Mental Health - Comprehending the incomprehensible

Tanushree Ghosh

The pandemic has brought mental health and its severe manifestations (suicide, domestic violence) to the forefront. It's about time. However, several points are persistently misunderstood or remain lesser-known no matter how much dialogue happens around even the relatively better-understood conditions like depression and anxiety.

1. I have lost the closest person I have ever had quite a few others to suicide.

2. I have been suicidal myself as a result of both diagnosed clinical conditions and situational worsening (I will divulge into this in detail to establish point one).

3. I have struggled with (and often struggle with) both forgiveness and anger towards ones who took their lives, guilt for my thoughts (the potential selfishness of it all especially since I have a young daughter), and acceptance and understanding that I want others to have when someone (read if I) chooses to end their life.

4. I have gone through extensive counseling and medication-based treatment plans and I have witnessed the same as a partner very closely.

5. Because of my constant writing and speaking out on mental health, I have had several (mostly women but also men) share with me their struggles. I have learned from their journeys and in some cases, have had very close views of their treatment (success and challenges).

I am stating these here because if needed, I am happy to share details of treatment plans and journeys to help disperse doubt, stigma, and misconceptions around this topic.

So with that, here is what I'd like to gather and summarize.

Ø Clinical vs. Situational

This point can be stated with a single sentence, but needs to be explained with multiple examples for this is a key contributor to the misunderstandings around mental health. Situational conditions (say sadness or even depression, or a sudden anxious phase) caused by a life event need to be separated from clinical conditions. So when Sadhguru advises on controlling our minds or we look into our past and find examples of how we were able to overcome situations much worse, we are quite possibly talking non-clinical conditions. To additionally confound this, it is not that clinical conditions can't benefit from mind modulation. Counseling and redressal techniques – from cognitive to EDMR therapies - to well-known findings on meditation and the comparatively recent findings of neuroplasticity – all support this. However, mental health is a spectrum. So this doesn't imply all clinical conditions can be remedied or 'cured' by mind management (or as more often put through self-belief and confidence). Clinical conditions have a plethora of causes – from neurological to hormonal, and there are examples of situational conditions triggering clinical onsets. Long story short: mental science is complex and nascent. We need to learn the facts (whether it affects us or not) especially today when we can find veritable, scientific information online before making statements on 'mental weakness', 'power of positivity', and 'the need to push through'. Let’s take a parallel: some patients do extremely well in cancer with a healthy lifestyle, routine chemo, and have no remission. But there are patients who despite the best of efforts, have their cancer metastasize. My uncle survived two years on stage four lung cancer but I don't get surprised when I hear of my friend's father getting detected at the same stage yet passing in two months. None of these comparisons will fit apple to apple off-course, but they fit close enough to help guide our thought process slowly towards framing mental ailments (esp. ones that can have high functioning manifestations and have situational variants) as conditions just like physical ailments are.

Ø The Unknown Middle.

There is a huge ‘unknown’ middle/overlap and huge unknowns in general when it comes to mental ailments. I know of at least two individuals who had situational conditions morph into serious clinical manifestations – including psychosis – and off-course I know of numerous for whom situational conditions got better and are now more like seasonal ailments they have learned to manage. In my personal experience, I have learned and accumulated 'tools' over the years to be able to manage a clinical condition to the extent that it's non-material. But it hasn't gone away – I am not 'cured'. It's managed. (Note: most of these conditions – like diabetes – can be managed, not cured). Also, most mental health medications are still by trial (I have psychiatrists and several online mental health forums I can direct folks who might challenge this to). So, just because I go see a doctor and get prescribed SSRIs (Seratonin Inhibitors) for example, doesn’t mean a). the known functional dose (which for most drugs is a range) will work for me as well as it did for a person X, b). will have side effects that are mirrored to someone else’s. I was, for example, put on a particular medication that I should have done well with given my history, but instead, got extremely suicidal. One important point to note here is that getting suicidal (or having suicidal thoughts) has stages/degrees of intensity. There can be long-lasting periods of such deep urge that it's akin to compulsion. At such times, the option of 'stopping and thinking to call a friend or helpline' doesn't exist. This can be neurological/hormonal/or physiologically manifested as part of the disease or brought about by medication side effects. And again, clinical conditions most often than not will worsen with life events (situations). The phases can also worsen with progressive years or get better. Let me offer some parallels. I have been an incredibly cheerful, not a care in the world, class topper who has then, in much happier and easier years of her life, struggled severely with a clinical condition. I have migraines, which I know how to manage. But ever since moving to an arid climate, I get severe sinusitis which triggers a migraine, and then, in a terrible catch 22, the migraine triggers the sinusitis back. I now don't know how to manage my migraine anymore and have days when I can't get up from bed. All the medications that worked for migraine, doesn't work anymore for the combined worsened condition. Also, I have many friends who have migraines and sinus and both. I see them faring much better, reacting much better to medications, and just, in general, being better with pain management. On the days I don't have migraines, I laugh, work and party hard. None of this makes my new experience with worsening migraine something that can be questioned or doubted. I am not trying to make things too simplistic. I am trying to point out how ridiculously simplistic the most common and immediate reactions we have on mental health are: how come she/he was so much stronger in youth/when I knew them? How can they have smiling pictures out just a week back? That makes no sense, I went through worse and didn't get depressed, and so on…

