INTO THAT HEAVEN OF FREEDOM, MY FATHER…

While the Covid pandemic has been raging for a full year or more, so has the deluge of articles about the psychological implications of the same. Scores of articles have appeared in almost all media. Many of them have psychiatric textbook technical jargon embedded in them which is Greek to the untutored innocent minds. To add one more to it would be adding fuel to the flames. So I thought of going about this task differently.

To the constitution of a human being’s personality, ego and self-confidence, goes a lot of stability in the outer environment of that human being. From birth through childhood, this stability continues in the majority of us. The Indian child is closeted, buffered, cushioned, buttressed and ensconced against all anxieties by parents and in rural India by the joint Indian family system. Childhood in a country like India lasts almost till a person is 23 to 25 years old. There is giving of psychological-emotional strokes and receiving of the same. By the time we have grown into true adults, innate maturity has developed and we somehow survive the rest of our lives on our own steam. But we still continue to receive stable, positive emotional strokes. Starting from the immediate family circle, going on to distant relatives, friends, the workplace, the society at large, our teachers, mentors, our heroes, we continue to receive all psychological strokes from just about everyone who matters to our psyche as human beings, to make us believe that life was worth the living and that we had a special place under the sun.

It is this stability and sense of self which has taken a major hit because of Covid.

No longer is the world surrounding us the same. People are afraid to touch one another, to hug one another, to give physical comfort to one another. Young children are not just getting separated from their parents when the parent is critical and admitted, the young are often losing the parent as well to the Covid illness. Many families have lost their earning member, many individuals have lost jobs, many are unable to cope with EMIs, many have been downgraded in their pay scale, many are morbidly scared (a real possibility) of contracting the Covid virus during their travel to and back from work. Work from home has become a nightmare. Others have no social outings, with parks, playgrounds and beaches closed to the public. Physical isolation, an unheard-of entity earlier, has become the norm. The TV is incessantly showing negative (albeit realistic) news and seemingly focusing relentlessly on Covid. Children studying (supposedly) online has become akin to reaching the moon, given the technicalities and the glitches in internet services involved.

All in all, just about everything that went into the development and consolidation of the human psyche right from childhood onwards has been turned upside down.

The net outcome is perhaps the slow insidious wood-ant approach of the destruction of the stability of the psyche and / or the cataclysmic collapse of that same stability of the psyche, given the sudden loss of a family member to the illness. Self-worth, self-image, self-confidence are all going south. And these entire tectonic shifts in psychological planes are conducive to the production of anxiety and depression within the individual.

Where anxiety (as an increase in the adrenergic-fight response of the mind-body to the on-going crisis) ends, and where depression (a giving-up response of the mind-body to the on-going crisis) begins, the edges are blurred.

But the symptoms which prevail in differing intensities in different human beings during the anxiety phase are insomnia, chest pain, tremulousness, palpitations, excessive urination, repetitive visits to the toilet, altered menstrual cycle, repetitive thoughts, multiple random ruminations, brooding tendencies, repetitive cross-checking of small issues (mundane events like the shutting of a door), repetitive compulsive acts (like the arranging or wearing of clothes in a specific order), dryness of the mouth, blurring of vision, dizziness, an actual recorded rise in blood pressure or heart rate, irritation, agitation, temper outbursts, an unjustified fear of body illness of any kind, a constant nagging, prickling fear of suffering from a heart attack or meeting with an accident, etc.

The ceaseless protection of the elderly with their attendant medical co-morbidities (coupled with their un-noticed penchant for allowing their masks to slip off their noses on the slightest pretext) has become an obsessive panic-inducing daily ritual by itself.

The symptoms which prevail in depression are dullness, inability to cope with work, lack of alertness, diminished sex drive, inability to look after day-to-day hygiene, crying spells, suicidal thoughts along with the final giving-up-given-up complex, all these with their different levels of subtlety colouring the presentations.

All of us have distinctly different sets of fingerprints and accordingly have different responses to an onslaught on our sense of completeness and identity.

And at the very end of the spectrum of depression (at the loss of or a possible incapacitation of a loved one) are grief, denial of reality, continuous outbursts of crying spells, the holding of one’s own self responsible for the turn of events, the feelings of having done inadequately in the situation, a sense of impotency (all summed up in a very poignant term given in psychiatric lingo – the ‘Survivor’s Guilt’), a sense of anger / rage at the system / society at large.

The children have their own distinct display of something-is-wrong at their fragile-mind levels. From surfing incessantly and randomly on the internet, to picking of one’s hair, to going out of the way to feeding / befriending / being physically assaultive to stray animals, to picking fights with siblings / peers / elders, to watching excessive porn, to caricaturing images of death, to sleeping throughout the day in an oblique attempt at bypassing of all the bad news and the disturbing events, the presentations take different levels and different tangents altogether.

