply because they don’t know what else they can resort to? Modern society has created structures which seem designed to cause ill health, and further can provide no reliable, safe health care. Something is rotten in the state, indeed.

This is the first in a four part series where the writer, Vatsala Joshi, will take a critical look at some of the mental health related problems faced by young women in Indian metros. All names have been changed to maintain privacy.

Vatsala is a writer and editor currently based out of Hyderabad. She received her first diagnosis of clinical depression in 2017, and since then, has had myriad (mis)adventures with psychiatry, psychotherapy and alternative healing. She is presently working towards accepting her states of mind as part of who she is, instead of pathologising it as “illness”. To this end, she is opening herself up by using her pain to fuel her art, writing, and conversations with other people.