During my 15-year stint (since 1999) in the US as a psychiatrist, I often wondered how India met its mental health needs with only a few thousand experts for over a billion people. On my annual visits to Bengaluru, I noticed stress levels increasing rapidly and an alarming rise in youth suicides. Was there a correlation between the era’s rapid cultural shift and the rise of depression?
Thousands of years ago, meditation evolved as a practice designed to help people realise insights about the ‘self’. Ancient Indian texts revealed that the individual self is a figment of imagination, an illusion. So when I first began investigating ideas from the East, I was drawn to the powerful liberation that this promised. While I began applying these ideas to teach my patients meditation and help them experience a state of non-judgemental awareness, I was also aware of the dangers. Given today’s scenario of short attention spans and high-functioning anxiety, meditation and practices such as Vipassana, or silent meditation retreats, is what many people turn to. While these are positive exercises, they are not quick-fix solutions to deeper issues one might be facing.
At the root
On my trips to ashrams in India I would meet many people – with clinical depression and anxiety – who had sought out meditation to treat their own suffering and had found some peace. But through many conversations with them, I saw that meditation too had ultimately failed them: in many cases, their sadness was replaced by a numb detachment from the world.
Malini, who was in her mid 40s, had left her family to live in an ashram . Despite claiming to have found peace, it belittled the suffering of her family she had left behind. “I was diagnosed with depression and was in pain. But now I am here, spending my life in service, and practicing vairagya (detachment),” she said. I then asked about her family and, fighting back tears, she said, “I miss my child and my husband keeps telling me to come back. I know it’s difficult for them, but I am happier like this.” The ashram had become a refuge for her, and instead of a means to liberation, meditation suppressed her conflicted feelings about life.
Karthik, who had been to a Vipassana retreat, spoke about how he ran away on the third day. “I think I almost went mad,” said the 28-year-old, whose mind was flooded with childhood memories of abuse in just two days of ‘silence’. “My friends told me to seek a psychologist’s help, but the guruji claimed that meditation can take care of everything and that my thoughts are not real.” While hallucinations are uncommon, meditation can bring up frightening or confusing imagery, and this requires a therapist.
There is no doubt that meditation is a powerful practice. There are many research papers proving its benefits: decreased stress and better sleep being some of them. But it is not a panacea. For people suffering from significant emotional pain, meditation is like a sledgehammer that breaks through defenses in the mind, compounding the pain.
Across the sea
As with all psychiatrists, I was trained in the western model of treatment and soon realised how ineffective it was. Even back in the 90s, depression was a chronic condition and despite treatment, more than 75% of people continued to suffer symptoms for years. CBT or cognitive behavioural therapy, by the far the most commonly practised method of therapy, proved useful — it helped people identify dysfunctional patterns of thinking and that definitely eased symptoms. But it only took them so far. Having overcome the problem that brought them into therapy, the person was often back a few months or years later when life had presented another stressful situation.
Currently, it is estimated that the US spends more than $250 billion on mental health care. But what was it about western society that caused so much emotional anguish? With every patient, I realised that an individualistic, capitalistic society placed tremendous emotional stress on individuals. And post liberalisation, I was seeing the same toxicity in India.
East meets West
An d so, as I moved between the East and the West, I learnt western therapies helped one handle the rat race of life but did teach you how to transcend it, and eastern therapies often distanced a person further. From the more commonplace issues to the most difficult cases, I found that integrating these two ideas proved beneficial. I called this ‘Integral Self Therapy’.
Many patients needed careful guidance through meditation to ensure they were not using the practice to increase psychological defences. Pavan, in his late 30s, had a successful career. Married and father to a five-year-old child, work-related stress and the constant battle for perfection had him struggling with anxiety and depression.
While medicines helped alleviate initial symptoms, through therapy, he understood his stress was due to underlying childhood issues. Growing up with critical parents, excellence was now a means of obtaining the parental approval he craved for as a child. I was careful to ensure that he was not using meditation to dissociate from his issues and with time, he learnt to observe his thoughts without judgement. On the outside, nothing has changed; he still works as hard. But he says, “I am doing so with a different purpose. On the inside I am secure even if things don’t work out.” Today, his sense of self is beyond torment, impervious to the barrage of advertisements and social media posts that promise a better life. He had found a balance.
The writer is a psychiatrist, physician and trustee on the board of The Live Love Laugh Foundation.
Published - September 28, 2018 03:40 pm IST