But the mooring point in all of the above manifestations is the same. It is the sense of the self taking a beating.

And each one of these manifestations draws the person further down into the quagmire of confusion, frustration and depletion of psychological reserves, further eroding the sense of self-worth and self-confidence.

Going a step further, in some unlucky few the sufferers may lose absolute touch with reality, start visualising images, hearing non-existent sounds / voices, may become violent, may become catatonically mute, unresponsive, may exhibit gross disorganised behaviour and become what in psychiatric parlance is called psychotic.

All of the above constitute manifestations of the turbulence within our own minds, from one end of the spectrum of psychological imbalance to the other. Suicide (the destruction of self) and homicide (the destruction of others) become the absolute extremes of the pendulum.

Even when Covid was not around, a sense of the graveness of the prevalence of mental illness worldwide was reflected by WHO estimates which claimed that by 2030 Depression would be the leading global disease burden.

The same WHO study said that 81% of people with severe mental disorders received no treatment at all in low-income countries, a category in which India fell, suggesting the vast need for mental health facilities in India.

Insofar as the Indian workforce goes, there is less than one psychiatrist for every 100,000 Indians. Paradoxically, there are more Indian psychiatrists in the US and the UK than in India, a sign of the ubiquitous Indian brain-drain. Topping that, the expenditure on the National Mental Health Programme (NMHC) in the Indian Union Budget 2021-22 was a mere Rs. 40 crores, or 0.06% of the total health budget.

Coming to specifics, an average of 381 suicides were reported daily in 2019.

The mentally ill often become homeless, which only increases their marginalisation and precariousness. Over 50% of the homeless are mentally ill.

Over a third of prison inmates in India have mental health issues.

There are gross violations of human rights of the mentally ill in India. They are often denied the right to work and the right to education. Severe mental illness is associated with the highest rate of unemployment in India – 90%.

And in the final analysis, mental illness leads to a spiralling whirlpool, viz., worsening of poverty and impacting economic development at the national level.

And this in a country which, according to a Lancet study, even otherwise had 197 million Indians with mental illness in 2017, of which a staggering 30 million had severe mental illness.

And, believe it or bust, this was our paradoxical ‘Shining’ India before the stork of the Covid came-a-visiting.

Keeping all of the above in mind, the golden questions are – How long will all these psychological fallouts of Covid continue? How do we overcome all of these? Can we actually overcome them?

To the first, I would say that the Coronavirus is unpredictable. Despite all the assertions and presumptions by world-renowned virologists, government bodies and health organisations, I, for one, believe that if there has been one constant Truth right from the time that the virus sprang upon us, it is that there is no constant or fixed pattern to the functioning of the virus, and despite all the proclamations of different world vaccinations, the virus seems to be ahead in the battle for existence as of now; and with multiple mutations available to it, it would seem to continue to be ahead for some years to come. We have a long-drawn, unending war ahead of us. We would be living in a fool’s paradise were we to presume otherwise.

Then comes the next million-dollar question. How do we get out of this fear-loneliness-defeated triad in our minds?

By realising that if ever there was a moment when we, and when I mean we, I mean WE, each and every one of us on the face of this Earth, have to hold hands and come together, then that moment is NOW.

In one of the most stimulating passages that I have read in a long, long time, the legendary activist and the drafter of the Constitution of India, Dr. B.R. Ambedkar, while pleading for humanity per se has mentioned in his book ‘The Buddha and his Dhamma’, that ‘Men are born unequal. Some are robust, others are weaklings. Some have more capacity, more intelligence, others have less. Some are well-to-do, others are poor. All have to enter into what is called the struggle for existence. And if, in this struggle for existence, inequality is recognised as the rule of the game, the weakest will always go to the wall.’ And as far as mental health goes, the most vulnerable and fragile amongst the populace succumb to mental illness. A case of survival of the fittest. Those who are mentally sensitive, unfit, unwanted, are out of the rat race.

Going beyond mental health statistics, a 2020 study from the World Economic Forum found 363 million Indians below the poverty line (BPL meaning earning less than Rs. 32 per day in rural India and Rs. 47 per day in urban India), 27 million Indians were disabled as per the New Disabilities Act, 2016 and the population of India classified as ‘tribals’ was a staggering 110 million.

Even assuming that there is an overlap between various categories, I would roughly estimate that 350 to 400 million people in India are underprivileged in some form or other.

