Rural India and Mental Health

Time again we see on TV and hear in news that a farmer committed suicide. Everyone assumes that is is some kind of a financial trouble and thereby the farmer committed suicide. India is a country which prides itself in family values and family supporting each other. Yet the social hierarchy of that exists in the society and family does not provide any room for issues such as mental health and the way it affects rural families.

Men in rural areas as supposed to be the achievers and darling of parents eye. This means every  man has to achieve beyond his capability otherwise he will be subject of ridiculed or undermined. This means if something goes wrong like a crop failure it is not taken as environmental failure but as failure of the man. So there is no going beyond that. Men who are then conditioned to believe that they need to be successful all the time and everything needs to be handed on a platter are suddenly faced with the humiliating situation of having to be unsuccessful and ask for handouts. In view of this scenario I have attempted to write about Mental Health so that it shines a light on this issue which exists in rural areas as much as in urban areas. Please understand and help people.

Mental Illness- Depression

The day you walk in other's shoe is the day you can judge them.

Introduction

In India, mental illness is generally either ignored or dismissed either due to a notion that it is a western or affluent country disease. Most Indians with mental illness go untreated, especially in poor and rural areas. “There is a huge treatment gap for people with depression,” said Dr. Vikram Patel a psychiatrist of the London School of Hygiene and Tropical Medicine (1). In large a population study conducted among urban south Indians, depression has been estimated at about 15% (2). Among rural poor a study done by The Princeton University showed that 7-28% of the men and 30-46% of the women reported at least one sign/symptom of depression (3).

Among the farmers, rates of suicide is on the increase with Andhra Pradesh itself reporting 17,500 farmers committing suicide between 2002-2006 and At least 160,000 farmers have committed suicide since 1997. Studies have shown that situation is similar in Karnataka (4). Although there are many causes for farmers committing suicide predominantly financial, depression could lead to a situation where a farmer or his family can not see a solution for their problem or seek help to solve the problem or have the capacity to function on a day to day basis.

Most urban people associate mental illness especially depression with poverty and lack of education and therefore assume that it does not happen in well educated, wealthy families. This is not true. Depression is there among all castes, classes, urban or rural, rich or poor. Since social stigma is attached most of the mental illnesses, it is neither recognized nor treated and at best it is hidden or mocked. It is a hidden destroyer of a family, society and a country. The effects of depression can be reduced through medical help. Depression will not just go away. You can not just hope that it will disappear. No one deserves to have depression or any form of mental illness due to their birth caste or family situation.

So what is depression?

Depression is not just a bad mood or irritability or erratic behavior or violent behavior or stupid behavior. It is an illness just like any long term illness. Those who suffer from depression usually are normal people who work as farmers, lawyers, accountants, doctors, bus drivers etc. But they find it difficult to function everyday. Depression can cause serious health problems in the body along with that of mind. Depression can not be suppressed. It needs medical help.

How do we know of a person is depressed or just sad for a short time?

1. If the person feels sad for a long time - for weeks or months.

2. Has no interest in social activities or mixing with family and friends.

3. Stops going out of home.

4. Does not do things properly at work, not having concentration.

5. Drinks too much every time there is a problem

6. Do not enjoy any activity which they used to

7. Constantly moody and irritable

8. May end up taking drugs either illegal such as ganja, chakras etc or legal sleeping pills etc. and mixing with bad company of people.

9. Is violent towards family and children - beating, kicking, verbally abusing, screaming, putting people down etc.

10. Works excessively without spending any time in social activities. Does not want to go home.

11. Could start doing destructive things such as breaking things at home or work, creating "accidents"etc.

What are the words depressed people use in conversations ?

1. I can never do anything correctly
2. I fail at everything anyway
3. Good things don’t come to me
4. No one cares about me
5. Who wants to live?
6. I always make mistakes
7. Life is not worth living

Note the words never, everything, no one. These are words which say everything is permanent and can't change. This is not true as things do change and can change. But depressed people do not see solutions to their problems. They see all problems as permanent. Therefore they generally tell lies to people to cover up their depression and withdraw from society.

How to depressed people feel most of the time?

Just like depressed people see their problems as permanent, they also are constantly struggling to feel good but can not do that. They mostly feel as follows for long periods of time:

1. Everything from outside their capacity is controlling their lives.
2. They can't control anything in their lives.
3. They get irritated for small things.
4. They get angry quickly if they can not get results
5. They feel they can not do things properly anyway
6. They are sad
7. They cry unnecessarily
8. They can not decide and everything is difficult
9. They are angry at others for not meeting their expectations

10. They expect everyone to "obey" them and agree with their thinking.

11. They think work will solve their mental problems without trying to solve the real problems.

12. They do not make decisions, do not take responsibility for their actions and blame others.

Please note: Generally people exhibit these behaviors sometimes but it does not mean to say they are depressed.

How does a depressed person feel physically?

1. Tired all the time
2. Gets sick most of the time

3. Has headaches and muscle aches (even without doing physical work)

4. Has anxious feeling in the stomach
5. Does not want to eat properly
6. Does not sleep properly-either too little or too much
7. They either gain excessive weight or lose a lot of weight quickly.

Please note: These symptoms are seen in where people have physical illnesses also.

What are the causes of depression?

