In a heartfelt moment in one of the Harry Potter books, Prof. Albus Dumbledore says, “Happiness can be found even in the darkest of times, if one only remembers to turn on the light.”
These words go on to inspire the children in the series by JK Rowling. Extending the same to the non-fictional world, doesn’t it apply to everyone, irrespective of their age?
Dr. Dida Khonglah shed light on the mental health scenario in Meghalaya, including the role of San Ker: Centre for Mental Health and Neurology, Shillong, to ensure appropriate healthcare to people with different mental illnesses. Since 2019, she has been working here full-time.
She said, “Our Centre has been working in this field for over 30 years. People suffering from schizophrenia, bipolar disorder, severe depression and suicidal ideation, among others, come to us. Additionally, we work towards de-addiction from substance abuse.”
Having expanded, San Ker now houses a day care centre. People with autism, learning disabilities, and seizure disorders come here and stay from 9 am to 4 pm. They have an activity-based approach where they indulge in various activities, ranging from art to handicrafts.
True to an inclusive method, they also work with geriatric patients suffering from dementia. The memory clinic mainly caters to people with dementia.
Khonglah pointed this out. “We tend to forget our elderly. Little do we know that they suffer in silence. They’re at an age where they contemplate about their lives, reason we should reach out to them. They, too, are vulnerable to depression.”
Stressing further on dementia, she added that patients often show behavioural and psychological symptoms, manifesting as anger outbursts, irritability and physical aggression during the progressed stage of the illness. Families often face difficulty in taking care of them at home. Thanks to the memory clinic, the elderly come at San Ker both for day care assistance and in-patient care.
The importance of a policy
On conversations surrounding mental health, she said, “Meghalaya is the third state after Kerala and Karnataka to work on a comprehensive policy on mental health and social care. The vision is to promote mental health and facilitate appropriate and easy access to care pathways. It also aims to reduce the extent of disability that mental disorders entail from the perspective of morbidity, mortality and social suffering.”
Terming the policy as “progressive”, she is hopeful it may address the stigma attached to mental health, and gradually change the nature of mental health conversations in the state.
Is mental health care affordable? For most mental health practitioners here, what remains to be seen is how the policy will be implemented. Affordable healthcare is the need of the hour.
People, she reminded, can relapse because they’re unable to afford healthcare.
Urban vs Rural: Who steps forward?
Mental health remains a taboo, surprisingly, in urban areas.
Khonglah emphasised, “People still ask me, with a big question mark on their faces if mental illness comes under disability.”
In this light, is talking about mental health an urban, woke affair?
She said, “We all think that mental illness is limited to urban spaces, assuming that people in our villages don’t suffer because they live away from cities. Would you believe that our rural patients from 1988 still come for follow-ups? Compared to this, patients from the city come during evening hours to make sure no one sees them. They are very guarded out of fear of a social judgement. My experience has been different and this has changed my perspective on the overall mental health scenario in Meghalaya.”
The conversation turned towards understanding this urban-rural divide.
Khonglah said, “It all starts at home. Even if someone doesn’t suffer from a mental health disorder, emotional expression is important, a sign of health. One should express joy, sadness and even anger. After all, it all starts with emotions. Talking about emotions create safe spaces as we navigate and learn emotional self-regulation together.”
Positing a question, she asks, “Why wait to hit rock-bottom where we contemplate self-harm?”
Dinner table conversations often replay how mental health should reflect outwardly. Most people comment with an, ‘Otherwise, how do we know someone is suffering from a mental health disorder?’
When Chester Benington, the frontman of the American band, Linkin Park, committed suicide, social media was abuzz with his photographs moments before his demise. His wife, Talinda Bennington shared a video of her husband laughing with his family before he took his own life.
Parental figures often comment on how an individual may not suffer from depression or anxiety because of how they appear in public spaces.
How can we, as a society, change this mindset?
In Khonglah’s own words, “This is an all-pervading stereotype. That one has to appear sad to be taken seriously. Meghalaya is no different. The literature shows that depression and anxiety are common in our state. Taken into context, living with a mental illness is living with a disability. A person can look healthy outwardly but is unable to perform his/her regular tasks.”
San Ker regularly holds outreach programmes, reaching out to people in far-flung areas – Mairang, Nongstoin, and Jowai – to name a few.
On rural people being self-aware, it’s important to remember that not everyone steps forward to address their problems.
The hint of caution evident as she said, “For the most part, they come to us when other means of addressing concerns are exhausted. Faith healers (indigenous healers), for instance, are revered figures among the people. They also consult general practitioners.”
Speaking on faith healers brought out an interesting aspect. They’re observant people. While they rely and use their indigenous herbs, oils and religious prayers, they also encourage consulting qualified mental health practitioners if the patient is too aggressive or violent.
Smiling, she said, “In few cases, our patients have told us that their faith healers have advised them to seek proper healthcare and guidance.”
Perception Woes
Most people avoid psychiatrists, fearing side effects and dependence on the prescribed medicines.
Khonglah emphasised on how dosage is controlled, usually tapered at the end, lasting as long as the mental health condition. One way to combat this fear is communication, with doctors and patients discussing possible side-effects of the prescribed medicines. “Therapy is difficult without proper training. Here in the state, we have to ensure quality psychologists and psychiatrists,” she said.
Unfortunately, people tiptoe around the word ‘psychiatry’ carefully. In the past, people would associate the term with words like ‘mad’, ‘crazy’ and ‘lunatic’.
With an optimistic tone, she said, “Things are changing now. To be in this field, one has to constantly evolve. Approaches have to move with the changing times.”
The World Health Organisation (WHO) refers to health as mental, in addition to physical and social well-being. Khonglah added, “Physical and mental health are bidirectional in the sense that chronic mental stress can heighten vulnerability to a range of physical health concerns and lifestyle-related issues such as hypertension, obesity, type-2 diabetes, to name a few. People with chronic physical illness such as cancer, strokes are vulnerable to mental health issues.”
A progressive mindset can indeed change the present conversations surrounding mental health in Meghalaya… an evolving dimension of health.
May is mental health awareness month. How can we reassure each other?
In the words of Christopher Robin from Winnie the Pooh, “Promise me you’ll always remember: You’re braver than you believe, and stronger than you seem, and smarter than you think.”