And to top all these numbing, demoralising statistics, we now have the ravaging Covid pandemic. Keeping aside actual figures let out by the government official machinery, the plausible reality is that the second wave of Covid is rampaging through towns and villages of the remotest interiors of India, leaving death and destruction in its wake.

While all these statistics existed earlier, too, perhaps the learned and the lost-in-their-own-sacrosanct-world naive amongst us never paid attention to these grim tragedies of life. Poverty, hardships and deprivation may have been in abundance, but not within us. So, while we tut-tutted the migration of daily labourers across miles of the countryside during the first Covid wave, we (or quite a few among us) never truly empathised with their plight, having been taught to keep these underprivileged people of our beloved country in the blind spot of our vision.

But now, with the second wave of the Covid, young and old across all age groups have got afflicted with or have succumbed to Covid. It is no longer an affliction of the underprivileged or the elderly-medically-compromised amongst us. Stinko-rich, robustly-healthy young have fallen victim and have been ground to the dust. Names of diseases such as Black Fungus which were alien to even the medical community, have now become common day-to-day terms. So, it is now that we realise that this is happening to us, you, me and all of us, yes, US. And in this moment of insight and introspection we, as citizens of the world, need to reorient our strategies and the ways of dealing with the crisis.

One of the most important psychological defence mechanisms to mitigate self-pain is to understand that I am not alone in my suffering, there are many others, not just in thousands but millions in number. Anxiety and depression affect at some point in time approximately 40% of the world population. One can take it for granted that this number, post Covid, just spiralled northwards.

Keeping this in mind, and on a philosophical note, the great searcher of Truth, Gautam Buddha, had mentioned at the end of his prolonged sojourn with the dilemma of existence that ‘All Life is Dukhaa (Sadness)’, reflective of the commonality of emotional and psychiatric problems in human existence. Perhaps we, immersed as we were in our own self-goals, had lost sight of this existential Truth. Now we realise that this is closer home than we had envisaged. And this acceptance in itself brings and will bring renunciation. A great deal of pain becomes mitigated and its sharpness dulled on realising its omnipotence. Each one of us has to understand that we alone have not lost a loved one, we alone have not hit upon bad times or are finding it difficult to make ends meet.

All of us are sailing in the same boat.

In the 1955 Satyajit Ray classic Pather Panchali, the protagonist, a young girl, dies at the end of the movie. In a stoicism unbelievable in today’s times of instant gratification, the father of the girl accepts it, forfeits his home, his village and his childhood dreams to move to Kashi (present-day Varanasi) to make ends meet. We have to draw inspiration from such examples.

On a more pragmatic daily individual ritual, to break the cycle of anxiety-despondency-depression, as a psychiatrist I believe that each human mind has its own stress busters. Some enjoy an hour of music, others yoga, some others monotonous exercises like walking, running, cycling, and still others enjoy callisthenic exercises. Some enjoy reading philosophical books, others may want to curl up with a fiction-suspense novel. Some enjoy knitting, others cooking. To each one his or her own cup of solace.

At group levels, to delink from that feeling of loneliness, one can have family groups spending time in playing cards or the non-draining eternal pastimes of monopoly, dumb-charades, antakshari, scrabble and so on. Amongst groups of relatives, friends or classmates (blurring political affiliations and consciously avoiding the in-vogue political confrontations) on social media platforms such as FB / WhatsApp, one can have the sharing of moments of joy, either of the past or of the present. Sharing of photos, poems, anecdotal experiences, jokes, all give a meaning of that much-desired existentialism to our existence. Always following the golden dictum that each fingerprint has got its own particular cocoon of solitude to want to reach out to, to be on terms with oneself. To each his own nectar for the continuum of existence.

On a personal counselling note, what more or less always works is to try to inculcate the cognitive changes in a person’s negative thinking pattern and make him think broad-spectrum into ‘There, but for the grace of a God above, go I’ modality of looking at any situation, which given a country like India with the huge, huge divide between the haves and the have-nots, and with the vast numbers of have-nots involved, is not a difficult goal to achieve. Covid-specific instances can be cited and these do create the necessary emotional catharsis for the mitigation of emotional upheavals in the sufferer / listener. I very often recount the case of our own Karjat Centre nurse who was pregnant with her second baby and her husband passed away because of Covid on the very next day of her delivery. Or of an IIT Mumbai Civil Engineer who succumbed to Covid and who was not just the sole provider of his own family, but also the provider for the entire family of his in-laws who unfortunately were afflicted with mental illness and were non-earners. Often in such situations, post the gut-wrenching disclosures, risking Covid norms, the very act of reaching out and holding hands for some time, without speaking a further word, suffices.

