The Equator Line 19 | April - June 2017 | Volume 5 Issue 3

Editor in Chief Bhaskar Roy

Copy Editor Sangeeta Purkayastha
Editorial Assistant Ateendriya Gupta
Marketing Priya Gupta
Design Nutan Tete
Coordination Priyanka Singh

16 Community Centre, 3rd floor, Panchsheel Park

New Delhi 110017, India
Email: info@equator.net.in

To subscribe go to www.palimpsest.co.in or call +91 11 4050 3956

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 CONTENTS
Editorial 3
You Gotta Get Off That Rock, Rohini Lall 7
Chuck
Ghosts From My Past Lisa C. 17
My Journey With Depression Sanjay Chugh 29
Where Have the Boys Gone? Shafaq Shah 36
Phoenix is Not Just a Place in Sumeet Panigrahi 45
Arizona
The Other Side of Midnight Reshma Hingorani 56
I Found More Rope Ateendriya 68
Along the Shadow Line Pallav Bonerjee 80
Images of an Invisible Illness Photo Essay 91
Behind the Mask of Normality Ira Pundeer 109
Living with Scars Nikita Sailesh 119
Psychotherapy in the Time of KK Aggarwal 126
the Vedas
Of the Mind and Its Maladies Rajesh Sagar and 132
Ananya Mahapatra

Cover photograph: Vageesh Lall

Cover design: Nutan Tete
Photography: Pramod Pushkarna, John Mathew, Shubhojit
Banerjea and Vageesh Lall

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 A LAPSE INTO THE DARK TUNNEL

L
ate one evening, there was an un-
usual sensation in the newsroom
– busy footsteps, excited conver-
sations. This kind of hold-your-breath
suspense is usually evoked by a sud-
den political crisis, a terror attack, or a
stock-market crash. But the buildup in
the spaces between the computer termi-
nals that evening was for something en-
tirely different. A supermodel, who had
set fire to the ramp until the other day, had been living rough,
acutely depressed, sleeping in temples or in the parks, at times
with strangers for drugs or alcohol, begging, working as a maid.
She had posed for a photographer from a tabloid of this media
group the previous evening and promised to give more time for
the hungry camera before disappearing into the dark. Her stun-
ning looks that had fired up fashion shows were now beaten, lay-
ered with signs of the sudden fall; her long, lustrous hair now
matted with the aftershock of mutiny. For the newspaper, this was
big news, quakier than the cracks in a ruling coalition.
Television cameras trawled the city for Gitanjali Nagpal,
to know more about her, her slip into the dark tunnel. She had by
then been tracked down by the authorities and admitted to a psy-
chiatric hospital for treatment. This story of sudden lapse is from
a time when issues of mental health had guilt associated with it. It
was a no-go zone, both feared and forbidden – an uneasy, invisible
silence.
Gitanjali, Gitu to friends, had everything that the glam-
orous fashion world needed. Daughter of a naval officer, she was
from the elite Lady Shri Ram College. After a two-month treat-
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 THE EQUATOR LINE 19

ment for depression, she recovered and lived down the memory of
the collapse to get back to normalcy. She later settled in Europe,
unwilling to revisit the past. Her case, however, gave the issue of
mental illness a new focus. A new debate started.

The inexorable process of urbanization, along with the complica-

tions of a technology-driven age, has taken its toll on the human
mind, fraying the nerves and weakening people’s ability to cope
with newer situations and challenges. What was considered an
elite ailment affecting only the top end of society – the power-
ful rulers and sensitive writers – now knocks at the door of the
common man. Depression is as common as diabetes and cardiac
problems. This certainly has not happened in a single day.
A king fully in command of his situation, presiding over
his court with absolute authority, a doting father, suddenly lapses
into insanity, confronted with the rude shock of betrayal by those
he has trusted – his own children. Filial ingratitude – every under-
graduate student of literature reading King Lear comes across this
term. The storm on the heath when Lear moves around challeng-
ing nature to do its worst to him adds an elemental dimension to
Shakespeare’s play. The disquiet in the human world finds its echo
in the wilderness. And it is also the time when political turmoil
shakes the kingdom. The unmistakable message is blatantly sim-
ple: don’t create a structure – political, social, material – you can-
not bear. This is truer than ever before. It concerns an individual
as much as a culture or a political system. The mind, an integral
part of the body, cracks up like any other organ when the pressure
is unbearable.

The creative community – writers, artists, actors, musicians – is

particularly vulnerable to mental illness. Every student of psychi-
atry must read about Sylvia Plath, the American poet and novelist
who, diagnosed with clinical depression, committed suicide after
several failed attempts in 1963. She was only 30. The morbidity in
her writing offers the surest clue to the torment inside her.

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 A LAPSE INTO THE DARK TUNNEL

‘Something else
Hails me through air –
Thighs, hair;
Flakes from my heels.’

These chilling lines from her poem “Ariel” leave the reader in no
doubt about the idea of death she was toying with.
Analysing the cause of Plath’s death, Brian Cooper, a well-
known psychiatrist, writes in a medical journal:
‘There was a constant dissonance between the bright,
buoyant, high-achievement persona whose ideals of success, social
status and domesticity are conveyed in the letters to her mother,
and the dark sense of isolation and inner emptiness that finds ex-
pression in her journals and poems. “No matter how enthusiastic
you are,” she wrote as a young student, “…nothing is real, past
or future, when you are alone in your room”, and later: “I look
down into the warm, earthy world… and feel apart, enclosed in
a wall of glass.”’
According to Dr Arnold Ludwig of the University of Ken-
tucky, who probed the relationship between mental illness and
writers in a study, ‘people in artistic professions are more likely
to have mental illnesses  than those in non-creative professions.’
More recent research has pointed to ‘neurological similarities of
mental illness and the creative mind.’
Both Virginia Woolf and Ernest Hemingway were di-
agnosed with depression. Woolf, who had suffered from mood
swings, insomnia and hallucinations, finally committed suicide
in 1941. Rebellious by temperament, Hemingway resorted to al-
coholism and risky adventures as a way of coping. That was the
way he was – defiant to the core, intolerant of conventions. When
his bipolar disorder and psychosis got severe, he finally agreed to
electroconvulsive therapy.

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I once visited his house on the outskirts of Havana. It was

a sprawling estate with lawns and an outhouse. In the outhouse
had lived the writer’s mistress, the guide, a young Cuban woman
speaking flawless English with a faint American accent, told me.
The writers’ world is morbid, hallucinatory but rebellious as well.

For an article I was once working on, I needed a UN report.

When I called one of their offices in Delhi, the voice on the other
end was friendly. ‘The report is right here on my desk; do come
and collect it.’
The man who greeted me looked very familiar. Bhaskar
Bhattacharya, a Doordarshan newsreader from a time when that
was the only television channel available. When reminded of his
news-reading days, he played it down. ‘There was not much com-
petition those days, so we guys had a little fun.’ He laughed ami-
ably. A man from Allahabad, he loved mountains.
We never met again. About a year later, I read in the pa-
pers about his death – jumping off the terrace of the Oberoi. He
was suffering from acute depression. The suicide note left behind
said he was ‘fed-up’ with the things around him.

This is the new killer stalking each one of us. The good thing is
mental illness is no longer a subject pushed behind the screen. Ev-
erybody is talking about it. Bollywood actor Deepika Padukone
openly talked about her depression and her struggle to come out
of it. Now, she is a campaigner for mental health and an inspiring
story herself. The mind needs care, and this was as much true
about Plath and Woolf then as about Gitanjali or Deepika now.

Bhaskar Roy

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 YOU GOTTA GET OFF THAT
ROCK, CHUCK 7
Rohini Lall

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 Teddy Daniels: So, what’s our next move?
Chuck Aule: You tell me.
Teddy Daniels: I gotta get off this rock, Chuck. Get back to the
mainland. Whatever the hell’s going on here, it’s bad.
[pause]
Teddy Daniels: [sotto voce] Don’t worry, partner, they’re not gon-
na catch us.
Chuck Aule: That’s right, we’re too smart for ’em.
Teddy Daniels: Yeah, we are, aren’t we?
[pause]
Teddy Daniels: You know, this place makes me wonder.
Chuck Aule: Yeah, what’s that, boss?
Teddy Daniels: Which would be worse – to live as a monster? Or
to die as a good man?

I grew up in a town without Marlboros and psychiatrists. It was

the year 2012. Contrary to the Mayan promise, the world had
not yet ended, and I needed both with an immediate, inexplicable
urgency. It was still the year of Eminem’s Recovery for me, and
I was desperate to seek mine. The breakout album had come out
not too long ago, and I was unwilling to stay at home. I needed
to peer back into me and I needed assistance and, as it turns out,
medication.
It wasn’t the first-world petulance that drove me out of

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 You Gotta Get Off That Rock, Chuck

there but true, dire need for help. I left in the dark, through hidden
alleys, dressed in my brother’s friend’s oversized clothes to board
the train that would take me to my halfway house. I couldn’t be
on a reserved seat. I could be tracked and brought home, to be
told that whatever I had could be washed away and I didn’t really
need to see anyone. After all, what good would that even bring?

The wooden berths were harder than surfaces I had previously

slept on, but the women around me let me have one because they
loved my large eyes, my wide smile, and my soft, shiny hair. One
of them explicitly said, ‘We are used to sleeping on the floor. Let
me touch your hair once, and you can have the top berth.’ I let
her touch my hair to her heart’s content.
It was a women-only compartment filled with the smell
of food, sweat, cheap talcum powder, and hair oil. The sound
that wafted through was of wailing babies. I was fussed over while
their own snotty-nosed children wandered about. I was fed, and I
was fed well. Succulent pieces of meat and hard boiled rice – that
is what I ate. Their water, probably out of a hand pump, was un-
sanitary and tasted of the earth. If I looked closely, I could see silt
at the bottom, but I was thirsty.

A few texts were exchanged between my cousin and I, and I then

destroyed my SIM card.
I sat by the window and pulled out a cigarette. The wom-
en said nothing. There were no sniggers, no prohibition, just si-
lent acceptance. It was temporary, but that is what I had longed
for and set out to find. The wind was cold and soothing and the
woman, all covered in a burka, asked if she could have one of my
cigarettes. I wasn’t going to decline after such effusive hospitality
and brilliant food. She almost snatched it, brought her face close
to the window, and lifted her veil entirely. I could see her hair now
– rough, streaked with henna, and tied into a large, stern knot.
She tilted her head backwards and exhaled, smoke pouring out of
both her nostrils.
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‘Sleep,’ she commanded. ‘I’ll wake you up in the morning

when Howrah is near,’ she assured. I climbed up, knowing that I
wasn’t getting my cigarette back.

The City of Joy

I was nudged softly. Prodded a bit and then, in a soft voice, told
it was 10 minutes away. I had been covered after I had slept, and
I was woken up by the woman who didn’t owe it to me. Sunlight
was pouring in and it was lush green outside, bathed in golden
light. I wasn’t ready to give up on the world. Not when it looked
like that. My shackles could be dealt with later. At that moment I
had to look at the light. My mouth still tasted of spices and hard
water, but I wasn’t sure I wanted to brush it off just yet.
The station came up quicker than I expected, and I got
down after a warm embrace from the veiled woman. I offered her
my cigarette box and she pulled out three. We said our goodbyes
and left.
I pity the fact that I was a fugitive in Calcutta, not a tour-
ist. I would have loved to go to the places I was asked to visit.
Stand and stare. Frolic, maybe. I had a flight to find and a flight
to catch. I had nothing planned out. I didn’t know the way to the
airport but I was told that the taxis are fair and not as expensive
as Delhi taxis.
What was curious though, was that I was fed everywhere
whether I wanted or not. Don’t misunderstand me, I was thrilled.
I was, however, light-headed and still carried the hurt within. I
had images flitting through my head as I chomped on my third
sondesh from the cabbie’s box. On and off, I’d tear up and the great
citizens of my country would stuff me with food.
‘Look, the airport,’ the cabbie said.
I paid my fare and walked in to look for the next flight
out. I had to wait for two hours and still did not have a plan or a
doctor. I, however, did have a plan for a doctor. I was supposed to
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 You Gotta Get Off That Rock, Chuck

reach Delhi and meet up with my old English teacher and draw
up a list. We’ll come back to that later.
For now, I had two hours to kill and enough books to
read. But, as a rule, one must visit the airport bookstore to pick
up a souvenir of your travel.
I picked up The Hungry Tide. It was divided into two
parts. The Ebb, or bhata, and The Tide, or jowar.
I finished The Ebb on the flight. And then, I slept. I
don’t often dream. But I did that day. Despite what I dreamt of, I
wouldn’t call it a nightmare. It no longer gave me cold sweats, it
did not jolt me awake, so nightmare it wasn’t.
His teeth sunk
into my flesh again, I lost
my hymen and my digni-
ty again. The thrusts very
excruciatingly painful,
and I remembered every-
thing, like a series of cu-
rated photographs. There
were pauses and dark
blank spaces. There were crisp images and blackouts. No blurs.
The scalding hot water stung my skin but not as much as
I expected it to. It gently tried to remind me of my cuts and sores
a little less. The red, pink sores turning into shades of blue and
purple. Colours I would avoid wearing for years. Now, however,
I seek dark blues with a passion. Interesting – how time works.
‘The world is so full of sluts that it’s a pain finding a vir-
gin,’ he slurred over and over in his drunkenness. That is where
I remember biting his forearm so hard that I felt his blood gush
into my mouth. I have no sympathies for drunken lechers, and I
would have drunk my fill faster than an impoverished vampire if
I did not have his body on top of me.
I dreamt it in my narrow seat, huddled like I was in its
aftermath.
I dream vividly when I do.
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 THE EQUATOR LINE 19

I see things as adequately exposed photographs. I hear

sounds. That afternoon, I saw my blood cover the marble floor
and slowly dissolve in the water that was getting tepid as the time
passed.
I did that for a week. Bleeding everyday. Sitting in the
shower till the scalding water grew tepid and blood changed co-
lour from raw red to a paler version of itself. The pain lessened
but never disappeared and showering with scalding water till it
goes tepid became an obsession. I still bathe the same way. The
difference, there’s no longer blood in the water.

I did not have nightmares. I slept. But, I drank myself to sleep. At

the age of 21, I drank myself to sleep. Or, when I was kinder to
myself, I ran myself to sleep. They were ad hoc solutions, patch-
works, band aids. I desperately needed a full-blown cure.

Delhi is Not Far

If I were to recount instances where I’d be incredibly, irredeem-

ably grateful to someone, it would have to be my cousin Kumar
Ritwik, my brother Vageesh Lall, and my then English teacher
Rowena Gideon.

The day I reached Delhi, I met up with Rowena Gideon and drew
up a list of 10 names. Between sleep, wakefulness and anxiety, I
burnt through nine names faster than an oil-soaked fuse.
‘Be careful with the last one,’ I was advised.
I was wary too.
The people were chipping away at me. The commute was
weighing me down, and I had no idea as to what was left of my
sanity. Or, for that matter, if I had ever possessed any.
‘Do you know him?’ I had asked before I visited the last
name on my list.
‘Not really,’ I was told. ‘All I know is that he is patient,
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 You Gotta Get Off That Rock, Chuck

unusually so, and a man in his mid-30s.’

‘Ringing endorsement,’ I laughed. Perhaps after a fort-
night. But I did. And at his expense. That is another nugget of
gratitude I owe him.

Before I left, she left me a note with a quote from the movie Un-
der the Tuscan Sun.
‘They built a train track over these Alps to connect Vienna
and Venice. They built these tracks even before there was a train
in existence that could make the trip. They built it because they
knew some day, the train would come.’
With the paper neatly folded, I went home.

The Repor[T]

I filled out the form and waited for the man who had been having
an unusually busy day. Well, the first thing was true. He did seem
patient. There was a part of me that wanted to walk away, but I
flipped my book upside down instead.
It’s a trick I learnt from Ruskin Bond.
‘When your patience starts running low, flip your book
upside down,’ he had told me. Yes, he had tried explaining to me
the virtue of patience. The benevolent man had tried to explain
patience to someone who had waited for four hours after a 13-
mile climb.

I digress.

The waiting area was not particularly cold or sterile, but it wasn’t
too noisy either. It was almost like the waiting area I had grown
up in, done my homework in, thrown tantrums in, bossed around
my parents’ employees in. I could make it work. I hoped, I prayed
that I could make it work. There was no grand reason there. No
attachment. Nothing just yet. All I wanted to not do was draw an-
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 THE EQUATOR LINE 19

other list. I just did not have it in me to research and write down
names all over again.
So, I closed my eyes, rested my head back, re-opened
them, and got back to reading Ruskin Bond upside down. When
I just wanted to read a little more, I was called in.
He was tall. Hair peppered with white. Streaks of henna.
The first thing that went through my head was that he
looked older, wiser, and unlike most mid-30s men I had come
across. Moments after sitting down, I’d find out that he was also
much kinder than most people I have known.

Tenth time was the charm.

I was willing to stay. I was willing to try. I was willing to heal.

I was willing to learn. I was willing to unlearn. I was willing to

humble down.

I don’t remember how long I stayed there. I don’t need to. Be-
cause, I’m still there.

Three hospitals and five years later, I’m still there. His hair isn’t
salt-and-pepper anymore. It’s dyed an even colour. But, I’m still
there. A lot has changed. And, it has changed for good.

The important bit now.

What am I doing? Why am I, a 26-year-old girl, pontificating

about mental health? What do I know?

There is a reason I haven’t named my malady. We have itchy fin-

gers now. One word and there will be people googling it slyly, try-
ing to match their symptoms with mine. Why? Having a mental
health issue is cool right now. It is the new hip thing!

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 You Gotta Get Off That Rock, Chuck

Mental illness is not a BuzzFeed quiz.

From your personality type to whether or not you suffer from

clinical depression, the web has answers for everything. Just a few
clicks and there you go.

NOT.

I wish I could tell you it was that simple.

Let me break it to you gently: i-t i-s n-o-t.

Please, please find a doctor.

The five years that I spent and the years that I’ll continue to spend
on the couch will be enriched with faith, trust, and the commit-
ment to endure.
I often think of the belt marks on my back, the hacked-up
hair, the blood pooling on marble, the brute, stinking body on
top of me. A strange pain eats me still and gnaws at me as I live
and breathe. But I sleep well now. I sleep peacefully. What was
once a luxury is easy to attain now. It is within my arm’s grasp.

Back in the year 2010, when sleep eluded me, I had turned to
movies and watched a lot of them. Some would say too many.
One in particular, Martin Scorsese’s Shutter Island, ignited in me
the idea of seeking help. I wondered too. I wondered for two
years, wearing myself to snatched sleep, drinking till I couldn’t
anymore, and beating Marco Pierre White’s smoking record.
In moments of extreme pain, I cooked. It healed me, and
it heals me still. But, I HAD to get off that rock. I had to get
straight. I HAD to get free of the shackles that I had put on my
own.
I HAD to go to sleep.
There are times when life, or putting it mildly, circum-
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 THE EQUATOR LINE 19

stances, knock us down. Humble yourself and seek help. It will

heal you.
I’m still cooking out of Marco Pierre White’s book. I’m
doing it better than before. I laugh more. I hurt less. It’s not that
my life got rosier after seeking help. I got dauntless. I learnt to
shake off my fears, and I have one man to thank, the tenth name
on the list: Dr. Vishal Chhabra. 

Rohini Lall is the author of The Sour Faced

Moon (Frog Books, 2013).

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 GHOSTS FROM MY PAST 17
Lisa C.

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 I
f you follow my journey to and from the summer of hell, you
will get an idea about who I really am. When I look back and
think of the passage through the dark tunnel and out, I see an
image of myself from that time serving as a reminder of the crisis
that almost crushed me. Almost. Before I delve into the depths of
my past, let me introduce myself.
First things first. My name is Lisa C., though that has not
always been my name, for I am a transgender woman. I am 22,
a psychology student and interested in many creative initiatives.
I am one of the many people whose paths intersect yours, whose
stories hide dark moments they have silently suffered, and who
have coped with various forms of gnawing mental illnesses. I have
always suffered from severe anxiety disorder. All my problems –
acute anxiety, obsessive negativity, and hypersensitivity – com-
bined to push me down a chasm at that point in my life – the
summer of 2011 – when I wished to take my own life because I
believed I was a waste of space, and life was no longer worth liv-
ing. Before I recall that dark hour, however, I want to first share
with you how I ended up feeling so much self-hatred and explain
the accumulation of disgust for being alive.

It all really started during my high-school days. I literally went

downhill to school. I was about 11 or 12, if I recall correctly. Mid-
dle school had been just a walk in the park. Though I had begun to
deal with being left out by ‘friends’ at times, I still felt some con-
nection to the world around me. Even to feel that I belonged was
enough to want to keep existing. I loved Winx Club, The Power-
puff Girls, Pokémon, Digimon, and Totally Spies!, and unbelievably,
I even had friends who enjoyed such shows. But when I continued
to cling to them in high school, somehow, I became someone to

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 GHOSTS FROM MY PAST

be shunned and laughed at. ‘Pokémon is for kids.’ I heard such de-
risive remarks echo around the playground for years. ‘Winx Club
is for girls,’ was another familiar refrain. Mind you, I was still a
boy at the time, so my interests were picked apart for being both
unusual and unconventional, to say the least (though we all know
now there is absolutely nothing wrong with a boy liking Winx
Club). In that crowd, I was not just a loner but an oddity too. I
was not a stereotypical schoolboy, running around, shouting, a
little rough and tough. For the rogues, I was an effeminate sissy.
The more self-aware – and increasingly ashamed of the things that
gave me joy – I became, the more the bullies targeted me. I had a
handful of friends at school and in our neighbourhood as well. I
liked to think I had a decent relationship with all of them; I’d al-
ways considered myself a nice and genuine person who could get
along with everyone. However, it soon became evident that what
they meant to me did not necessarily correspond to what I meant
to them. While I considered them my friends and loved hanging
out with them whenever I could, they slowly revealed their lack
of interest in my friendship. Eventually, I became someone they
sought out when no one else was available – a backup plan; I was
the desolate rock or a solitary pebble that lies unobtrusively in a
corner, a substitute football sent flying by someone passing by on
a whim.
During this time, I had a friend who liked to switch up his per-
sonality depending on who was around us. If it was just the two
of us, we could talk and hang and have fun for hours without any
issues whatsoever. But the minute the cool guys joined the circle,
he was quick to jump on the bandwagon, his words, actions, and
his entire demeanour going through noticeable changes. And I
endured it all, because, why wouldn’t I? They were still spend-
ing time with me, and that was an infinitely better prospect than
being a complete loner forever. This terrifying thought, of being
left alone, the perfect fodder for my anxiety, fed my growing de-
pression as well. The only person with whom I could sit and eat
lunch suffered from chronic bowel disease, so he was often absent

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from school for one or two months at a time. With him gone for
long periods of time, I found myself spending lunchtime alone.
With or without physical company around me, in my mind, I
was always alone. Being a slow eater didn’t help either; when the
other kids tore through their lunches and rushed out to play, I sat
there all alone, feeling the razor-sharp pierce of everyone’s eyes
on me. I took to eating my lunch in a bathroom stall, with music
blaring through my earphones. With music, I could relax; I could
stop focusing on the dreadful isolation, disassociate myself from
the world. I never faced the dramatic bullying that many people
are familiar with. I didn’t have people throwing pens, pencil cases,
or chairs at me. I wasn’t locked inside closets. Nobody ever phys-
ically harassed me, none of them laid a finger on me. However,
my entire existence was slowly being ignored, obliterated, and
somehow, on some plane, that made sense to me, because I felt
it could have been worse. When people could truly look through
me without really seeing me, the voices in my head began to taunt
me: ‘You don’t matter’, or my personal favourite, ‘No one’s going
to miss you when you’re gone.’
To this date, I haven’t been able to truly wipe out these trauma-
tizing notions from my anxious mind. I’m fully aware that there
is no reason for me to still believe those negative voices my mind
is riddled with, but it is now almost second nature. I had believed
them for too long – a whole stretch of 17 years of my existence –
to be able to stop now.
That famous saying that everybody just loves to throw
about: ‘sticks and stones may break my bones, but…’ Though the
but is usually followed by whatever random conclusion the person
can conjure up, the original words completing it keep coming
back: ‘…words will never harm me’. This has been so far removed
from my reality… words were precisely what broke me down from
the inside – and they still do, to this day. Ironically, it was not just
the words that I was susceptible to. It was also the loud silences
that I had to deal with, while my mind proceeded to tear itself
apart. The sheer loneliness, the fact that I had no one to help me

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 GHOSTS FROM MY PAST

fight my wars against the negativity, aggravated my depression. I

was all alone tackling my mind, and if there is one thing that I
have learned over the years, it is that my mind is the most danger-
ous thing I could confront. Or as RuPaul, the famous American
drag queen puts it, ‘the inner saboteur’. Sometimes, there were
rare kindnesses: a classmate would tell me not to be alone when
my friend was absent, or when someone would notice that I was
being excluded from a group conversation. And yet, a circle of
people always shrank right at my spot, in a way that I got pushed
out of it; even if someone noticed that I wasn’t included, the cir-
cle would always close back in a matter of seconds. And I went
on to feel that if I wasn’t even worth being on the playground at
school, I wasn’t worth a spot on the planet. Many of my high-
school exclusions went beyond the realms of getting picked last
at gym, or not getting invited to a cool classmate’s birthday party.
Unless something was needed that I could provide – homework, a
pen, or a textbook – I was dutifully ignored. And the 15-year-old
me was always quick to share, because maybe, just maybe, they
would start to notice me, respect me, or surprise, want to become
my friend. When my class decided to order pizza during one pizza
break, they skipped right over me as if I were nothing but an emp-
ty seat. There is an abundance of stories like these, and these were
the deep-seated wounds that led up to that summer.

Now, as bad as this all sounds, during high school, I was at least
thrown into contact with other human beings, whether they ac-
knowledged me or not. I still had to leave the house; I still had to
be busy with homework and studying (though I was relatively lax
at that); and I still had to talk to people I somewhat knew. But
during the summer of 2011, which was the summer in between
my penultimate and my ultimate year of high school (fifth and
sixth year for me, being part of the educational system of Bel-
gium), my life reached an all-time low. Firm social groups had
been created, and I was inevitably and irrevocably ruled out from
their plans. This pushed me down a dark passage of loneliness,
and I felt desolate, discarded, and scared. I remained in this state

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 THE EQUATOR LINE 19

of isolation for two months, feeling depressed and drained out.

There was something haunting about my unmitigated loneliness.
I was like a bird, storm-swept and unflocked. It was around this
time that my depression became acute. The prospect of another
day was terrifying. During that summer, I had nothing to distract
me from myself. Stuck with only my mauled and lacerated mind
for 60 days, my loneliness was assailing me. My spirits were low,
and I had no courage to go on. I no longer bothered with any-
thing. I did not care one bit about my life; it was not much to
begin with, anyway. I didn’t care for hygiene and appearances.
What am I going to wear today? The question never entered my
mind, because I wouldn’t be leaving the house, and therefore, it
would be a ‘pyjama day’ every day. Whatever tormented me at the
moment, I decided, was for me, me alone, to face and figure out.
It’s my life anyway. The causes of the turmoil inside me began to
unfold themselves with more clarity – a fleeting gender-identity
crisis, concerns about my sexuality, and thoughts about ending
my life. I never mentioned my self-hate and other related prob-
lems to my parents, mainly because I didn’t want to worry them.
So they had absolutely no idea about the storm ripping my life
apart.
However, I did one thing right. Even as I sidestepped
thoughts of ending my short life every single day of that summer,
I chose to take refuge in many fantastic outlets (fantastic, as in
fictional and surreal rather than amazing, though that works too):
anime, Korean pop, online games, vlogs of K-pop groups, and
more. The resulting vicarious sense of belonging worked won-
ders. I took to a nocturnal lifestyle, sleeping most of the day away,
because hey, if I was going to be alone anyway, it was definitely
better to be alone at night, when everyone else was asleep and
gone. I have never wanted to die as much as I did in those two
months, and I have never felt as depressed and lonely as I did back
then. Telling myself that I was unworthy of living and that no one
would miss me even for a second if I decided to end it, I was filled
to the brim with a sense of morbidity and being utterly useless. I
do not recall too many incidents that happened during that peri-

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 GHOSTS FROM MY PAST

od; I did absolutely nothing, after all, preferring to confine my-

self to my room with my familiar and comforting pursuits. Every
day was like another day, unvaryingly gloomy and monotonous.
Luckily for me, when I had escaped into the fantastic realm of
the Internet, I was presented with an online version of a social
life. What had all started with simple messages after online fights
on Tekken 6 quickly turned into all-out, abiding friendships. On
the Internet, I was to no extent inhibited by my anxiety, simply
because the fears of physical exclusion did not apply. Moreover,
the friends that I had met across cyberspace all shared the same
interests as me so there was always something to talk about. I
realized very quickly that the friends I had made appreciated me
for who I was and actively acknowledged me, even going as far
as actually seeking me out or missing me when I was not online.
This had been my very first encounter with people who seemed
to thoroughly enjoy my presence and my personality. But when-
ever that power button was switched off, I returned to reality and
felt as worthless as I had done before. Summer of 2011 thus be-
came a little more manageable for me because nobody forced me
to switch off the power, enabling me to always access my online
social circle. Nevertheless, I could still feel the limits of online
friends every single day. I am convinced that those people played
an important role in saving my life. So, even though things went
awry between one of them and I, and I have now lost track of
most of the others, they still hold a special place in my heart for
rescuing me.

So far, I have mainly focused on the warmth and intimacy of

friendship, or its absence. But what about my family? Honest-
ly, I don’t even remember leaving the house for family visits that
summer, though I most likely did and ended up feeling isolated
anyway. Brace yourselves, this may come as a surprise, but I never
truly had a sense of belonging to my family as a whole, and have
never been attached to the extended family, either on the maternal
or the paternal side. For some reason, I was always left out, though
I truly wasn’t, but I did not realize it then. It was just my wicked

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 THE EQUATOR LINE 19

mind telling me all these nasty lies; the irrational fear of being
ignored and excluded had driven me crazy at school and in our
neighbourhood too. No doubt, the same fear was back, haunting
me, I tried to comfort myself. Surely the spooks in my mind were
driving a wedge between my family and me? The fear, I suspected,
was alienating me from those who were there for me uncondi-
tionally. I somehow believed that I was, or would be, ignored if I
asked for something. Gradually, I stopped asking for anything. I
was too afraid to even ask for the ketchup or some extra fries when
the whole family was dining together, because I felt my requests
would only be ignored. So, I didn’t bother until someone asked
me if I needed anything else, and then I would hesitantly request
a second helping. Feeling awkward, they always told me to just
ask next time I needed something, but I never could. It got to
a point where I started to panic and sweat at the mere thought
of asking something out loud. These traits even now remain as
residual side-effects of my physiological metamorphosis. Today,
however, I have an amazing relationship with my entire family.
Incidentally, all it took to open up to them was my increasing

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 GHOSTS FROM MY PAST

realization and acceptance of who I was as a person. And it was

my coming-out as Lisa that truly made me realize how much they
all have cared for me and still do. On my father’s side, everyone
is fairly loud, uninhibited, and unable to experience anything but
positivity, much like him. I have always admired them, and I wish
I could be free like them someday. And even though I have trav-
elled quite a distance towards that goal, I still have a long way to
go. Somehow, after I survived that one near-catastrophic summer,
even as I spent another bad year at high school, I was able to get
and remain in touch with the people around me. My life slowly
got back on track, and I made an adventurous new friend who
influenced me to travel to a lot of places and meet a lot of people,
who, magically, all seemed to like me.
The following summer was not at all like the one before. When
I set out to choose a university to attend, a few months prior to
leaving high school, I decided I would travel to a distant city and
find a dorm. I wanted to study literature and linguistics, and that
could only be done in a city far away from my hometown, so I
basically had no other choice but to move out and find accommo-
dation. It was a big step; it caused a lot of distress to my mother,
whom I completely take after when it comes to mental struggles.
She had, by then, become aware of my nature and was worried I
would only sink deeper into the hole of insecurity and loneliness.
But was she ever wrong! Deciding to move to this city to study
there has proved to be nothing short of a miracle. Right from day
one, guided by the bleak memories of that unfortunate summer,
I had succumbed to the burning desire to make friends and con-
fidants, to break free of the ghosts from my past and get over the
initial anxiety standing in the way.
With steadily increasing poise, I am now ready to take the city
by storm. I have realized that the more I stay true to myself and
embrace everything that is me, the easier it is to open up to peo-
ple and make connections. It took me only about a month to
establish a group of about 12 or 13 friends – a surprisingly large
number, considering my track record – who were all very amazing
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 THE EQUATOR LINE 19

in their own ways. Most importantly, though, for the first time
in my life, I was able to say: I have found a place where I belong.
I have already talked about my life as a transgender woman, and
this realization, the knowledge of who I am, has made my life
increasingly worthwhile. As I said in the beginning, I have always
been interested in feminine toys, shows, characters and so on. A
thought haunting me used to be ‘I wish I were a girl’, which I had
repressed for years. The summer of 2011 was not much different
except that my desires by then had got stronger and my self-hate
worse. I began to watch vlogs in which a group of girlfriends went
on adventures; all I wanted was to be part of them. I simply want-
ed to be friends with those girls, hang out with them. But the
more I reflected on it, the more I realized I actually wanted to be
one of them, a real girl. For a while, I assumed that my divergent

attitude towards life was due to homosexuality and that I just

needed to come out as gay in order to start living with myself and
for myself. However, during the summer of 2015, I met a trans-
woman who noticed something about me that was more than me
being gay. She agreed to talk about it and I spent an entire week-
end revising my every thought, desire, and action only to come

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 GHOSTS FROM MY PAST

to a conclusion that she had already guessed. I then took the nec-
essary steps to get in touch with a gender team as quickly as pos-
sible because I needed understanding. The correlation between
the gender ambiguity and depression began to get clearer. Now I
knew better why I had been so depressingly unhappy with myself
for all these years. But, on the other hand, the sheer idea of having
to go through a full-fledged transition was beyond anything that
I had ever expected to happen and it pushed me briefly to retreat
into my shell of anxiety. Though I knew this was a dream come
true, I still found myself wrapped in a shroud of apprehension.It
was my anxiety that triggered this negativity.
Luckily, after the current process of one and a half years, includ-
ing a hormone treatment for almost four months, I can say that
I am conquering my anxiety. Just recently, I truly realized how
much of my inhibiting and debilitating anxiety was caused by my
self-loathing and extreme lack of confidence. My body changes
and with that the entire metaphysical world surrounding me. Per-
haps, people will stare questioningly, but I know who I am and I
have come such a long way that such things really do not bother
me anymore. For me, it is liberation – from fear, from anxiety,
from my past. I have never before been as happy and fulfilled with
myself as a person, and it can only get better from here. It took
meeting only one person to learn how to love myself.
Though it is difficult to emphatically pinpoint or troubleshoot my
mental illness, I know that I have always suffered from it. Luck-
ily, after that one summer from hell, I haven’t truly experienced
another debilitating attack of depression. In the end, as positive
as my life is now, the shadow of my mental illness never truly
leaves my side, because specific experiences and the strong neg-
ative emotions induced by them have become a core part of my
being, whether I want it or not, and whether I’m always conscious
of it or not. But in the last few years, with the help of the bonds
I have forged with some remarkable people around me, I have
undoubtedly learned how to successfully cope with and combat
the cacophony of detrimental voices in my head to the point that
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they can only rarely show their ugly faces. I have figured out who
I am, where I am headed, what I want to do with my life; I have
discovered that there are marvellous people everywhere, and most
importantly – something that I never would have dared imagine
back in 2011 – that my life is worth living. If someone asks me
the meaning of my name, I would simply say, ‘Lisa means to be
alive.’ 

A student of literature, linguistics

and psychology, Lisa C. lives in
Genk, Belgium. She is a transgender
woman currently in the process of
her transition. 

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 My Journey With Depression 29
Sanjay Chugh

TEL 19-7.4.17 .indd 29 08-04-2017 11.20.00 AM

 M
y journey with depression and other mental illnesses
began some 30 years ago. When I was studying medi-
cine, I never imagined that one day I would be work-
ing as a psychiatrist. In medical college, we read about mental dis-
orders purely as diseases. And yet, we found ourselves diagnosing
various ailments in us. Back then, this wasn’t a very comfortable
idea. ‘Me having traits of depression or anxiety?’ Such thoughts
bothered me. Little did I know that my experience of depression
at that time was nowhere close to the real thing! When I look back
now, I see it purely as my imagination.
I remember vividly the mechanical ease with which I
worked for the first six months of my internship – with people
suffering from a whole range of psychiatric conditions like de-
pression, obsessive-compulsive disorder (OCD), substance abuse,
eating disorders, schizophrenia, phobia and so on. I was good at
diagnosing, even better at differential diagnosis, and the line of
treatment came to me easily. After a point, it became so simple
that I found no challenge in it. I almost started to feel a bit bored.
I began to wonder if I had made the right choice. As I was going
through this existential crisis of sorts, I encountered depression
for the first time, in the real sense.
Anil (name changed) walked into my chamber, and I
started my routine by taking his history. One look at him and
I knew that he was suffering from depression. He looked like a
mess. He was in his pyjamas, which I’m sure he hadn’t changed

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 My Journey With Depression

for several days; he was unshaven, with dishevelled hair and a

lost look in his eyes. Every step was an effort for him as he slowly
walked up to my desk. He let his weight fall on the chair as he sat
and made no effort to make any eye contact with me. His very
presence was so resigned that it seemed to yell out, ‘Well, what’s
the point anyway?’ I somehow gathered motivation in the face of
this despair and started asking the routine questions. He spoke in
a low, burdened voice as he struggled to answer them. I did my as-
sessment, promptly wrote a prescription, and asked him to see me
after ten days. I spent the rest of the day in the usual way, seeing
many other patients. But for some reason, Anil continued to be
on my mind. I kept thinking about him and could sense a strange,
unfamiliar heaviness in my chest. I dismissed it thinking that it
must be the result of a stressful day at work. Later in the week, I
was sitting with a colleague who pointed out that I appeared to
be a bit preoccupied. That set me thinking, and I connected with
the fact that I had never really stopped thinking (even if subcon-
sciously) about Anil. For some reason, his condition had affected
me like nothing else. I asked myself why it was bothering me so
much when I had actually seen people who were in much worse
conditions. Then it struck me – the point at which I sort of froze
in my mind was when Anil took out a picture of his from a month
ago, when he was doing fine. I could not believe that this was the
same man. The dapper man in the picture had little resemblance
to the tired and bedraggled patient sitting in front of me.
Anil was a successful professional doing very well for him-
self till depression struck. He was someone who had worked his
way to success through sheer grit and hard work. He had studied
at the best schools in the country and seemed to be a master of
his trade. He said, ‘My work comes so naturally to me that it no
longer excites me. I do it mechanically.’ As he narrated his story to
me, I could really relate to him. He sounded like another version
of me. The way he thought, the way he worked, his ideas, and
even the traces of that sense of humour were all things that could
have easily been me. Two near-identical lives had run parallel till
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we reached this point where we sat across each other – me as the

doctor and him as the patient. This is when it started to dawn
upon me why Anil’s story had impacted me the way it did. There
was just one thought in my head: it could have been me in his
place.
In retrospect, this was the point when I really started to
understand depression. I could relate to Anil on so many levels
and so deeply that I could almost feel the depression that he was
going through. I had always known that depression was a terri-
ble illness to go through. But this time, I could deeply sense the
abyss that this disease could lead you into. I could feel the impact
of crash-landing from a successful, happy life to the unending
gloom of depression. This ailment gives more meaning to the
phrase ‘pulling the rug from under one’s feet’! One day you are
the cat’s whiskers and just overnight a pathetic thing with no grip
over your own life.
My self-assured hubris rattled; Anil had brought me down
to face my vulnerability. I realized that till now I had never felt
depression so closely because I never allowed myself to connect
with anyone. I would look at them from a safe distance so that I
saw only the symptoms of a disease and the person behind them
would just be a haze. After all, I thought to myself, we were taught
in medical college that we are supposed to maintain a profession-
al relationship with patients and not get involved or attached to
them. I thought to myself that these people were perhaps not
smart enough to understand that they needed to fix the way they
were thinking. Or perhaps, they were not efficient enough to be
able to do what was needed to get them out of depression. Little
did I know that the real way of understanding depression was not
through a textbook, or the words of a patient, but through one’s
own vulnerability. This was the first time that I allowed myself to
feel vulnerable – to my own fear that this could happen to me,
and to the realization that I really did not know what depression
was and so I may not have all the answers to the unknown and
unfamiliar feelings that had suddenly welled up inside me.
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 My Journey With Depression

Over the years, as I have continued to walk hand-in-hand

with depression, it has never failed in keeping my work challeng-
ing and putting me on maximum alert. It keeps revealing to me
yet another layer of the riddle called the human mind each time
I get close enough to it. It amazes me each time I realize what a
huge, inexplicable difference there is between something that I
have understood theoretically and that which I have learnt intui-
tively and experientially.
Somewhere down the line, I decided to do psychothera-
peutic work with my patients. This helped me connect with de-
pression even better. I have had the good fortune of working with
some of the most genuine human beings, who were extremely
generous in opening up their inner selves before me – pure, uned-
ited, uncensored versions of their bruised, depressed selves.
My patients helped me see how the sadness that they ex-
perience in depression is not the same as the sadness or low moods
that we experience on a day-to-day basis. My experience of work-
ing with them made me extremely particular and careful about
the usage of the word ‘depression’. I too, like most of the people
around me, used to casually remark, ‘Oh! I’m feeling so depressed!’
On a regular day
when things were
not going my way
this would be my
response. I no
longer use it as a
synonym for feel-
ing low or upset.
We can perhaps
empathize with
depressive sad-
ness if we tune in
to our own experience of low moods and crank up the intensity
and duration.
As part of a training exercise in understanding depression
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 THE EQUATOR LINE 19

with a group of students and colleagues, I took them through a

creative visualization experience. I asked them to imagine a tough
situation in life – loss of a loved one, the end of a relationship,
being fired from a job… any such thing. They were told to relive
those experiences in every minute detail and asked to feel each
moment with absolute intensity. The various facets of a depressed
state of mind were described in depth in order to make their ex-
perience more complete. Once they had attained fairly high levels
of intense emotions, they were asked to further visualize the sense
of despair, helplessness, loss of hope, worthlessness, and bouts of
numbness following pangs of anguish that are commonly experi-
enced in depression. The participants were then slowly and care-
fully brought back to a neutral state of emotions and then back to
a state of wakefulness.

Needless to say, it was one of the most powerful and moving ex-
periences that any of them had been through. The discussion that
followed this experiment made them empathize with depression
even further. In the experiment, at least they had a trigger. For
someone who has been suffering from chronic depression, there
may be no trigger at all. They could see how bottomless the pit
was. In our day-to-day upsetting experiences, we know that we
will be out of it soon. A phone call from a friend, some good
music, a walk in the park, getting back to work, or sitting with
family and friends is all that it takes to help us snap out of our
sadness and get back on track. But for a depressed person, these
things, the very same retreat route to pleasant normalcy that used
to brighten them up and give meaning to their lives, suddenly lose
all relevance. Even though what these people experienced in the
process was intense, they still felt something for themselves and
wanted to get out of this state somehow. It’s often not the same
for a person who is depressed. They seem to have a disconnect
with their own selves and feel so worthless about themselves they
tinker with the idea of ending their lives. Hastening death, they
feel, would be like rendering a service to mankind. The partici-

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 My Journey With Depression

pants could just about imagine the dark mood, extreme negativity
goading the afflicted person to death. They knew what it must feel
like.

With the help of my patients, I learned how to constantly remain

aware of my own feelings. I understood that I can connect with
them best if I stay connected with my own self at all times. So, if I
felt uncomfortable while talking with a particular patient, I would
tap into my own sense of discomfort trying to understand where
it was stemming from. I learnt how to use a tiny bit of irritation in
me to connect with intense anger in my patients, a small amount
of sadness in me to comprehend deep depression in others, and a
speck of fear in me to sense the paralyzing phobias of my clients.
This journey with depression has been an exploration of
my own self. This expedition, full of its own twists and turns, has
made me grow in a way that leaves me feeling humbled. I work as
a psychiatrist, but that is just a very small part of what I do. What
I really do is listen – to you and to myself. 

Dr Sanjay Chugh is a Senior Neuro-

psychiatrist. He has written extensively
on the subject.

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 36
WHERE HAVE THE BOYS GONE?
Shafaq Shah

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 H
e is talking about college, courses, and places. ‘Once I
leave for college, I am never coming back to this place.’ I
am not looking at him. I do not need to. I know his face
as good as I know mine. I have known him for 20 years now, or
maybe more, I don’t know. Birthdays aren’t a priority here. Ran-
domly chosen dates become birthdays.
On my first day at school, the teacher glanced at me, while
I shifted uncomfortably in my new shoes, and gave me my new
birthday – so casual, so quick that it still makes me wonder what
made him choose that particular date for me. How do I look like
someone born on 7 February and not 30 August?
We are sitting at our tiny mohalla shop, where recharge
cards, biscuits, pins are sold. Packets of brightly coloured, neatly
arranged Uncle Chips dangle in front of us. This has been our
meeting point for years now.
Curfew was lifted today. That means bright school uni-
forms, blaring of horns, and the bustle dispersing the chill – all
this now part of the morning scene. Normalcy has returned, at
least for the time being, and the biggest proof of that is my neigh-
bourhood uncle, Deputy Saheb as he is called, taking his ancient
monument, older than God, a dilapidated Maruti 800, for repairs
for the hundredth time. I immediately turn my face away, lest he
ask me to accompany him. I do not want to waste the first day of
our newfound and clearly short-lived independence listening to
the Sheikh Abdullah tales from the days of Uncle’s youth.

He is still talking about college and going away. He, it seems, just
cannot stop talking.

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 THE EQUATOR LINE 19

‘I couldn’t sleep last night, couldn’t stop thinking about

him. I’m okay, there’s nothing really wrong with me, but I’m just
so angry.’
This makes me sigh, like an old man waiting in line for
his pension. I want to shout at him. Or grab him by his shoulders
and shake him. Or just walk away and never return. Our child-
hood friend is dead. He’s dead. We were all supposed to go to col-
lege together. Remember we shopped for our schoolbags togeth-
er, smoked our first fags together, bought our first smartphones
together? And the other day you stared at his body while others
were reciting al-Fātihah at his funeral. You are not supposed to be
all right!

It then hits me like a chill running through me, colder than the
harshest winter in the Valley. A sudden realization that the sun is
setting and we can’t remain outdoors after dark. What if he goes
too and joins them? What if he, like so many other angry boys, takes
up the gun? I am troubled. Do they feel the same when they see
the lifeless bodies of their friends, brothers, their fathers, and re-
call how wide their smiles used to be and how kind their hands?
Were they battling the same demons? All this blood and death and
boots and this gloom… Did they feel it too, the ones before us?
So much anger on those angst-ridden faces and an overwhelming
sense of loss… There was a ruckus in the state Assembly over re-
ports that some 200 boys had taken up guns after Burhan Wani.
What if he becomes another number in this mindless spectrum of
violence? Another hothead sneaking into forbidden territory to
train and come back to unleash chaos?
Should I talk to him about it? What do I say? Quote
Gandhi’s words about ahimsa? Talk to him about PTSD? He
would probably laugh in my face, ignore the worried look in my
eyes, and ask me to stop reading all those crazy books. ‘All this
crap is corroding your mind. How do you even read these boring
theories? What good are they? Attend next Friday’s khutbah, and
God might save you,’ his voice rang in my head. This was the last
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 WHERE HAVE THE BOYS GONE?

month when the world was still okay and our friend wasn’t in the
grave.
Perhaps I should have attended the khutbah.
 
Why hadn’t he talked to us? Why hadn’t he talked to someone?
Why didn’t anyone talk to all those boys? Why won’t anyone talk
to us? Where are we supposed to keep all this anger and rage and
helplessness? Kashmir, Kashmir, Kashmir – so much noise and
confusion over Kashmir, but why there is nobody here right now
to tell us what to do with ourselves. How to get out of all this? So
many boys would still be here, gossiping in the mohalla square. So
many boys. Those who never returned home, those who arrived in
coffins, those who had stones in their hands and masksover their
faces, those fighting their battles on Facebook, and the lucky ones
just glad to have left this beautiful Paradise, our home. So many
boys. Shouting during cricket matches, their pherans dangling
along their lank bodies, wheezing off on their motorcycles along
the tree-lined paths, walking along the bunds,  loitering at the
kandurwanns. The old-fashioned bread shops have always been
the meeting points for the village folks. All those boys with their
merry eyes and red cheeks.

Bashir dada’s voice rang in my ears.

‘Dai Kher Karus Pot Alau Dis, Ya Ash Dadrai Che Traw
Mateo. Yus Sham Dalith Aze Nanworeu, Gare Trewith Koh Kut
Darv Mateu.’ 
He asked me to pray for the boys or to call them back. The
old man wanted me to weep for the barefoot boy who had gone
away at dusk leaving behind his home, hearth – everything.

He gets up, without warning, leans on the counter, and says, ‘It’s
getting late, let’s go, we shouldn’t stay outdoors after dark, no.’

Many conflict studies over the years have made it pretty evident

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that death as a result of wars is only the tip of the iceberg. Armed
conflicts have been the ugly constant in history since mankind
started calling itself civilized. They have had the most devastating
impact on the mental health of civilians exposed to such conflicts.
The  people in rural areas, women and the young in particular,
are usually the worst affected. And a large number of those living
in active conflict zones experience regularly traumatic events that
result in very severe mental conditions − major depression, anxiety
disorder, schizophrenia and PTSD.
According to a research study on mental health, social
functioning and disability in post-war Afghanistan, the disabled
and women are perpetually haunted by the ghosts of fighting,
suffering and torture, and have been rendered mere shadows
of their original selves, their will shattered by the trauma, their
mental health in shambles.

Conflict, violence and physical suffering have brought in their

wake a still unheard-of phenomenon, mental illness, something
Kashmir had not been previously familiar with. Recently, a
mental-health survey of Kashmir has been doing the rounds of
social media. My Facebook friends share it nonstop. The number
is growing by the day.
According to this survey, conducted by the medical
humanitarian organization Médecins Sans Frontières (doctors
without borders) – better known by its acronym MSF – about 1.8
million, 45 per cent of adults in the Kashmir Valley, have significant
symptoms of mental distress; 1.6 million adults, constituting 41
per cent of their population, are living with significant symptoms
of depression, 26 per cent having significant symptoms of anxiety
related disorder.
And it goes on.

‘Living with’ – interesting words, huh? But in a place where

countless people are dead before their time, their shadows loom
so large that the living pale in comparison. Their misery, their
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 WHERE HAVE THE BOYS GONE?

struggle is barely noticed. So many morgues but not enough places

of congregation for the ones who still walk, no one to talk to, no
one to listen to, no places for celebrating the fact that they haven’t
joined their kin six feet under, except maybe after jummah, to
pick up stones and use this asymmetric weapon against a colossal
adversary, unfazed or unaware that they may not come back alive
or come back only after losing their eyes, limbs, or minds.
Perhaps there is more than I exactly know. Quite a few
crossed over to the other side, trained in special camps and
returned to wage war. At times, they overstep the line into the
unforgiving territory of terror that the whole world is struggling
to come to terms with.

I am now ‘living with’ Delhi. There are no chinars here, no blue

mountains, no snow-crested peaks, but no guns either. People
are different here,  the heaviness seems to be lifting a little. But
Kashmir doesn’t leave me – its memories, its pain, the rustle of
the chinar trees…
Your home never leaves you, even if it kills you. A thud
anywhere and I freeze instantly. A blast? Firing? A suicide attack
on an army camp? Another crackdown? A village circled in for a
combing operation? Voices in my head raise an alarm; they make
noises. Still my first thoughts, after all these years…
Actually, the only sound here in Delhi is the watchman’s
whistle. I  remember this day, long ago, back in our village,
when crackers were burst by some neighbourhood boys  during
a wedding, and before this reckless gaiety of the young could
transform into an adult, mature disdain for silly things, we saw
throngs of people running, shovels in hand, wrinkled foreheads,
worried eyes, panicked, women with their pherans across their
shoulders, frayed locks, hissing. Blast? Firing? Crackdown? There
are no boys in a war.

One of those friends grew up to  be a successful engineer in

the Middle East, with severe anger issues. I do not know what
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happened to the  rest; hopefully the sound of crackers doesn’t

unnerve them anymore. Yet, it was not the  sound of gunshots,
tear-gas shells being lobbed, slogans of azaadi or the azaan
echoing across the orchards, which comes back to me when I look
back on my childhood. It’s that eerie silence of the nights in my
village that still haunts me. No movement, no sounds, no outing
after dark. The windows so tightly shut that everyone inside felt
stifled. These nights have snatched away so many of our people,
ruined our peace and challenged our sanity.

Dr Arif Khan, a mental health counsellor in the Valley, has many

disquieting things to say about the young men who feel helpless
and angry, children who were forced to grow up before their
time and lost their dreams before living them. Women were no
different either. War widows and half-widows of Kashmir have
been waiting for their husbands for years; those men have been
the subject of op-eds and movies, treated with an unusual cruelty
by fate and society. Parents of those who never returned, presumed
dead, buried in some strange place.They walk to the camps
tirelessly everyday, carrying pictures of their loved ones, hoping
against hope. So many of them are suffering from depression and
panic attacks. Those children, blinded by pellets, can’t see Paradise
now, filled with rage. That one girl who washes her hands twenty
times a day, suffers from obsessive compulsive disorder after the
uninterrupted curfews, stone-pelting protests, and violence, for
she’s been a witness to all that.
There has been an exponential spike in mental illness in
the Valley since the 90s, since the insurgency began plunging the
place into turmoil. It is not just the perpetrators of violence and
those who have been at its receiving end; numerous others get
caught in the crossfire too. They all bear the brunt of this conflict.
The Valley has been shut down every summer since 2008, for
months together. Life comes to a halt – schools, colleges, offices,
everything closed. No interactions – social, cultural, commercial

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 WHERE HAVE THE BOYS GONE?

– happen. Scores of people put under house arrest, the mind

wanders to dark  places when there’s nothing to do, no one to
talk to, no place to go. This situation is particularly suffocating
for young girls. Boys could still go out, at least for some hours,
play gully cricket, fish, hang out around the village square. Where
would the girls go? What would they do? What have they been
doing in the long months of curfew? How is a healthy growth
or a healthy life possible in such a situation?  The social stigma
attached to mental illness poses a huge obstacle in seeking medical
interventions. And under the shadow of guns and stones, where
survival is at stake, this illness gets buried under the debris of
chaos and violence.

The day Haider was released, I had rushed to a PVR in

Connaught Place, expecting nothing less than brilliance from
Vishal Bhardwaj. I was standing in a long line at the food counter.
The movie was about to start, and I was waiting for popcorn and
Pepsi, the theatre essentials. ‘We’re going to miss the first five
minutes. Shahid Kapoor is brilliant in this one; this has been his
best performance. And that other actor… what’s his name? The
art-film type, Menon. Yeah. Good that we booked in advance. It’s
houseful everywhere.’ I overheard stray conversations. I smiled to
myself and thought about how furiously I had booked my own
ticket.
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For the first time, I was thankful that there are no cinemas
in Kashmir. This movie could have led to a massive breakdown
over there. Wails would have been heard from every corner of
the theatre. Here, among all these strangers, who were unfamiliar
with our pain, sipping Pepsi and munching popcorn, laughing
about the scenes they found funny but weren’t, not to me at least,
one had to muffle the sobs. Pretend to watch the movie like a
soap and gulp down all the awful. The protagonist went mad in
the movie, and that’s where I was headed too perhaps. I needed to
talk to someone.
There’s this scene in the movie: the hero is trying to find
his missing father. A poem of Faiz Ahmad Faiz, ‘Gulon mein
rang bharein’, is playing in the background, while his father’s
photograph is torn into pieces and thrown in his face; he looks
up at the gloomy grey sky, while the torn bits fall all over his face.
I had dug my nails in the seat and couldn’t bring myself to
watch the movie again. The Pepsi went flat – untouched. 

Irfan Gull assisted in the research for this essay. A student in the
Kashmir Valley, he is currently striving for socio-political changes in
the conflict-ridden Jammu and Kashmir.

Shafaq Shah is a lawyer in Srinagar

and a columnist for the Greater
Kashmir newspaper.

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 PHOENIX NOT JUST A PLACE IN
ARIZONA 45

Sumeet Panigrahi

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 One

18 March 2017

After almost eight arduous hours, three bottles of packaged water,

three glasses of natural water, nearly six to seven glasses of lem-
on juice, several gulps of aerated drinks, one and a half packets
of Monaco biscuits, three tamarind candies, recurring phases of
overwhelming fatigue, several moments of despondent weakness,
and a flurry of expletives from my friend-turned-coach Srijit Basu,
a cinematographer in Mumbai, I finally complete the ascent and
descent of Mount Girnar in the afternoon.
A chilled glass of sugarcane juice, an overjoyed Srijit, and
appreciative smiles from Vishwas and Mandvi welcome me at the
base. Having gone up to the Dattatreya temple at around six in
the morning, we come back after taking short breaks and one
breakfast stopover that lasts around half an hour during our de-
scent. That is 20,000 steps: steep inclines and sudden declines.

They say less than one per cent of the people who enter the gates
of the Girnar temple go up to the Dattatreya temple. Out of
those, most of the people take almost the entire day to finish the
trip, avoiding the harsh midday sun when heat and fatigue sap

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you alternately.
But I am not boasting about my feat as an explorer here;
this is not even my story. I am just a side character in this odyssey.
In truth, it’s the story of Mandvi Garg, a gutsy girl from Hary-
ana. I will trace my own roadshow, started long ago, a while later.
Here, it’s Mandvi, the intrepid girl on an incredible journey.

Mandvi grew up in Hisar. Even before she was 20, she lost her
vision due to retinitis pigmentosa. This is a host of eye problems
affecting the retina. Now completely blind, the young woman de-
cided to grab life by the horns and live it fully, with meaning and
purpose. In the next 10 years, she became an avid mountaineer
and went on many treks and expeditions all over India. In March
2017, she decided to do the impossible.
Here is what she did. With strong support from two
sports enthusiasts, Vishwas Bhamburkar and Vishal Chavda,
Mandvi cycled from Ahmedabad to Junagadh along National
Highway 47, covering a distance of 346 kilometres in three days
sharp, rested for the evening, and climbed Mount Girnar the very
next morning.
Now that you have read about it, do your own math.
Mandvi knew Vishwas from before, and she met Vishal after she
arrived in Ahmedabad. And then, on 15 March, the three of them
started to cycle on one of the most chaotic national highways in
India. Mandvi managed the spectacular rally without any prior
training or cycling practice, unlike Vishwas and Vishal; both of
them are long-distance cyclists and athletes. Close your eyes and
try to walk from one room to another in your house; that will give
you some idea about Mandvi’s heroic journey.
Just try it.

Thanks to a few common friends, I got to travel with them to

document this event and interpret her determined ride for a larger
meaning. I sat behind the camera capturing the blind girl’s tri-
umph.

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On 18 March, I set out with them to conquer Mount

Girnar. I realized the toughness of the challenge – 10,000 steps
– a little later, and by then, it was a little too late. Here is some
more context: I weigh 88 kg, and that means I am easily 25 kg
overweight. I have never worked out in a gym or participated in
sports of any kind at any level. I have – here is the most ludicrous
part – never run more than 10 metres in my life. I have trouble
breathing after climbing four floors. ‘Unfit’ is definitely an ideal
word, but I managed to do this unbelieving feat with all three of
them. As one can imagine, I touched the base a good 20 minutes
or so later.
Vishwas had run a hundred miles in a single go in Bra-
zil and still remains the only Indian to have done so. Vishal is a
born athlete and cycles city-to-city regularly. Mandvi is a trained
mountaineer, who carries up to 20 kg of weight on her back and
climbs up and down the stairway 200 times at home almost reg-
ularly. Srijit has been a swimmer for 28 years now. I, on the other
hand, have done none of this and have in fact abused my body,
living as a shut-in and a couch potato for years, binging on junk
food to keep myself occupied. The maximum number of steps I
had climbed was at the Panchalingeshwar temple in Baleshwar as
a child. At 30, I possibly might have high blood pressure, which
I plan to get checked soon. Acid reflux, unreliable digestion, long
phases of ennui, and disenchantment are some of the other as-
pects of my existence.
So, at a personal level, this was my biggest physical feat.
Srijit and Vishwas both asked me how it felt to do what less than
one per cent of visitors dared. To be honest, it did not feel like
much, and that I attribute to my anhedonia and general sense of
despair combined with my discontent. But that’s not important.
Here is the important part: it’s never too late to reclaim
your life and live it 2.0. All you need to do is just do it. It’s that
simple.

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Two

Sometime in February 2017

Scene I

I wake up one morning and start to sob. I rush to the washroom,

lock it from the inside, bite my hand to stop whimpering, and
sob uncontrollably. The sobs come in oscillating waves, hitting me
in the depth of my being where the hurt is immense. It lasts for
about 30 minutes, and by the end of it, I can barely stand. I finally
regain my composure and come out of the dark pit.

Scene II

I am bored. No, it’s more than that. I am disenfranchised in life.

Even sitting and breathing seems like a Herculean task.
I see on YouTube the latest trailer of Logan, the last Hugh
Jackman outing as Wolverine, flashing on top. I start watching it,
and midway, tears start to stream down my face. The trailer ends,
and I cry. I cry some more and then – again. I get up, wash my
face, and make myself some coffee – black with no sugar.

Scene III

I wake up in the morning after a dream and find myself crying.

It’s around 7, and I feel tired. I manage to stop after five minutes.
In my dream, I won an award. That was the trigger. The notion of
winning an award, probably as a filmmaker or a screenwriter, in
my dream made me feel gloomy enough to cry.

Scene IV

It’s YouTube again. In the recommended section, there is a video

of Corey Taylor, the frontman of the heavy metal band Slipknot.
I watch the video and cry, feeling suddenly overwhelmed. I imme-

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diately listen to ‘Iowa’, one of their earlier tracks, and fall asleep.
(Yes. That song is sort of a lullaby for me.)

Scene V

It’s two in the morning. I

toss and turn and finally
wake up. I have been home-
less for several months now,
having run away from my
marriage and my home in
October 2016, and will con-
tinue to stay in this shelter
for another couple of weeks.
I have been an insomniac for
decades and moving about
the house like a ghost has
now become a ritual for me.
I switch on my cell
phone and check the table –
a packet of cigarettes, some
magazines, and the computer. I don’t smoke now, switching the
Mac might wake people up, and I have not read a book or a mag-
azine in years. So I take my phone to the washroom and try to
masturbate. I have been celibate for more than four months. In
this moment, I just want to feel something, anything: intimacy,
a surge of passion, a little joy, joie de vivre, an urge to live. Or an
orgasm. Or the worst – an ejaculation, which will result in a small
explosion of dopamine. That will be something.
I want to hold another human being and be held. There
are three people in the flat, and they are all grown men, deep in
their sleep. But I am afraid of being judged. I am afraid of being
seen this naked and this vulnerable. So my effort increases and my
fingers grip my shaft tighter. I try for ten minutes or so.

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By the end of it, I feel the hurt: physical, emotional and

spiritual. I am one with the universe, in my profound loneliness.
I am one with Sartre, Kafka, Kierkegaard, Nietzsche, Schopen-
hauer, Camus, Beckett, Tom Waits, Leonard Cohen, and I am
overwhelmed by my own misery. I don’t want to live, and I don’t
want to die. I don’t want ‘want’ and I don’t want ‘thought’ or
consciousness or existence or nonexistence. I want nothing, and I
don’t want ‘wanting nothing’. I am a black hole in the toilet, gain-
ing mass, and I have an urgent, sincere wish to be sucked inside
the commode and flushed out like filth. Or maybe methane. I
am the sombre Sisyphean nightmare. I am Mahler’s quartet. I am
both my funeral and my corpse. I hate oxygen. I hate humanity. I
hate life. I hate hormones. I hate women. I hate eyes and the ache
and the mountain that is stuck in my throat. I hate my engorged
manhood; I hate its curvature and the fire of lust that rages with-
in, albeit superficially. I hate my small hands. I hate my body. I
hate my parents and their small frames. I hate my wife for drifting
apart as I sink beneath in the darkness of life. I hate the lack of
love. I hate ‘hate’. I hate thought. I hate the word ‘I’.
I get up and sit in the shower. It feels better. I undress
and embrace myself, coiling my arms around me. For the first
time in 30 years, I want to love myself. Maybe a little. And the
tears rush. They scald my face despite the cold water raining on
me. Five minutes elapse and it’s an eternity. I get up, unlock the
door and scan the flat: they are all asleep. I take out my clothes
and walk naked to my backpack in tiptoes. I change into a pair of
shorts and a tee, drink a glass of water. Next I switch on the Mac
and continue to cough for 30 seconds as if it will drown out the
boot music. My eyes sting, my testicles hurt, and I want to burn
the world for tormenting me. Instead, I open up a document and
type nonstop for 10 minutes. I change the alignment to ‘centre’,
convert it to a PDF document, and open my Facebook account. I
rename it “The Letter”.
In the next 40 minutes, I send it to close to four hundred
people.
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 THE EQUATOR LINE 19

And then, Facebook blocks me from sending messages for

a few days.

Within a week, I start getting replies, most of which are from

strangers. They ask questions; all kinds:
‘Did you write this?’
‘How did you know?’
‘Are you a writer?’
‘What is this? Is this virus? Did you send it?’
‘Did you not edit it? There is a typo in there. Good job,
by the way.’

I send it to maybe a hundred more after a week. All in all, at least

a hundred do not reply. I am sure maybe a hundred have not read
it. But it has made a lot of people smile, and they have written
back to me. "The Letter" would go on to make someone finally
decide to quit their job, grow hair and travel. It would make a
complete stranger in the US believe in ‘miracles’ again.
In a way, the letter would reach all the right people.
But here is the truth: I am not the writer. In all humility
and without the faintest exaggeration, I am the conduit and the
universe could just speak through me on one of those nights. Till
date, I have not even read what is on those four pages. That’s my
closure, my monument. My time capsule. I am the universe, and
the universe is all me. And I have a little bit of everyone, and ev-
eryone has a little bit of me. I have actualized it after decades of
darkness.

Three

Sometime in October 2016

I have an epiphany in sleep. The sunrise is two hours away. The

voice inside tells me to stop my clinical descent, the nonchalant
self-sabotage, and live. For dreams, for life. It’s clear as a summer

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day in Greenland. It’s the will of the universe. I decide to stop

taking my pills for good measure, end my dependence on them
and stop living like a zombie. I plan to heal myself through dia-
logue, a conscious effort, and by staying away from negativity. I
plan to go out and live as a ‘free radical’. I plan to live and die by
my own will. I realize I am in love with life, with love, and with
people. And hope. I vow to help others to the best of my capacity
and love everyone selflessly beyond my capacity. All this happens
in less than a second.
In a little over four hours, I run away from my home,
from my marriage. I leave my Lhasa Apso behind. I know this
is the final nail in the coffin of my strained marriage. I know
that my wife is one month pregnant with twins. I know that my
psychiatrist had told my wife that my progeny might inherit my
illness just like I did from my parents. I know that I have no
money with me and that it will be difficult for her. I know I will
be guilt-ridden all my life. But I go ahead and do what I believe is
necessary. My act of running away – without any intent to justify
– is an act of free will.
My wife conceived because our need for each other was
stronger than logic. The lives that are growing within her had no
say in any of this. All my life I questioned why I was born. And I
do not want my children to feel that way. I do not want to prove
my virility, neither do I want to prove my wife’s fertility. I am a
clinically depressed man, with frequent mood swings, no job, and
no financial security. I am in no position to take charge of two
lives.
So, I run away.

Epilogue

After my Mount Girnar trip, I travel from Junagadh to Ahmed-

abad back, have dinner, check into a hotel, take a hot bath, and
sleep for one hour. I sit down to write this, and that means this is
important.

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I am not ashamed of myself. I am not ashamed of being

the black sheep. I am not ashamed of being a mess, a wreck, a
fuckup, nuts, a freak or anything they can label me with. I don’t
hate myself with the intensity that was there a few months ago. I
am healing and helping others heal.
I hate the world a lot less. It does not help to hate. I don’t
hate the tutor who thought pinching my buttocks, pulling my
penis, and undressing me on public roads would make me a better
student. I don’t hate my parents for being indifferent and naïve.

My wife terminated her pregnancy. Though we have been living

separately for the last five months, we speak occasionally. I have
her name carved on my left arm (it was a serrated kitchen knife)
and an amalgam of our names is tattooed on my forearm, above
the scar tissue from the cuts I had made four years ago. (Self-
harm, I believe, is colossally self-defeating.) I hope she forgives
me someday.
I am trying to find myself. I have nosedived into photog-
raphy and am trying to find my niche there. I have worked for a
music video for Papon, written two short film scripts after several
years. I am working on three feature-film scripts and developing
a ten-part web series that deals with mental health among other
things, which I hope will see the light of the day.
I am more confident than ever. I recently addressed a
crowd of 50 in Whistling Woods International where I spoke on
Dadaism. It was my first public speaking experience after 15 years
of avoidance. It was a breeze.
No self-help book, life coach, motivational guru, or Face-
book post can change anyone’s life. The change comes from with-
in. Listen to it. I genuinely believe one can heal oneself without
DSM IV, salt-and-pepper psychiatrists, and polychrome pills that
blur reality. You just need to try hard enough.
Hard Enough.

I am no longer suicidal. I no longer believe sitting on ledges and

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trying to jump from buildings is cool. And the drugs do not work.
It’s just a maze, an escape. I visited a rehab to reassess my belief,
and I stand by it.
I still listen to ‘Fade into You’ and cry. Eternal Sunshine of
The Spotless Mind and Blue Valentine wring my innards even now.
Paris, Texas somehow seems like a film that might closely resemble
my life.
I have made peace with myself, rolled all the negativity
into a ball, and hurled it deep into outer space. This is my 2.0, and
I have arrived. If you are reading this, know this: I am waiting for
you in all earnestness. I will wait for you at the mouth of infinity
in light.
See you there. 

Sumeet Panigrahi is a Bollywood

scriptwriter. He works as a cinema-
tographer as well.

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 56
THE OTHER SIDE OF MIDNIGHT
Reshma Hingorani

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 I
graduated in 1981, a medical doctor at last. A few years later,
when it was time to specialize, I wanted to get into psychiatry.

‘Psychiatry? Are you already out of your mind?’

‘Psychiatrists are crazy people; or they eventually become
loony; okay, even if they don’t go mad, they always look, well, not
exactly normal!’
‘Char bimariyan, char davaiyan, thik kisi ne hona nahin.
Kya faida, beta, aisi line pakad ke? Gyne kar lo. Ladki ho, hamesha
kaam ayegi! (Four illnesses, four medications, no one gets well
anyway. What’s the point of getting into such a field? Become a
gynaecologist. You are a woman, it will always work out.)’
The last one, from my family of course.
And so it was that I got pushed into a politically correct
discipline, my wishes be damned.
Years later, after I had switched over from a women’s spe-
cialist to a ‘mind’ doctor, what’s the question I’ve had to answer
the most? You got it! I finally perfected the answer to that why: ‘to
make both ends meet!’
But the truth is, I had an N.D.E. (a near-death experi-
ence), and at that precise moment of truth, when I thought I
wasn’t going to live, I regretted the fact that I hadn’t done what I
wanted to do.
So I promised myself that if I made it, I would listen to
my heart. As you can see, I survived! And I learnt my big lesson:
if you don’t love what you do, you’ll end up doing what you don’t
love, and you’ll be stressed out.
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The ‘char bimariyan…’ myth was shattered when the in-

ternational diagnostic systems began listing hundreds of mental
disorders, pharmaceuticals released innumerable medications for
the mentally ill, and recovery rates improved sufficiently to ease
psychiatry out of the closet, although it still has a long way to
go to full freedom. Celebrities have contributed in a big way by
openly talking about winning their battles, and the ones that lost
equally brought into focus the hitherto stigmatized area of mental
illness.
Why this near-phobia of anything psychiatric? This re-
luctance to accept mental illness and seek treatment? I found
a strange misconception: most people seem to believe that the
slightest emotional disturbance is the beginning of the end, that
it will slowly but inexorably slide on to the other end of the spec-
trum, that ‘madness’ is now inevitable (an idea that, unfortunate-
ly, comes from its stereotypical depiction, mostly in movies). The
result – denial. It’s like believing that diabetes or hypertension
will all end in the dreaded cancer. The most common disorders
– anxiety and depression – are just as manageable as any other
medical illness; in fact, except for infections and surgery, ‘control’
still remains the norm rather than ‘cure’ in most medical sciences.
And how does one keep the flame of hope alive, while
being surrounded by tormented souls? Remain optimistic even in
the midst of morbid noises? At times, it overwhelms my coping
abilities, and my inner cobweb zone goes into overheat mode, but
the whole process of lifting someone out of their blues is a thera-
peutic triumph as well.
Let me relive some of those special moments here…

Vignette 1

‘Zindagi tarq pe nahin chalti doctor-saab, bhavnaaon pe chalti hai…

(Life doesn’t run on logic, doctor, it runs on emotions…)’
With that one sentence, he rubbished my entire lecture.
That sentence has often returned to haunt me. And hit me with

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its truth.
He was admitted in our psychiatry ward for attempted
suicide. It’s the same old story. Unrequited love. But he was will-
ing to talk about it. In the presence of medical students. This was
unusual since most such patients are embarrassed or ashamed. So
I presented him to a group of about 20, all of whom sat in rapt
attention, some possibly identifying with him to various degrees,
as he regaled them with the story of his passionate love affair,
ending as usual with her marriage being fixed elsewhere and him
overdosing. There was crying involved, more than a few wet eyes.
He answered all their questions honestly.
And then I went about putting all my counselling and
psychotherapeutic skills to good use. As I proudly wrapped up,
a half hour later, the audience suitably impressed with my efforts
and convinced that he had been cured of his ailment, I ended
with the usual question, ‘Do you feel better?’
‘Mere jeen eka koi maksad nahin bacha… Ab ki baar koshish
fail nahin hone doonga… zindagi tarq pe nahin chalti doctor-saab,
bhavnaon pe chalti hai… (I have no reason to live anymore…
This time, it won’t be a failed attempt… life doesn’t run on logic,
doctor, it runs on emotions.)’
Shocked faces and confused eyes demanded an explana-
tion of what was going on. After getting him escorted safely to his
bed, we began deciphering what was going on.
It was clear that the situation was more of a bereavement
reaction than clinical depression. Mourning isn’t always over the
dead. It can be over a loss, perceived to be as serious as death – of
money, a relationship, one’s job…
His life had centred around her and what they had
shared… Not only was he losing her, he was losing her to some-
one else.  His self-esteem was bruised. As soon as he heard the
news, he consumed a mixture of whatever pills he could lay his
hands on from their first-aid kit at home. Then, he called her. She,
of course, lost no time in informing his family, who rushed him
to the emergency, from where he was referred to our psychiatry
department.

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There was no pre-meditation – accumulating a lethal dose

or adopting a fool-proof method. This was more of a para-suicide,
a suicidal gesture, a cry for help that gets labelled as ‘emotional
blackmail’. While the intention may not be to die, it is serious
enough to merit a thorough evaluation and proper management
to prevent repeated attempts, because the risk of another attempt,
a successful one, remains throughout life.
Moreover, he was what gets referred to often as the
‘heart-driven personality’. He was impulsive by temperament,
driven to excesses in behaviour, emotionally unstable, and all
these might have contributed to rocky and fragile relationships,
not only with his partner but even with family and friends. This
would then lead to brief depressive episodes and lability of mood,
resulting in some socio-occupational decline, and the vicious cy-
cle would continue, till some form of continued therapy was un-
dertaken.

Take-home message:

Suicidality is an emergency, and in fact, the only 100 per cent

preventable death; hence, always an indication for hospitalization.
Although very often, it is not always an indicator of severe de-
pression. Suicide attempts could be impulsive acts, resulting from
deviant personality traits. Many end in repeated attempts or even
successful suicides. All the prescribed precautions must therefore
be taken unfailingly, and patients must be followed up with, to see
if the mental state settles down or escalates into a clinical depres-
sion, which would then invariably require antidepressant medi-
cations in addition to psychotherapy and sometimes, even ECT
(electroconvulsive therapy).

Vignette 2

‘Ma’am, she did it…I wish I’d listened to you…’

The phone all but dropped from my hand. I was on my

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way to the conference hall for a lecture…

‘Is she…?’ I found it difficult to complete my question.
She was my colleague’s mother, 69, brought by her to my
OPD one winter morning. She was not eating or sleeping well,
seemed sad all the time, felt useless and helpless, couldn’t find
pleasure in anything, had no energy or enthusiasm. In short, she
displayed all the classical symptoms of depression. It was quite
unlike her; for over a month, the elderly woman had not been her
usual self.
During assessment, I asked her about any death wish or
suicidal impulses. Two things happened. The daughter gave me
a hard, accusing glare, as if I were planting the idea of self-de-
struction into her mother’s head. And the mother began sobbing
quietly.
Both are very common reactions to an essential line of
questioning in all cases of depression. Any explanation of the ac-
tual truth, that such ideas emerge from an inner feeling of utter
hopelessness and despair when life doesn’t seem worth living, nev-
er convinces the caregivers, as also the fact that if not enquired
into, one will not be able to prevent their progression into dan-
gerous, life-threatening attempts. On the other hand, the patients
invariably feel relieved that they can talk about it. That someone
empathizes. After all, a death wish is a silent cry for help. They feel
understood. Like she did.
Then it all came pouring out. ‘Din mein kayi baar vichaar
aata hai ki aisi zindagi se to jaan le lun. (Several times a day, I feel
it is better to take my life than be so miserable.)’
Next, the professor from our medical college broke down,
hugging her mother. ‘Mom, why didn’t you ever tell us? Oh my
God!’
Incidentally, her brother, also a medical doctor, lived in
the same house. But such is the ignorance about mental-health is-
sues that there is an overwhelming tendency to rationalize any ab-
normal emotions or behaviour and attribute them to some event,
a belief that our locus of control is outside us, and so of course ‘sab
thik ho jayega (time will heal everything)’ – that much avoidable

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suffering continues.
I advised hospitalization, as would be the norm in all such
cases, and met more resistance of the usual type: ‘Psychiatry gen-
eral ward? Can’t we keep her in the private nursing home?’
‘No, she needs constant attention, for which the wards
are more suitably designed, plus there will be lots of staff around.’
My voice was firm. The mere mention of ECT sealed the
issue. It was a perfectly safe and ideal procedure, especially for
her age and severity of illness, with definite rapid results. Many
phone consultations later, the family’s collective decision was that
they would do all that was necessary at home, her dad and brother
would manage, and she would visit frequently to be monitored.
No amount of convincing helped, and I wrote out the
standard protocol, the antidepressant medications, no sharp or
rope-like objects around her, 24x7 observation, supervised medi-
cation delivered by family and so on.
And then, the phone call came.
All seemed to be going fine; the old lady was improving.
Then one early winter morning, as the husband dozed off briefly
(how much energy does one expect from a 75-year-old?), she qui-
etly slipped out, and leaped off their second-floor balcony.
‘Is she...?’
Yes, I had found it difficult to complete my question.
Through broken ribs and many other broken bones,
through many surgeries and a prolonged ICU stay, that die-hard
spirit miraculously defied death and tempted me to believe in
fate. And finally, she made it back to my OPD many months
later. All smiles, a little bashful, extremely grateful, but all in one
piece. And peaceful!
Meanwhile, I had helped her doctor children cook up a
story about a seizure leading to her accidental fall, which she was
told since she did not have a complete recall of the whole event.
Everyone’s face was saved.
The stigma did not stick.
But I have questioned myself several times since: could I
have pushed harder? Where does one draw the line between re-

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spect for a doctor colleague and asserting firmly as a professional?

But retrospective wisdom should not lead to guilt. It only serves
to guide future decisions in similar situations.

Take-home message:

While sadness is a normal and universally experienced emotion,

one must get assessed if it becomes persistent for at least two
weeks, and pervasive over different situations in life, like home,
work or society. This is required to decide if it has developed into
a disorder called ‘depression’. Clinical depression can be self-lim-
iting, but it is so easily treatable with medications, with very few
side-effects and very good recovery rates that it is imperative that
one cuts short the agony and nips it in the bud, preventing its
progression into a more serious illness. Unabated, it is fraught
with risks of self-harm, requiring a much more rigorous treatment
and for a longer duration.

Vignette 3

‘Doctor saab, hamare inka ilaaj to bas aapko hi karna hai. Hamare
padosi bhi aapke under bharti hokar gaye thhe – pehle se bhi jyaada
achhe ho gaye!’ (Doctor, you have to treat my husband too. Our
neighbour had been under your care – he became even better than
before!)
During morn-
ing rounds, this wom-
an walked up to me.
Turned out, she’d been
specifically asking for
me in the OPD and
got directed to the
ward, since our unit
OPD was the next day.
Many accompanying

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staff members nodded in appreciation!

‘Doctor madam bahut acchhi hain. Wait kar lo – round ke
baad dekhengi. (Our doctor madam is very good. Please wait – she
will attend to you after the rounds.)’ The nurse took charge of the
situation.
Was I flattered? I couldn’t be, having immediately realized
what had happened. The gentleman in question, her neighbour,
had been admitted with severe depression, had recovered, and ap-
parently had become very cheerful, talking and laughing a lot, and
seemed full of energy. She said it was almost as if ‘his motor had
been changed!’ He wasn’t like this before his illness. She thought
I had even changed his personality for the better! I wish I could!
Well, his motor had surely been changed, in a manner of
speaking. He had probably switched into a manic state. I asked
her to make sure he came back for evaluation to my OPD along
with her and her husband. It was important for me to find out
why it had happened: was it an oversight of our team? In any case,
we needed to clarify the diagnosis and modify the management
plan immediately.
One of the risks with every patient of depression is of the
condition actually being bipolar disorder, where depressive epi-
sodes alternate with manic episodes, where ‘the motor reverses’ –
there is hyperactivity, excessive talking, laughing, increased energy
levels, grandiosity, reduced need for sleep and appetite – almost
the exact opposite of the depressive picture.

Take-home message:

Every patient with depression must be carefully evaluated for any

manic episodes in their past (since milder cases go unnoticed or
even admired, like this neighbour did; so, one has to very specifi-
cally delve into the past and family history).
The management then includes a mood stabilizing agent,
in addition to the antidepressants, or else, the patient might
switch to mania. In fact, bipolar depression has characteristic fea-
tures that help predict the risk of it being a bipolar disorder – the

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depression is usually more severe, with a profound reduction in

energy levels and atypical features like increased eating and sleep-
ing.
ggg

The vignettes in a doctor’s life are unlimited, but my

word-count is limited. Time to wrap up!
Since we talked about depression and touched upon sui-
cide, have I ever actually lost a patient? I wonder if there is any
psychiatrist out there who hasn’t.
The first time was during my training days when the fam-
ily came and informed me about a young patient with schizo-
phrenia who took his life. I was filled with extreme guilt and was
perplexed at their calm acceptance of the tragedy. My seniors
assuaged my feelings by telling me about many difficult-to-treat
patients who respond to the voices in their head urging them to
commit acts, which they then feel compelled to perform, aided
by their delusions. And so, not only do they take their own lives
but sometimes harm others too; hence, the immense importance
of getting those with serious mental illnesses the best and fastest
possible management.
The only other patient that I know I lost was a young girl
with a neurological condition that had caused her depression and
complete apathy; she did not even experience sadness. These pa-
tients with ‘organic depression’, caused by a medical illness, suffer
the most; their bucket has a hole, so no matter how much you
turn the tap on, it never fills up. Unless the primary condition is
taken care of, the depressive picture remains difficult to control.
The 17-year-old was admitted in the ward, and we had
pulled all stops from our therapeutic armamentarium. But noth-
ing moved her to emote, and that emotionlessness made her feel
so hopeless that she found a permanent solution… by taking a
plunge from the loft.
A policeman called me; by the time I reached, it was all
over.
Her mother, who had been shadowing her for two weeks;

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our entire staff, who had been labouring so hard; the rest of the
admitted patients; their relatives; other hospital staff – everyone
was left grappling with their own emotion, almost as if what she
had not experienced, she left behind many times over, torment-
ing us all for a long time to come. Lifting that pall of gloom off
them all was a Herculean task, and I’m not sure if they ever fully
overcame it.
But echoing Robert Frost, I would say, ‘In three words I
can sum up everything I’ve learned about life: it goes on.’ 
And talking about the reactions of caregivers, the worst,
and the one that I will never ever get over, was from the mother of
a young girl with schizophrenia:
‘How much time does she have, doctor?’
‘Please don’t worry on that count, lady. This is not a
life-threatening illness. If all goes well, she’ll go through her nor-
mal lifespan.’
‘Oh…’
That pregnant ‘Oh’ delivered it all – the chagrin, the de-
spair, the absolute hopelessness. The resignation in her voice com-
pletely shattered me.
Her 18-year-old daughter had responded very poorly to
all treatments available till then. She suffered from bizarre sex-
ual delusions, so the family couldn’t afford to let her meet any
outsider or hire a caregiver – forcing one family member to be
constantly around her. She would break things and scream and
create a havoc. I daresay one of the worst cases I ever handled,
and the family was too emotionally attached to give her up to
an institution. And even that, only if they would’ve been lucky
enough to find a spot near their abode, a small town three hours
away from Delhi.
That reaction explained other similar ones (of near-relief )
from caregivers of patients from our de-addiction clinic – of bat-
tered beloveds and penniless parents and supporting siblings –
when they lost that ‘addict’ relative to alcohol or other drugs or
related crimes.
But from the parent of a child, that too a mother?

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It didn’t help that I dealt with the poorest of the poor, in

a government hospital. The only thing completely free there was
the treatment. Everything else extracted a very heavy price.
So, was one surrounded only by such bleak tales? How
easily we humans take all the positives for granted and recount
only the negatives… to ourselves… and then to the world… and
then slide into the ‘poor-me-why-me?’ state.
No, sir. For every tens of heart-wrenching stories, there
were thousands of unsung knights in shining armour… the nev-
er-say-die survivors who showed me that all was never lost, that
merely accepting what destiny had handed them helped them
handle it with great fortitude, that they only needed to look for
the strength that we are all blessed with but are either ignorant
about or never try to tap.
The only worthwhile take-home-message is this: that de-
spite all odds, there exists the glorious dawn of hope… the other
side of midnight. 

Dr Reshma Hingorani, a former

Chief Medical Officer at GB Pant
Hospital, Delhi, now practices in
Maryland, USA.

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 68
I FOUND MORE ROPE
Ateendriya

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 Y
ou’re nine years old, wedged between your parents on the
modestly large double bed. In the morning, you com-
plained that you’d like a room of your own, like your
brother has. Come next morning, you’ll complain again. But all
through the night, you’ll grab onto a bit of your mother’s dress as
she sleeps with her back to you. All you can think about is your
parents dying.

You don’t want them to die.

You can’t voice this absurd, untimely fear as you cry yourself to
sleep, the tears rolling sideways down one cheek. It feels uncom-
fortable, all that salt water pooling on the pillow under your left
cheek, but you don’t have the heart to let go of mother’s dress. So
you close your eyes and go to sleep; the nightmares follow you. In
the morning, you have the memory of that hollow fear you felt in
the dark, but you cannot, for the life of you, access that feeling.
You know it’ll come again, come night. You dread it; but you can’t
tell anyone.

They’ll think you’re insane. They might just laugh at you.

ggg

You’re 13 years old, on a school bus. You’re relegated to a corner,

because the kids don’t really like you. You don’t care. You clamp
your teeth shut, take out a bit of your frustration with the world
on your jaw, and look out the window. You think about the class-

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es. You think about homework. You think about the 3rd period
test. You try not to think about recess.

You’ll have to find a corner that people won’t stumble into. It’s
a daily dance. Your strategies need modification every day. If re-
cess is outdoors, as usual, you will linger in the classrooms and
hallways. Until a janitor or a cleaner or a teacher finds you and
commands you out to where everyone else is. Then you’ll find a
way to give them the slip and look for a different spot, away from
the kids. If it rains and recess is indoors, you’ll find an empty stall
in the washroom.

Come recess, you botch up the execution of plan A and plan B,

even the contingency plan. You take a look at your lunch box,
throw out the food, and make your way to the library. You can sit
there as long as you don’t eat.

You didn’t like what your mother had packed anyway.

ggg

You’re 15, standing on the edge of the terrace, looking down,

wondering how many limbs you’ll break if you take the plunge.
You don’t want to end up mangled yet breathing. It’s just three
floors; there’s a good chance this will not kill you. You wish you
lived in a taller building. You think of other strategies. Something
full-proof. At this point, the only thing worse than dying would
be trying and not dying. You don’t want to set yourself up for that
lifetime of mockery.

You think about leaving a note. So that people don’t assume that
you died for something silly, like exam results (which is why
you’re doing this before the results are out) or a boy or a girl.
What would you write?

I decided to die when I was writing my board exams.

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I had already begun studying for them, so I thought

I might as well see it through. But I see no point in
continuing. Life is tiring, and I’m exhausted all the
time. I don’t really enjoy it much and the cons out-
weigh the pros.

You read it and you’re pleased. This is exactly what you feel (which
is mostly nothing), and it has come out sounding right. Sounding
mature.

You end up not jumping, in the end. You decide that it is too
much of an active decision. You decide to let life play itself out.
[Maybe you were scared. You don’t want to admit to that coward-
ice.]

ggg

You’re 17 and you’re reading a chapter on torque. You’re texting

the closest thing to a best friend you have about how badly your
physics teacher had explained stuff because, honestly, you’re read-
ing the Resnick and Halliday chapter and this is so lucid. You
absent-mindedly run your fingers over the scabs on your left arm.
They’re almost… beautiful.

Your mother walks in with snacks and you pull down your sleeve
in a rush. You accidently knock something over. As your mother
picks it up, she says in the passing: Isn’t it too hot for full-sleeves?
You just shrug.

You started cutting yourself a few months ago. You hide the scars
as best as you can. Not because you’re ashamed. You’re not. You’re
rather proud, in fact. People misconstrue cutting. You don’t do it
because you want to die. You do it because you don’t. It takes the
edge off; it makes you feel in control. It gives you an alternate pain
to focus on. Sometimes, it is the only thing that can tell you that
you’re still alive.

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Once, someone who noticed the scars asked if you were suicidal.
You laughed and said, ‘Dude. I’m not stupid. Do you see how far
from the veins these cuts are? What do you think, I keep missing
the wrist accidently?’

They laughed. You laughed. You both thought it was pretty funny.

ggg

You’re 19 years old. You can’t breathe. The walls feel as if they are
closing in on you; your claustrophobia is not helping. You stare at
the ceiling, imagining it shrinking by the second. You’re hemmed
in, bricked up – all alone in a dark cell. Cabined, cribbed, confined
– the haunting line from Macbeth unfolds its full meaning for
you.You want to shout, but you don’t want to wake up the entire
house. You thought you had things under control, but you clearly
don’t.

That night, you try to break down the walls of your room with
your hand. You. Just. Want. To. Breathe. So you ram your fists
against the wall until your fists are bruised and bleeding. Without
realizing it, at some point, you start crying, then howling, scream-
ing for someone to let you out.

You just wanted to breathe.

Your mother hears you from the other room and comes running.
She is mortified. She holds you back as you struggle against her,
against the wall, against your lungs that are threatening to col-
lapse. Your mother worries that it has something to do with your
arrhythmia, but you eventually fall asleep – drained.

No one speaks about it the next day. You cross your mother in
the hallway and look her in the eye, and you’re thankful that she
doesn’t bring it up. If she did, you’d want to die.

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ggg

You’re 21 and alone in your apartment. You love living alone. The
silence that comes with it is exhilarating, because honestly, living
with people can be so trying. You love being away from voices all
the time. Until you realize that you’re not… away from voices.

The first time you start living alone, you realize two things – that
it is the life for you; and that you cannot have it. Not because you
are scared, or lonely, or incapable of handling it. But because as
the day settles and you shelf your work for tomorrow, the voices
in your head come crawling out of the woodwork. A stray whis-
per here, a din there, a hiss outside the door – you go so close, so
perilously close to losing your mind. You’ve seen the edge. And it’s
scary as hell, because through all your years of senseless emotional
shipwrecks, you had at least been sure that you were just sad, cut
off, not raving mad. Now, you’re not so sure anymore.

Reality starts to slip – a rip here, a crack there.

You open your laptop and put on an episode. You don’t even no-
tice what show it is; you just want those voices to drown. You drift
off to sleep with dialogues blaring in the background.

ggg

You’re 22 and back at home. You’re running through your contact

list to see if there’s anyone you could call up. You realize you don’t.
You have friends who are unaware of this side of you. You have
friends who think your afflictions are fabricated. Imagined, not
real. You have friends who tell you that you are wrong about your
own illness. Even worse: you have friends who don’t react well to
words like depression and bipolar. They think these are cool tags
that you’re using to one-up them. They get pissed off when you
tell them they’re wrong.

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You just don’t understand. Who would think this covetable? You
think: You want it? Take it. I’ve been trying to get rid of it all my life.
Finally, you call up the one person you think might care. You tell
them: I’ve hit a wall. You tell them: I need help. You realize this is
the first in your life you have used these words.

You hear nothing from the other end. You wonder whether this
was a mistake. ‘I don’t know what to say to you,’ the voice at the
other end murmurs. You realize this was a mistake. You were told
if you wanted help, you should ask. You took up this advice for
the first time in 22 years and your cynic was proven right.

You hang up. What else can you do?

ggg

You’re 23, walking down the street, running errands. On the

roadside, the screams of animals being dragged off to their death.
It feels like someone is running a sandpaper across your raw heart.
You want to shrink into yourself and stop existing. You’re over-
whelmed by guilt.

You’ve been vegetarian for over a year, because you started to face
the reality of slaughterhouses and you could no longer contribute
to that orgy of violence. You have become involved in animal wel-
fare. At first, it gives you hope; an added meaning to life. Until
you realize it is a cross you constantly carry with you – another
memento mori forever imprinted in your brain.

The animals you care for die around you despite your best efforts.
The puppy you nursed back to health came under a car; the lit-
ter you made a shelter for got beaten to death; the sickly kitten
you fostered died before your eyes, gasping for breath. You spiral
down; you cocoon yourself in smoke and antidepressants. You’ll
do anything to stop feeling. Eventually, you do stop feeling.

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 I FOUND MORE ROPE

A shrink tells you that you have too much empathy. People find it
funny, because you are kind of stand-offish and unfriendly. How
does that work?

You don’t really care how it works. You realize too late that you’ve
opened a floodgate that you can’t close. You try to undo your
empathy without letting go of your ideology. It’s an odd thing to
attempt. But you need it to carry on.

ggg

You’re a few months past your 23rd birthday. Bleary-eyed. You

didn’t sleep a wink last night. You’ve been in a ‘funk’ again. That’s
what you call it. You are used to it by now. It comes and goes in
waves. Last week was good to you; you had felt on top of the
world. Then, you felt it coming – the funk.

You let it happen then. You know the motions by now. Sometimes
you joke about walking before a speeding truck. More than some-
times. You joke about it often. So much so that it has become a
meaningful word in conversations with a few people. Life is miser-
able. I wish I’d met my truck already.

You speak about meeting speeding trucks as if they were knights

in shining armours.

Maybe they are.

ggg

You’re 24. It’s lunch time at work place. There’s a lump in your
throat – a choking feeling. The people, small talk – they bother
you. The light bothers you. You recall the dread you feel going in
to work every morning. It takes every ounce of strength you have
to drag yourself out of bed and put yourself through these social
situations day in and day out.
You acknowledge it; this anxiety that people trigger in

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you.

You like the work. You just wish people would leave you alone.
You try to figure out a way to have it happen without coming
across as rude or shy. You’re neither. You think it best to be up-
front. When they insist you accompany them for lunch, you tell
them – Introvert with a severe case of social anxiety.

They smile and nod. Too many voices pipe up: I get that! I am too!
Then they ask you again the next day and the next. Eventually,
they wear you down and you go with them. You smile and nod
through banal discussions and grin through conversations that
you don’t care about.

The lump in your throat grows. You get used to it.

One day, you quit. You can’t do this to yourself.

ggg

You can feel another funk en route. It has been a particularly tiring
day. You can feel the static noise in your head build up. It happens
– it’s one of the signs. At the onset, you’re irritable. There’s that
familiar white noise jamming your thoughts. Disrupting clarity.
Then you’re miserable. Then – you’re numb, scrapped out. As if
someone scooped you out and left you hollow, like the Halloween
pumpkin.
You have words bottlenecked in your throat. You want
to catch hold of somebody. You want to speak, yell. To them, at
them. But you get tired at the first word. You just don’t have it in
you to form sentences out of your thoughts. Eventually, every at-
tempt to communicate becomes a sigh deeper than the last. Until
you’re just a spectre among the living – always there but not quite.
Sometimes, you find a bottle and drown everything in it. Some-
times, you drown yourself in work. Sometimes, you take to a
punching bag. Sometimes, if you can afford it, you sleep through

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 I FOUND MORE ROPE

it. Whatever you do, you always come out on top.

That’s when it hits you.

You tried therapy (it was shoddy); you tried prescribed medica-
tion (it just numbed you out). Nothing really worked.

And yet, for 24 years, you’ve been coming out on top, sometimes
with a little help from a few unlikely friends you’ve found on the
way. Every wave that hits feels worse than the last, but you come
out at the other end. Intact; more or less. Every time you think it’s
the end of the rope, you find a little bit more of it.

You realize: the rope is longer

than you had imagined.

You make peace with this

madness you live with. You
accept the high-functioning
nature of your afflictions.
You accept that you’re too
mad for most of the world
but never quite mad enough
for people’s sympathies. You
accept that your eccentricities
will always either be glorified
or derided. You accept that
justifying yourself is tiring,
pointless, and never enough.
You accept all that you are, and all the ripples it creates in the pool
of people around you. Perhaps, you prune that pool a little. You
pull the plug on the overwhelming assault on your senses – social
media, people who demand explanations for your existence.

You reconcile to reality – the one that is yours. Some days will
be crippling. But you’ll pull through… until you won’t. Perhaps

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you’ll give treatment another chance.

But that uncertainty is irrelevant.

You’ll deal with it, one ‘funk’ at a time.

ggg

Several years ago, I had read a piece of fiction that ended in the
following words:
‘Apparently, it’s a comedy… but I’ll probably cry.’

The line, while originally written in a very different context, sums

up perfectly the erratic, unprompted nature of mental-health dis-
orders. Even so, understanding this volatility itself allows for a
much-needed certainty.

Until a certain age, I had been a surprisingly gregarious, happy

kid. It is only when I recall that jovial, eager child that I under-
stand the insidious, uncontrollable and pathological nature of
mental illness. Because I grew up to be a generally sceptical per-
son, not given to a rosy outlook on things – a worldview, not a
condition – for the longest time, my episodes of unfounded irrita-
bility, abysmal gloom, indescribable apathy, and suicidal tenden-
cies seemed to me an extension of my personality, legitimate in
the face of reality. The emotional highs – equally arbitrary – were
in fact more confounding. I justified it as ‘just who I am’.

By the time I started to come to terms with the idea that there was
perhaps more to me than ‘just me’, an idea validated when other
symptoms began to surface, I had been living with my condition
– undiagnosed, untreated, repressed – for several damning years.
So much so that I was fiercely protective of this disease that was
eating me alive. To this date, I cannot imagine who I might have
been if things were different.

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 I FOUND MORE ROPE

Unfortunately for me, when I did seek help, I was met with
pompous professionals and careless prescriptions, all of which
only made me retreat with renewed stubbornness. Eventually, I
learned ways to cope with my afflictions on my own, in whatever
ways I could fathom. Often, that is enough, even if my ‘quality
of life’ is debatable. Sometimes, however, it is not. And sooner or
later, I understand that I must reach out again, even if that means
putting my trust in a system that has failed me before. Regardless,
what remains constant is an unceasing effort to carry on.

In over 15 years of my association with my invisible affliction in

its various forms – sometimes triggered, mostly not – reconcilia-
tion has been my foremost ally.

