Tag: mental health

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Issue 22

A Conversation With Dr. Arvinder Singh About Grief, Mental Health and Well-Being

OpenAxis had a conversation with Dr. Arvinder J. Singh, a psycho therapist and trainer, about the recent addition of prolonged grief in the DSM-5.  

Lakshya Sharma

Hello, Dr. Arvinder! This conversation is pegged by the recent inclusion of prolonged grief in the Diagnostic and Statistical Manual. Grief is a part of normal human experience. It is inevitable. So, by including grief are we reducing the horizon of normal human behavior?

Dr. Arvinder J. Singh

Pathologizing is not always the way out. We need to ensure that a normal human emotion such as grief should not be stigmatized. I stay away from diagnosis because diagnosis has a way of stigmatizing and pathologizing. Moreover, anxiety and grief affect different people, differently, and conversation is the way out. Even at Ashoka we have the gatekeepers programme to ensure that situations of anxiety and grief are smoothly taken care of.

Lakshya

In your clinical experience, have you ever felt, need for such a diagnosis?

Dr. Arvinder

I stay away as far as possible and refrain from diagnosing and labeling. I think because what it does is it just limits the kinds of ways you look at it because any kind of mental health concern has many strands to it. So it’s not necessarily just this one diagnosis and you operate out of that one. Moreover, there are no medical or blood tests to pinpoint a cause.

I think what is important is for us to see emotions like grief or  anxiety could impact different people differently and there’s no predicting. Even the duration after which grief is tagged prolonged is highly debated. Six months is politically incorrect whereas one year sounds better because it is the anniversary of everything. The conversations around such issues are very nuanced. It is not only about generational gaps but differences in personalities. Due to the pandemic we saw a loss in the grieving spaces, and a loss of contact and spaces.. 

Coming to DSM, how do we know if the grief is prolonged or delayed? How do we label it? And if you indeed label you need to understand the consequences of that label. If you club prolonged grief with depression, you end up stigmatizing the person. Grief might come up as an illness rather than a very normal human emotion. 

Lakshya

Grief can be triggered by numerous different causes, and sometimes small triggers lead to a huge impact and vice-versa. So, how do we understand the complexities of grief? 

Dr. Arvinder

So I think there are many factors involved. One is the preparedness. How prepared are you for the change? For instance, graduating from high school or losing a terminally ill relative leads to a less severe form of grief compared to unexpected losses.

Secondly, it depends on your coping mechanisms. How do you deal with your emotions? DO you talk or do you isolate? Thirdly, is it about how robust your support structure is? A stronger support structure helps in healthy grieving. Finally, it is about attachment. How attached were you to the person or item that you lost? While working in Gujarat, during the Bhuj Earthquake, a girl was grieving for her dog while her mother was grieving for her father. The two cannot be compared because both are grieving according to their attachments. Acknowledgment of pain is also really important. Denial might suppress the emotions for some time, but they will come back again and again. Final step is to seek support from people you can while following well-being practices.

Lakshya

When talking about well-being and accessing providers of well-being services, there is always an aspect of elitism. Seeking mental well-being services is perceived as elitist. So how do we bridge that gap? How do we make well being services more accessible?

Dr. Arvinder

That is an excellent question, because the gap between the number of professionals available and number of professionals required is humongous. Now, to bridge this gap, there are two ways. One is that it need not completely depend on professionals. So what we do is to bring the issue of a model, where we do capacity building from within the community, and we encourage open conversations around mental health and wellbeing.

Secondly, to not see well being as a time waster but rather as investment. Even at Ashoka our current model in place follows these principles of emotional robustness at the heart of education. That is why we promote conversations around problems people are facing, it is okay to talk about them and we need this kind of model in our community as well. 

Before, joint families were the norm and it provided a safety network. Now the family system has disintegrated, and we ended up with two working parents and a single child, leading to isolation. With the advent of the digital medium people have lost real connections  that end up with people living in their silos. But if we have these connections and spaces we must go and talk. I always encourage students to go and check on each other. In the worst case scenarios they might end up not talking. Or they might find a company, and will be grateful that you checked on them. The notion, however, is very individualized. 

Finally there is awareness. People have very little awareness about terms and well-being. They throw words like ‘OCD’ and ‘depression’ like that, but we don’t wish that on anyone, because it is hard. For the longest time, people did not know the difference between mental illness and mental retardation. Many other things in the illness spectrum also get the same treatment. What is a disorder? What is behavior? These are all nuanced conversations about which people don’t know much because they haven’t been talked to. Moreover, mental health is such an invisible space whereas physical disability is visible to all. People are compassionate about them and it is easy to talk about. On the other hand, mental health has a lot of stigmas around it. Most people don’t understand how crippling any anxiety or depression can be. So we need awareness to bridge the gap and make spaces for open conversations. 

