Even in this day and age, there is a stigma associated with seeing a shrink.

Often, the first thing that many of my clients tell me when they first come to see me is that there's nothing really wrong with them, but they just want to bounce something off me. Sometimes they shuffle their feet, look embarrassed and say they really didn't want to come, but their circumstances compelled them to. Some look at me truculently and say, in unnecessarily loud voices, that they have been forced to see me by their family members, challenging me to prove there's something wrong with them. Some arrive late for the appointment and want to finish the session early so as not to be seen by the previous or next client. And still others ask for the last appointment of the day, preferably after sunset, to avoid being seen by anyone at all. Even in the 21st century, seeing a shrink remains a discomfiting experience.

Stigma is something that most mental health professionals are used to. Before psychiatry emerged as a legitimate medical discipline, those doctors who worked in what is today referred to as the field of mental health, were referred to as ‘alienists', and society was quite comfortable locking them up in asylums together with their incarcerated ‘lunatics'. While people were grateful that some doctors chose to care for the mentally disordered, the general feeling was that it was a pretty asinine career choice, particularly in view of the prevailing belief that those who worked with mental problems over a period of time, usually became a bit ‘mental' themselves. To this day, many people still subscribe to this belief, and I've learned to take in my stride the not-so-discreet stares I get when people I meet realise I am a psychiatrist, as they scan me for any signs of incipient ‘insanity'.

Refuge of eccentrics?

Since no one really believes that cardiologists end up with heart disease or neurologists have more than their fair share of strokes or nephrologists have weak kidneys, these are considered sensible career choices, but psychiatry and it's allied fields of psychology, psychiatric social work and counselling are generally seen as the last refuge of eccentrics. Such is the power of stigma, for, in our country today, to cater to the needs of 1.2 billion people of whom more than 20 million actively require mental health interventions, we have only a little over 3,500 psychiatrists, an equal number of psychologists and psychiatric social workers and an even smaller number of trained counsellors.

When a friend, family member or doctor refers someone to see a shrink, the first response is “I'm not mad. So, why should I see one?” Most of us are basically afraid of being branded or labelled as a ‘nutcase', which is why we are reluctant to approach a psychiatrist or therapist and more often than not, the initial few sessions end up being devoted to getting people to admit that they do indeed have a problem (or an ‘issue' to use the more acceptable terminology). Needless to say, aforementioned cardiologists, neurologists and nephrologists are not faced with this potentially piquant situation. At least, not often. But why this fear, which results in stigmatising those with mental health problems?

First off, there is a major concern that if one seeks psychiatric treatment or psychotherapy, one can never stop doing so. Permit me to assure you that while mental health interventions can be life-changing, they are rarely life-long (except in the case of a very small number of people with very severe mental disorders). The second major concern is that if it gets out that one has seen a mental health professional, it may affect one's marriage prospects or those of a close relative, for, nobody's comfortable marrying into a family with a history of ‘madness'. Although there is a widespread obsession about ‘bloodline purity' in Indian society, it is less difficult in the age of Internet portal matrimony to find a suitable boy or suitable girl, provided full disclosure is made before marriage. The third concern is that ‘insanity' can be used as grounds for divorcing one's partner and this often becomes the reason for people's reluctance to seek couple therapy. Fortunately, the law has in-built checks and balances to obviate this possibility, since it is not merely the presence of a mental disorder that can be used as grounds for divorce, but the existence of a disorder of such severe or untreatable proportions to preclude the individual from discharging the responsibilities of marriage.

On the decline

That said, going by the increasing numbers of people who seek the services of a therapist in contemporary India (an astonishing number of people are referred to me by Google), it appears to me that stigma is progressively on the decline. And even if seeing a shrink is not really ‘in', and I hope it never becomes that (the last thing one wants is for people to unnecessarily see a psychiatrist because it's fashionable to do so), it's fortunately still not ‘out' (I hope it never becomes that either). If this trend continues, I soon won't find it necessary to reassure my reluctant clients that it doesn't matter if they are seen visiting a shrink, for whoever sees them is also being seen by them.

The writer is the author of 3's a Crowd: Understanding and Surviving Infidelity and can be contacted at: vijay.nagaswami@gmail.com