SUNDAY MAGAZINE

Out of the blues

SilenceThere is still immense stigma around mental health issues and resistance to appearing ‘weak’.(Images used for representation only)R. Ragu & V. Raju  

It’s about half past six on a hot March evening in Manipal and the light is beginning to fade. Medical students, still in their white jackets, race towards a nearby food court on their bikes. Two women emerge from their hostel clutching turquoise yoga mats. The working day is almost over for many in this university town of Karnataka. But for a young woman standing on a wide road lined with rain trees, the most challenging part of her day is just beginning. She slips into the compound of a small house and, casting a quick look over her shoulder, makes her way indoors.

The building, with its pale yellow walls, ochre tiled roof, and back patio, could pass for any of the residences that accommodate faculty members. But it functions as the Student Support Centre of the Manipal Academy of Higher Education (formerly Manipal University). Here, in the soft light that streams through the house’s many windows, three clinical psychologists speak to students about a wide range of mental health issues, including clinical anxiety, depression and personality disorders.

Panic attack

According to the National Mental Health Survey of India 2015-16 (quoted by a 2017 World Health Organisation report) one in 20 people in India over the age of 18 have suffered from depression, and more than 80% of sufferers have not received any treatment. The National Crime Records Bureau reports that students made up almost 7% of recorded suicides in 2015. Around the university campus, anecdotal evidence of mental health problems is just as grave: there are many accounts of a sudden and complete withdrawal from student life, panic attacks, and cutting, all taking place in the face of a relentless pressure to succeed.

Amrita, 22, is an undergraduate medical student, confident and quick to laugh, a keen walker, mulling over options for specialisation when she completes her degree. But a couple of years ago, in the grip of a severe depressive episode, she would look at buses rumbling past in the streets and think: ‘If one of those hit me, at least it would look like an accident.’

Her difficulties began at the start of her second year in Manipal, having adjusted well to college life over the previous 12 months. She lost interest in classes, began to cry herself to sleep every night, and became frightened of spending time alone. She says that in spite of being a medical student, she had no idea what was happening to her.

Her parents were hugely supportive, coming down from Bengaluru to see her on weekends, encouraging her to talk. But in one sense, this almost made matters worse. One of her lowest moments was when her father took her on a trip to a nearby beach to help lift her mood. On their way back, all she could feel was a tremendous burden of guilt for what she was putting her parents through.

She was finally diagnosed with depression in Bengaluru, started medication, and returned to Manipal to take up classes again. But it is the sessions at the student centre, she says, that have really given her insight into her condition.

“I had always prided myself on being able to achieve every goal I set. I think we create an image of who we want to be and every time that is challenged, we just can’t take it.”

The support centre project was initiated by Gayathri Prabhu, Associate Professor at the Centre for Philosophy and Humanities, after seeing too many students unable to cope and fail to seek the treatment they required. A different system was required to support them effectively. The Vice-Chancellor’s office was responsive to her proposal and the centre was up and running in a little over six months.

“It’s never enough just to hire a few qualified counsellors or therapists,” says Dr. Prabhu. “What we have aimed to do here is to create a mental health ecosystem, which includes outreach, peer referrals and support, and above all, provides students with a safe and inclusive space to seek help. We have a moral obligation to help struggling students.”

There were other resources available to students at the university prior to the support centre’s establishment. But these would often involve waiting around in hospitals and trying to see busy teaching staff who students are reluctant to burden with their problems.

The other issue, Amrita says, is the ‘green sheet.’ Mental health issues are flagged in a student’s medical file with the insertion of a green sheet, which a doctor will see, regardless of the reason why a student is seeking medical treatment. “Many of my friends tell me that doctors just look at them differently after seeing the green sheet,” she says.

Same difference

Debasmita Phukan is a full-time clinical psychologist at the support centre. She says the fact that the centre has been located away from the hospitals, with its own files and dedicated staff, makes an enormous difference — a pioneering change. Working hours make allowances for students’ schedules and confidentiality is taken very seriously. Phukan also says that the psychologists are all under the age of 35 and students feel more able to communicate with them.

“We watch the same programmes, listen to the same music, speak their language,” she says, with a smile.

The students’ difficulties can stem from a range of reasons; from relationship troubles to sexual abuse, drug and alcohol problems to gaming addictions. Sometimes the inability to cope comes from the culture shock experienced by students from traditional backgrounds who find themselves in a vibrant university town with far fewer strictures and constraints. Often, the root of the problems goes much further back to poor parenting and neglect.

Mohit, 22, has completed his undergraduate medical degree and is currently doing his internship. His slight diffidence turns into an eagerness to talk in a matter of moments — and the words come tumbling out.

“I want everyone to know about this service. I’ve told so many of my friends here about it,” he says with an evangelical zeal.

Mohit’s depression took hold in the final year of his undergraduate degree, months before his exams. He too lost all interest in his classes and found himself beset by bouts of crying. He isolated himself and began to spend much more time alone in his room, often resorting to alcohol and substance abuse.

His darkest moment came in the middle of the night about a year ago — the one time that he contemplated suicide. Terrified, he woke up his roommates and described to them how he felt. Together, they stayed up, seeing him through the long night, watching whatever was on television, hour after hour until the sun came up. “I used to be one of those people who would see people with depression and tell them to cheer up,” he says, with a sad shake of his head.

A quiet corner

Mohit found out about the student service from a friend and gives full credit to his sessions there for his recovery thus far. He continues to see his psychologist and can see that this will be a long process. But his face lights up when he speaks of the help he has received.

“Now my psychologist here is the person who knows me best,” he says. “Better than even my parents or close friends.”

His desire to give something back to the centre is palpable. He is an artist and is planning to contribute to the collection of artwork from students, hanging on the centre’s walls.

Phukan says that the centre makes every effort to publicise its presence through college information networks and workshops but that the most effective mechanism is word of mouth. There is still immense stigma around mental health issues and a huge resistance to appearing ‘weak’ by seeking help, which makes the vocal attitudes of students like Amrita and Mohit all the more vital across Manipal’s different departments and institutes.

There are plenty of places for quiet contemplation in Manipal — silent corners in libraries, wooded trails with a view of the bend in the Swarna river, the benches that surround the serene Manna Palla lake — but for struggling students that hush can be unbearable. More and more of them are discovering that the help they need can be gained from the conversations they have in a small yellow house in the shadow of the rain trees off Manipal Drive.

Looking at the haze that hangs over the Western Ghats in the distance, Amrita pauses for a few moments.

Then she says: “I can honestly say that becoming un-depressed has been the most beautiful and enriching experience of my life.”

(Some names changed

to protect privacy.)

The writer is the author of The Smoke is Rising and One Point Two Billion

Mental health issues are flagged in a student’s medical file with the insertion of a green sheet

The inability to cope often comes from the culture shock students from traditional backgrounds get