Half way through the year 2020, it has been a tough time all around the world: Covid-19 epidemic, loss of lives, economic hardships and also numerous other problems – natural disasters and political protests. Coming together, it all has mental health under immense strain. To discuss this and other relevant matters, Praggya Guptaa talks with Dr Radhika Bapat, a renowned clinical psychotherapist. She is one of very few internationally recognised psychologists practising and residing in India. She has been awarded the distinguished position as a ‘Young Emerging Psychologist’ by the International Union of Psychological Science. [You can learn more about her here] Edited excerpts from the interview:

Mental health issues are all the more relevant during the current epidemic. A large number of people are facing extreme worry and anxiety. How should it be responded to?
Human beings have endured flu pandemics before, but this time we see an ease of access to information – which is a good thing. So, yes, there is undoubtedly the anxiety and depression preceding or caused by violence, isolation, financial hardships, as an effect of school closures, stigma, emotional contagion and mass panic, and most importantly burnout and stress amongst the frontline medical workers – not to mention those affected by the cyclone and locusts.

We have to understand that different classes have different problems. If we are looking at a class which does not have to struggle for ‘roti, kapda and makaan’ then the issues are slightly less logistical than those faced by migrant workers. We are all practising physical distancing. We need to now practise mental distancing for staying afloat. This means learning how to distance yourself from peripheral problems such as “my internet speed is not good enough” or “I am bored”. Speaking to a therapist trained in cognitive behavioural techniques will help you sort this out. This has to be a long-term model in case we have to live with this new normal for more than 12-18 months.
 
What would be the impact on work productivity when professionals work from home? Satya Nadella, for example, spoke of long-term WFH being detrimental to employee productivity because of psychological issues.
Satya Nadella spoke about social capital and the lack of touch. While I do not disagree with him, I do believe as a mental health worker that the problem is far more nuanced than that. He said, for example, that he misses walking into a physical meeting, which gives one a chance to connect with the person next to him for the two minutes before and after. That is true for many businesswomen and men that I know, but I also know those who are immuno-compromised, sole breadwinners and petrified of being marked absent if they are not physically present at work. I think it, therefore, boils down to choices. Working from home, if this is a choice that I consciously make, is easier to digest than if it is a mandate. And the same goes with going back to work. Humans are very controlling beings like that. We like to feel that we have control over at least some little freedoms. So having choices, a menu of options, is very important to us; even if these choices are limited. To emphasise my point, I would like to take the example of someone who is forced to go to work and then contracts Covid. In addition to Covid, we would also have to deal with anger, fear and a compromised immune system. In comparison, if this is somebody who has elected to go to work, the problem would not be compounded. Work productivity always suffers when you are at home because of distractions and [other] duties. But human beings evolve. So we evolve to get better at working from home, and I think we need to be given a choice.
 
There is a surge in domestic violence cases. The National Commission of Women (NCW) data suggested an almost 100% increase in domestic violence during the lockdown (mid-April).
Domestic violence or ‘intimate terrorism’ has been labelled by the World Health Organization (WHO) as a “global epidemic” even before the coronavirus lockdown. The WHO puts out the staggering figure of one in three people having suffered an incidence of such violence in their lifetime. There has been a definite surge in the number of cases during the lockdown, no doubt. In 1968, William Goode was asked, “Why do relatives, spouses, lovers, and close friends commit violence against each other?” and he replied, “Perhaps the most powerful and crude answer is that they are 'there'.” Being 'there' does not touch upon the more significant ecological reasons for “unequal power relations” in a family or in society. In psychology, we also surmise one of three other reasons, first is men defending their perceived status or reputation in the family or community, the second reason is adults perceiving a wrong done to them, with the need to immediately seek justice or revenge for it and the third is men wanting to shape someone else’s behaviour to suit them or their needs.
 