1. Family conflict or lack of happy family memebers with in the family.
2. Loneliness (not the same as just being alone)
3. Not having a job for a long time to earn money
4. Having a permanent illness-mental or physical
5. Having family memebers with permanent illness.
7. Drinking liquor or taking illegal drugs
8. Having a family memebers with depression
9. Lack of social support and help

10.Disasters such as fires, flood, earthquake etc. destroying homes, family memebers and community.

11.Poverty (although poverty causes depression, not all poor people are depressed).  

12. Lack of support from the society.


When you see a family member/friend is seen with possible depression what should you do?

1. Talk to them gently. Encourage them gradually to talk about their problems. Do not make judgments as you are not in their situation or their mental state. Learn to understand their point of view whether you agree with it or not. It is not about you it is about them.

2. Don't blame the depressed person or their family for the way a depressed person feels and don't dismiss their feelings. Elderly, very young and poor are not equipped to open up their feelings easily due to their social conditioning. Do not treat them like a burden. Depression can happen to anyone anytime triggered due to different situations.

3. Don't expect a depressed person to listen to you and change their behavior immediately just because you are an elderly person advising them. This type of social conditioning in countries such as India does not help younger people to openly talk to older people to seek help. A depressed person may not be in a state of mind to think in a logical manner. A depressed may not trust you to open unto you. You may not be in a position to help them directly either. Seek other memebers of the family for help/advice discretely. Encourage them to sit and talk to a family memebers they trust or had relied upon in the past.

4. Learn to treat a depressed person with respect and dignity as you would any other person. They have an illness. They do not need pity or mocking. They need your support, kindness and understanding. Learn to seek their permission in a manner appropriate to their age prior to getting outside help. Do not discuss in a family or a social group or work group openly.

5. Don't make them feel foolish or stupid. Don't tell them it will go away. Learn to listen not just hear. Don't try to "fix " the problem. Learn to help them to develop solutions. Ask questions to help them rather than giving "instant" answers. You will not have all the answers to their problems or issues. Do not pry into their personal life without gently asking their permission first.

6. Poverty is only one cause of depression. Giving money to them may not solve the underlying problem. Help them to seek access to financial literacy or seek access to banks and other financial organizations.

7. Encourage them to develop a social network within the family and outside the family.

8. Create situations such as family outings for example, sitting and having a family meal in a park to encourage them to go out.

9. Ensure that a depressed person goes out for short walks during daylight preferably during early mornings. Being in low light at home for long periods of time could lead to some depression especially in elderly due to their limitation in mobility.

10. Encourage them to develop hobbies, go the gym or do outdoor exercises or farmer’s fares local agricultural shows etc. where they meet like minded people. Encourage them to meditate and do yoga if they can.

11. Encourage them to stop drinking alcohol/taking drugs by finding out the root cause of their drinking/drug taking. Drinking/drug taking is an additive behavior. It will not stop immediately so encourage them to divert their attention to reduce their levels of drinking.

12. Encourage them to seek medical help. Do not force them as it will not help them. Give them the support they need. In Bangalore NIMHANS has counseling facilities. Take family counseling if needed. It is as important as for the depressed person and the family to take counseling to help one another.

13. If medications are prescribed, encourage them to take medications regularly and ensure that they do not stop taking them abruptly. Talk to their doctor and develop an understanding your self. Ignoring treatment of depression due to social stigma may lead to serious consequences for the depressed person which includes suicide.

14. If counseling is not affordable or accessible, talk to the local doctor and seek ways of helping the person. There may be options such as an elderly person in the village, or the family with skills to talk to people, local teacher or a priest that the person trusts who could be requested to talk to the depressed person in a discrete dignified manner.

15. Do not exclude them from family activities due to social stigma or your inability to "manage" them. If you are not a family member provide information to the family member who looks after the depressed person to assist them.

Conclusions

A depressed person can function effectively and even achieve at high levels in their field of work if they are given the right understanding support and treatment if needed.

A country, a society and a family does not benefit from ignoring depression amongst itself. For example, if every one of the 160,000 farmers who committed suicide were living today, they would be producing food grain, vegetables, and livestock for India and export markets.

Governmental organizations can only do so much. Every village, farmer, society, community needs to take an active part in developing effective and efficient work and home environment.

Food production system growth in India which will allow farming sector to thrive as much as manufacturing and information technology, textile etc.

Security of food production is critical to the security of a nation as food is the key to good health, productivity and growth of a nation. As the farm production increases, farmers can spend more money for their health, food and wellbeing. This can only benefit everyone.

Disclaimer

This article has been written in the interest of the Indian agricultural and associated communities. The author does not claim having conducted any original work in this area not claims medical expertise. This is only to bring awareness to all especially for the farming sector.
 
References

1. http://www.nytimes.com/2008/03/11/health/11psych.html?_r=1
2. Poongothai S, Pradeepa R, Ganesan A, Mohan V (2009) Prevalence of Depression in a Large Urban South Indian Population — The Chennai Urban Rural Epidemiology Study (Cures – 70). PLoS ONE 4(9): e7185. doi:10.1371/journal.pone.0007185
3. http://www.princeton.edu/rpds/papers/pdfs/case_deaton_healthwealth.pdf
4. http://viacampesina.net/downloads/PDF/Farmers_suicide_in_india.pdf

More Reading

http://www.thebanyan.org/
http://www.beyondblue.org.au/index.aspx?link_id=1.3