In 1954, Dr Brock Chisholm, the first Director-General of the World Health Organization (WHO), presciently declared that “without mental health, there can be no true physical health.” Some 68 years later, most citizens of the world’s largest and oldest democracies have inadequate access to mental health facilities, much less treatment, which often involves therapy as well as pharmaceutical approaches. In addition to the absence of resources, both countries to varying degrees stigmatise those with mental health problems. It’s a common retort when we are annoyed with someone to say: “Go back on your meds.” Anyone with actual experience with mental illness likely has a lot to say about this offensive quip. Would we ever say something like this to a diabetic: “Go back on your insulin”? No. Yet, the brain is like any other organ and sometimes it too requires care.
The statistics are staggering. More than one in four American adults suffer from a diagnosable mental disorder. Suicide, the most extreme manifestation of mental illness, is the tenth leading cause of death in the United States. For adolescents (15,019), it’s the fourth-leading cause of death. In 2019, 47,511 Americans killed themselves in addition to estimated 3.5 million people who planned to do so and 1.4 who attempted suicide but were saved. Overall, the United States has a suicide rate of 13.5 people per 100,000 people.
In India, mental health is also at a crisis point. In 2015-16, the Indian government undertook the Indian Mental Health Survey and concluded that some “150 million persons are in need of mental health interventions and care (both short term and long term) and considering the far-reaching impact of mental health (on all domains of life), in all populations (from children to elderly), in both genders, as well as in urban and rural populations, urgent actions are required.” India’s suicide rate is estimated to be 10.1 per 100,000.
Globally, each year some 800,000 people will take their lives. One person will commits suicide every 40 seconds and for each suicide, there are another 20 attempted suicides. The pandemic has only exacerbated acute mental health crises across the world, failing those citizens who are most in need. In January 2022, I became one of those statistics.
I don’t hide my own struggle with mental illness purposefully. When the social media trolls spanning the political spectrum between dangerously stupid and pathological malignant offer the “Go back on your meds” prescription, I confidently retort with complete sincerity: “Oh no, munda. I cannot go off my meds. It requires a lot of meds to keep this F16 jalopy in the air.” I am open about my experiences of trying to fix a jet while flying it because I know that there are others whose airplanes aren’t in tiptop condition either. Those without depression will most likely ask in earnest puzzlement: “Who wants to fly a broken plane?” The answer is easy: It’s the only plane we have. I know that I am not waging war on an injured brain alone.
To give you the elevator introduction to my brain, she’s fifty-three. She’s kept me alive despite more than a decade of childhood sexual abuse, a jaloos of every imaginable sort of zalims malingering in out of my mother’s life largely for economic reasons, and from my own inept mother, who despite her best efforts, was first unable and then unwilling to help me. And she was also known to give me a good whooping with any whooping object she could find, in addition to a sharp tongue and no internal filters. So unless she intended to raise a highly educated savage, we may question her parenting skillset.
While I first deduced that I could end this “bhayaanak naatak”, if I could figure out how to make myself die at the age of eight, I’ve largely managed these urges with medications and therapy until I couldn’t. This past year was the year the urges became too strong and too loud. The last calendar year has been an unending onslaught of major assaults to my central nervous system. My tendentious mother-in-law finally died after three years of dying and my remaining in-laws, who consider me one chromosome short of being a chipkilli inhabiting the reading light in the dining room, have repeatedly assaulted the fundament of my marriage. I am being sued for defamation by an alleged sexual assailant for defending her alleged victims.
The emotional strain and drain of trying to help the Afghans who sought my help added to the burgeoning intolerable burden. Just when it was clear than window to help Afghans was closing, the holidays came. The holidays are that special time of year when your loved ones demonstrate how little regard they have for you. These specific challenges further strained my brain chemistry evolving under the ravages of menopause all the while suffering from unending pain from a broken wrist. One of the medications (gabapentin) given to me to stem my wrist pain has a regrettable side effect of suicide. One of my physician's ex post facto categorically denounced this drug as “dangerous.”
And so, on a lovely Friday afternoon on 7 January, without any compulsions or reservations at all, I drove my car into my garage, tried to run a hose from my exhaust pipe to my window and I hoped for that permanent sleep. Sometime later, the police were breaking into my garage and car and all hell broke loose. What happened next isn’t even clickbait: It’s just a horror show.
I was rendered into what is called a “Temporary Detention Order” and I was forcefully admitted into our local hospital. There was one problem: That hospital had no psychiatric care. (As a well-practiced mental health survivor with an unfortunate habit of getting injured, I know my hospitals.) I explained this to the police who kindly offered not to cuff me (as per protocol) for the short ride and they agreed that I was correct. But statutorily they could not take me to the hospital that did have those facilities unless they asked for permission and they didn’t want to do that.