Ø Mental health experience, and how one functions with it, varies. Just because 'I' am ‘strong’, doesn’t mean everyone is. Because I have hopefully established the premise of this swim lane through the prior two, I will just continue with my migraine example. Just because I know 'Y' can cook all day with a migraine, I don't feel bad (or am not made to feel bad) if I can't. Because it might be that I am indeed less tolerant to pain (which is something I doubt very few people will fault anyone else for when the pain is not a beyond any doubt band-aid boo-boo situation). But it might also be because my condition is indeed more severe, and/or my physiological reaction to it is different. Someone's reaction to severe devastation might be much calmer than my reaction to the loss of my house and that might be so because of my underlying clinical condition, a completely new condition triggered inexplicably by this loss, or because I have less mental strength/thought management power/value and support system to pull me through. This is where I feel the life coaching business need to be sensitive and have extra responsibility. No one is challenging that there is value here but acknowledging medical science and being cognizant of the unknowns is a critical responsibility before promises are made on ‘manifestation out of depression’ and ‘remove your anxiety through power exercise’ promises.

Ø And just because I am battling, doesn't mean 'I' am broken. Someone is battling clinical conditions doesn't mean they are non-functional or dysfunctional. They can mostly, and at most times, be high functioning. This seems to surprise us. Because of this extrapolated assumption all of us can't help but make on mental health, most will not be able to make their conditions public. Just like we won't doubt if we hear an ever-smiling someone we know died of severe colon infection which they never had made public and were fighting a silent battle instead, we shouldn't assume people owe us a real-time update on their mental health.

Ø Talking to someone is not easy. Continuing on the above point, the reason most folks, including myself, will not be sharing our underlying condition or inner thoughts every time we smile and have a good time with you, is because

1. There's a high chance you will not understand and not know what to do with the information. We don't blame you for that. But we don't want to discomfort you.

2. There's a high chance you will not be able to get what was shared out of your mind and will talk about it behind our backs. And you will not talk about me having depression the same way you would about me having diabetes. Again, we don't judge you for this, but this is why we will feel further inhibited in sharing our mental plight with you (call it shame if you will, or just discomfort - that doesn't matter).

3. There's a high chance that you will not get the magnitude and intensity. For example, you might understand when I am feeling sad and with the best of intentions, provide some guiding thoughts; but you won't understand why I can't stop thinking of the ceiling fan (obsessive thinking merging onto depression) when everything in my life is well.

4. As you share this, there might be implications on my job, the opportunities I get, and even relations I can have in life. This point doesn't require elaboration. The only way around it is by demonstrating again and again that just because there's a mental condition, doesn't mean there will be an extrapolation into dysfunctional.

So in sum, talking to friends or close relations won't work because they won't understand, will be unnecessarily worried, and would make it worse. Even with the best of intentions, most of us will fail. I have had several trained coaches give up, overwhelmed, and helpless.

Talking to a therapist or counselor is also easier said than done, and I will possibly write a follow-up piece outlining fifteen years of personal and close contact experience in multiple countries to outline why. But for now, I will just leave it by noting the key problems: finding a good fit, finding an effective fit, and finding someone who will have availability (geo-based challenges differ and include further considerations around expense, insurance, specialization, etc.). So yes, everyone going through a severe situation should reach out is a piece of advice we shell out, but we need to understand that that option doesn't exist for most. A friend whose daughter shot herself in her head said this best: she was so surrounded, yet so alone.

Ø Lastly, the acceptance of suicide doesn't mean encouraging or role-modeling suicide. But acceptance needs to happen.

The last, and most difficult point to make on suicide is the ask of forgiveness and healing in place of looking at it as a selfish and cowardly act. We have perpetuated this by making attempted suicide a criminal offense (in several nations) and by touting the idea of suicide being a sin. That all would be valid if it would be a black and white matter of an individual (with responsibilities and loved ones presumably) really 'choosing' to take this path of ultimate abandonment. However, as we hopefully have established, the act, albeit self-initiated, is a side effect of an ailment causing the loss of life. I have been in a place where I had harbored tremendous resentment towards someone for 'choosing' such an act. But I am writing this piece today so that such thoughts stop one day. So that everyone who falls off the cliff, losing the battle (and trust me, they have fought tooth and nail) are understood by their loved ones. So that their end is accepted with no resentment towards them, just like we would accept the death of a loved one by a fatal accident or from a terminal physical ailment.