Akhilvaani: Question 1:

Ranjitha welcome to Akhilvaani, a platform to “Own Up Open Up and Talk Mental Illness. At the outset, tell us, who you are, what your profession is and what is your passion.(you can tell anything and everything you want to tell in free-flowing manner. I want the people to get a feel of what you are)?

Answer (RJ)

Thank you, Akhileshwar for giving me this opportunity. I am Assistant Resident Editor with The New Indian Express in Telangana. That means that I am responsible for the editions of the newspaper published in the State. I have worked with TNIE, off and on, for about a decade now.

I chose journalism as a career for two reasons. First, because I wanted to become a writer and I thought reporting would expose me to different aspects of the world and give me something to write about. Second, because I believed journalism would be a way to help people. I don’t know how successful my career has been from this perspective. My work has given me opportunities to travel, meet different kinds of people, study and learn about issues that affect their lives. It has given me permission to be nosy and curious and care, while ensuring that care is mediated by print. I haven’t changed the world, by any measure but my work has changed me. And I think that counts for something.

Someday, I still hope to write professionally. I hope that I will develop the discipline and patience and persistence to do so. I hope I will rediscover the joy it once brought me. My work is a large part of who I am because being a journalist means being connected to the world and what happens in it in a very intimate way. I care about politics, culture, policy and such. I always have. It made me weird as a kid in school because peers thought I took things too seriously.

My other interests include dogs — I have two in Chennai — travel, food, pop culture, fashion, literature, comedy and anthropology.

Akhilvaani: Question 2:

Let me congratulate on your decision to talk about your Mental illness. And the decision could not have been more opportune, you let me know your decision to publicly “Own Up, Open Up and Talk  Mental Illness” on 7th April the day India joined World to talk Depression on the World Health Day. Can you educate us of the process that gave you courage to open up.

Answer (RJ)

I have to confess there is very little courage involved in opening up about my depression. I am one of those people who have “no shame” in a manner of speaking. I have always been open about aspects of my life — not necessarily my inner world though — whether it is about love, loss or health. Talking to people about depression is part of that. I like attention. I am self-absorbed, though hopefully not too self-absorbed. I don’t think it detracts from who I am to talk about these things. And as far as depression is concerned, I think it helps other people feel comfortable about dealing with their own issues. Or so I hope.

Akhilvaani: Question 3:

Earlier you were kind enough to let me know that you have suffered off and on from Depression and were diagnosed suffering from clinical depression in 2008. Can you tell, when and how it all began.

Answer (RJ)

This is essentially going to be the story of my life. As far as I can remember, I was a talkative, slightly bossy, regular child till age eight. I was born in Hawaii where my father was working on his PhD. I had a brother, Stephen, who was 12 years older than me. When I was two years old, we moved to Singapore, where we lived till I was eight.

In 1992, for a variety of reasons, my parents and I moved to India, while my brother moved to Canada for his college studies. It was not an easy move for me.

We went from Singapore to Dindigul near Madurai in Tamil Nadu. I spoke limited Tamil, had barely any friends till I started school. I had books and spent too much time with adults. We moved to Pondicherry soon after so I could start school with French as a second language since I struggled with Tamil. I was homeschooled for a year before I started Class 6 in 1994. We lived on the University campus. Again, I had no friends. Just books and too much time with adults.

I wasn’t a particularly nice child. I could be manipulative, selfish and spoilt. I don’t think my parents had an easy time with me.  I mention this background because things changed again in 1994. My brother moved back to India that August (if I remember correctly). He died in an accident in November. This changed me. It changed all three of us. It was my first experience of death. I realized that death wasn’t just something that happened to other people. It made me realise that nothing in my life was secure or certain.

After he died, I spent a week in bed. I didn’t bathe or change my clothes. My parents coped in their own ways. Now, I realise we were all depressed. My mother stopped buying new clothes or dressing up. My father spent more time on the computer. I was perpetually on the verge of tears. We all fought constantly. I was terrified my parents would die any day. I would creep into their room at night to make sure they were still breathing. To some extent, I turned to religion. I was raised Catholic and some aspects of faith brought me comfort. After he died, I remember crying alone and talking to myself, walking in circles in my room clutching a pair of scissors because I so badly wanted to die.