The police took me to the back-most room in the emergency room and cuffed me to the side of the rail, leaving my broken wrist unfettered. I briefly met with a doctor, who was younger than most wines I drink, who did a cursory exam and disappeared. I wouldn’t see her until about 9 or 10, some seven hours later, when I was begging to see a psychiatrist. The Alexandria Social Worker tasked to evaluate me via an overpriced notepad with ten percent battery remaining for all of ten minutes, announced that I should be remanded to a facility based upon virtually nothing.
For about nine hours, I was cuffed to that bed. I had been given juice and a turkey sandwich when I came in at about 3 pm. They did not serve me dinner. When I asked for dinner, I was told the service was over. They did not apologise for failing to give me dinner and indignantly complained when I explained I hadn’t had a proper meal since 7 am and needed to eat. They brought another turkey sandwich with the same enthusiasm with which one might dig a communal latrine. There was no privacy for my misery. A cop sat out my door. People wondered in front of me and stared. They thought I was a criminal. My students, colleagues or neighbours could’ve walked by.
For the entire duration of the stay, which spanned 3 pm to past midnight, I cried nonstop. Without a proper meal, without any medication for my anxiety or even a sedative to help me sleep, I was chained to that bed. No one, including my husband, could visit me. I was essentially a prisoner receiving no medical care for my principal illness: PTSD-related depression. The bright lights and constant noise and untreated anxiety meant sleep was impossible. I was denied my phone and had no mental stimulation at all apart from coming up with creative ways to insult the humanity of the various humans whose actions and inactions put me in this situation.
A bit past midnight, I was ‘transferred’ in an unmarked police vehicle to a psychiatric ward about three hours from my home. My husband could not see me off and in fact, I wouldn’t see him until many days later, after my court date.
Once checked into the pagal khaana, I realised how bad our mental health facilities are. At one point, I actually considered checking into one of these clinics voluntarily. I now realised how bad that idea was. The ward was unsegregated which meant that I never felt safe the entire time I was there. What stroke of genius was this to put a woman with PTSD with a history of sexual assault onward with men? The staff was thin due to Covid-19.
The first doctor who saw me was a creepy older man who was redolent of brill cream and moisturizer for his pasty skin. He bristled when I introduced myself as “Dr Fair,” after he introduced himself to me with his own title of “Doctor”. To regain the upper hand in this power dynamic, he casually announced that he “would not do my vaginal exam”. To which I replied, “Great. Because I wouldn’t let you.” This was a needless power move to reassert his control over the situation and my own helplessness. In the words of my therapist, to whom I later recounted this fiasco, it was “retraumatising.” He also sought to deprive me of medications that I required to manage my menopause symptoms which in large measure are intended to help regulate my mental state.
Given that I was remanded to the paagal khaanaa on an emergency basis against my will, one would have thought that getting me to see a psychiatrist would be the highest priority. But it wasn’t. I wouldn’t see a psychiatrist until the day before I was allowed to go home, following a court hearing. This was not treatment: It was involuntary incarceration. It was a place they put me in hopes that my misery would pass without medical intervention. It was holding a tank.
I could fill pages with the insanity of that psychiatric ward. For those who have seen (or read) One Flew Over the Cuckoo's Nest, let me say that that film is more documentary than fiction. I had to get out of there. My PTSD made me a very unsuitable candidate for this kind of facility. (I’m not sure who is a good candidate for what was the equivalent of a goldfish bowl for humans.) I became very anxious as the court date came. Despite the efforts of my local authority in Alexandria who advocated the judge via telephone that I should remain detained against my will, the court-appointed lawyer and my own therapist persuasively and successfully argued that I should be released.
I’ve been home for twelve weeks and the hell of that event continues to play out. In their efforts to medicate me without understanding me, my trauma and my needs, they put me on medication (aripiprazole) known for inducing a state of hypomania. Unbeknownst to me, I had been living in an unsustainable state of hypomania for weeks. Eventually, my state became so disturbed that even I could discern it. I was fearful of what would follow when this hypomania ended.
The current task is to find what works to silence the voices in my head without causing yet another set of problems to manage. Knowing that I’ll be under treatment for the rest of my life and am unlikely to ever be cured and thus free of this illness, is itself a source of depression that can be overwhelming.
There’s no happy ending to the story: Just a story of how one person, who at first blush seems together and successful, manages the darkest of demons. And despite having some of the best health care an American can have, it’s still not enough. I share this deeply personal account because I know right now, someone reading this is going through I what I am going through. In short, ladai jari rahegi (battle is on). Because it has to.
Here’s the final kick in the teeth: Just as I’ve been trying to get over the shock that even seeing that hospital brings, those people had the temerity to send me the bill. Do prisoners pay the cost of their incarceration?
C Christine Fair is a professor at Georgetown University, a life struggler with depression. She is the author of ‘Cuisines of the Axis of Evil and the Other Irritating States’, ‘Fighting to the End: The Pakistan Army’s Way of War’, and ‘In Their Own Words: Understanding the Lashkar-e-Tayyaba’. Her website is www.christinefair.net. She tweets at @CChristineFair. Views expressed are personal.