That, and a visceral desire to survive. 

Ateendriya, who read English Liter-

ature and Linguistics at Delhi Uni-
versity, works in publishing. Her
short story, “The Final Cadenza”,
won the first prize in a Juggernaut
short story contest in 2016.

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 80
ALONG THE SHADOW LINE
Pallav Bonerjee

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 A
young woman, a trainee in a big corporate house, said
something during the course of her treatment that gave
me an insight into the general perception of mental health
and illness and the issues it encompasses. During a counselling
session, she told me that the company she worked for had an in-
house mental-health professional available to the employees for
consultations. Hearing this, I was a little surprised. ‘Then why do
you come to me?’ I asked her. ‘You could very well consult the
doctor in your office.’
Noticing my puzzlement, the corporate trainee smiled
and went on to narrate something that had elements of Franz
Kafka’s The Trial in it. A senior executive of her company had of-
ten consulted the psychologist in the office. He was seen walking
into the doctor’s clinic quite regularly. His performance appraisal
by the HR for that year was damning, and he was fired on the
basis of that. The management apparently thought that since the
executive was so stressed out on his personal front, he would not
be able to meet the targets set for him.
Hearing this, I was both shocked and amused. Some
amount of stress or anxiety surely would not have stood in the
way of the executive’s satisfactory performance? It became equally
clear to me why this young woman was consulting me instead of
the doctor at her workplace. My client could perhaps guess the
question bothering me. Since that incident, she said, people in her
organization had chosen not to consult the in-house psychologist
anymore. They looked elsewhere for help. The well-publicized ini-

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tiative by the corporates and the MNCs to promote mental health

of their employees, I now knew, was nothing more than tokenism.

The stigma attached to mental illnesses has perhaps something

to do with our social psyche. There is a certain amount of mor-
bidity associated with mental health in our culture. This inhibits
a person needing medical support from approaching a doctor or
talking about his problem. The old idea of a lunatic asylum as a
refuge for the insane still evokes powerful negative emotions and
images, conveying a sense of dread and loss. The notion that it is a
dungeon from where no inmate returns still seems valid. Despite
the sweeping changes and technological breakthroughs, some-
how, the image has stuck with us. Most people find it difficult to
look at it from any other perspective, even though we no longer
use terms like ‘asylum’, ‘insane’, and ‘inmate’, at least within pro-
gressive medical communities. That this horrid image persists is
perhaps not without some basis.
An important fact I came across during my post-gradu-
ate training has stayed with me. Mostly, the psychiatry depart-
ments in general hospitals are situated in very inconspicuous and
obscure corners of the building complex, like the basement or
the rear. The reason? To keep this malady and the abnormal air
around it as far away as possible from public attention. It seems
the hospital itself is ashamed of having such a department, an em-
barrassment that needs to be pushed behind, as if the psychiatric
ward were an indecency the authorities are trying their best to
hide. In fact, some are located right beside the forbidding morgue
with the seemingly bizarre logic that the screaming mental-health
patients will not be able to vitiate the hospital atmosphere from
the back of the beyond.
The concept of treatment for people suffering from men-
tal illnesses has undergone a sea change, thanks to the advent of
modern drugs and research on effective psychotherapies and other
non-pharmacological therapies, which are accessible and afford-
able in most healthcare setups in the cities today. Unfortunately,
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people are very quick to judge an individual as mentally unstable

if they happen to mention that they are seeking treatment or help
for their emotional issues. What baffles me is the lack of under-
standing among a rather large number of educated people that
not everyone seeking such help actually suffers from a severe men-
tal illness or needs immediate hospitalization. Everybody seeking
psychiatric treatment, we need to understand, may not be a threat
to themselves or others. Such incorrect perceptions promote fear
and ignorance and only add to the barriers of seeking help for
people who genuinely need it.

Interestingly, the greatest and the most profound learning for me,
as a clinical psychologist with some years of training and practice,
was not the mere knowledge of the different forms of potentially
debilitating mental illnesses and their treatment approaches but
the simple fact that all of us are vulnerable to it. This realization
itself was liberating for me. It made that bold line dividing the
normal us and abnormal them disappear for good. It helped me see
that I was not immune to it, nor was anyone else around me. It
suddenly put everyone on an even keel, and the matter ultimately
boiled down to who was sitting on which side of the table on a
given day. Unfortunately, many of us may not be able to appreci-
ate this fact entirely, at least not yet.
A tradition that has always hero-worshipped the brave
warrior riding a white horse may not offer enough space to those
suffering from mental illnesses. Persisting prejudices lead to dis-
crimination and isolation of such people, adding to our fears and
acting as a major barrier to seeking help. For many people, it is
unacceptable to seek treatment for anxiety, depression, and a host
of other common mental illnesses – first for the refusal to accept
that these are ailments worth treating and then the fear of be-
ing exposed, isolated from their families and communities. The
lurking apprehension of being cast aside and ostracized by those
around stands in their way of reaching out to the doctor.
In the absence of adequate information about these con-
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ditions, dark beliefs and superstitions sneak in. Our culture leaves
spaces for prejudices to grow. There is a notion that mental ill-
nesses are a consequence of bad deeds in the previous life, that
they are an expression of demonic possessions and, therefore,
need a ghostbuster to exorcise the evil inside the mind. The huge-
ly popular movie The Exorcist brings the trauma and tribulations
of the possessed to a superb effect. Many mentally ill people go
to faith healers and herbal doctors for help, without understand-
ing that their ailment is a simple case of depression and treatable
with some medication and therapy. In the popular perception,
the mental hospital is the kind of blind alley from where coming
back is not possible. Families, therefore, take the mentally ill to a
fakir, pir, shaman, or Baba, claiming that the affected person has
come under some evil shadow. In a conventional society, the fear
of being stigmatized as mentally ill is real. For such people, the
mental hospital is the last option.
I remember my internship in a government-run mental
hospital in Kolkata in 2006. The building was in shambles. But
the thing to note was they had a whole unit to take care of pa-
tients left behind by their families; abandoned, nobody would
take them home, even if they recovered and became normal again.
Their families had simply given up on the patients and wanted
an easy escape when things had become unmanageable at home.
In many cases, they gave wrong addresses and phone numbers so
the hospital would not be able to get in touch with them again.
Such patients became the sole responsibility of the hospital from
then on. It was a very convenient way for the families to wash
their hands of the patient, who perhaps needed the most care and
support from the entire family. It was a classic example of institu-
tionalization being forced on an individual not by the state, but
by the family – a consequence of both indifference and ignorance.
In many cases, the families seemed to believe that the afflicted
member was only pretending or merely acting in strange ways
to avoid responsibilities and duties. Thus, their response to such
suffering was often harsh and at times even violent. They felt that
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being strict and threatening would pull the person out of their
condition. We tried to explain to them that if anything, such re-
sponses would only aggravate the patient’s stress, something that
should be avoided at all costs.

The mental healthcare community now seems to be learning from

past mistakes. Both private and government mental hospitals to-
day insist that one family member stay with the patient round the
clock, thereby ensuring that the patient does not end up simply
getting dumped by their kin. No patient, according to law, can be
kept in a mental hospital for more than 90 days at a stretch and
must be sent home after that period.
The need of the hour is to look at mental health from a
fresh perspective, not through the traditional prism that offered
only a black-and-white approach. As a culture, we need to learn to
be more tolerant, accommodating diversity of human situations,
rather than getting intimidated by those who fail to conform to
the mainstream. Seeking help should be seen as a sign of strength
rather than weakness. The myths surrounding mental illnesses
and their probable causes need to be busted as much in the cities
as in small towns and rural areas. Ailments like depression, anxi-
ety disorder, and hypertension have been largely caused by urban-
ization and social disorders. To cope with this new surge, treat-
ment facilities need to be made available everywhere. Community
outreach programmes can take mental healthcare to the remote
places where people require professional support. Our National
and District Mental Health Programme is one such initiative in
the right direction.

The concept of psychotherapy or ‘talk-therapy’ is still a little ab-

struse as most people expect to leave a doctor’s clinic armed with
a prescription for medicines that should cure them of their ail-
ment in a couple of days, almost working like an antibiotic or
a painkiller. Unfortunately, with mental-health challenges, the
treatment approach is different. A psychiatrist is a doctor trained
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in medicine, who can diagnose the condition on the basis of the

symptom-profile and prescribe medicines as per standard guide-
lines in order to manage the symptoms and reduce them over
time.
A psychologist or psychotherapist, on the other hand, is
not trained in pharmacology at all and, thus, will not focus on
symptom reduction using medicines. They may instead focus on
the possible reasons for the development and progression of the

clinical symptoms, and try to help the affected person understand

the motivations and reasons behind the behaviours that are mal-
adaptive or dysfunctional. It works as a system of self-discovery,
where the patients learn to understand themselves more objec-
tively, get in touch with their emotions, and acquire skills to help
themselves deal with the stress factors in a better way. On the
patient’s part, it requires the ability to trust someone and commu-
nicate openly within a safe emotional space and be open to receive
feedback to help build insight. The effectiveness of psychotherapy
also depends on the strength of the relationship between the ther-
apist and the patient, as well as on the trustworthiness and level of
empathy that the therapist is effectively able to employ; and these
take time. Both psychiatrists and psychologists are mental-health
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 ALONG THE SHADOW LINE

professionals and have their distinct approaches, but they work

in a complementary fashion with the singular aim of improving
the patient’s mental health. Many patients need both profession-
als working in tandem, while there are others who just need one
of them, depending on the nature and severity of their specif-
ic condition. And then, there are career counsellors and school
counsellors, who are also mental-health professionals who work
with students and children by networking closely with teachers
and parents.

Mental health in India receives a pittance from the health-bud-

get allocation, where the priority lies in combating infectious and
communicable diseases followed by maternal and child health
issues. Subsequently, the spectrum of non-communicable diseas-
es like cancer, diabetes, hypertension and heart diseases steal the
show with their health impact and disease burden. Mental health
and disability is largely invisible to the policymakers and, thus,
has to make do with the leftovers on an annual basis.
The World Health Organisation (WHO) published a re-
port in February revealing that clinical depression is the largest
cause of mental and physical disability worldwide. They reported
that, as per global estimates, one in every 20 people suffers from
it, cutting across socio-demographic and economic factors. More-
over, anxiety disorders also seem to be present in a large number
of people around the world. And then, there are those who suffer
from both depression and anxiety. These numbers are only going
to grow with time, if people in general do not choose to address
them early on in their lives and seek treatment.
Sadly, in India we have a very small community of men-
tal-health professionals to cater to our ever-growing population.
There are less than five thousand practising psychiatrists and not
even a thousand trained clinical psychologists. Moreover, most
of this small fraternity of professionals and experts are in the cit-
ies due to better living standards and growth opportunities. This
leaves the population outside the cities to rely on alternatives –
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more dubious than dependable. Faith healers and shamans thus

end up doing brisk business in the absence of qualified doctors.
Many patients and their hapless family members have narrated
horrific stories of abuse and human rights violation that they un-
derwent in the garb of treatment from some such voodoo healers
who would mysteriously disappear from the scene after a few ses-
sions, swindling them out of money and valuables.
The most potent reason that inhibits people from seeking
help, however, lies in the fact that a diagnosis of mental illness
may take away from a person the right of self-determination. Sim-
ply put, it means that those diagnosed with severe mental illness
will face questions about their sense of reality and be suspected
of poor judgment and impaired insight into their own situations.
Therefore, they may not be allowed to make any major financial
or legal decisions concerning their own lives. Someone else from
the family is entrusted with those rights and responsibilities. This
is done with the assumption that the family member who is held
responsible for the patient should ideally have their best interest
in mind and act accordingly. However, there are plenty of cases
where this assumption has been misplaced. Family members in
complicity with shrewd lawyers have used such medical diagnoses
in court to usurp property rights and inheritances of innocent
and helpless patients, thereby throwing them out in the street. No
prizes for guessing that the women suffering such atrocities far
outnumber men, even in the metro cities. This situation has trig-
gered an endless debate among the stakeholders, but such debates
have always remained inconclusive.
The Aamir Khan movie, Taare Zameen Par, focused on
the issue of learning disabilities (dyslexia) in children. This term
was not so familiar until the film put it right at the centre of every
dinner table in the country. Suddenly, everyone started talking
about it. Parents were keen to get their children evaluated, espe-
cially if they were not doing very well academically. Schools want-
ed to employ trained professionals to help the teachers identify
children with special needs and help them re-integrate into the
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process of learning with extra support. There were interviews, talk

shows and panel discussions on television. Mental-health experts
everywhere in India celebrated the success of the movie. This was
a major achievement for us – the fact that people were talking
about it openly and without inhibition. This was indeed progress
in the real sense.
There has been a string of other films since, exploring the
unchartered territory of mental health and illness. Dear Zindagi is
perhaps the latest one riding the new wave of meaningful cinema.
It certainly seems to be making the right kind of impact on youth,
who now probably feel that it is okay to reach out to someone
in times of need beyond their parents. Moreover, many celeb-
rities have also started openly talking about their own struggles
with various mental-health and emotional issues. This has further
strengthened the movement against stigma about mental health
and given immense support to the silent sufferers to come out and
combat such issues fearlessly.

Today, the larger questions that we need to ask ourselves and oth-
ers are how to manage and treat mental-health disorders and re-
lated illnesses. What are the different ways to prevent them? The
breakdown of the joint-family setups has resulted in nuclear fami-
lies, particularly in the urban areas. People are relocating to newer
places in search of opportunities, thereby moving away from their
families and close friends, who are usually seen as the primary
safety net during stressful life circumstances. The pace of middle-
class life has hastened, and therefore, there is not enough time for
reconnecting and investing in meaningful relationships or even
nurturing the existing ones. Facebook updates and Twitter feeds
have become the only way to keep track of what is going on in the
lives of others around us. Instant gratification is the order of the
day. Technology does seem to be taking over our lives in a major
way. The accidental loss of a mobile seemed to have affected one
of my patients much more than the demise of a grandparent. I
guess it’s time for us to pause and think about the priorities in
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our lives. The mindless daily chase needs to be halted every once
in a while for introspection, to see whether we really are mov-
ing forward in our respective lives and in which direction, and
make efforts to change it if necessary. Some are adept at doing it
by themselves, while others may need help. Many mental-health
professionals I know themselves seek therapy from their peers, for
the very same reason. There is no shame in that.
A picture from a comic book has stayed with me for a
while now, and I’ll share it here. It has the picture of the famous
cartoon character Dennis the Menace riding a wooden horse furi-
ously. Below it is written: ‘I love riding my horse because it is fun,
unfortunately it gets you nowhere.’
It sets me thinking. 

Pallav Bonerjee is a Consultant

Clinical Psychologist at Vimhans
Hospital, New Delhi. He has a
Master’s degree in Applied Psy-
chology from Calcutta University
and an MPhil in Clinical Psychol-
ogy from the Institute of Human
Behaviour & Allied Sciences, Del-
hi.

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 PHOTO ESSAY
IMAGES OF AN INVISIBLE ILLNESS

I
t is almost impossible to capture the images of mental illness on
camera. It is something not really visible. A severe breakdown may
perhaps leave a trace, but not depression, a sadness that no one
recognizes as a malady. And there are an endless number of such
invisible maladies.
Our first thought was to drop this regular section where we
carry pictures in keeping with the theme of the number. No doctor
can help you, one of them explained, for confidentiality is the basis
on which their relationship with a patient grows. The hospitals would
not even hear of such an idea. And at the same time, the visuals or
the sketches we carry to give more layers to the chosen theme are
something the reader has become familiar with, grown fond of. So, we
found a way out.
We brought together a few who, at various stages in their
lives, have been treated for depression, bipolarity, psychosis and so
on. They did not actually pose for the camera; they let the photogra-
phers do their work. They were conscious that their private moments
were being clicked away.
In some cases, it is the lensman’s perception; they caught
someone unaware; perhaps they saw a glimpse of the illness in a
moment. You need to see the images from their prism, for there is
no way of confirming, vouching for the images. Look at them closely
– those anguished faces, faraway looks, their puzzlement with the
world around. Let them be etched on your memory. They live among
us. Soon, you will see more of them at bus stands, at the workplace,
or on the balcony right across yours, looking into a distance we cannot
measure.
Sangeeta Purkayastha

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 BEHIND THE MASK OF NORMALITY 109
Ira Pundeer

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 A
preschool child, ready in my neatly ironed uniform, I
could not leave home in the morning without howling for
my mother. That is one of my earliest memories. I remem-
ber exactly the thing about school that scared me – the din of the
children playing among themselves; all of them played but not
me. I would block my ears to keep the noise out; the screeching
of the school bell drove me nuts. I used to flinch at the thought
of physical touch with other children and adults. I remember sob-
bing inconsolably at being forced to hold hands with a classmate.
To my utter horror, my teacher retaliated by openly deriding me
for being a ‘snob’ and benevolently whacking some ‘sense’ into my
big head. Naturally, I became a target for bullies. I was tormented
for weeks by a girl who would quietly pinch me from under the
desk for a little pleasure. By then, however, I had grown remark-
ably well in suppressing my outrage and saving the sobs for later.
I was not going to be the one to complain.
School was no longer the place to learn and express myself. The
few hours I had to spend in school were torture, enough to set
me off in a flurry of anxiety for the rest of the day. The struggle
to make it through drained me out and left me irritated. I was
one stressed-out kid. I started dreading school, begging my mom
to let me stay at home. Everyone thought I was lazy. But what-
ever said and done, I desperately wanted to blend in, not stand
out, just so they would leave me alone. To avoid the risk of being
misunderstood and punished, my five-year-old self was forced to
bottle it up and learn to ‘behave’. And I soon became wonderfully
adept at doing just that.
At the end of the year, I managed to pass with decent marks. My
teacher signed off my progress report with a few remarks on how

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 BEHIND THE MASK OF NORMALITY

I was painfully shy and constantly nervous, but nevertheless very

‘well-behaved’. My parents sighed in relief. They could probably
have paraded me as a triumph of disciplining in Indian schools.
These days, I joke about it by saying that it was a traumatic start
to my lengthy acting career.
ggg

On a summer night in Delhi in 2009, I sat on the floor of my bath-

room, exhausted and burned out. I could feel a constant stabbing
at the back of my head, which made me writhe in silent agony.
I lashed out with my fists, attempting to dent the cool off-white
tiles. The self-stimulated physical anguish was distracting, to say
the least. Screaming would have been less painful, the familiar
flapping of the hands would have been the most comforting, but
I would not have allowed myself to regress. Moreover, I did not
wish to wake up my roommate who was sleeping in the room
outside. What would I say to her? How would I explain that I
was not trying to hurt myself, just looking for an outlet? I did not
have the words to explain what I was going through. Did I even
understand what was happening? Once you show the propensity
to self-injury, nothing you can say will let them trust you with
your own body. Were they going to put me in a hospital? Would
I end up institutionalized like my brother? It was a Monday and
I had the whole of the week ahead of me, with no idea how I was
going to make it through.
I managed to recover in a few days and continued with my classes
as usual. But it turned out to be the year of doom as the spectre
of relentless exhaustion and anxiety followed me wherever I went,
leaving me tongue-tied, aloof, and constantly paranoid. That
summer, I spent far too many nights on the cool, pale tiles of my
bathroom.
ggg

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‘Don’t be too harsh on yourself.’