Mental Health should not be seen from only an illness spectrum, it should be seen from a wellbeing spectrum. Practice various practices that are informed by positive psychology, whether it’s mindfulness, gratitude, or self-care. You don’t need to go to a specialist everytime there is a mental health concern, you can also deal with it yourself. If you can listen to somebody passionately without judging, advising, and moralizing. People will themselves come up with solutions, you won’t have to give it to them. It all starts with stress, if you don’t deal with stress, it becomes distress, and distress becomes crisis. If we deal with it at the stress level itself, the situation becomes much easier for both the professional and the patient. People also feel empowered enough to say, we can deal with this. So if these are the things that we work upon,  and empower or enable the community capacity building, it definitely would bridge the gap.

Dr. ArvinderJ. Singh is a psycho therapist, consultant and trainer who has worked for over 20 years in the area of leadership as well as building healing spaces through listening and stories including in areas of political violence and natural calamities.  She is the founder of an initiative called Listening Circles Healing Spaces that builds on this aspect of her work. She is currently Director of Ashoka Centre for Well-being and guest faculty for the course ‘Effective Leadership Strategies’ at IIM, Ahmedabad where she teaches mindfulness and empathic  leadership.

Interviewer: Lakshya Sharma

Picture Credits: Harper’s Bazaar

We publish all articles under a Creative Commons Attribution-NoDerivatives license. This means any news organisation, blog, website, newspaper or newsletter can republish our pieces for free, provided they attribute the original source (OpenAxis).

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Issue 22

Astrology, Mental health and the Economics of Well Being

Around 75 per cent of the Indian population lives in rural areas, but their access to quality mental health care is limited and traditional approaches continue to be in use. The shortage is to such a large extent that there are only  0.7 physicians per 1000 population and only one psychiatrist for every 343,000 Indians. While over the years the mental health sector has seen major developments, like the 2017 mental health care act. This act establishes equal access for all citizens, to avail government-run or funded mental health services in the country. However, it does not bridge the gap in society as the majority of the population remains deeply unaware or unable to access these services. 

While the uncertainties of the pandemic brought mental wellbeing to the forefront, the national budget for the sector dropped, making this an issue of human rights. This accessibility to services is further corroborated by the recurring financial expenses of medications and frequent visits to government clinics. The cost of sessions is steep and a single session is not ideal. Spending exorbitant amounts on healthcare is a burden most families can’t afford leading to debt. In the absence of insurance and healthcare schemes and provisions, therapy remains a luxury to many Indians.

Economic struggles are only one of the causes of this discerning gap in the mental health sector. Barriers caused by sexuality, gender, caste and religion also play a major role in mediating people’s perception and access to therapeutic services. The persistent stigma surrounding mental health, especially in India continues to be a hindrance to seeking help. The supernatural inhibitions and disparity in knowledge across communities only create more confusion. The notion that mental well being is an optional expense is popular, even though the country’s population is in a dire state. Data collected in a WHO report found that nearly 15 per cent of Indian adults need active intervention for one or more mental health issues.

The population disregards the very prevalence of such mental disorders and more than often finds it fruitless to receive treatment. Some who are open-minded fail to afford the hiked fees that therapists in urban settings charge, leaving them with no option. While for years Indians attributed the systemic weakness of the mental health system to the people’s attitudes, a 2016 survey showed more than 42% of people have positive attitudes toward mental wellbeing and treatment. While the skeptics remain, these underprivileged sections of society too struggle to gain the accessibility they deserve.

This is where astrology, tarot card reading and other spiritual practices, have created a market for themselves in the well-being industry. The sceptics, and those from poor socio-economic backgrounds resort to these local and easily accessible ways of coping, to instil the faith they so desperately need. Astrology is a layman’s substitute for therapy, or for some even a supplement when they cannot afford extended periods of treatment. Visiting a local astrologer in many ways breeds the self-awareness one would expect from a session in therapy. These practices even hold certain similarities to actual psychotherapy settings, in the way they define, and alleviate aspects of one’s personality and behaviour.

Very often one simply needs an explanation, or an answer to the ‘why’ no matter how scientifically rooted that response truly is. Astrologers impart a level of faith, that things will get better. For those in rural areas, struggling to provide the bare necessities to their family affording therapy is impossible, so their local psychic, astrologer or pandit becomes their anchor during emotional duress. Tarot cards and other practices primarily focus on the future and act as a guide point for how to deal with the things ahead. For a farmer coping with anxiety, access to anti-anxiety medication is strained, and so is therapy. His best bet remains to consult his next-door jyotish about his burdens.

A famous clinician Caroline Hexdall in an interview said that “ Part of the popularity of astrology and tarot today has to do with their universal nature”. With growing technology and the pervasiveness of social media, people can gain easy access to self-care and astrology resources. Apps and web pages provide daily tarot cards, zodiac signs readings and astrological predictions for people, and almost serve the purpose of a therapist. Is reading the lines on our palm, and checking the alignment of the stars enough to cure the mental illness they undergo? Is it a solution or a quick fix as a consequence of an ignorant healthcare system?

Several studies have also shown the deteriorating effects of depending on astrology. Cases of worsening and onset of depression, anxiety and personality disorders are common for those who use astrology as more than just a temporary coping mechanism. It also becomes a source of losing control, as every feeling is attributed to fate and destiny, instilling a sense of helplessness. Ultimately can the mental health system single-handedly address the concerns of inequality and economic access in society?

Maahira Jain is a third-year student at Ashoka University studying Psychology and Media studies. She is a movie buff and is extremely passionate about writing and traveling.

Picture Credits: kabar-priangan.com


We publish all articles under a Creative Commons Attribution-NoDerivatives license. This means any news organization, blog, website, newspaper or newsletter can republish our pieces for free, provided they attribute the original source (OpenAxis).

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Issue 22

Prolonged Grief: A New Mental Disorder?

The latest edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) features a new diagnosis: prolonged grief disorder—used for those who, a year after a loss, still remain incapacitated by it. This addition follows more than a decade of debate. Supporters argued that the addition enables clinicians to provide much-needed help to those afflicted by what one might simply consider a too much of grief, whereas opponents insisted that one mustn’t unduly pathologize grief and reject an increasingly medicalized approach to a condition that they considered part of a normal process of dealing with loss—a process which in some simply takes longer than in others.    

By including a condition in a professional classification system, we collectively recognize it as real. Recognizing hitherto unnamed conditions can help remove certain kinds of disadvantages. Miranda Fricker emphasizes this in her discussion of what she dubs hermeneutic injustice: a specific sort of epistemic injustice that affects persons in their capacity as knowers1. Creating terms like ‘post-natal depression’ and ‘sexual harassment’, Fricker argues, filled lacunae in the collectively available hermeneutic resources that existed where names for distinctive kinds of social experience should have been. The absence of such resources, Fricker holds, put those who suffered from such experiences at an epistemic disadvantage: they lacked the words to talk about them, understand them, and articulate how they were wronged. Simultaneously, such absences prevented wrong-doers from properly understanding and facing the harm they were inflicting—e.g. those who would ridicule or scold mothers of newborns for not being happier or those who would either actively engage in sexual harassment or (knowingly or not) support the societal structures that helped make it seem as if it was something women just had to put up with. 

For Fricker, the hermeneutical disadvantage faced by those who suffer from an as-of-yet ill-understood and largely undiagnosed medical condition is not an epistemic injustice. Those so disadvantaged are not excluded from full participation in hermeneutic practices, or at least not through mechanisms of social coercion that arise due to some structural identity prejudice. They are not, in other words, hermeneutically marginalized, which for Fricker, is an essential characteristic of epistemic injustice. Instead, their situation is simply one of “circumstantial epistemic bad luck”2. Still, Fricker, too, can agree that providing labels for ill-understood conditions is valuable. Naming a condition helps raise awareness of it, makes it discursively available and, thus, a possible object of knowledge and understanding. This, in turn, can enable those afflicted by it to understand their experience and give those who care about them another way of nudging them into seeking help. 

Surely, if adding prolonged grief disorder to the DSM-5 were merely a matter of recognizing the condition and of facilitating assistance, nobody should have any qualms with it. However, the addition also turns intense grief into a mental disorder—something for whose treatment insurance companies can be billed. With this, significant forces of interest enter the scene. The DSM-5, recall, is mainly consulted by psychiatrists. In contrast to talk-therapists like psychotherapists or psychoanalysts, psychiatrists constitute a highly medicalized profession, in which symptoms—clustered together as syndromes or disorders—are frequently taken to require drugs to treat them. Adding prolonged grief disorder thus heralds the advent of research into various drug-based grief therapies. Ellen Barry of the New York Times confirms this: “naltrexone, a drug used to help treat addiction,” she reports, “is currently in clinical trials as a form of grief therapy”, and we are likely to see a “competition for approval of medicines by the Food and Drug Administration.”3