Domestic violence is seldom a one-off incident. Instead, it is a pattern that repeats itself. A victim must have what is called a ‘safety plan’ in place, in case of an emergency. The very first thing to do in an emergency is to inform a confidante. Thoughts such as “What will people say? I have failed as a parent/ as a partner/as a daughter” need to be understood as normal but irrational. Getting emergency medical help at the casualty of a hospital and getting treated is first and foremost necessary. Documentation of any physical injury by a registered medical officer is important. Law enforcement and the judicial system can be dealt with, thereon, once you are safe.
 
Since we are spending more and more time online, there has been a rise in cases of cyber-bullying, especially among school kids. What will you suggest to kids, parents and teachers to deal with the situation?
I want to talk about the research done at UCLA [University of California, Los Angeles] on cyber-bullying. Bullying is a pervasive problem affecting school-age children. Electronically mediated bullying involves texting via cell phone; emailing or instant messaging or posting messages on social networking sites and in chat rooms. Much like bullying in general, cyber-bullying can be either direct with threats or nasty messages are sent to the target or indirect with malicious comments, pictures, and private messages are spread much like rumours.
 
Cyber-bullying is unique in that all forms of e-bullying are fast in their speed and vast in their spread. Degrading messages can quickly reach not only the target but also a vast number of other individuals. Anonymity is the second feature that makes it unique. Limited social controls (monitoring) make it easy to send a hostile message or post embarrassing pictures of someone. So tracking is crucial. Further, pro-social skill-building programmes in school help and there should be zero-tolerance policies around cyber-bullying.
 
A notable programme against bullying that worked very well was rolled out in Finland and is known as KiVa. This programme specifically focused on bystanders or witnesses to bullying. It aims to develop among bystanders more empathy for victims and strategies to help victims when they are being harassed – in short, to be little heroes.
 
Teen depression is emerging as a significant issue. It is difficult for Indian parents to differentiate and accept the difference between typical teenage growing attitude and teen depression.
You are right. Culture defines and creates specific sources of distress and impairment and affects how symptoms are interpreted. I think when in doubt, approach a professional who can objectively assess if your child is depressed. There are some red flags to look out for are appearing sad, irritable, or tearful. Some of those to look for can be change in appetite or weight; a decreased interest in activities your child once found pleasurable; a decrease in energy; difficulty concentrating; feelings of guilt, worthlessness, or helplessness; major changes in sleeping habits; regular complaints of boredom; talk of suicide; withdrawal from friends or after-school activities; and worsening school performance.
 
Your comments on the Mental Healthcare Act 2017?
People including psychologists are not very aware of the Mental Healthcare Act caveats and enacting the ideal bill will take years. The government is still struggling with ‘Education for All’, Sustainable Development Goals, and to make provisions for persons with mental illness to live in the community and not be segregated in large institutions, make provisions for half-way homes, group homes and other such facilities for rehabilitating persons with mental health problems – writing an advance directive when you suffer from a mental problem is all very ideal: how do we implement it? But it is a start.
 
What I like about is the Act is it provides persons with mental illness protection from cruel, inhuman and degrading treatment, right to information about their illness and treatment, right to the confidentiality of their medical condition and right to access their medical records.

Actor Sushant Singh Rajput’s alleged suicide has again put focus on mental health. How do you see the media coverage and debate on the issue?
Sushant’s case reiterated for me how fickle the press in India can be. I have so often seen journalists composing pieces that either verify or glorify people. They need a hero and a villain in their prose. Suicide has shock value because it is so final. It is absolutely catastrophic that we do not address mental health in a similarly passionate way that destigmatises it, with as much zeal as we offer a perverted coverage of premature death. It is wretched to make a spectacle of a serious occurrence, and it is even more corrupt to speculate why it happened and who was responsible. Society is collectively responsible for the fact that mental health is stigmatised. It is a systemic failure on the part of you and me. Health as a whole is a priority. Health does not mean health of body or of mind; it means health of the body and of mind. Let us neither aggrandise nor belittle mental health. It should be as easy to walk into the cabin of a psychiatrist as it is to walk into the cabin of a neurologist.