“Yeh toh Videshi Bimaari Hai”
ANXIETY IN INDIA, A PUBLIC HEALTH CONCERN
Anxiety seems like a very foreign concept to most people in our country, literally and figuratively. But anxiety is not an imported problem.
We see anxiety as a problem that was brought to our country by globalisation and social media. This belief stands in the way of treatment for many people. It increases social stigma and introduces barriers in the acceptance of anxiety, within families and our close-knit communities.
Par theek hai galti waise kisi ki nahihai - sure, humne kabhi Indian context dhoonda nahi, but humein kabhi kisi ne yeh samne se bataya bhin ahi.
In India, conversations about psychology and psychiatry are influenced and shaped by Western frameworks. Indian realities can get lost in this context. Western organisations like the DSM (Diagnostic and Statistical Manual of Mental Disorders) did not recognise cultural context till 1994. Before 1994, there was no acknowledgement of the difference in anxiety in different societies.
Society kehisaab se anxiety ka kaaranbhialaghotahai, anxietyke symptoms bhialaghotehai, aur anxiety ka treatment bhialaghotahai.
The first difference is the cause of anxiety. Western communities are individualistic in nature, while we Indians believe in collectivism. Individualistic cultures place importance on self-sufficiency and independence. In collectivistic cultures, “we” is more important than “I”.
Each has its own pros and cons. In the west, people might be more independent and self-sufficient, but they are also more lonely, have to worry about financial and health struggles on their own, etc. In India, we almost always have people around us and rarely have to deal with material problems by ourselves.
Problems arise when expectations rise. When aunty, uncle, chacha, tau, fufa, bua start asking questions. When you not only have to worry about yourself but your family - your parents, your kids, your husband/wife/partner, brother/sister, friends, jo bhi ho.
Humeinbachpan sesikhatehai kihumeinapnebado kadhyanrakhnahai, and to always wonder “logkyakahenge?”- this is too much pressure and difficult to navigate for any one individual. Hence, it becomes the cause for anxiety by perpetuating feelings like guilt and shame. Aur, “Sharm aur lajjtohaurat ka gehnahai” - putting even more pressure on women.
“70% OF THE CLIENTS THAT COME TO YOU ARE ALREADY IN A LITTLE MORE ADVANCED STAGE. BETWEEN MILD, MODERATE, SEVERE, THEY COME TO GET TREATED WHEN ANXIETY IS MODERATE OR SEVERE. " -MADHULIKA AGARWAL
Let’s come to the symptoms. Humein jab ghabaraahathotihaitoh yeh sirf
humaremannmainahirehti. The general Indian experience of physical
symptoms of anxiety, also called jeeghabaraana, can be a wild combination of stomach pain, acidity, nausea, dildhadakna aur chakkaraana.
The DSM-5 still focuses on psychological symptoms of anxiety more than it does physical symptoms, which means that our experience of anxiety is unaccounted for and overlooked quite easily.
There are many cases in India where anxiety is mistaken for heart problems or stomach problems and mistreated or simply let go. We often don’t understand the difference between anxiety attack versus heart attack. Jab logo ko lagtahai ki heart attack horahahai aur ECG maikuchnahiaatahai, it’s written off as a “minor heart episode”, causing even more anxiety.
Panic disorders are often centred around more physical complaints like fainting in public or losing control. Social anxiety is heavily influenced by societal expectations and general pressures arising from the collectivistic culture, as discussed before.
The National Mental Health Survey 2015-16 (NMHS Phase 1) was the last big mental health survey conducted in India. It revealed a high prevalence of anxiety and stress-related disorders, with the urban-metropolitan population experiencing the most anxiety, and 40-49 year olds being the most affected age group. Many studies agree with these findings.
Anxiety-related disorders are a prominent concern in India, especially in cities. Maybe the fast-paced life really is getting to us, or maybe this is because people are more aware in cities. What it does say is, we need to take action.
While a lot of support and care is influenced by Western frameworks, India has its own unique way of treating anxiety, as it is fit for us. Even talking therapy, which seems very western, is seen in the Gita where a guru teaches their chela to emotionally regulate and self-reflect.
Therapy in India is known to be flexible. Your therapist will most likely mould their treatment to you, what you are comfortable with, what your family and individual values are and what might be most helpful for you.
Indian therapists most likely understand your situation far more than someone who doesn’t understand our culture. Now how to explain to a non-indian why we cannot miss our sister’s bhabhi’s bhai’s wedding in Goa and also have to take a 50g chaandi ka sikka which people don’t realise, ki chaandi ka bhavkitnabadhgayahai.
Indian therapists are also culturally aware and know how to implement teachings from our rich history to help us. Ayurveda has long recognised the mind-body link between anxiety and has simple holistic ways and lifestyle changes that help manage anxiety. Yoga and anulom vilom might be rebranded as “breathing techniques” but it is still Indian, and it works.
“YOGA AND MEDITATION DON’T EVEN NEED TO BE SPIRITUAL. IT CAN BE A MINUTE OR TWO OF THINKING ABOUT ANYTHING THAT COMFORTS YOU. AND EVEN MANTRAS, THEY HELP PEOPLE. WE LIVE IN A COUNTRY WHERE THIS IS A PART OF OUR CULTURE SINCE GENERATIONS, WE SHOULD CONSIDER OURSELVES LUCKY.” - KAVITA MUNGI
We may not explicitly call anxiety, “anxiety”, but we have always seen it,
recognised it and dealt with it. So this stigma for the word “anxiety”, I get it, but is it really worth it, to let that get in the way of us and people around us getting better?
To know more about The National Mental Health Survey (NMHS), Prevalence of Anxiety in India, Physical Symptoms of Anxiety, Ayurveda and Anxiety, Yoga and Anxiety, etc. you can refer to the links below: