When I was contacted by Complete Wellbeing to write about my experience as a psychiatrist in India, I winced. Would I be able to adequately express my passion for the treatment for mental illness, I wondered.
When I left India in 2001, with “just” an MBBS—unfortunately, being a general practitioner can be a challenge if you want to be able to earn enough for three meals a day—the government of India did not recognise an MD from the United States. So, pursuing a speciality in the US and coming back to India to practise was not an option. But since I was going to the US, I decided that I might as well pursue psychiatry, as it was something I had always wanted to do. I graduated from Duke University and I began practising in the US for a while before relocating to India. Thankfully, by the time I was back, the rules had changed and I was allowed to practice after registering with the appropriate authorities.
In for a surprise
I assumed that armed with a degree from a reputed university and four years of psychiatric practice under my belt, I could swoosh in like Zorro and get a job anywhere I wanted. In my practice, I had seen a lot of cases of Post Traumatic Stress Disorder [PTSD], so the altruist in me offered to volunteer with the military services. Unfortunately, the armed forces were not keen on hiring me. So I began thinking about joining a private hospital and contacted a number of them, but without success.
So there I was—a qualified and experienced psychiatrist, in a country with more than a billion people, where 20 – 30 per cent of them suffer from anxiety or depression and yet I could not find a job. My faith in Zorro began to wane. Was I wrong to move back? Should I have stayed in the US? Was I going to stay unemployed for the rest of my life in India? My fears were exhausting. Eventually, I did join a private hospital [where I currently practice], but not before working for three years at The National Institute for Mental Health and Neuro Sciences [NIMHANS]. During my tenure there, I learnt fascinating things about the Indian mindset, aspects that were very different from my experience in the US. I went through a whole new learning process.
There I was—a qualified and experienced psychiatrist, in a country with more than a billion people and yet I could not find a job
What I learned in India
I learned what it means to have neither the money nor the access to mental healthcare. I learnt that in India, people with psychiatric issues go through immense and prolonged suffering before they seek help. And once they came to you, they want to be fixed quickly [even though their problem might have started a decade ago]. I learned that even though many people are depressed and even more have all kinds of anxiety disorders, most are not aware of their problem. Others don’t know about treatment options. A significant section of the population cannot afford even basic mental healthcare. The most heartbreaking thing I learned was the stigma associated with mental health due to which most prefer to suffer in silence. I found that literacy does not make it any better. Even educated people hesitate to seek out mental healthcare. People would rather see the heart specialist or the neurologist than a shrink!
It isn’t that people in the US always seek help on time. There are issues even in the developed world but they talk about mental illness a lot more than we do and are generally more accepting of it.
On the brighter side, what uplifted my spirits during my camps was that some of the patients [in spite of not being literate and having very little support] would follow the advise of my team and would see a tangible improvement. The gratitude these people expressed on getting better was overwhelming and motivating—I found myself getting back into the groove, thanks to these patients.
What my patients taught me
I know that I have learnt more from my patients than I could ever learn in my residency or in books and I should acknowledge them. We often get cases that are straight out of a textbook, but no matter what kind of a patient, every “case” is a person who has unique problems and is suffering.
In the US, I met patients who saw me every week for therapy. I call it therapy and so would the patients but a part of me wonders if they came so that we could just talk. I loved hearing about the lives they lead, the houses they live in, their relationships and their heartaches. I heard as they spoke about their holidays and the trips they made with their family. For the one hour I spent with each of my patients, I found myself absorbed into a life that was painful even though it was not mine. Many of them suffered from serious mental illnesses and were disabled as a result. Some of them were old, well into their 60s. A few even told me how they missed being manic, energetic and ecstatic.
The most heartbreaking thing I learned was the stigma associated with mental health due to which most prefer to suffer in silence
But when I started working in India, these stories only got more challenging. The women I met in my rural clinic seemed to have a common theme of an alcoholic husband, 2 – 3 kids, no support and domestic violence. Many of these women worked just to put food on the table and did not rest from the moment they woke up to the time they went to bed. Their resilience astonished me.
A case of attempted suicide
I remember how a mother and a father brought their 20-year-old married daughter who had attempted to kill herself the day before. The whole family was in tears and they talked about how unsupportive the girl’s husband was. He was in another relationship and he provided neither financial nor emotional support to his wife and two children. On finding out about the affair, the young woman attempted to hang herself and was stopped just in time by her mother who happened to walk into the room.
I sat in a crowded noisy OPD [300 patients on any camp day] wondering how I could help this family, especially the young woman even as I struggled to keep myself from breaking down. I counselled her and her parents on that hot sweaty afternoon, over the noise, the din and the curious onlookers. I told her things I would tell a friend who came to me for advice. I counselled her about the power of the soul, the self and reminded her of her love for her children. I hope it helped.
Being a psychiatrist in India is not easy. I see people every day that look like me, dress like me and speak my language, in my accent and have problems that are just like everyone I know in my own life. It is really hard not to get angry at the couple that won’t stop fighting and start loving, it’s even harder not to cry when a son comes into my clinic with his mother and says to me that his mother sees no reason to live anymore because her 22-year-old daughter just died in a road accident because a lorry would not slow down while she crossed the road.
Fixing life is difficult
There are illnesses and then there is life. Mostly what I see in my practice is people whose lives are not what they want it to be. Occasionally, I see an illness too. It’s easy to “fix” the illness but fixing lives—that’s a whole different ballgame.
As I conclude, I am reminded of one professor at Duke University who underscored the power of kindness in transforming lives. In my experience I have found that therapy is about working with gratitude, acceptance and kindness and teaching the same to my patients.