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depression

‘You’re OK. You’re alright. You’re loved.’

On Wednesday afternoon I was walking up the Holloway Road in the pouring rain when I saw a body lying in a heap beneath the bus shelter. Two Japanese tourists were staring at it. I crouched down next to the body. It was a girl, maybe 18. Her jumper was covered in mud and she was sobbing.
‘Are you OK?’
She ignored me, and carried on sobbing. She was a mess, snot dribbling down her nose, eyes squeezed shut behind her thick glasses.
‘Are you OK love?’
‘I want Zoe!’ she sobbed, not looking at me. ‘Does Zoe care about me?’
My first thought was she was a teenager having a breakdown. Maybe her first psychotic episode, her reality suddenly crumpling like a screwed-up newspaper.
‘Can we call your parents?’
‘No! I don’t want to be sectioned. I want Zoe!’
She pulled out a packet of cigarettes, sending them spinning across the wet pavement.
Another passer-by came up, a middle-aged lady. ‘Is she alright? Is she drunk?’
‘I think she’s having some sort of psychotic episode’, I said quietly.
‘Should we call am ambulance?’
‘We could…although then she might be sectioned, it might make it worse. Let’s try and call her family.’
Friends were calling her on the phone. I saw one text flash up: ‘Just tell me that you’re OK.’
She answered one call. Her voice went from wheedling to screaming. ‘Jessie, it’s Chrissy. Do you care about me? Do you? WELL WHY DON”T YOU? I WANT ZOE!’
We tried to persuade her to call her family but she ignored us. The middle-aged lady hunched down and tried to speak into her phone to tell the friend where Chrissy was. ‘Hello? Can you come to the bus stop outside Sainsbury’s on Holloway Road and help your friend?’
Chrissy leaned over to be sick.
‘Do you think she might have taken an overdose?’
‘Maybe. We should call an ambulance.’
At this the girl got to her feet and staggered down the road. She veered into the Edward Lear pub.
I called an ambulance. ‘It’s a girl, maybe 18, she’s really drunk, and I think she has mental health problems. She may have taken an overdose.’
‘And she’s in the pub now?’
‘Yes…she’s gone into the toilet.’
The emergency services said an ambulance would take around 45 minutes.
Chrissy lurched out of the pub, propped up by the bar-maid, a small resilient-looking lady who couldn’t have been more than 20 herself. I thought she might be throwing Chrissy out but she was trying to prevent her from leaving.
‘I want to go!’
‘You can’t go love, just stay here.’
Chrissy tried to light another cigarette. She looked like a distressed mole, her eyes screwed up, oblivious of the world around her, in a tunnel of her own misery.
‘She can’t go’, the barmaid said to us. ‘She says she wants to kill herself. She’s got marks all over her arms. Just sit down here Chrissy.’
‘I’ve called an ambulance, they’ll be here in 45 minutes.’
There were now four of us sitting round Chrissy as she sat on the pub bench, chain-smoking. The bar-maid brought her a hot chocolate. Chrissy tried repeatedly to call a crisis help line that was saved on her phone, but she was too drunk to communicate.
‘Are you sure you don’t want to call your parents Chrissy?’
‘They don’t love me. My dad doesn’t love me and my step-mom hates me.’
‘Im sure they don’t’, I said hopefully.
A man was sitting at another of the pub’s outdoor tables with a pint. He was maybe 40, in a white polo shirt, and looked semi-neanderthal. ‘What’s going on?’ he said. He pointed a finger at me and narrowed his eyes. ‘You should know better.’
‘What?’
‘Getting a young girl drunk.’
‘I was just walking past, I don’t know her!’
‘What’s wrong with her?’ he said. He crouched down next to her and put a hand on her knee. ‘Here, Chrissy, Chrissy…listen to this song.’ He clapped his hands and started to wiggle his hips. ‘Fogggy daaaay in London toooown!’
‘Don’t touch me!’ said Chrissy.
He fixed me with a look of pure stupidity. ‘You should know better. You wanna watch it. I hurt people for a living.’
The rain dripped down our faces. It was a miserable moment. Chrissy was trying to light another cigarette. The bar maid lit one too. So did the middle-aged lady. I thought about asking one of them for a cigarette but it didn’t feel appropriate.
‘What’s wrong with her?’ asked the man. ‘Let’s get her inside. Come on.’ He more or less grabbed Chrissy.
‘I think just leave her here’, I said. ‘So she can smoke.’
He gave me an evil look. ‘You’re not a big man’, he said. ‘I’m a big man. Watch it.’
‘Shall we call the police?’ asked the bar-maid. ‘They might get here quicker.’
I know what she meant. I was worried the man was going to kick off. He was worse than Chrissy.
‘Call the police’, said Chrissy. ‘I want the police!’
A police car drove past. ‘There’s the police, flag them down!’
The man wandered out into the middle of the Holloway Road, waving his arms. The police car drove on. He stayed in the middle of the road, like a swimmer adrift in a river.
‘He’s doing my head in’, said the bar-maid. Me too. He was trying to help, sort of.
Chrissy tried to leave, but we shepherded her back to the bench. Finally the ambulance arrived. The bar-maid explained the situation, told them that Chrissy was apparently known to the crisis helpline in Highgate. They helped her into the ambulance.
‘It’s so sad’, said the bar-maid. ‘She’s just a young girl.’
It was another transcendent moment on the Holloway Road, that boulevard of unremitting joy. Outside that very pub a year earlier, I’d seen a man get his head kicked in. On evenings, you went to sleep serenaded by police helicopters buzzing overhead.
Holloway Road can make you feel what a mess, what a total fucking mess humans are.
But at least four people stopped and spent an hour trying to help Chrissy.

