Almost two years ago, Bollywood diva Deepika Padukone spoke openly about fighting depression. She also credited someone for helping her come out of it, a lady she fondly calls Anna Aunty, her therapist and transactional analyst, Anna Chandy. At the World Economic Forum recently, Deepika thanked Chandy for the comfort level she shared with her that enabled her to reach out to her. “Acceptance is the road to recovery. Embrace the experience and know it will get better,” she said.
In 2012, a WHO report announced a shocking fact: India accounted for the highest estimated number of suicides in the world. Today, approximately 150 million people in India have mental disorders and the average age for onset of depression is 30. Chandy and Deepika have been making dedicated efforts for the last two years through the Live Love Laugh Foundation to create awareness on mental health issues, which they believe is the need of the hour.
Dressed in a simple beige kurta, Chandy exuded a warmth that made me realise why she was a successful therapist with a clientele that includes some very famous names. Having gone through a difficult childhood herself, which she has chronicled in her book, Battles In The Mind, she seemed to be on a mission of sorts, as she spoke of making relentless efforts to break the stigma surrounding mental health. “A movement is beginning in the country,” says Chandy. In a long chat over tea at the foundation office in Indira Nagar in Bengaluru, Chandy spoke about mental health issues and why addressing them should be priority.
In 2014, Deepika was at the peak of her career when she was diagnosed with clinical depression. It was her mother who noticed the signs and gave her friend Anna Chandy a call. Chandy, who has known Deepika since childhood, recounts that day in Battles In The Mind, “I could sense from Deepika’s voice that it was something serious this time. Her voice communicated deep pain and distress. She began to cry as she asked “Will you come?” Of course, I would.” Chandy met Deepika the following day and after spending an entire day with her, talking and listening, she realised Deepika was suffering from clinical depression. Deepika not only underwent treatment and recovered but she also decided to talk about it to the world. “She told me she was going to do it… initially I was surprised. When she asked me, I told her I’ll support you,” recalls Chandy, who calls Deepika a social influencer. “I think people like her make a difference, her actions impact people. She is a role model. When she comes out and says I had a problem and this is how I dealt with it, people first become curious and then start reading about it. Last week at the World Economic Forum, she also said ‘I am always concerned if I don’t take care of myself, I can have a relapse and I am frightened’.”
Mental health in India
The problem of depression and other mental health issues is increasing in India, admits Chandy. “More and more people are getting impacted by it younger and younger, even adolescent kids,” she says. There are various factors responsible. “Lifestyle changes, being overburdened, not getting adequate rest, no quiet time—it is a packed day, our sense of wanting to achieve and gain recognition fast is dangerous. We are not willing to do it in a planned manner. These are impacting the way we function, and experience ourselves psychologically,” she states. But a good thing is that the number of adolescents asking for help is increasing. “They say they know something is not okay with them.”
To say there is stigma associated with mental health in India would be to state the obvious, but Chandy believes the situation is improving. As more and more people come out and openly talk about it, others are encouraged to do so as well. “We just came back from Davanagere [in Karnataka] and it was so impactful to see rural people come out and seek help. When they first said they had a problem they were ostracised, but the moment they started getting help and recovered, not only were they accepted but others started seeking help, too,” recalls Chandy. “It is a rippling effect. Some of us have to do it first and face the flak for it. But as more people come out, more people will seek help.”
The Live Love Laugh Foundation, which was founded by Deepika and has Chandy as its managing trustee, is making consistent efforts to create awareness about mental health, break the stigma and build an inclusive community, “inclusive as in to include mental health in our daily conversations,” she clarifies. The foundation has depression awareness sensitisation programmes for students, teachers and general practitioners. “We also have a partnership in rural Karnataka where we provide accessibility and sensitisation. We are planning to go into research a little later and also start a corporate programme. We are not just promoting but are building a movement in mental health in India.”
Signs to look out for
Anyone can suffer from depression, anxiety or any other mental health problem. Crying excessively or being edgy all the time are signs of a stress-related problem. “You may also experience physical symptoms like losing your appetite or even headache or backache. Some people feel like there is a cloud over their head, some feel a constant sinking feeling and there is no obvious external factor. There could be physical symptoms accompanied by psychological and behavioural symptoms,” explains Chandy.
What happens once I see I have a problem? How do I go from first admitting to a problem to seeking professional help? “I believe all of us need support. We are relating human beings. If you catch yourself reacting to different situations and you are unable to contain and problem-solve, you definitely need to seek professional support,” advises Chandy. “You may or may not be having depression, but you need to take professional support. It helps you ventilate, express and problem-solve. It is like cleaning your cupboard. If you have a cupboard with too many things, you can’t shut it, it begins to spill out. Spilling out is a form of distress—could be in the form of bouts of rage, being irritable, or crying continuously. You are not able to contain anything. When you have four or five symptoms going on for over two weeks and you don’t look forward to anything as you used to before, then it is a sure sign you need to get checked for depression. You need to seek professional support.”
Role of TA
Chandy uses counselling and transactional analysis, a radical social psychology developed by Canadian psychiatrist Dr Eric Berne, to help her clients. “He developed it as a theory of personality and a theory of communication. In TA, we understand that all human beings have repetitive patterns and we are able to identify and distinguish the repetitive patterns. From the way we probe and inquire with the individual, we are able to understand the deeper intro-psychic process, which means the unconscious pattern,” explains Chandy. “Very often, human beings feel stuck, because we catch ourselves doing the same thing which at one level we know is unhealthy or limiting for us. When people come to me with problems, through the process of inquiry and the relationship, which is a safe, non-judgmental space, the individual is able to first become aware of the pattern and they are able to identify the source, which then becomes the trigger that causes them to do the same thing. Then we work at how we can overcome this, what is in our system, is it our values, our attitudes, the way we communicate and who are the influencers in our early life who have impacted us so deeply that we are unaware that in a way we are copying them. We bring out your whole unconscious template into the conscious and you can observe and become aware of the way we function psychologically.”
Growing up in a dysfunctional family, Chandy admits she suffered from anxiety and that it has been a long journey from there to what she is today. Battles In The Mind is a moving story of young Anna as she was caught amid the fights of her parents, her personal issues and how she found a way out of it to emerge a positive person. She says she was lucky to not get completely lost in life as she started taking help after her marriage. “When I had my first child I was a very anxious mother; I knew I needed help. My husband actually asked me once, do you think you need to take help. When you come from a dysfunctional family, you somehow want to hold the marriage together; it is almost a compulsion. I knew I needed to do this if I wanted to hold it together. I have been taking professional support and I continue to take professional support,” she says with pride. “I find therapy so empowering even for myself because a therapist provides a space where you can talk about your deepest darkest secrets and not be ashamed and yet find a way to manage that, without the fear of being judged. I tell my clients my story and tell them there is nothing to feel bad about. I come from the philosophy that it is okay to be vulnerable and I encourage that. I see vulnerability as a strength.”
Chandy, 54, believes the first seven years of life are extremely important and any powerful experience you have in this time shapes your adult life. “Early impressions have long-lasting effects on us psychologically and they play out in our adult life. They become a part of your adult life in terms of how you engage with others, situations and with the world,” she stresses. “Like sexual abuse, coming from dysfunctional families, physical or emotional violence, socio economic factors like famine or disasters can trigger trauma, which can lead to depression. The first seven years are the most crucial.” She admits that her early years of living in a dysfunctional home have impacted her in multiple ways—“the need to please people, the need to keep quiet, I would never say things I wanted to. So I was considered manipulative. I was suspicious of people.”
Chandy says she would be inauthentic now if she says she did not suffer from anxiety. “I was a very anxious adult in my early years. Anxiety didn’t come out in the form of worry but in the form of irritability and anger. I have written in the book how I used to please people. Even now, I can feel a bodily sensation when I am going to say no but I am aware of what it is so I manage it.” Having said that, she acknowledges that her childhood experiences have helped her become who she is today. “When you are going through a difficult time in your life, one that society does not accept, it is a lot of pressure to project that all is well when actually all is not well. Understanding that in people is part of my success today. I really feel for people.”
Need for medication
While Chandy herself did not need or take medication, many others need medication to treat problems like depression or anxiety. “Medication depends on what the issue is and to what extent it impacts the person,” explains Chandy. Therapists use a PHQ questionnaire, which is a world standard format that helps them understand the level of depression. “Anybody who comes to see me, fills in the questionnaire for an understanding. Along with that, I also talk to the individual to assess if it is a life issue or is there a biological component as well. I take three to four sessions with an individual to assess whether they need to be sent to a psychiatrist for medication or can we work through the early distress issues therapeutically. If there is a biological component, the psychiatrist will give the medication but in addition they also tell them to continue therapy. It’s a collaborative process. If you need to feel better or see change, you need to have at least 12 sessions. If they are coping well, even after that it is good to connect with the therapist once a month to understand how you are doing and if there are any other triggers causing distress.”
The early stages of depression can be managed with good food, meditation, yoga, along with therapy, states Chandy. “It is when you ignore what is happening to you that you reach a point when you will need to go to a doctor.”
When dealing with a mental health problem, the importance of family support cannot be undermined. “I believe a person’s recovery requires the doctor, therapist and family to support them. The family has to understand the illness and be sensitive and not label the person,” says Chandy. “When I work I say I work with individuals who belong to families. So, I meet the families as well.”
Chandy recalls the case of a 17-year-old boy from an international school. “He had signs of depression—anger, headaches. His school said he had bad behaviour. After a few sessions, I referred him to a psychiatrist and started medication. I also called the family in. I used to have family sessions with the mother, father and younger sister on what was happening to the young boy. I also had separate sessions for each of them to see how they were separately dealing with it, like what it was for the mother to see her son suffering and how she dealt with it.” Families need support, too, she points out.