Adding diagnoses to the DSM-5 creates financial incentives for players in the pharmaceutical industry to develop drugs advertised as providing relief to those so diagnosed. Surely, for various conditions, providing drug-induced relief from severe symptoms is useful, even necessary to enable patients to return to normal levels of functioning. But while drugs may help suppress feelings associated with intense grief, they cannot remove the grief. If all mental illnesses were brain diseases, they might be removed by adhering to some drug regimen or other. Note, however, that ‘mental illness’ is a metaphor that carries the implicit suggestion that just like physical illnesses, mental afflictions, too, are curable by providing the right kind of physical treatment. Unsurprisingly, this metaphor is embraced by those who stand to massively benefit from what profits they may reap from selling a plethora of drugs to those diagnosed with any of what seems like an ever-increasing number of mental disorders. But metaphors have limits. Lou Marinoff, a proponent of philosophical counselling, puts the point aptly:

Those who are dysfunctional by reason of physical illness entirely beyond their control—such as manic-depressives—are helped by medication. For handling that kind of problem, make your first stop a psychiatrist’s office. But if your problem is about identity or values or ethics, your worst bet is to let someone reify a mental illness and write a prescription. There is no pill that will make you find yourself, achieve your goals, or do the right thing.

Much more could be said about the differences between psychotherapy, psychiatry, and the newcomer in the field: philosophical counselling. Interested readers may benefit from consulting Marinoff’s work. Written in a provocative, sometimes alarmist style, it is both entertaining and—if taken with a substantial grain of salt—frequently insightful. My own view is this: from Fricker’s work, we can extract reasons to side with the proponents of adding prolonged grief disorder to the DSM-5. Creating hermeneutic resources that allow us to help raise awareness, promote understanding, and facilitate assistance is commendable. If the addition achieves that, we should welcome it. And yet, one may indeed worry that practitioners are too eager to move from the recognition of a mental condition to the implementation of therapeutic interventions that are based on the assumption that such afflictions must be understood on the model of physical disease. The issue is not whether certain mental conditions are real—they are. It is how we conceptualize them and what we think treating them requires.

No doubt, grief manifests physically. It is, however, not primarily a physical condition—let alone a brain disease. Grief is a distinctive mental condition. Apart from bouts of sadness, its symptoms typically include the loss of orientation or a sense of meaning. To overcome grief, we must come to terms with who we are or can be without the loved one’s physical presence in our life. We may need to reinvent ourselves, figure out how to be better again and whence to derive a new purpose. What is at stake is our sense of identity, our self-worth, and, ultimately, our happiness. Thinking that such issues are best addressed by popping pills puts us on a dangerous path, leading perhaps towards the kind of dystopian society Aldous Huxley imagined in his 1932 novel Brave New World. It does little to help us understand, let alone address, the moral and broader philosophical issues that trouble the bereaved and that lie at the root not just of prolonged grief but, arguably, of many so-called mental illnesses.

Footnotes:

1 For this and the following, cf. Fricker 2007, chapter 7.

2 Fricker 2007: 152

3 Barry 2022

References:

Barry, E. (2022). “How Long Should It Take to Grieve? Psychiatry Has Come Up With an Answer.” The New York Times, 03/18/2022, URL = https://www.nytimes.com/2022/03/18/health/prolonged-grief-
disorder.html [last access: 04/05/2022])
Fricker, M. (2007). Epistemic Injustice. Power & the Ethics of knowing. Oxford/New York: Oxford University Press.
Huxley, A. (1932). Brave New World. New York: Harper Brothers.
Marinoff, L. (1999). Plato, not Prozac! New York: HarperCollins Publishers.

Professor Raja Rosenhagen is currently serving as Assistant Professor of Philosophy, Head of Department, and Associate Dean of Academic Affairs at Ashoka University. He earned his PhD in Philosophy from the University of Pittsburgh and has a broad range of philosophical interests (see here). He wrote this article a) because he was invited to do so and b) because he is currently nurturing a growing interest in philosophical counselling.

Picture Credits: CBD Oracle

We publish all articles under a Creative Commons Attribution-NoDerivatives license. This means any news organisation, blog, website, newspaper or newsletter can republish our pieces for free, provided they attribute the original source (OpenAxis).

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Issue 11

bestdressed

Film student, feminist and fashion enthusiast Ashley creates intricate and artistic portraits of her life as a young adult, trying to make it in a big city. 

Some of her most popular videos are her style guides, apartment makeovers and thrift shopping hauls + thrift flips. Thrift flips involve altering or ‘flipping’ clothing items bought from a secondhand or thrift store. The concept has become increasingly popular in the DIY and fashion circles of youtube, as vintage clothing (that can only be bought cheaply in thrift stores) became a huge trend. 