 

Everyone is mental. Everyone is broken. Everyone is fucked.  And everyone is OK.

That’s what I believe on a good day. That beneath our broken, battered, fucked up egos, there is something more – sparkling consciousness, depths of loving wisdom, a force more powerful than we realize, more infinite.
That’s what Christianity teaches us, and Islam, and Judaism, and Buddhism, and Hinduism, and Platonism and Stoicism. That we have an infinity of love and wisdom within us.
Within and beneath our brokenness is a shining white light, which is both ‘me’ and more than me. Our souls have the capacity to reflect and contain the infinite, like a puddle of rain reflecting the moon.
The most powerful message that all spiritual traditions have to tell us was said to me by an 80-year-old Zen master in Tamil Nadu.
You’re OK. You’re alright. Be kind to yourself.
It’s pretty much the same thing a therapist says. ‘You’re OK. You’re alright. Be kind to yourself.’
Why are you so cruel to yourself? You’re wonderful.
So much of our suffering comes from the feeling we’re not OK, we’re not lovable, nobody loves us, our parents don’t love us, Zoe doesn’t love us, we don’t love ourselves. We hate ourselves.
You’re OK. You’re alright. You’re loved. Be kind to yourself.
Loved by what? I asked the Zen master. Or who?
He was an ex-Jesuit, who’d converted to Zen but was still sort of Christian.
He spoke a lot about opening to ‘the emptiness’. But can the emptiness love us? Can the emptiness hold us when we’re lying in a heap under a bus-stop?
The emptiness is not nothingness, he said. That’s the mystery. That’s the grace.
He said the way beyond the ego is not to deny ourselves or be cruel to ourselves, but to try and love ourselves and love one another. Otherwise when we open to the infinite it terrifies us and can send us mad.
We need to love ourselves, love the broken, wounded imperfect people we are. We are finite, imperfect, paranoid, mortal beings sprawled on a pavement in Archway on a wet Wednesday afternoon. And we are the infinite, sparkling with loving wisdom like the waves on a sunlit ocean.
We are broken. We are mental. And we are OK. We are loved.
That’s what I sometimes feel, on a good day. Right now I’ve locked myself out of my flat, and I’m sitting in a cafe, looking out at the rain on the Holloway Road.

Mental illness: shedding the stigma around India’s big secret

From the 2016 movie Dear Zindagi, about a young woman seeking therapy for depression

Yesterday, I was at a panel on mental health in India, at a conference in Goa organized by UCL. One of the speakers – Ratnaboli Ray, who runs a mental health NGO called Anjali in West Bengal – asked for anyone in the audience who’d ever had mental illness or been on psychiatric drugs to raise their hands. For a few seconds, no one did. And then about 10 of us did, in a room of around 100.

It felt strange to me, raising my hand, in a way I’m not sure it would anymore in the UK – like I was risking my status, pushing against a wall of shame and secrecy. Like having had a mental illness was a big deal (which it isn’t). In fact, I only raised my hand because the lady next to me did first.

This is the paradox: that a culture with such a huge focus on health, well-being and spiritual wisdom should see mental illness as so taboo. If Prince Siddhartha hadn’t had a breakdown, India would have never given the world Buddhism, yet this is a country where mental illness is simply not discussed.

Why? My tentative initial answer is that India (like the UK) is a country obsessed with status and hierarchy. Mental illness is still seen as a terrible blot on one’s status, and therefore a risk to one’s career advancement, one’s marriage prospects, one’s place on the social scale, and to your family’s social prospects. India is the country that gave us Snakes and Ladders, and mental illness is seen as one big snake down to the bottom of the social hierarchy. (I might be wrong in this assessment – let me know in the comments!)

It’s also a threat to your rights. If you’re diagnosed with a mental illness, it can affect your ability to open a bank account, to get a driving license, to maintain custody of your children. Until 1976, it was accepted as grounds for divorce.

To protect the family status, the mentally ill are often abandoned in over-crowded psychiatric care facilities, where they can be ‘treated worse than animals’, according to a report by Human Rights Watch.

Mental illness is also hiding in plain sight in India. According to two recent surveys, between 130 million and 150 million Indians are suffering from a mental illness, including depression, anxiety and substance abuse. I’ve met successful young Indians on my travels who are clearly stressed, over-worked, and in need of support. But mental illness is seen as a terrible curse, not something that pretty much happens to everyone in varying degrees of intensity.