The cloud lifted, somewhat, in my late teens. From being an annoying ‘daddy’s girl’, I became closer to my mother. We still fought a lot — my mother had a way of finding the right words to make the deepest cut and I was no treat. In 2001, I started college in Chennai and moved into hostel. My parents visited me almost every week. This was our first time apart. I think it was harder for my mother than it was for me.

In February 2002, my mother died in a car accident. I think something inside me died as well that day. I spent a lot of time just wanting to die. My cousins and friends saved my life by sensing what I was feeling even when I couldn’t or wouldn’t articulate it. I think you could say that my depression started off as grief-related. It was certainly triggered by grief. The depression triggered by my mother’s death lasted, in varying degrees of intensity, for perhaps as many as six to eight years. After she died, I remember entering phases wherein I felt like I was in a bubble. Things were happening around me but I was looking and feeling them from a great distance. I unintentionally walked towards oncoming traffic. I imagined — and believed — strange and horrible things. I ate. A lot. Through it all I wanted to die. To not exist. To not wake up. To not breathe. To not be.

Several other things happened in that period that would ‘re-trigger’ this intense sensation and start off the whole spiral again. My father said something. Someone I loved didn’t love me back. A close friend, inexplicably, stopped talking to me. A guy picked my friend over me. My boss said something. Everything was a trigger to remember that I didn’t want to exist and the world didn’t particularly want me to exist either. Me dying was win-win.

If I am alive today it is for two reasons: I have always been scared of causing myself physical pain and I have some very patient people in my life who loved me enough to fight for me. To stay afloat, I ‘medicated’ with food and alcohol till I finally saw a psychotherapist in 2008. I went to see him because something had happened that triggered all those feelings again. I was a blubbering, incoherent mess. However, because I had briefly worked with a mental health organisation, The Banyan, I had enough exposure to know that it was time to “get help”.

The doctor — the very patient, no-bullshit Dr Vijay Nagaswami — diagnosed me with Major Depressive Disorder and started me off on anti-depressants. My father freaked out — he was worried about the psychiatric medications and side effects and if it was all his fault. MDD is not his fault.

The diagnosis was a relief in a way. To know that there was really something wrong with me and I wasn’t just being dramatic or selfish or self-absorbed or a crybaby. I’m not a drama queen. I’m depressed! (In fairness, I am also a drama queen).

Akhilvaani: Question 4:

It is told both nature and nurture plays a role in onset of mental illness including its most common expression-the Clinical Depression. Do you think there was some genetic lability in your case (like mental illness of a close relative even if you do not want to name). Similarly can you in retrospect the environmental triggers from the past (including any specific trigger from the childhood or early adolescence).

Answer (RJ)

Well, I think I have answered the question of triggers in the previous answer. I do think my parents were depressed after my brother died and my father, after my mother died. I don’t know if that was part of the grief they felt or if it lasted as long as it did for me. I had an aunt — unrelated by blood — who committed suicide when I was a child. I do think genetics plays a role but I don’t know if I can trace that back in my family.

Akhilvaani: Question 5:

Stigma around Mental Illness is deeply ingrained in the  Indian Society. Tell about your experience of any stigma that you have encountered in society, family, friends or neighborhood. Also as an opinion maker, tell as to what actions are needed to combat stigma on war footing in the country

Answer (RJ)

Have I experienced stigma? I don’t think so.

Not because everyone around me is very open-minded and understanding (though I know many who are) but because I am protected by layers upon layers of privilege that allow me to be oblivious of it. I will say that my father had a difficult time coping with the idea of me requiring treatment and medication but I think that is because he was afraid and helpless and didn’t know what to do. I think among friends and family there is a view that medications aren’t good and that one needs to go off of them. This is usually expressed as concern and quite gently. It would be harder to me on medication if the people I cared about made more of an issue of it.

As to the actions to combat stigma. This is a complicated issue.

On one hand, mental healthcare should be integrated with general healthcare so that it is seen as just another aspect of health. On the other hand, there are reports that the current ‘western’ view of mental illness has itself contributed to stigma.

I think there are culture-specific ways in which this should be addressed but I honestly don’t know enough to make a suggestion.

http://www.nytimes.com/2010/01/10/magazine/10psyche-t.html?mcubz=2

Akhilvaani: Question 6:

You are one of the few user survivors  of Mental Illness who has had the courage to disclose about your Depression at your workplace. Tell about  the support you have received at your workplace to manage your Depression. Also tell from your experience what improvements/ accommodation are needed to make workplace more inclusive for mentally ill in the country.

Answer (RJ)

I have been very fortunate to have bosses who have exposure to issues related to mental health and who made it possible for me to talk to them. I have received a lot of encouragement at work. My supervisors have been patient and accommodative of my issues over the years and given me time off whenever I required it.

Reasonable accommodation as a concept needs to be more widely recognized and accepted in India. Specifically on mental health, I think there is stigma against people who are different and “weird” as such. I do think we need to be more accommodative of difference — persons with mental illnesses would just fall on that spectrum of difference.

It would be easy to say that people need to talk about their mental health problems but employers need to create an atmosphere that encourages someone to talk about something so personal and potentially so stigmatizing. Employers need to be creative in finding ways to help people be productive — it may involve time off, flexi-hours, a transfer. But as long as a person is skilled, competent and willing to work, I think we should find ways around barriers that prevent them from being at their best. And the company benefits too.

Akhilvaani: Question 7:

Depression often is considered as weakness and or character flaw of a person. The deep rooted stigma also forces the sufferer to be in denial mode. Have you ever battled such a situation in your long fight with the illness.

Answer (RJ)

As I mentioned earlier, I have definitely felt that how I was feeling was a character flaw. I was too self-absorbed and that was my fault. Once, someone — himself under treatment for depression — asked if claiming to be depressed was some kind of fashion statement.

Another time, a very good friend said — the day after I had cut myself (very poorly) — what my problem was when there were people surviving actual wars and such.

Sometimes, even I wonder if I have a problem or I am just lazy and making excuses. Of course, as my therapist pointed out, it can be both at the same time. That then feeds into a cycle of shame and disgust and negative thoughts and depression. I wish people knew that while their words can definitely send someone like me on a spiral of misery, there is virtually nothing horrible that they can say that I haven’t said to myself before, while being depressed.

Akhilvaani: Question 8:

One thing is for certain that despite your Depression you are a successful media professional. What role psychiatric medicines have played in your well being. And other than medicines what other things (therapy, meditation, yoga, walking, exercise) have helped you.

Answer (RJ)

Medicines have been helpful in coping with aspects of depression.

However, I have noticed that when I am so depressed I can’t move, the medicines don’t really do much. I am slowly tapering off on the medication and hope to start cognitive-behaviour therapy at some point to get more holistic treatment.

Other things that have helped me include my friends, my dogs, books and TV. Unfortunately, I also have a few bad ‘habits’ that I use as crutches or coping mechanisms that are actually counter-productive. One is sleep, the other is procrastination (by watching TV).

When I am stressed out about a project — which is usually related to how terrified I am — I cope by procrastinating. This is one of the things I hope to work on in CBT. Of course, I am also procrastinating starting CBT…

Akhilvaani: Question 9:

There is a small (and growing ) group of Indian youngsters who think medication is not the necessary part of armamentarium of a sufferer to deal with severe mental illnesses. What suggestion do you have to give them?

Answer: (RJ)

I think every possible treatment option should be available for everyone. I know access to these options will be mediated by class and income but I think ensuring that kind of access to options is something that we should aspire for.

Medication is definitely a treatment option. It may not work for everyone and the ways in which people are diagnosed and given meds in India at present need to be overhauled. But the option must be available.

