Mental Health
“One of my clients once told me, ‘Depression is such a tepid word for the agony which I am going through’.”

If you glance through the Facebook page of Arjun Bhardwaj, the 24-year-old who killed himself by jumping out of a hotel in Mumbai, what leaps out at you is the number of people who are eager to judge and condemn the young man for his choice.

And it’s not just Arjun, each case of suicide brings with it a flood of people eager to announce that this was a cowardly act, a selfish one where the person did not even stop to consider the feelings of their loved one.

Perhaps the most charitable explanation you could give for such comments is, as Anna Chandy, a Trustee of The Live Laugh Love Foundation says, that they are “an indicator of the lack of awareness and sensitivity towards understanding depression or any form of mental illness.”

“When a person has depression or any form of mental illness, unlike a physical illness, you cannot see any physical manifestations. And therefore individuals or people outside of this person who is suffering are not able to relate to the extent of psychological pain this person is experiencing,” explains Anna.

Without immediately recognisable signs or the vocabulary to properly articulate psychic pain, experts observe, most people fail to recognise just how intense and complex the emotional experiences of a person in the depths of depression are.

As Dr Lakshmi Vijayakumar, Founder of the suicide-prevention centre Sneha, and a consultant with the WHO, describes it, such persons experience an intense churning of a variety of emotions such as anger, guilt, loneliness, helplessness and hopelessness that is difficult to grasp in its full intensity and variety. “One of my clients once told me, ‘Depression is such a tepid word for the agony which I am going through’.”

One of the reasons for our failure to grasp the intensity of this psychological pain is the looseness with which we use words like depression, and our failure to understand the difference between temporary feelings of sadness and even a “death wish”, and the more sustained states of depression and what experts call suicidal ideation.

As Ajanta De, Counsellor and Co-Founder at InnerSight Counselling, points out, sadness is a temporary reaction to an external trigger that passes as we cope with it. Depression, on the other hand, is a mental health problem, much like a physical disorder, that requires treatment and counselling, and cannot simply be wished away.

Similarly, she points out, “When people feel sad, sometimes there is a sense of ‘I wish I don't have to wake up anymore’. That sort of a death wish is like sadness. You just think that you don't want to face something, but the next day you get on with life. Suicide ideation is different. It's the stage where you feel absolute despair to the lowest degree. You feel that there is just no hope. And that happens when you reach the stage where nothing or nobody or yourself can do anything, there's no hope left in life.”

To compare such states of intense despair to the feelings of sadness that one encounters in daily life, and to offer advice like “Snap out of it”, adds Ajanta, is to be completely apathetic to the kind of pain a person is going through. “One's survival instincts are so sharp that to actually end your life is when you've reached a place where you just don't feel any sense of hope. Even in your most trying times, one may not feel hope but one may feel that I will get up tomorrow and see how I feel,” she points out.

Dr Lakshmi agrees, pointing out that no one contemplates suicide happily. Given the trauma and intense emotional pressure people undergo in the moments when they contemplate suicide, she says, no one could ever call suicide an easy step.

“Suicide is neither a cowardly act nor a brave act. It's actually a cry of a person in distress. It's a form of communication that says, ‘I am helpless and I don't know how to cope with helplessness’,” she says.

What most people fail to recognise is the kind of pressure that people come under to deny their own emotional vulnerability, so that people experiencing mental health problems are often forced into their own shells where any sort of help and support seems an elusive prospect.

“There is so much emphasis in society to be constantly strong. Subtly, and not so subtly, we are giving these signs. We are hence saying it's not ok to feel despair. We are also saying that it's not ok to express despair or ask for help,” observes Ajanta.

Given that depression itself produces feelings of darkness, feeling alone and feeling withdrawn, points out Anna, such stigma that comes with mental illness creates the possibility that those around a person with depression fail to empathise when he or she attempts to reach out. In turn, this only reinforces the isolation that they feel, and intensifies their despair.

“When you have suicidal thoughts, you also feel terrible because you have such thoughts. And you feel terrible that you just don't know any way out other than suicide. You also know what that very act will mean for your loved ones. So again you're feeling conflict, which then adds on to your despair and hopelessness,” she explains.

What’s often missing in this entire process, experts point out, is an empathetic attitude from families and society at large towards persons with depression, and a failure to recognise that mental illnesses exist as objectively as physical illness. As Dr Lakshmi points out, when a person fractures their leg, those around them do not need to have undergone a similar experience to anticipate the difficulties this person will undergo. If we accept the objective existence of mental illnesses in the way that we accept any physical disorder, she says, then we can find ways and means to relate to persons with mental illnesses too.

Ajanta points out that most people fail to generate such empathy because they go looking for ‘valid reasons’ for a person to be depressed, or worry that they are enabling an unhealthy behaviour. But, she says, depression does not bear a direct relation to external triggers in this manner. “Depression is not caused by what you have or don't have. It's not relative in that sense. It can happen to anybody of any age, any gender, any socio-economic strata.”

“What is actually happening for somebody who is going through visible signs of depression is for (mental health) experts to assess. You can't decide if it's a phase or whatever... You can't take a chance because we are talking about a life here,” she says.