But all throughout the journey, to be surrounded by some rays of sunshine may make all the difference and is a must. Whether they will ward off all future Covid attacks on our bodies is anybody’s guess, but to give the vaccines their just due, they do instil hope. And sometimes hope is all that is required to prevent the final descent into oblivion. Actual psychiatric experiments are witness to the power of positivity. Newspapers often have columns such as Beacons of Hope. There is an outstanding inspirational-anecdotal-stories-filled internet newsletter called The Better India. Occasional homage is paid to altruistic human behaviour on TV screens, too. But such depictions of courage and humanity are too few and far between. There have to be many, many more. Depicting stoicism, depicting both the acceptance of the odds and the fight against the odds. Buddha’s teachings have to be revisited once again.

The entire Covid pandemic is traumatising, marooning and swamping all of society and with it our collective memories and our collective conscience. To preserve and rebuild our innate sense of self-worth and self-confidence, to promulgate an ingrained human instinctual belief of truth over evil, justice over injustice, society and community at large over the self, the greater common good over individual tunnel-visioned interest, all of us can do our bit.

Yes, all of us can do our bit. Not just the psychiatric fraternity.

The private sector can do their individual minimalistic worthy contributions, the corporate sector their mega contributions, the NGOs can do their often selective (but effective) coordination and outreach to the interiors of India, the pharmaceutical sector can do its bit by giving medicines at cost or a little above, the funding agencies can chip in, the local governing authorities can do their bit by easing rules to meet priorities, the nursing colleges can do their bit, the social work institutes can pitch in by providing socially-minded manpower, the youth organisations can add their infectious, optimistic joie-de-vivre, the print media / the electronic media / the social media can spread morale, the foreign funding agencies can pump in their super-mega-financials, the UN agencies can add their might, the inter-governmental agencies can do their bit, the religious organisations can add their salvation balms, the advertising agencies their outreach programmes, the HR development experts their professionalism, the CSR funds reaching out vide either the NGO branches of the individual corporates or vide other ground-zero NGOs, the tax exemption schemes drive contribution incentives, the educational institutes can do the consolidations of social foundations, the vocational guidance organisations can do their counselling, the employment bureaux re-direct appropriately suitable applicants.

And so can the human contributions for survival and succour go on. All of us can do our bit. On different, pragmatic, point-driven available fronts.

We have to, we simply have to, display a one-for-all and all-for-one wisdom, tenacity and sagacity.

But this is going to be a long haul. From whatever little medical science I have learnt, this is going to be one nerve-sapping long haul.

Coming to the last but most important question simmering in our subconscious – Can we actually overcome this? And the answer is yes, we can and we will.

The human spirit will endure. We endured the ‘Spanish Flu’ of 1918 with its 50 million worldwide deaths, we endured the brutalities thrust upon us by the English Empire for over 150 years. But we endured. In pursuit of that dream within the quintessential Tagore poem, ‘Where the mind is without fear…’, we endured.

To end on a very personal note and a very personal example of inspiration which I came across in history – Vinoba Bhave gave talks on the Gita when he was in Wardha jail during the freedom struggle. Why? To increase the morale of all the freedom fighters incarcerated in jails. No one knew how long it would take India to attain freedom. But till then, why not boost the spirituality of India’s imprisoned freedom fighters? That was Vinoba Bhave’s greatness of thought.

Coincidentally, or call it Maharashtra’s great destiny, during the same period (from 7th October, 1930 to 6th February, 1931) Pandurang Sadashiv Sane, popularly known as Sane Guruji, was imprisoned by the British in the same jail. He was very good at long-hand writing of dictated matter. During the above period, from October, 1930 to February, 1931, he could have been transferred from that jail to any other jail by the British. But he was not. Again, this is Maharashtra’s great destiny. He actually wrote down in long-hand the entire explanations of all the chapters of the Gita as professed by Vinoba Bhave and finally this was published as ‘The Gitai’. And such is the power of goodness that in the year 2020 when we were surrounded by the bad news of Covid all around, I read ‘The Gitai’ and drew inspiration from it. So, what started as a seed in 1930 by Vinoba Bhave has continued to bear fruit in the year 2020 in my soul.

For you, and me, and all of us who care for human beings and humanity, who believe that we are God’s creations (be they different Gods whom we worship and be they different religions that we follow), it is our moral, just and compassionate obligation to Indian society that we focus on each other’s goodness, hold on to each other’s arms and swim against the current of pain surrounding us, giving each other hope and optimism for the future. We owe this to the memory of Vinoba Bhave and Sane Guruji who are sons of the soil of our hallowed India.

Immortalising in our hearts the words ‘Such are the ways that human lives must untwine, and darkest is the hour before the coming of the Light’.