I remember one patient who came in and said she needed to reduce her dosage. I asked her if the antidepressants were working, and she said something I’ll never forget. ‘Yes, they’re working great,’ she told me. ‘I feel so much better. But I’m still married to the same alcoholic son of a bitch. It’s just, now he’s tolerable.’”
This is not an anti-Prozac joke. Although it could well be. This is Andy Thomson, a psychiatrist at the University of Virginia, quoted in a New York Times article titled ‘The Upside of Depression’ by Jonah Lehrer (25 February 2010).
The upside of depression? It’s an interesting perspective, no doubt. In a way, depression does force you to look at your life long and hard. It is that state of mind that could possibly trigger the best life decision you made in a really long time.
But the point is this. What is the price we are willing to pay before we arrive at that moment of clarity? How do we keep from slipping deeper down the abyss before we get there? How long do we stay in our emotional hellholes before we give in, one way or another?
Ranjitha Gunasekaran is a 26-year-old journalist working with a leading daily in Chennai. She has been depressive, even suicidal, she says, since she was 16 years old. She started therapy two years ago. To be depressed, says Ranjitha, is to “feel like you have been nailed to the bed and you can’t get out”.
She went through her worst patch two years ago. “I was in a state wherein I would start blubbering. You speak to me for ten minutes and I would dissolve into tears.” Her friend, who was already seeing a psychotherapist, suggested she see him too. “I went to meet him. I blubbered for about 45 minutes. At the end of it, he very calmly told me that I had major depressive disorder.” For Ranjitha, to be diagnosed as such was a burden off her chest. She had always wondered why she was not as stable as her friends were.
“For me, it made such a difference to know that I actually had a problem, as opposed to being one of those painfully self-conscious, self-involved early-20s types, tortured romantic soul and what not. It makes a difference to know that you are not just being a drama queen or something like that.”
Ranjitha had considered therapy once before, while at her post graduate studies. But at that time, she just ended up wallowing in it. And the fact that it cost as much as it did also deterred her.
She recalls the time when she finally decided to get help. “My mind was running on this treadmill, going over the same thing again and again. You then eventually hit rock bottom and you don’t move beyond that.” And what was rock bottom? “It is being either suicidal or completely inert.”
What is inspiring about Ranjitha’s story is her willingness and courage to talk about it. For instance, she has told her colleagues that she has this condition. “Once I started going for therapy, it became important to talk about it because people need to understand what you are going through. Whether it is at work or with friends.”
Ranjitha senses a larger social context to why she has been able to find this emotional support in her circle. “See, the thing is, with a particular class of people, it is uncool to show that you are bothered by these things. You could be bothered by it. But you don’t show that you are. If a colleague says ‘Hey, I’m gay’ and you belong to an urban upper-middle class educated background, acting homophobic becomes politically incorrect.”
That is not to say Ranjitha did not have any apprehensions. But in the long run, she says, her openness has worked to her advantage. “You shouldn’t be too prickly about it because if you are open about your illness and what it means, people are willing to try and understand, and people are very helpful.”
Ranjitha’s attitude towards her illness and the acceptance that she has received from friends, family and colleagues, is largely exceptional. In India, seeking therapy and talking about it continues to be a huge emotional challenge, not to mention its social implications.
Take the case of this 45-year-old homemaker who went through a harrowing time before she finally sought help. Luckily for her, a recent episode of depression that her close friend had been through had turned her both sensitive to the symptoms and open to the idea of therapy. She’d gone into a slump after her mother passed away, and couldn’t understand her own weeping. It was incessant. “I was not able to coordinate anything. I could not get up and send my kids to school. I couldn’t think straight... all I did was cry. My energy levels were so low.”
Years and years of caring for her parents, both of whom required intensive medical care, adjusting to an arranged marriage, and then the death of her mother all took a heavy toll on her sense of well-being. She eventually hit rock bottom. And a little after, came realisation. “I told myself, I don’t want to cry anymore. I was so tired of it. I wanted to do something else with my life.” She approached a general physician, who referred her to a psychiatrist. At the same time, she approached a psychotherapist recommended by her friend.
“Along with medication, when you also seek therapy, your recovery is a lot more effective,” she says, “Medication will bring up the chemical levels. But you have to start making changes in your life, so that when the medication stops, you have coping mechanisms in place. And that is why therapy is vital.” Luckily for her, the therapy went off brilliantly. A good therapist is half the battle won.
But before that, one must decide. So, when is the time right for therapy?
Ranjitha has her own take on it. “I think even if you wonder about therapy, you should just go. If you think you are not being yourself, or are too stressed out, or are losing your mind, or you are not sleeping well, or whatever it is, you should just go.”
Of course, the natural instinct is to sort out problems on our own. Reaching for professional help might have increased quite significantly in certain Indian circles, but it is still not a natural option for most. Even among those who are aware of therapy and have access to it, it is rarely a choice made without misgivings. Says Arvinder J Singh, a psychotherapist, “My philosophy is that a person comes to you at the right time, in the right space and for the right reasons. He or she didn’t come before that because he or she was not emotionally ready. And for any process of change, for any process of therapy, it takes two people. It does take my client to be emotionally ready.”
Therapists need you to reflect, need you to side with your survival instincts, and need your will-power all the way through. Make no mistake, therapy is a way in, not a way out. It can only work if the client wants real help. You can’t have a passive client in a therapeutic situation. And breaking internal resistance mechanisms in the head can be a long and lonely effort. Making matters worse is the social stigma bogey, a lopsided perception that going to a therapist is a reflection of some failure or inability to deal with life.
The feeling of utter hopelessness, says Jyotsna Swaroop, a counsellor, tends to set in at a much later stage, though. “Even if you are in a situation where help is available, if you have reached a state of hopelessness, you will not reach out. You will feel there is no point in reaching out. That is the severity of depression talking. There is an inbetween stage that is crucial. When you begin to feel something is going wrong. You think, ‘Can somebody help me, how do I manage this, where do I go next?’” It’s decision point.
To then succumb to circumstances could send you spiralling downwards. When self-worth begins to take a hit, the light begins to fade quickly. And the last thing a person needs—good-intentioned lay advice—will come in torrents.
To look at therapy as a process of empowerment is to give it a whole new perspective. It does not have to be a last ditch attempt at life. But a deliberate choice to stay in the game and win, without confusing self-care with selfishness. Singh puts it best. “Like a cosmetic ad says, ‘Because you’re worth it’. I think it is such a lovely catchline. It accords a certain self-worth to that person. If I can talk, and it helps me get in touch with my inner strength, and it helps me move on, wow! That is worthwhile. That is all it takes.”