Has your 'Dark Passenger' ever visited the couch?

Dexter is an American TV drama that I watch with much intrigue and inner conflict because the protagonist’s character is that of a serial killer working in the police department of Miami, Florida. His only saving grace is that he kills the ‘bad guys’ a.k.a. murderers, rapists, child molesters etc. Although his character is more extremely portrayed as pathological with a traumatic past, it often gets me thinking about how we strive so hard to keep up appearances of a ‘normal’, healthy and functional individual (or family) in the society.

I think that, like Dexter, we all have a ‘Dark Passenger’ owing to all those skeletons in our closets and our neglect to systematically acknowledge or deal with this dark passenger that leads to unanticipated domestic crimes like that of a 56 year old employee of a private company in Chennai who killed his wife with a crowbar for fighting with neighbours over the TV noise, whom he later duly informed that he had “solved the issue” (Source: India Today).

Even the famous Sigmund Freud (called the Father of Psychotherapy) referred to the ‘Death Instinct’, or Thanatos, as the drive for destruction that makes human beings strive towards an inorganic state. It is subjugated by the libido (sexual drive) and takes worldly shape as a will for mastery and power. In simple words, it is certified to say we all have a dark side that doesn’t get banished out of existence or importance by the deeds of our better side.

I don’t mean to encourage the reader to necessarily ‘give in’ to its lesser half and act as per their whims and fancies but to duly acknowledge it and systematically control and release it. Here’s where timely counseling (especially in times of grief, loss etc.) or/and even intense, long-term investment in psychotherapy is helpful.

The old argument for this (or almost any wave of change in India) is that for a country where basic medical facilities of natal care don’t exist in many parts and even the educated believe in “religious” quacks, the infrastructure or awareness for counseling is lacking and therapy is too high brow and western a concept, let alone a practice.

I spoke to some young and aspiring professional helpers in the field about the status and future of mental health care in India.

The immediate first question that pops up is that due to the lack of awareness of the importance of mental health care, is it mostly accessed by educated and upper classes of the society?

Padma Kasturi pursuing an M.Phil in Psychotherapy and Clinical Thinking in Ambedkar University, Delhi said, “I actually don't think that more and more people from different classes of society are going for psychotherapy. The clientele is extremely skewed towards the elite in society.”

Medha Gupta, an M.Phil Trainee at the Institute of Human Behavior & Allied Sciences (IBHAS), New Delhi felt more optimistically about the numbers. “I would say more and more people are aware now about psychiatric illnesses. I can tell you about IHBAS, where they had not more than 7,000 patients in 2000 and now almost 60,000 new patients come every year, and most of these belong to the lower SES (socio economic status). So, yes more and more people are not ashamed of admitting "mental illness. Most even come for follow-ups as well as many from rural areas come in regularly. Finally, bhoot-pret are given a second thought”.

Pallavi Tomar, a young psychologist in Kasturba Hospital, Manipal also believed that walk ins had increased with the younger generation (especially couples) being more upfront to get help apart from children who get referred by schools in special cases. “As far as people coming from different classes of society is concerned it depends a lot on the setup. In a private hospital you would see the high society coming directly to a psychologist with their concerns. People from middle classes are generally referred by medical professionals when they find the need for a psychological intervention. Then there are those from low socio economic status who again are either referred by other medical professionals or come in contact through NGO's and other such services.” 

Given the rampant superstitions in the country and the taboo around mental illnesses and challenges, one tends to jump the gun to assume that making therapy or counseling a routine requirement by health care professionals, your workplace or to make a PAN card seems like the only feasible way for mental health care to become common place.

Tomar expresses her doubt towards such a move. “Therapy in essence requires the individual to at least have the basic insight of feeling the need for it. Hence, I don't think it can be an equivalent to a medical check-up. Though efforts to generate awareness and workshops in schools, corporates, colleges and even at hospitals can be very helpful. “

Kasturi further adds, “People in India come from different regions, use different languages, have castes, classes, religions.... all of which contribute to a person's way of being in the world. Therapy would lose its essence if it ignores these…”

Gupta mentions the progress in counseling gaining more footholds where many big companies include stress management in their health package for employees. However, this is not a mass institutionalization, especially at the grassroots level. She points out an infrastructural incapability for catering to the masses.

“Frankly, even though I am all for making it a routine and essential practice, we do not have enough trained and motivated professionals. As I see it everyday, due to the patient rush often we are not able to give enough time to those who really need it, because we have to attend to everyone. I wonder what will happen when everyone starts coming in. Therapy usually happens at an individual level, and somehow the need is more for community outreach programs, especially for the masses”, said Gupta.  

All in all there is a general consensus towards inculcating an environment of psycho education in all our set ups whether it be schools, colleges, hospitals and workplaces to raise the awareness towards mental health related problems and to slowly and surely remove the stigma surrounding both mental illnesses and accessing service providers. Moreover, more practioneers need to strike the fine balance of private practice (which is often catering to a niche section of the society) and community or group work as a part of their responsibility in spreading the growth of mental health care in India.

As Gupta quoted, “ Somehow a constant reminder is needed. Like, everyone knows about pulse polio program, but still people miss out on it.”

Would you be open to seeing a therapist to deal with the dark passenger inside you?