When everything else had failed, I found my 17-year-old self in
the large and airy room of the private clinic of a renowned psychi-
atrist in my hometown.
Ever since my brother’s diagnosis of autism more than a decade
ago, this man had been godsend to our family, the interpreter of
its maladies. That was the reason my mother had dragged me to
his clinic when the chips were really down. In a nutshell, here’s
what had happened: Being home for the autumn break from my
first year of graduation in Delhi, I had told my parents about my
decision to not go back. I told them that I had made a mistake
in choosing my subject. I felt like a misfit. I did not tell them
about the cool bathroom tiles and the muffled sobbing at night. I
did not have the courage to suggest that I perhaps need help. My
mother, who had always been particularly sensitive to my pain,
detected some kind of a warning signal in my desperate words
and managed to convince me to see the psychiatrist. This, she
thought, would help me start a conversation to unburden myself.
Even though I should have been comfortable talking about my
emotional breakdown to a professional who was there to help, I
could not keep away the nagging suspicion that I would sound
like a complete wimp. I loathed the idea of someone coming to
know about my vulnerabilities. Big girls, after all, don’t cry.
Going through the session with the psychiatrist, I wondered if the
good doctor was being sarcastic, a little dismissive hearing my tale
of woes. By any chance, did he get it? He wore an impenetrable
smile all over his face, like a face mask. Do all doctors wear masks?
I toyed with the question inside my mind. I had a feeling that he
was perhaps being condescending to me.
As if he got a hint of what was going on in my mind, the
doc smiled genially. ‘Stop worrying, you’re doing just fine.’

ggg

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 BEHIND THE MASK OF NORMALITY

In the summer of 2009, I moved into a paying-guest accommo-

dation on North Campus, Delhi University, to pursue a graduate
degree for the next three years. It was a change I had really want-
ed, but for which perhaps I had not prepared myself well enough.
Being in the constant company of people who did not know me
well was debilitating in that I could not be myself in front of
them. I had always known that flapping hands was considered
to be a sign of stress and tension, and a regressive habit too. This
habit from childhood, I had learnt, one must give up. No one had
ever told me that this was my way of stimming, which is a coping
mechanism that people on the autism spectrum use in order to
counter stress. It was meant to be pleasurable and not something
to be detested and repressed. Being ignorant about my own needs,
I tried to suppress the one thing that allowed me to put up with
the rigours of everyday life.
The year I was born, my brother was diagnosed with autism. My
parents were naturally shocked and worried about raising a child
with this life-long condition that they had no clue about. These
were the early 1990s, mind you, and research on mental-health
issues was not a just click away on the Internet.
For a very long time, my parents dismissed my habit of stimming
and repeating words – echolalia – as something I did mimicking
my brother. After all, young children do pick up habits from their
elder siblings. They thought it was just a phase that would pass
eventually. And pass it did, at least in the public eye. As I grew
older, I learnt to camouflage my stimming into more inconspic-
uous and loud expressions. Growing up in a household that was
so used to my brother’s stimming, my minor deviant behaviour
never stood out as being particularly odd. What was there to wor-
ry about? I was not loud and aggressive like my brother. I was just
the typical child, though a little shy, awkward, and anxious.
ggg

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Despite the egalitarian impulse to think of everyone being born

not just as equal but much the same, it is quite obvious that peo-
ple’s brains vary. In 2006, a London orchestra cellist in her late
20s, having lived through years of personal suffering and alien-
ation, stood on the edge of a damning emotional crisis when she
stumbled upon a piece of information on Asperger’s Syndrome.
The streak of misdiagnoses at the hands of psychologists forced
her to embark on her own research. It turned out that she had
been suffering not because of a pathological condition but be-
cause of her specific neurological type. But the correct diagnosis
remained elusive as she had learnt to mask many of her textbook
autistic traits. Exhausted by being repeatedly turned away by doc-
tors and psychologists, she armed herself with all the knowledge
she had acquired through the books, articles and papers she had
read on the subject, and confronted her doctor with the appeal to
listen to her. Her appeals were finally taken seriously and she got
her diagnosis in 2009.
Today, Elisabeth Wiklander is a proud advocate of neurodiversity.
I came upon Wiklander’s story long after the episode in 2009, but
it did put things in perspective for me – although very late. The
realisation came as a relief, as it helped put me in my context.
Growing up, at different times in my life, I identified as a non-au-
tistic child to an autistic sibling, a non-bipolar granddaughter to a
bipolar grandmother, a permanently anxious girlfriend to a some-
times anxious partner. My difficulties were, however, not signifi-
cant enough to meet any diagnostic criteria, and for much of my
life I did not need extra support – or so I thought.
And this is where it gets a bit tricky. You see, there is no way to
know what might have been if things had been different. What
I can vouch for is the fact that had I known then what I know
now, I certainly would have taken into account what my body and
brain were trying to tell me over the years about how I work and
how I can best look after myself.

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 BEHIND THE MASK OF NORMALITY

I have known for years that I am prone to depression. I can easily

identify at least two lengthy periods in my life when depression
had impacted my ability to function normally. There are far too
many instances when my default position of lurking on the pe-
riphery of depression affected my performance in one way or the
other.
Sensory overload has also been a part of my life all the time. I
need regular downtime so I do not feel overwhelmed by sound
in particular, and by touch and light to a slightly lesser extent.
Having an exceptionally busy brain also means that I morbidly
fixate on things. It is very easy for me to get caught up with work
or a special interest and forget having meals or lose count of ap-
pointments.
I may appear a confident and outgoing person, but I am not really
so. I have to routinely rely on well-practiced scripts to get through
social situations. I disappear and take regular timeouts from social
media interactions to look after myself. A day that involves heavy
socializing will need to be followed by a few days’ layoff – a quiet
time at home to avoid the state of overwhelm that might trigger
depression. That does not mean I do not enjoy time spent with
friends and family. I absolutely do! It’s just that it comes at a cost.
When I started reading up more on neurodiversity, before long,
I found the neurodiversity paradigm. According to the autistic
activist Nick Walker, neurodiversity is ‘the diversity of human
brains and minds – the infinite variation in neurocognitive func-
tioning within our species.’ The neurodiversity paradigm holds
that autism and other neurocognitive variants are an innate part
of the natural spectrum of human biodiversity, like variations in
ethnicity or sexual orientation (which have also been pathologized
in the past). It underlines the fact that no one type of brain is right
or wrong, further rejecting the idea that there must be something
‘wrong’ with neurodivergent individuals because of the way their
brains work. Therefore, non-consensual attempts made to ‘cure’
or ‘fix’ neurodivergent individuals, in order to make them fall in

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line with the conventional ways of society, are not only antipa-
thetic but detrimental to their well-being.
ggg

It was not until a year ago that I realized that what I had gone
through in the summer of 2009 was properly called an autistic
burnout. Formalized research on autistic burnouts amounts to
precious little, but once I set out to find answers to my questions,
I found a thriving community of autistic adults and advocates
who shared their experiences on the Internet. Many of these peo-
ple were diagnosed in adulthood, and many of them were earli-
er misdiagnosed for co-morbid issues that exist alongside autism
such as depression, bipolar disorder, and schizophrenia.
Autistic burnout is kind of tricky to define as it unfolds differ-
ently for everyone. What we know is that one gets to the point
of a burnout by spending a lot of energy over a long period of
time in reminding one’s body and mind, or both, to ‘pass’ as a
neurotypical (referring to
individuals who have a
style of neurocognitive
functioning that conforms
to the norms of society).
If you follow closely, you
will find a number of cues
setting the stage for an im-
pending burnout. Among
the usual suspects would
be a change in the routine
that was particularly hard
to cope with. As a conse-
quence, there would be
signs of stress, meltdowns,
a rise in physical and men-
tal demands. These things
pile up, leading up to the
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 BEHIND THE MASK OF NORMALITY

burnout. In a way, it is your brain telling you that it is exhausted

and you can’t push yourself anymore.
For most neurodivergent people who are adept at passing as neu-
rotypicals, when they experience autistic burnout, they tend to
get confused and panicked because they suddenly fear they are
becoming ‘more autistic’. Burnouts, however, do not suggest a
regression. Carol Greenburg, a special education advocate and the
editor of the book and the blog Thinking Person’s Guide to Autism,
maintains that most neurodivergents who routinely ‘pass’ have not
actually lost their autism, but have picked up coping mechanisms
that allow them to ‘simulate a non-autistic persona’. Greenburg
also waves a red flag as she adds, ‘All autistics are forced into a
position where we have to use that energy to create an appearance
of normalcy rather than to actually function.’
While an autistic burnout among children will be marked by an
increase in the instances of meltdowns, in autistic adults, a burn-
out will take the form of lack of motivation. All of a sudden, it
will seem like you can no longer continue with college and work
and you can barely take care of yourself. Even neurotypical people
go through periods of time when they are burned out. So they
take a break and maybe go on a vacation, or they lighten their
workload. For autistic people, a burnout permeates every area
of their lives, including things like remembering to eat or take a
shower. It happens to a lot of young adults and teenagers when
they are transitioning from school to college or starting with a
new job. Ignorance prevails at most institutions and workplaces,
leaving them ill-equipped to meet the unique needs of neurodi-
vergent individuals. Some of us are expected to keep a job while
continuing to pass as neurotypicals due to society’s ableist notions
of how an adult should behave. A burnout can take place at any
stage in an autistic person’s life because of the expectation to look
neurotypical, to not stim, to be as non-autistic as possible. When
it comes down to it, pretending to be something that neurologi-
cally you are not is exhausting.

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The most difficult thing about burnout, to my mind, is the self-

doubt and frustration that comes from not being able to do the
things we used to be able to do (or at least, not in the same way).
For autistic people who have thus far been very independent and
self-reliant, it might even be embarrassing to go through a burn-
out, and they may not want to tell people about it. This could
backfire, because when you are going through a burnout, you
need all the help that you can get.
A pioneer in the field of child psychology, DW Winnicott, wrote
that when children grow up in environments where it’s unsafe
to express their true selves, they develop ‘false selves’ that are in
closer compliance with what’s demanded of them. While catering
to societal expectations for years, they may forget that the false
self is a mask by the time they reach adulthood. The mask stays
on, however badly it might fit, while the true self remains buried.
Compliance, he adds, is a ‘sick basis for life’.
For me, I gave up being harsh on myself the day I started under-
standing and accepting myself the way I was. In a society that
values compliance way too much, for most of us hanging onto the
fringes of various neurological conditions, wonderfully adept at
‘passing as a neurotypical’, even if we are not formally diagnosed,
coming to terms with the fact that our minds work in non-typical
ways can be a powerful realization and an important milestone in
advocating for our specific needs. 

A freelance editor and researcher, Ira

Pundeer writes on invisible disabili-
ties. She lives in Delhi.

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 LIVING WITH SCARS 119
Nikita Sailesh

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 W
e’re all survivors, with scars from different battles.
Maybe yours run deeper, or perhaps they don’t. It
doesn’t really matter. Scars aren’t medals. They’re just
reminders. Reminders of your battles, my battles. They’re not a
yardstick to draw comparisons of strength, nor do they speak of
your valour. They’re just a part of you, like any other.

But don’t be mistaken. I don’t mean to trivialize them – your scars

or mine. For all their ugliness, they are beautiful. They are there
because you went through something. It’s just that ‘something’
that interests me more than the scars themselves. I don’t want to
admire your scars from a distance; I want to know how you got
them in the first place.
I hope one day you will share this with me. Like I am
sharing with you how I got mine. Maybe we could sit together,
sipping cups of tea, tipping off ash from our cigarettes, and laugh
about them – our battles.

I suppose the signs were there from an early age. I was an un-
usual child, who would keep to herself mostly. I didn’t have that
many friends at school. I was an atypically imaginative child, who
would make up stories to amuse herself. I guess everyone thought
I was an introvert. The anomalous spells and the bouts of sadness
hadn’t revealed their presence up until I was older.
I was 18 when I had my first brush with the debilitating
‘disease’ called depression. I had just written my board exams and

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was soon to join college. To be honest, I didn’t have anything to

be sad or depressed about. But this is the funny part about depres-
sion. It doesn’t knock on your door, and ask you for permission
to step inside. It doesn’t give you any reasons for its sudden visita-
tion. Like an unwelcome guest who will force his way through the
gates of your mind, it will come down on you suddenly, forcefully
and will never give you a departure date.
I remember how my life had turned upside down for me.
How I was scared all the time, too scared to enter a classroom
full of students, too scared to talk to anyone, too shaky to even
make eye contact. I was anxious all the time, about nothing and
everything. I had lost interest in eating, and sleep was hard to
come by. I’d lie awake all night, engulfed by fear, too nervous to
face the next day. When the next day did come, I was too afraid
to step out of my house. Never before had I felt the utter helpless-
ness that I was feeling then. I was consumed with despair and a
certain despondency that is hard to comprehend, and even harder
to convey. I didn’t know what to do. Luckily, my parents noticed
that something wasn’t right and sought help right away from a
trusted doctor.

Dr K agreed to see me. I went with my parents, and as soon as I

sat on the chair in front of him, my eyes welled up and the tears
didn’t stop. He smiled and politely waited till I was done. Then he
simply said, ‘You’re depressed. And guess what? Depression is like
a flu. It’s common. And you have to take medication for it, just
like you do for the flu.’
Dr. K had so simply broken down the big fat monster that
depression was for me, into something as common, as trivial as
a flu. Fortunately, I bought his explanation and views. Unfortu-
nately, the world does not hold the same view.

You see, the world was never the same for me once I was diag-
nosed with depression. Living with depression is like living with
a cruel stepmother who is out to destroy you, to break you. I
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struggled for years, with

bouts of anxiety and
immense sadness that
would go on for months
with no sign of clearing
out. There were periods
of normalcy, when I re-
gained my confidence,
but for the most part, I
was constantly afraid of
the next time the un-
welcome visitor would
come by. Those months
of being depressed were
the worst, not only be-
cause they would take
away all the happiness
and joy I had, but because they turned me into someone com-
pletely different – a total nervous wreck who could not get any-
thing done, talk to people, or even function normally.
I still remember the time when my apparent breakdown
had just begun. I was new to a job that I’d dreamt of for a long
time. It was exhilarating to be in that position, to be in that office.
It felt like I had finally achieved something after a great struggle.
But slowly, I began to feel uneasy. The pressure to perform was
provoking the anxiety that I had tried so hard to keep at bay. I
began to mistrust my surroundings. I began to mistrust my peers,
my seniors. I began to doubt myself. I soon found myself in a
situation where I felt incapable of doing anything. Fear had set
in, surreptitiously but surely. I went into a spiral, with every dis-
turbing thought leading to another set of destructive thoughts. I
couldn’t do anything to stop it. Finally, I decided to quit my job.
I lost my sense of independence and with it, my sense of being.
This has been the story for almost three years, with me
not being able to find my footing, being unsettled, and switching
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from one job to another. The funny thing is, depression can often
make you feel like you’re at fault. Like you’ve done something
wrong. Like you are letting down yourself and others by being
‘sad’ or ‘unstable’. You often blame yourself for not being more
‘together’. In extreme situations, you feel so low and lost that you
start hating yourself. Self-loathing and self-destruction go hand in
hand. When things are bleak, your natural response is to give up
on yourself. It’s easier to do that.

I’ve had times when I feel in control and am able to churn out
work productively. I’ve had times when I am able to express my
artistic side, when I feel like singing and writing songs. But there
are also times when I feel utterly blocked. Completely incapaci-
tated. During these times, I can hardly write, sing, or even read,
for I can’t seem to focus enough. Times like these make me realize
just how potent the storm really can be. There was a time when I
was part of a band. To me, it was a great feeling to be able to sing,
collaborate, and write music with other musicians. We would get
together every weekend and write songs that would ultimately
lead to us recording an album.
But here’s the thing: I couldn’t. I couldn’t do it. When the
time finally came to record in the studio, I froze. I couldn’t find
my voice. It had suddenly disappeared. I left the band, with a
heavy heart and a feeling of immense disappointment. All I could
really feel at that point was that I had failed miserably. I regret
my decision to leave to this day, but at that point, there was really
nothing else I could have done. I wish things had turned out dif-
ferently, but there’s only so much wishful thinking you can afford.

Depression made me become insecure about who I am as a per-

son. It made me lose trust in my own self, my own abilities, and
my own judgement. It made me lose my will to live an indepen-
dent life, for I was afraid to. ‘What if I fall into a spell again?’
has successfully silenced so many of my dreams and desires, like
travelling or starting my own venture. It’s even harder to convince
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your loved ones that you’ll be okay doing this and that you are
indeed capable of handling the pressure.
Battling this disease has not been easy. One of the many
things I’ve realized along the way is how much it affects our way
of functioning in a world that is obsessed with being free of
anomalies. Depression is viewed with much apprehension, and
the struggle of dealing with the stigma is real. You’re abnormal, a
poor candidate for jobs, a bad influence for your peers, a bad suit-
or, the unstable and the unsettled sort. Worst of all, you’re incapa-
ble. You’re weak. You’re not fit. The biggest stigma, especially in a
country like ours, is that if you’re facing depression, bipolarity or
any other mental-health issue, you are labelled ‘crazy’, incapable
of making any rational decision. Depression is looked at as a sign
that you’re soft. Sensitive. Over-sensitive. I’ve had many instances
where I’ve been told to not think too much, or that I need to de-
velop a thick skin. Unfortunately, I was born without a thick skin,
and as far as I know, you can’t just grow extra layers of epidermis.
So many stigmas to deal with. So many wrong ideas that
condemn a sizeable portion of our society into living a life of cast-
aways. So many people with wrong notions who refuse to accept
or understand that depression is not a disability or a handicap or
a criterion for dismissing people, for writing them off as ‘cases’.

I’ve been dealing with these stigmas for the past six years. It’s an
ongoing struggle. I have been lucky in that I have parents and
loved ones who support me… Something I am forever grateful
for. I was lucky that my parents were open to the idea of therapy,
something that has helped me immensely in dealing with my own
emotions. I just wish people would be more empathetic, more
open, more encouraging in their approach to mental health, be-
cause it is an issue that calls for attention and empathy.
More than anything, I wish that those who are suffering,
people like me, can find the courage to open up. I wish that we
can find the space to talk openly about our issues and have the
courage to not back down. I want us to dream big, with nothing
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limiting us. I want us to find the strength to go out there and do

things, with nothing holding us back. I want us to be able to look
at the bad days as if they’re just that – bad days that will ultimately
pass. I pray that we are able to search for the parts that we think
we have lost, and that we find them right there inside us like they
were never gone. Because they aren’t gone, they never were.
There is just as much love out there as there is fear. We
have nothing to fear but fear itself (as the wise saying goes). I am
confident that if we choose to look for it, we will find support. We
need to open our own minds to the idea of asking for help when
we need it. We have to be more accepting of our own condition.
The more we familiarize ourselves with it, the better. Get to know
your dark side. Get up close and personal with it. Take it out for
walks, take it with you to the movies, read to it, talk to it. I don’t
care what you do with it, just get to know it. Because there’s little
chance it will leave you when you want it to go away. But if you
know it well, you’ll be able to cope better. You will be able to heal
and recover faster.
I hope one day you'll laugh about it. Like I do now, in my
lighter moments. This is my attempt to do my bit by being open
about what I have faced, in the hope that others who go through
similar problems find the courage to talk about them. The bat-
tleground, the scars… mine may be different from what you have
faced, but at the end of it, we’re all survivors in this world full of
anomalies.

Nikita Sailesh is an advertising pro-

fessional in Delhi. She is also a West-
ern contemporary vocalist.

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 PSYCHOTHERAPY IN THE TIME
126 OF THE VEDAS
KK Aggarwal

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 L
ong before Freud, and millennia before talk-therapy was
even coined as a term, a man, full of insights into human
situations, counselled a reluctant prince – a brilliant war-
rior – to take up arms and get back into the battle. After this
counselling session, the young man got over his melancholia and
overcame his dilemma about fighting and vanquishing members
of his own clan. He had been convinced by his therapist that the
battle at hand was not an ordinary one, but was meant to defend
dharma, to reinforce the moral order.
Krishna, in the true sense, was the first and perhaps the
most celebrated counsellor, whose sessions with his patient, Arju-
na, not only led to his spectacular recovery but also constituted
one of the most revered ancient texts, the 700-verse Bhagavad
Gita.