Her film background and editing prowess (she worked as a freelance video editor before creating her own channel) shines through, making every video uniquely memorable. Bestdressed also has the occasional video discussing politics, sexuality and mental health with refreshing candour, based on research and her own experiences. 

All in all, this is a great channel to watch for relaxation, upliftment, life advice, or all of the above. 

Categories
Issue 9

Encounters with the Black Cloud

The black cloud never fails to rain on my parade. Shrouding and guiding my hesitant, shaky hands and beating chest, it starts to sink deep.  Slowly sinking in, it taunts, “Are you sure you are not making a fool of yourself again?” Usually, it would work to dispel the cloud with some faltering rationale, but the boxes on the screen appear too jarring. I convince myself that everyone is just mocking how inarticulate my stutters are, how wonky my nose is, and how I do not deserve to be here in this call, at all. 

Pressing the tempting red button and exiting the call, I run leaps and bounds inside my head – rehearsing and flagellating what I could have – no, should have said. I could have worded it differently, perhaps used a different inflexion, or maybe just not tried talking at all. I can practically imagine disappointed faces showing up in my brain over and over again. The cloud grows bigger and laughs at the ruminating spiral that encompasses me. Faltering words and a growing pulse, it derives pleasure from my fear of embarrassment.

I take a few breaths to focus on something around me, and my mind starts to gravitate towards the question, “How did I end up here?” 

Everything felt fairly regular before the pandemic – the hesitance and rumination persisted, but they were not persistently spiral. I used to fuss over and stutter about my words, but those around me seemed to give nods of comprehension. Compassion made me fairly more relaxed about self-expression. Quickened heartbeats found ways to soothe themselves, ways to cope, without looming black clouds. Even when I worried about tone, pitch, words, and most of all, embarrassment, the thoughts stuck but got easily replaced. Perhaps it was the pace at which I was dealing with life. 

This pace came to a halt when they announced the lockdown. Initially, it felt like a huge relief for a person like me who was avoidant of social interaction. Having to not interact with others and feel the every-day pangs of overthinking that came with this interaction felt freeing. However, shifting to online modes of communication – some that I thought I could handle due to the possibility of engineering replies and responses carefully, actually became a cause for more concern. 

Text messaging fails to convey tone, and so, an “ok” seems scarier than an “okay”, and a full-stop feels like you are on a battlefield, being attacked by passive-aggressive weapons. I would spend hours agonizing over whether my friends actually did feel upset with me or that I was worrying once again. Extremely concerned, I would shoot them a, “Hey, are you upset with me?” daily, and then progressively feel more worried whether asking them over and over again annoyed them further.  It felt like I was stuck in a loop. Worry about friends being annoyed, then try to message them, worry about annoying friends with messages to ask them if they were annoyed, and restlessly repeat!

The slumber that the world was in also projects this idea that you must be ever-available to reply every second throughout the day. This expectation often makes conversations more pressure-filled. It becomes energy-reducing to reply and guilt-inducing to not. Even having conversations with people on video calls was hard. Where there existed tone, there existed near to no non-verbal cues that could signal to me whether or not what I said made any sense. Zoom made me feel more seen than I wanted to, hyper-aware of what I looked like on-screen, and ever on guard to not end up doing anything embarrassing. In a lecture filled with a hundred people or so, it felt daunting to even speak up in class. I could picture professors thinking about how incompetent I was in my scrambled answers. The few times I did, the black cloud refused to leave me alone, insisting that I continued to embody embarrassment. Everything slowly became more and more draining, furthering alienation. 

In such a  circumstance, I wonder, am I the only one? It certainly does seem so when everyone else is seemingly coping fine. The promise of the world opening up again feels even more daunting now. Nagging me, yet again, the cloud says, “Haven’t you forgotten how to interact socially altogether? If everything opens up, you’ll just embarrass yourself further.” 

The fear of going back into the world again, with my frazzled and anxious self feels very real. I wonder if being in the middle of a classroom with a hundred distracted kids would help me realize that no one is focusing on me, or if it would get too overwhelming to feel eyes on me. One is already scary, over-complicating what physical conversation takes for granted, but the other holds within its grasp the overwhelming nature of unpredictability and in-person embarrassment. 

Oh, decisions, decisions.

Deeksha Puri is a first-year prospective psychology major at Ashoka University.

Picture Credits: Artwork on “Depression” by Ajgiel

We publish all articles under a Creative Commons Attribution-Noderivatives license. This means any news organisation, blog, website, newspaper or newsletter can republish our pieces for free, provided they attribute the original source (OpenAxis).