By Sarah K.
Perhaps you should have seen it coming – when he dropped out of college and stopped calling even the best of his friends. He would stare blankly at the wall, and didn’t seem to hear you calling his name. But it had seemed like such a normal day when they found your twenty-two-year-old son wandering aimlessly on the road out of your village.
Now you sit in front of the pandit (Hindu priest) who sits at a smoking altar chanting a mantra that mingles with your son’s ceaseless muttering. They told you his strange mental state was the result of a curse, or the evil eye – cast by someone who was jealous of your smart, ambitious boy.
If the pandit’s mantras don’t work, you can go to the mulvi (traditional Muslim healer) down the road. If the holy string tied around his wrist and the pungent incense blown in his face doesn’t return your son to his former self, there are shrines you can try, and remedies handed down from holy men and natural healers. You may not even think of visiting a hospital or consulting a psychiatrist.
Ninety percent of mentally unwell persons in India will never access care, other than traditional or spiritualist healers. Most communities don’t understand mental illness, ascribing strange behavior to curses, the evil eye, or simple misbehavior. Those who want to seek the care of a psychiatrist encounter a system that’s devastatingly understaffed. Unless you can afford to pay a private specialist – most can’t – you’re left seeking the care of a government psychiatrist who is likely to be hours away, the only one treating in a region of millions of people.
Dr. Kaaren Mathias works with Emmanuel Hospital Association (EHA) projects that are aimed at increasing awareness of mental health and access to care for the unwell. One woman she met has a twenty-four-year-old-son who developed schizophrenia, which the family thought was the result of black magic. “We knew he was behaving badly,” she told Mathias, “so we beat him every day to tell him to stop this silly nonsense that he was hearing voices. He carried on, so we kept beating him. After two years, we realized beating wasn’t doing any good.”
Fear, lack of knowledge, and utter exhaustion can lead to high levels of violence towards the mentally ill. Many families become worn out from dealing with erratic behavior they don’t understand and can’t control. They often resort to locking the ill member of the family in a room where they can’t escape or do harm to themselves or others.
“The trauma of the stigma in itself is another disease,” says John K. John, founder and leader of the Biblical Counseling Trust of India. He spent a year counseling a young man struggling with depression, anxiety about the future, and an inability to cope with work-related stress after the sudden death of his father.
The man’s Christian community told him he didn’t have enough faith to overcome his problem. His brother repeatedly told anyone who would listen, “He has no problem. He’s normal. He’s pretending.” Pushed further away by these accusations, the young man stopped talking and began wandering away from home without telling anyone where he was going. His family responded by institutionalizing him again and again. Eventually he became completely silent. It took six months of counseling in a supportive environment before he began to speak again.
Misunderstanding and shunning of those suffering from mental disorders affects not only them, but their care-givers as well. The mother who used to beat her schizophrenic son for misbehaving eventually came to understand that he wasn’t choosing to act abnormally. The neighbors, however, did not. They continue to tease and mock him whenever he goes out, and he has increasingly isolated himself in the house. His mother has scolded the neighbors so many times for taunting him that they no longer want to speak to her. “I just go buy my rice and come home. I don’t talk to anyone,” she told Mathias, crying over how lonely her life has become.
Death by Stigma
“We didn’t even know these people existed until we started looking,” says Nalini Christi, manager of the Roshni (Light) Project operated by EHA’s Duncan Hospital. Roshni has recently turned its attention to addressing mental health issues within its community. As they conduct awareness campaigns in the community, people have begun to call staff members about someone they suspect to have mental illness. Staff and volunteers can then intervene to help the family access care.
Divya’s family was exhausted when Roshni staff met them. Their best efforts to care for Divya had failed, so they closed her in a room to prevent her from wandering off. She refused to wear clothes, and didn’t understand that she should go to the appropriate room when she needed to relieve herself. “When we went to her house to meet them, [her room] smelled so bad,” says Nalini.
Roshni staff encouraged the reluctant family, who’d already put so much time and money into seeking care for Divya, to bring her to Duncan Hospital. They finally agreed, and brought her in the minimum of clothing she would wear. The staff purchased a sari so she could be clothed when she saw the doctor and introduced the family to the counselors at the hospital. Divya was started on medication and Roshni staff continue to visit the family, who have been infused with new compassion and resolve by seeing Divya lovingly cared for by the community.
Aman Vidya’s family was also exhausted by coping with his illness. At age 25 Aman had been diagnosed with schizophrenia, which had been left untreated. He had become impossible to handle, even threatening his mother with a knife. After that, the family kept him chained in a room on the roof. His terrified parents fed him through a grate.
When Dr. Mathias’ staff visited him, they found he had developed a leg infection. They encouraged his parents to take him to the hospital, but they refused. “The last time we took him in a car,” they said, “he was so angry he broke a window.” They were heartbroken but terrified. “We don’t know what he’ll do to us,” they told staff.
Aman’s cause of death reads “untreated leg infection.” But behind those words is an unseen, oppressive weight of exhaustion, stigma, isolation, and ignorance. Supportive community can mean the difference between life and death for people with mental illness.
Community, the Church, and Finding Healing
“Change or healing is a community project,” says John. He leans forward intently, his eyes narrowing whenever he talks about his vision of churches fully engaged in mental health issues: “The Church is the place where healing should happen”.
The Biblical Counseling Trust of India equips Indian pastors with basic pastoral counseling skills. This helps them to identify and deal with marital and parenting issues, conflict, and addictions. This training isn’t usually offered in Bible colleges, but affects pastors’ everyday interactions with people under their care. Pastors learn the difference between serious mental illness requiring medication and needs that can be met with counseling and support. Instead of simply shipping off problem church members to psychologists or praying away demons, churches can be an integral part of offering holistic care to families affected by even serious mental illnesses.
This may be one way to meet the need in a country where there are just three trained psychiatrists for every million people. Studies in the West suggest that some issues handled by psychologists or social workers could be met effectively through trained community-based counselors.
While more serious mental illnesses will still require the attention of a psychiatrist, Mathias says the need for supportive community is still vital for patients and caretakers alike. Of the few places she has seen it happening, she says, “It’s just been amazing for churches to be part of listening to people and talking with and supporting families who are very isolated.”
Mathias, John, and others long to see churches fully awaken to the potential they have to become communities of healing and support for those with mental illness.
This, they believe, is how stigma begins to fall away. “When we started, our staff was full of apprehension and prejudice – just as anyone would be,” says Dr. Mathias. “But then they meet people and sit and listen to them and they recognize the humanity and the light of God that’s in each person”.
SIM India has two opportunities for people with experience in counseling or mental health care. By coming for six months, a year, or longer you could help fill India’s massive resource deficit. “It’s a really strong opening to show the love of God,” says Mathias. “It’s touching people at an area of deep need.”