The history of psychiatry in India begins with Sri Krishna’s suc-

cessful counselling of Arjuna before the 18-day battle of the
Mahabharata. This raises a valid question: how did the ancient
Indians deal with mental conditions, personality traits that were
not ‘normal’? At a time when there were no psych drugs or men-
tal-health professionals accessible on Justdial or LinkedIn, what
was society’s response to depression, bipolarity or an extreme form
of anxiety visible in someone?
The Sanskrit epics seem to have offered a few answers. The
Mahabharata itself is full of pointers to such issues of psychiatric
dimensions. Did Shakuni come under the shadow of evil, some-
one unable to bridle his wickedness? The Kaurava crown prince
Duryodhana clearly displayed the Freudian id – strong instincts
ungoverned by a superego. He knew he was nowhere near Ar-

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 THE EQUATOR LINE 19

juna and Bhima in terms of valour and heroism. The inferiority

complex that drove him to do evil deeds has a clear psychological
explanation. Torn between fighting against his relatives and his
‘sacred duty’, or dharma, to fight the battle of the Mahabharata,
Arjuna went to Sri Krishna for counselling. His symptoms were
clearly those of melancholia.
Of course, the Vedic Indian did not know about anti-
depressants. But it was a time when the bucolic environment –
woods running along the riverbanks, deer prancing around, pea-
cocks strutting close to the courtyard – had its own way of healing
the bruised mind. The Bhagavad Gita is largely read for spiritual
guidance, and it has drawn the attention of many modern-day
philosophers as well, but it is also possible to look for psycholog-
ical insights in this sacred text. With twitchy, sweaty palms, fro-
zen limbs, goose bumps, and a whirling mind – signs that point
towards depression with acute panic reaction in medical terms
– Arjuna sat through 18 sessions with Krishna.

Today, the Diagnostic and Statistical Manual lists over 400 men-
tal, neurological and behavioural problems. Feeling anxious, fear-
ful, sad, confused or forgetful is quite natural, but when a per-
son’s emotions begin to govern every waking second of their life
and disrupt their day-to-day activities, it is quite possible that the
person is suffering from a mental illness. The greatest challenge
psychiatrists face is to determine which of the many illnesses the
patient is suffering from.
Today, there is an assortment of drugs available that nour-
ish the mental health of an individual. The prescription differs
from person to person, of course. However, the case wasn’t really
so a few decades ago.

In the Vedas, the mind has been conceived to be the instrumental

aspect of the soul. There is ample emphasis on the prevention of
mental pain or depression in these ancient scripts. In the Yajurve-
da, the mind has been theorized as the inner flame of knowledge,
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 PSYCHOTHERAPY IN THE TIME OF THE VEDAS

the very basis of consciousness. Thoughts spur from consciousness

and are analysed by the intellect. The ego transforms the thoughts
into actions, which lead to memory and in turn, to desire. This
cycle becomes your habit and by extension, your personality. As
you think, so you become. Disconcerted thoughts, however, of-
ten lead to pent-up frustrations that lead to aggression. Either
you gulp it down and become passive-aggressive, or you spit it
out. While the stored anger manifests itself in sudden outbursts
and physiological ailments such as acidity and heart diseases, the
exposition of rage results in crimes, high blood pressure and heart
attacks.
The Vedic approach to mental health focuses on con-
trolling your mind, intellect, and ego. Lord Shiva presents a very
Vedic way of anger management. Whenever you are filled with
resentment, store the negative thoughts in your throat (neel-
kanth). After some time, think about the issue at hand with a cool
mind (the moon and the Ganga flowing from Lord Shiva’s matted
hair). What the Vedas really depict is a holistic way of managing
emotions. Had Duryodhana controlled his jealousy or Shakuni

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 THE EQUATOR LINE 19

sought counselling for the malevolence that his mind bred, the
Mahabharata would have been a very different epic, heroic but
not so tragic.
In the Atharvaveda, there are meticulous descriptions
of subjects related to psychology, such as will power, emotions,
consciousness and inspiration. Unmad, or psychosis, often stems
from extreme emotions like hostility, grief, laziness, attachment,
envy, pleasure, guilt, anger or delusion. Typically, the treatment
for mental illness during the Vedic times meant learning to con-
trol the mind and practising will power and pranayama. Describ-
ing the various mental faculties, such as the power of perception,
memory, imagination, judgment and volition, the Upanishads
delve deeper into the subject of psychology.
If you read the Ramayana critically and take a closer look
at King Dasharatha, you will see just how grave the issue of men-
tal health is. Though the epic has been written many times over,
the mysteries revolving around Dasharatha’s acute melancholia
and mental suffering that finally resulted in his sudden death is
deeply disquieting. If I were to look at his case from a sheer med-
ical point of view, he suffered, most certainly, from a major de-
pressive disorder.
In the present times, there is no dearth of such cases of
acute depression. Every two out of three patients that walk through
the doors of a psychiatrist’s cabin confess to going through their
very personal ‘to be or not to be’ moments. Unsettling as it may
be, there are far too many people suffering from mental health
problems. While some seek help, some fear the stigma and co-
coon themselves. They shut their traumatic experiences and never
open up. In a bid to reach out to these people, the Indian Medical
Association has launched a campaign, Baar Baar Poocho (ask again
and again).
When it comes to the case history of a patient, more often
than not, they find it difficult to divulge the very personal details
of their lives. They hesitate to open up and share sensitive infor-
mation despite the confidentiality document they sign with their
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 PSYCHOTHERAPY IN THE TIME OF THE VEDAS

doctor. They hesitate to talk about their sexual past, substance

abuse, anxiety issues. In the first few sessions, the patient remains
very guarded. Only in the sixth or seventh session does the patient
begin gaining confidence and having faith in their doctor. The
doctor needs to earn the patient’s trust by asking them again and
again.
The Medical Council of India mandates that the patient’s
privacy cannot be tampered with under any circumstances. You
cannot talk to the husband without the wife’s consent nor the
other way around. A safe and private environment is mandato-
ry for the patient to feel comfortable in sharing their problems.
IMA’s campaign is primarily directed at the youngsters who face
great difficulties in coming to terms with their puberty issues,
molestation cases, and so on. Recently, actor Deepika Padukone
has launched a similar campaign called Dobara Poocho (ask once
again), which follows similar tenets as Baar Baar Poocho.
This concept is derived from the Bhagavad Gita. Sri
Krishna takes 18 sessions with Arjuna. Not one or two. In the
first session, he only listens to the panic-stricken Arjuna. Only
from the second session does he begin to counsel him. Sri Krishna
provides him with solace, reasoning and knowledge. These are the
principles of cognitive behaviour therapy (CBT). Only after 18
long sessions does the depressed, miserable and anxious Arjuna
emerge as an unbeaten hero in the battlefield of Kurukshetra. 

An eminent cardiologist, Dr KK Ag-

garwal is the current president of the
Indian Medical Association.

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 OF THE MIND AND ITS MALADIES
132
Rajesh Sagar and
Ananya Mahapatra

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 ‘…because wherever I sat – on the deck of a ship or at a street
café in Paris or Bangkok – I would be sitting under the same
glass bell jar, stewing in my own sour air.’

– Sylvia Plath, The Bell Jar

Sylvia Plath, the celebrated poet and writer, was formally diag-
nosed with depression at the age of 20, and barely a decade lat-
er, she took her own life. Her works, including her semi-autobi-
ographical novel, The Bell Jar, poignantly describes her mental
anguish as a shroud of darkness gradually consuming her mind
and colouring her perceptions in dismal shades, finally stemming
the flow of her young and promising life.
The afflictions of the human mind have been a subject of
deep inquiry over the ages, fascinating scientists, spiritualists and
philosophers alike. They have been intrigued by the inner suffer-
ing of humans, which may be at variance with a person’s material
situation. The whole idea of mental illness has evolved over a long
period of time, and it is an interesting story in itself. The defini-

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 THE EQUATOR LINE 19

tion of this malady has changed with the changing definitions of

what is considered normal and abnormal with the passage of time.
Throughout history, there have been paradigm shifts in how the
mentally ill are treated and cared for, in concert with the changing
societal views and knowledge of mental illness.

In ancient times, mental illnesses were explained in terms of var-

ious supernatural phenomena ranging from punishment for the
evil deeds done in previous lives to demonic possession. As a con-
sequence, the mentally ill individuals were subjected to various
punitive practices. Around 400 BC, Hippocrates made an at-
tempt to tease out the supernatural and socio-religious views from
medicine by proposing that a deficiency in or an excess of one of
the four essential bodily fluids known as ‘humours’ was responsi-
ble for physical and mental illness. He proposed that there were
four fluids in the body: phlegm, blood, yellow bile and black bile,
and that the variations in the levels of these fluids were connected
to changes in people’s moods.  It was the first attempt to bring
mental afflictions into the realm of medicine – the idea that they
were illnesses that happened to people, not conditions caused by
one’s own doing. Thereafter, through the Middles Ages, mental
illness was believed to result from an imbalance of these humours.

Since then, medical science has tried in various ways to unravel

the aetiology of mental disorders. Scientists have tried to look
for an answer as to what causes the machinery of the mind to
break down under stress. A whole lot of explanations are offered,
starting from ‘wandering wombs’ resulting in hysterectomies be-
ing performed for women suffering from ‘hysteria’ – an ancient
catch-all phrase for emotional or mental-health issues pertaining
to women – to various infective causes, weakness of the nerves
and so on. In contemporary times, mental disorders are attributed
to a web of factors – genetic predisposition, early childhood expe-
riences, and psychosocial stresses among them. It is only now that
scientists have learned to appreciate the complexities underlying
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 OF THE MIND AND ITS MALADIES

the functioning of the mind and the futility of trying to simplisti-

cally explain its dysfunction.

While the brain is concrete, made of flesh and nerves and cells
visible to the human eye, the mind is an amorphous concept,
invisible as well as invincible to the traditional methods of study-
ing the human body. However, the functioning of the mind is
vital to the functioning of the human body. Even Ayurveda takes
due cognizance of the individuality of manas (psyche) and shari-
ra (body) and their intertwined dynamics in the functioning of
the human body. However, the limited knowledge of the ‘mind’
handed down by traditions poses a Herculean challenge to the sci-
entists who have attempted to systematically study mental disor-
ders and subsequently find means for treating them. As one of the
earliest treatises of human afflictions, Ayurveda probably made
the first attempt to classify mental disorders based on dosha types.
The formal classification of mental disorders in contempo-
rary medicine began in the late 18th century, with the European
diagnostic systems beginning to describe different temperaments
and patterns of behaviour in psychiatric terms. Most physicians
during this time were focused on observing and describing the be-
havioural phenomena of the mentally ill. Meticulous observation
and cataloguing of symptoms as well as following their course
diligently over the years have yielded the present classification sys-
tems − ICD (International Classification of Disease) and DSM
(Diagnostic and Statistical Manual) – of mental disorders, which
are used to diagnose mental disorders and as a standard reference
for physicians. With improved understanding and rigour of sci-
entific studies, these classificatory systems have evolved over time
and become more comprehensive.

The attempts to treat mental disorders date back to antiquity.

Probably the earliest attempts to treat mental illness date back
as early as 5000 BC. Archaeological evidence in the form of tre-
phined skulls from this period, in the regions that were home to
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 THE EQUATOR LINE 19

ancient civilizations, has spurred scientists and historians to spec-

ulate that this might have been one of the earliest interventions
engineered for mental disorders. Trephination involved chipping
or drilling a hole in the skull using crude stone instruments. It
was believed that through this artificially created aperture, the evil
spirits causing mental afflictions would be released.
Ancient history of various regions, including the early
Mesopotamian civilization, documents evidence of magico-reli-
gious rituals, exorcism, incantations and various other mystical
rituals used to drive out such evil spirits. Egyptians in this respect
devised more rational treatment procedures for mental illness as
they recommended that those afflicted with the illness of the mind
engage in recreational activities in order to relieve symptoms and
achieve some sense of normalcy.

The first mental hospital is believed to have been set up in Bagh-

dad in 792 AD, followed by others in Aleppo and Damascus.
However, mass establishment of asylums, and institutionalization
and subsequent segregation of the mentally ill from society be-
came a standard practice over the centuries. What prompted this
isolation was a belief that mental disorder was a symptom of de-
monic possession, and various socio-cultural taboos contributed
to the stigmatizing of the mentally ill; in fact, they were viewed
as a threat to society. Due to the shame and stigma attached to
mental illness, many shunned their family members or kept them
in seclusion, hidden away from society.
Although asylums began to be set up from the beginning
of the 16th century, for the purpose of housing the mentally ill,
the primary service provided by these institutions was to keep so-
ciety away from them, rather than their treatment. Most inmates
were institutionalized against their will; they lived in squalor, of-
ten chained and exhibited to the public for a fee. By the 18th
century, there was a public outcry over the conditions in which
the mentally ill lived, and by the end of the 19th century, a more
humanitarian view of mental illness evolved. Many physicians
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 OF THE MIND AND ITS MALADIES

during this period urged these institutes to abolish the practice

of chaining the patients and encouraged good hygiene, and rec-
reational and occupational training. French physician Philippe
Pinel advocated the practice of ‘moral treatment’, which involved
unshackling of the patients, moving them into well-aired, well-lit
rooms, improving their basic living conditions, and encouraging
purposeful activity and freedom to move around the premises.
Such humane treatment paved the way for the mental hy-
giene movement. Clifford Beers, a former patient in Connecticut,
US, who had been institutionalized for mental illness for three
years, led a major initiative to improve institutional care, chal-
lenge the stigma of mental illness and promote mental health.
During his hospitalization, he had experienced physical abuse,
humiliation and dehumanizing treatment, and resolved to cam-
paign for reform. He wrote about his experiences in A Mind That
Found Itself, a book that made powerful impact and helped launch
the mental-health reform movement in the US. By recounting
the appalling condition in the asylum and highlighting the brutal
practices that may have slowed his recovery, Beers was instrumen-
tal in alleviating the stigma of mental illness among people and
providing dignified treatment to them.

Despite tremendous efforts by many people, a radical shift in the

treatment methods for the mentally ill in these asylums did not
happen until the inception of psychoanalysis by Sigmund Freud
in the early 1900s. His psychoanalytical theory of personality
and his likening of the three layers of the mind to a submerged
iceberg brought forth a revolution in the way mental illnesses
were viewed. Freud’s treatment was known as psychoanalysis, or
‘talking cures’, and began with hypnosis. Since then, various psy-
chodynamic schools of thought have emerged, often at logger-
heads with each other in their effort to explain the machinations
of a dysfunctional mind.
Also in development and widespread use during this time
were somatic treatments for mental illness, such as electrocon-
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 THE EQUATOR LINE 19

vulsive therapy
(ECT), psy-
chosurgery and
psychopharma-
cology. These
treatments were
based on the bio-
logical model of
mental patholo-
gy that assumes
mental illness is
the result of a
biochemical or
structural im-
balance in the
body and can
be compared to
physical diseas-
es. Therefore,
somatic treat-
ments were de-
signed to correct an individual’s chemical or structural imbalance.
Since the serendipitous discovery of a chemical cure for psychosis,
a plethora of drugs have been engineered for various mental ill-
nesses such as psychosis, depression and anxiety.
Most psychotropic medications are approved only after
rigorous clinical trials and have been proven effective in reduc-
ing the symptoms and improving the quality of life of patients.
Even ECT, which was earlier considered a fearsome procedure,
has now been refined and, coupled with anaesthetic procedures,
is a safe and effective treatment for a host of severe mental dis-
orders. A number of new biological treatments have since been
introduced – repetitive transcranial magnetic stimulation, vagal
nerve stimulation, transcranial direct current stimulation. These
newly designed procedures are non-invasive, pose minimal threat,
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 OF THE MIND AND ITS MALADIES

and produce no permanent disability. Because of the favourable

safety profile, these options are being explored for various kinds of
mental illnesses with promising results.
Besides the pharmacological and biological treatment, a
number of psychotherapeutic treatment modalities have emerged,
in order to cater to the individual needs of the patients. Cogni-
tive behaviour therapy, dialectical behaviour therapy and ratio-
nal emotive therapy are various methods developed to work in
conjunction with the biological treatments. Although contingent
upon the availability of trained therapists and infrastructure, psy-
chological therapies greatly help in steering the trajectory of re-
covery towards favourable outcomes.
Psychiatric research has proliferated radically over the last
few decades with greater availability of funds and increasing inter-
est. In the next few years, neurobiology-focused research, employ-
ing the newer imaging modalities, molecular genetics, pharma-
cogenomics etc. should generate greater interest among scholars.
The advent of an exciting array of biological therapies – rTMS,
Deep brain stimulation – has also spurred research in order to
explore their effectiveness in various mental disorders.

The scenario of mental health in India also has undergone tre-

mendous changes and radical paradigm shifts over the last centu-
ry. The surge of psychopharmacological agents, which galvanized
the treatment strategies and greatly improved outcomes; the pro-
liferation of general hospital psychiatry units, which was instru-
mental in extending the mental-health services beyond the realm
of asylums and mental hospitals; and the National Mental Health
Programme, intended to serve as a policy document as a part of
the National Health Policy are a few milestones in the nation’s
journey towards mental health.
The recognition of right to mental-health services as a
fundamental human right has gained focus in the media as well
as health-related legislative policies, resulting in increasing aware-
ness, proliferating research, and implementation of the District
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 THE EQUATOR LINE 19

Mental Health Programme as a landmark public-health initiative.

In 2013, the Mental Health Care Bill was passed with a vision
to protect the human rights issues of these vulnerable patients.
Over the past half century, the model for mental-health care has
changed from the institutionalization of individuals suffering
from mental disorders to a community care approach.
Although these endeavours have been commendable and
enduring, a lot remains to be achieved to fulfil the ‘unmet’ needs
of the suffering masses. Although the services are in place, im-
plementation remains a challenge. Lack of trained professionals,
inadequate infrastructure and unavailability of funds are some of
the primary reasons.

The future demands scaling up of a wide variety of interventions,

ranging from public awareness, early identification, treatment of
acute illness, family education, long-term care, rehabilitation, re-
integration into society, ensuring of human rights of the ill per-
sons, and efforts to reduce the prevalent stigma and discrimina-
tion against these patients. The stigma poses a daunting barrier to
the utilization of mental health services, especially by people be-
longing to remote rural areas of the country. Proactive measures,
to promote awareness and to dispel myths and notions regarding
mental illness should be given priority, especially in the far-flung
regions of the country. Wide media coverage, street plays, cam-
paigns and health camps are being organized for this cause, and
hopefully these efforts will be scaled up further to reach the far-
thest corners of the nation.
Our traditional systems of medicine have served as indig-
enous remedies for a multitude of maladies, from time imme-
morial. Expanding paradigms in the field of psychiatric research
should look into these traditional healing practices as possible
treatments or adjuncts to treatment for mental illnesses. Research
directed towards the impact of yoga, meditation, Sudarshan Kriya
etc. in ameliorating psychiatric illness has of late received a greater
impetus. We can thus adequately utilize our age-old traditional
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 OF THE MIND AND ITS MALADIES

resources in synchrony with modern treatment methods. Further-

more, ethnographic research exploring the role of culture-specific
factors, in phenomenological aspects of mental illnesses, as well as
their role in tailoring psychotherapeutic treatments is increasingly
being given its due importance in recent years. Mental health in
special populations, including women, children and the elderly,
pose unique challenges. In the coming years, we need to focus on
the special requirements of these groups.
India is a country plagued with terrorism and communal
riots. The rise in crime rates, especially rape and child abuse, is an
area of grave concern. The past years have witnessed devastating
natural calamities like tsunamis and earthquakes. Every year, the
number of farmers committing suicide in rural India rises expo-
nentially. Such catastrophic events impact the mental faculties of
the victims, the survivors, and their families. The National Mental
Health Policy, drafted in 2012, makes an attempt to address the
needs of certain minorities who bear the brunt of natural disas-
ters, social inequity, or perpetration of crimes, and abuse of their
human rights.
The recent times have also witnessed an initiative by the
government and civil society for the promotion of mental health.
The role played by the NGOs needs to be mentioned in this con-
text. The private sector involvement can range from their sup-
port to train the personnel, monitor the work locally, or take up
specific care programmes. NGOs can be instrumental in the set-
ting up of self-help groups of patients and families, undertaking
public mental-health education to reduce associated stigma, and
providing financial and technical support for setting up a range of
rehabilitation services.
The suffering of mental illness is not visible to the naked
eye, like a sore boil or a fractured limb, but its all-encompassing
tentacles engulf a person’s life and all its spheres. Mental disorders
afflict people irrespective of their age and social status, and wreak
havoc with their lives and those of their loved ones. It is only
in the recent years that people have started to realize this, with
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 THE EQUATOR LINE 19

celebrities sharing poignant accounts of their battle with mental

illnesses. 

Dr Rajesh Sagar is Professor of

Psychiatry at the All India Institute
of Medical Sciences (AIIMS), New
Delhi.

Dr Ananya Mahapatra is a Senior

Resident at the same institute.

142

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 ISBN 9789382622185
Paperback | ` 250
PALIMPSEST www.palimpsest.co.in

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