To take the medicine or not is up to the user-survivor. We all do what we can to get by and should be able to do so with access to complete information and support and without judgement, especially without judgment from other user-survivors.

Akhilvaani: Question 10:

Depression comes with deep-seated distress and inexplicable sadness where the person finds himself/herself mired in hopelessness, helplessness and nothingness that leads to suicidal ideation, suicide attempt and even completed suicide. Has suicidal ideation ever bogged you down. If yes, how have you managed it?

Answer (RJ)

Let me first explain the ways in which I experience depression. Feeling physically weighed down by something on my chest or my feet, unable to take in a full breath no matter how deep I inhale or heavily I sigh. That is one way. The other is when even the slightest thing reduces me to tears.

Another is when a cycle of negative thoughts about myself, about something I did long ago, about some failure starts in my mind and continues till I am hiding under the blankets or numbing myself by binge-watching something on TV. I

have had suicidal ideation over the years. In the past, I would either call and friend and they would talk me through it. I have also cut myself (very ineffectively) a few times. I have spent a lot of time trying to find ‘pain-free’ suicide options online. But in recent years, I have tried to keep alive the notion that the low phase will eventually pass one way or the other and all I need to do is somehow hunker down and wait.

Akhilvaani: Question 11:

Your vocation is media. Tell us what role can media play in promotion of Mental Health and a bold new goal of “Mission Zero Suicide” in India

Answer (RJ)

This is a complicated question to answer.

First, off the top of my head, let me consider ways in which we encounter mental health or illness in the media — and I include suicide in this. I fear we most often come across the issue in the context of awareness raising efforts by organisations, persons who are victims of abuse of some sort, or people who have committed suicide — this, mostly in crime copy.

The few ‘proactive’, reflective articles perhaps come in the context of suicides or stress amidst professional classes or students. Even farmer suicides are rarely covered from a mental health dimension, this because I think we forget that suicide can be a result of distress caused by a variety of factors including economic.

Seen that way, mental health support should be integrated into all support structures for vulnerable people. The problem with coverage of mental health and suicide in the media is not isolated to this issue. It is systemic. However, mental health is too often seen as niche rather than integral to health and well-being as such.

I think the two things that can be done with regard to mental health is to de-stigmatise the issue. This ought to be done by not just focusing on victims of abuse or horrors but also by providing rounded, nuanced, careful information on what support mechanisms are available for persons with mental illness and caregivers, what options are available to continue living productive and meaningful lives, what are the stumbling blocks in the path to wellness.

Also how mental illness could happen to anyone, distress can happen to anyone, stress can happen to anyone. I think we need to have a multidimensional approach to each problem — IT layoffs, domestic violence, farmers’ debt, school exams, etc — that take all aspects and solutions into consideration. We should also ensure that we don’t contribute to the problem, for instance, by hyping the success of teenagers in exams which adds to the feeling for some that competitive exams are do-or-die.

Akhilvaani : Question 12:

If I recap, in personal life (even though you are going public now), you have made it a point to be open about your depression and treatment and that you have been very lucky to have extremely supportive family, friends and colleagues. From your experience, what message you would like to give to society in general and family, friends and employers in particular as to how to make life of a mentally ill more fulfilling.

Answer (RJ)

We need access to information about all treatment options and should be able to choose those options based on what we want and need, rather than what our caregivers or doctors believe we need. Barriers to this are poverty, location, caste, education, and so many more. So, a more immediate need is to recognise the importance of mental health, the humanity and rights of those living with mental health issues, to increase availability of resources, to ensure rehabilitation and livelihood are given as much importance as treatment and diagnosis, to recognise that a variety of factors contribute to mental illness and a holistic approach is needed…

We need to have pathways to work and productivity and independence.

Believe us when we say we feel shitty. Don’t compare us to Syrian refugees. That’s only likely to make us feel shittier.

We need to remember and recognise that illness is a part of who we are, it isn’t all we are.