As the Buddha put it, life is suffering – having a mind means you sometimes experience mental distress, and there are techniques we can learn to mitigate that, both psychological and pharmaceutical. India invented many of these techniques – indeed, Buddhism is one of the major influences on Cognitive Behavioural Therapy, which the NHS has put over one billion pounds into providing.

Yet in India, 90% of those with mental illness receive no treatment at all. India has 0.3 psychiatrists per 100,000, one of the lowest figures in the world. And they’re almost entirely in big cities.

Even among the urban affluent, very few seek therapy because of the stigma attached. I sat next to one lady on a plane and said I wrote about mental health. She told me of her ex-husband, who refused to admit he had depression. I didn’t like to ask if they had divorced or he was one of the 250,000 Indians who kill themselves each year.

Soumitra Pathare, an academic who drafted a new Mental Health Act, says: ‘There is institutionalized discrimination against the mentally ill. If they were a caste or women, we would be doing something for them, but we do nothing.’

Things are finally beginning to change. The new Mental Health Act is due to be made law this parliament, and will legally guarantee Indians’ right to treatment, and also to refuse treatment if they don’t want it (many inmates are in asylums and given Electro-Shock Therapy without consent). There are new initiatives to train community health workers to give brief psychological therapies.

There are several new apps and websites that offer counseling and therapy online. In Chennai, India’s third biggest city, I saw adverts for private counsellors and a wall painted with a big sign: Depression Is Treatable. There’s even a sex therapist in Bangalore (something so unusual it was written up in the media).

There are signs of a new openness around mental illness – last year, there was even a Bollywood film, Dear Zindagi, about a young woman seeking therapy for depression from a hot therapist. Imagine if one of India’s cricket superheroes opened up about mental illness – something several western sports stars have begun to do.

At the UCL conference, I spoke to Vikram Patel, a Wellcome-funded psychiatrist from the London School of Hygiene and Tropical Medicine, who has pioneered training rural community care workers in India and Africa in the delivery of brief psychological therapies. He was voted one of Time magazine’s 100 most influential people in the world (he points out the leader of Boko Haram is also on the list).

Why are there so few psychiatrists in India?

There’s a bottleneck problem in training – only accredited teachers can train new psychiatrists and there are very few accredited teachers. There’s also a stigma around being a psychiatrist, compared to say a neuroscientist. And there’s a huge distribution problem too – most psychiatrists work privately in big cities. In rural India, there could be a region with 10 million inhabitants and no psychiatrists.

Your approach is to train community ‘health visitors’ to give brief therapy?

Yes, we’ve trained health workers to give specific treatments for specific conditions. We found it worked very well when they were trained just for that, in controlled conditions. We now need to see how it works out in the field, in frontline primary care, where health workers treat not just mental but physical illness. The treatment of both in fact uses similar skills – lifestyle support, behavioural change support, the promotion of self-care.

And they give similar sorts of psychological therapies to western psychotherapy? Cognitive Behavioural Therapy, interpersonal counseling etc?

Yes, similar therapies, but briefer and simpler. The most profound discovery for me is that the theory of psychological mechanisms is universal. Cultural factors play a role in the metaphors you might use. Say you train people to use meditation and yoga in the treatment of anxiety. You could train them to breathe in, and then breathe out saying ‘om’, or a prayer to Jesus if they’re Christian. Those cultural factors make a difference because you’re tapping into hope, which is a very powerful healer.

Is depression and anxiety treated here?

Hardly at all. I thought the ‘worried well’ was a Western phenomenon but it exists here too. The majority could recover with some form of self-care, but some need more clinical interventions. But depression and anxiety are not even seen as illnesses. It’s just your social situation. It gets somatized, as fatigue or insomnia for example. And doctors would also not recognize they’re actually treating depression, they would treat it with painkillers or sleeping pills. People criticize me for medicalizing people’s experience, but these people are already in clinics, they’re just not getting the right treatment.

So nothing like the NHS’ psychotherapy service exists here?

Nothing remotely like it. We recently published a trial of psychotherapy in the Lancet- that was the first ever trial of psychotherapy in India. We don’t want to repeat the mistakes of the NHS’ therapy service, which was too professionalized. We want more self-care and community care – my dream is to be able to train someone off the street to treat someone else for depression.

Do you think computerized-CBT apps could be a way of getting therapy to more people?

Yes, I’m bullish on technology, it will transform healthcare in general. But there are limits on access to the internet, particularly for the poor and women. But we’re beginning to see things like Facebook pages for people with schizophrenia.

Are there charities and NGOs lobbying for improved mental healthcare?

There are, but they’re small, very local, and not yet working effectively together in the way we’ve seen, for example, in the treatment of HIV.

Could online media – blogs etc – play a role in opening up the conversation and getting rid of stigma?

Definitely. In fact, we’re launching a website in April which will encourage people to share their experiences online through various social media.

You can watch Vikram’s TED talk here: