The Health Collective 

Mental health

The Law and You: Trans Persons, Mental Healthcare and the Law

By Vandita Morarka

“People call us hijra, chakka and all sorts of things, no one asks us our individual names or what we want to be called. Terminology doesn't matter when there is no respect,” Surekha*, a transgender woman from a low income community, who self-identifies as belonging to the hijra community tells The Health Collective. These same people use the terms they call us as, as an insult for other people. I can proudly say I am from the hijra community today but others only look at it with disgust and shame.”

(Translated from Hindi; Log toh humein hijra, chakka or bahut kuch bulate hain. Koi nahi puchta ki naam kya hain ya phir hum kis nam se jaane jaana chahte hain. Yeh sab nam toh dur ki baat hain, jab koi adar hi nahi hain, log humein insaan jaise hi nahi dekhte, toh phir naam se kya pharak padhta hain. Jo naam humein dete hain, unhi namon ko aapas main gaali jaise isltimal karte hain. Main aaj garv bol sakti hoon ki haan main hijra hoon kyunki inhi logo ka saath raha hain, aur sab niradar aur gandagi se dekhte hain.)

Transgender persons face continued systemic oppression and violence in India. Constant social exclusion has led to their aggravated disadvantaged economic status, in turn lowering access to basic civic rights of housing, sanitation, education and healthcare. Even the National Legal Services Authority v. Union of India (NALSA) judgement, considered a landmark ruling towards establishing the rights of trans persons and providing social welfare schemes targeted at their specific needs, leaves an important aspect of healthcare directly undiagnosed - that of mental health.

The few research studies undertaken on this subject drive home the urgent need for more sustained mental healthcare solutions for trans persons along with dismantling of social barriers and continued discrimination.

Photo Hijras of Panchsheel Park II, New Delhi, 1994by R Barraez D'Lucca, shared under Creative Commons Licence 2.0 


Whenever one speaks of the mental health of trans persons, somehow the dominant discourse always seems to be on seeing their gender identity as a mental health issue in itself, rather than focusing on other aspects of mental health concerns that can oft be aggravated in trans persons due to societal systems and structural oppression.

Trans persons have constantly been diagnosed as having a “mental illness” and this continues to happen even today. Varied forms of therapy continue to be used by quacks for supposed "treatment". It was only in 2017 that Denmark became the first country to remove the classification of “transsexuality/transgender” as a mental illness.

An earlier change took place in 2013, when “gender identity disorder” was dropped from the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), published by the American Psychiatric Association. A condition called “gender dysphoria” was added to diagnose and treat trans persons. The new diagnosis recognises that a mismatch between one’s birth gender and one’s chosen gender identity is not pathological. It shifts the emphasis in treatment from fixing a disorder to resolving distress over the mismatch.

What does this mean on the ground? Trans persons in the USA are no longer classified as being mentally ill owing to their gender identity. In fact, transitioning biologically, through surgery, is considered as one of the final treatments of gender dysphoria by the American Psychiatric Association. Alongside, there is an increasing call for biological transition to not be seen as the necessary end goal of choosing a different gender identity for oneself than the one assigned at birth within the community.


Few research studies, especially in India, focus on the mental healthcare needs of trans persons. The National Alliance on Mental Illness, an American Non Profit Organisation has stated that trans persons are at a higher risk of mental illnesses.
In India, a recent study reported that about 54% the trans persons responding to the study questions had the habit of consuming alcohol and 26% of them had severe depression. It also stated that 31% of trans persons in India end their life by committing suicide, and 50% have attempted suicide at least once before the age of 20.


According to a study done in Mumbai and referenced here, 48% of hijra participants suffered from psychiatric disorders, ranging from alcohol abuse and dependence to depressive spectrum disorders. None had ever had psychiatric consultations for these issues.

Often the fear of ‘coming out’ and being discriminated against for one’s sexual orientation and gender identity can lead to: depression, posttraumatic stress disorder (PTSD), thoughts of suicide, and substance abuse.

According to the “minority stress” theory, disparities in health are due to stressors from a more dominant culture, ie “For transgender people living in a majority heterosexual culture, minority stress takes the form of discrimination, victimization, harassment, and maltreatment,” to quote from The American Addiction Centre.

Social stigma, discrimination, prejudice, harassment, and abuse are not uncommon in India. Rejection by family or missing family structures and peer support also aggravate this issue, increasing feelings of loneliness and social isolation. Fear of prejudice and stigma can be extremely harmful, especially when one may want to seek treatment. Aside from discordance between gender identity and natal role, there appear to be several socio-cultural stressors for trans persons from hijra communities that predispose them to mental health issues. These include family pressures to conform to gender norms, coming to terms with sexual identity and orientation, and migration to cities with strong hijra communities.


The law doesn’t say much when it comes to specific mental health care needs of trans persons. It is either bundled up with general healthcare, or not addressed at all. The NALSA judgement doesn’t directly refer to any supportive mental health needs of trans persons.

We asked Sourya Banerjee, a lawyer, for his view. “Currently, unfortunately, Indian Law does not even properly take into account the physical well being of trans persons. The only place the currently pending Transgender People's Rights Bill, 2016, even mentions mental health, is the token Section 19 (d), which states: ‘harms or injures or endangers the life, safety, health, or well-being, whether mental or physical, of a transgender person or tends to do acts including causing physical abuse, sexual abuse, verbal and emotional abuse and economic abuse’. This is a token penal section and does not actively aid or help trans persons.”


While The Mental Healthcare Act in India articulates the right of everyone to mental health treatment, without discrimination on the basis of gender, sex, sexual orientation, community, caste, religion, culture, social or political beliefs, disability doesn't provide specific provisions regarding mental healthcare requirements of disenfranchised groups and communities, including trans persons.

It also doesn't specify where people can go for support against discrimination by mental healthcare practitioners in treatment and care, so it's important to do a reality check on the ground, to assess lacunae in terms of implementation. 

The first step is knowing your rights: Under S.3(i) Part II of the Act, it does state that, “Mental illness shall be determined in accordance with such nationally or internationally accepted medical standards (including the latest edition of the International Classification of Disease of the World Health Organisation) as may be notified by the Central Government.”

Surekha*  tells The Health Collective, “In our community, it is difficult to get general healthcare, forget mental healthcare. We don't even know where to go and what doctor to ask for here.Such care if extremely necessary for us because so many of us are under extreme stress and depression and help is very necessary. We've faced discrimination from the time we were born, have very little access to anything and even living every day can be a struggle, even as part of a community, but where do we go and where do we find the time for this.”
(Translated from Hindi; Mere jaise logon ke liye to yahan sadharan doctor ke jana mushkil hain, mansik ilag toh bahut hi dur ki baat hain. Hum na hi jante hain ki jana kahan hain or na hi ki is bimari ke liye kaunsa doctor hota hain. Jabki aisa ilaj humare liye bahut zaroori hain, hum main se bahut log bahut dukhi rehta hain, har roz ki itni zimidari or kit kit hain. Jab se paida hue hain, tab se humare mere or mere doston ke saath alag vyavar hua hain. Har rooz jina bhi mushkil hain, koi bhi cheezo tak pahuchne ka rasta nahi hain. Jab ki aur logo bhi hain humare saath, phir bhi bahut mushkil hain. Jaye bhi toh kahan, itna waqt bhi toh nahi hain.)

Here’s what she wants people to understand.

“When they need blessings for anything they come to us but otherwise avoid touching us like we carrying some disease. We wish people would understand that this is not something dirty, it is how we feel and how we want to express ourselves and for many of us, there are no options in India outside joining the hijra community if one does not identify with their assigned gender. Several parts of our identity may be performative, but it gives us happiness, why do people have a problem with us being happy?” (translated from Hindi)

(Jab dua chahiye hoti hain, tab humare paas aate hain, apne ghar bhi bulate hain, warna toh koi galti se chuega bhi nahi, aise karte hain jaise humein koi bimari ho. Main or hum sab yahi chahte hain ki log samjhe ki humare jaise hona koi gandagi nahi hain, yeh humari pehchan hain. Aur is samaj main nahi toh aur kahan jayein? Humare jaise logon ke liye is desh main aur koi jagah nahi hain. Haan hum taali bajate hain, aise kapde pehnte hain,hum jaise hain uske kuch aise bahri dikhawa se lagte honge, par humein isse khushi milti hain, Humari khushi se logon ko kya problem hain?)


Banerjee tells The Health Collective, “It is surprising to think that historically Indian culture has always been open and supportive and yet as a developed country, we do not take care of a section of our own citizens. Hopefully, the currently pending curative petition by Naz Foundation before the SC, will finally actively protect the rights of trans persons.”

Support for mental health care needs of trans persons comes in from NGOs and civic society organisations, like the NAZ Foundation, Prothoma, Humsafar Trust, with minimal governmental support. For large scale intervention, action and impact, a national policy framework supported by on ground infrastructural changes and trained human resource personnel is of utmost necessity.

(*Name changed on request)

Views expressed are personal. This post was updated on March 19, 2018 to clarify on provisions of the Mental Healthcare Act. 

Tweet @healthcollectif @vanditamorarka with your thoughts using #RightToMentalHealth


Your Stories: Autism Awareness


(By Kishore Mohan and Merryn John/ Health Collective)

Avoid Stereotypes, Navigate Your Way to Mental Health

Havovi Hyderabadwalla is a clinical and forensic psychologist, who believes that the knowledge of psychology is a powerful tool that can improve lives. Edited excerpts of her interview with The Health Collective’s Sukanya Sharma.


Can you take us through any gender-related stereotypes?

Some of the common stereotypes which are extremely prominent in parents today is 'boys are blue and girls are pink.' 'Boys don’t cry, girls do', 'You fight like a girl.' You have parents discriminating and segregating during ages where children are forming concepts especially those related to gender. 'Boys don’t cry because boys are strong' -- Statements like these are extremely unhealthy in nature. Crying or being sad is not gender-specific. It’s only human. In fact women are emotionally stronger because they are given emotional freedom or a conduit to cleanse their system. (It) makes them more resilient in nature.

Photo by Wang Xi on Unsplash


Any stigma that you feel women face more in the field of mental illness or getting help?
Women are more open to seeking help than men which is amazing to see in today's' society. In my personal practice, I see a lot more women than men. They are more in tune with their emotions and are aware that they would benefit from receiving an external opinion.


As someone who teaches --  give us a sense of your journey. What drew you to psychology? And what were some hurdles or challenges?

Teaching was inevitable for me. I come from a family of teachers. Even as a child while we would play games I always enjoyed being the "teacher". My friends always told me I was a fun teacher. As far as hurdles go, after entering the system you realise that there is a lot of pedagogic teaching. Students are use to being spoon fed and not thinking and applying their knowledge. I teach my students that that’s not how it works on the outside world. I make sure I impart application oriented knowledge. We cannot continuously teach the future about the past. We have to be able to equip them for the future.


What are some of the stories you’d like to share when it comes to the importance of prevention or self-care as well as awareness?

Life has become a rat race. There are a few who have been able to step out of the rat race and build a healthy regime for themselves. As most of us know - "Health is wealth." We have to look at health as a puzzle which is made up of the mind, body and spirit. It is not just the body.

  • Check yourself whether you are stuck in a mundane routine.
  • Do you want to be stuck there?
  • Do you want to do something different?
  • Are you growing as a person?
  • How can it be different for you?

All work and no play makes jack a dull boy. I urge people to not just go to the gym or a run but engage in activities which are independent of mundane routine and make you happy. Try something new. Every city has a lot of opportunities to try something new.

Photo Courtesy: Neela Venkatraman

What is forensic psychology? What is your work like?

It is the study of Psychology and the legal system. One can understand the different aspect of the legal system and how it can benefit from psychology. To draw a familiar picture -- Sherlock Holmes, Pink Panther are all based on the psych aspect of crime. Forensic psychologists also work with rehabilitation of victims of sexual violence, physical or emotional issues, victims of crimes who eventually develop different psychopathology e.g. depression or post traumatic stress disorder.

Share something on how you would come to a diagnosis?
Just as a doctor sits and listens to a patient, prescribes tests and gives medication, psychologists do the same. In place of medication, we prescribe a certain therapy. We tend to chart out a road map of interventions which we feel are best suited to individual needs.

A lot of clients walk in with real but general life problems which generally they cannot handle as they are almost on the brink of emotional burn out or they are burnt out. They find themselves caught in repetitive patterns of behaviour which they spiral into and cannot resolve why. E.g. a person is divorced three times over and finds himself or herself on the verge of a fourth divorce. It’s definitely not karma. As a mental health professional, we help them understand "why him?"
I also get a lot individuals in their late adolescence to early adulthood who may be facing a lot of anxiety as well as depression. It’s a relief to see that the younger generation is more open to receiving help to make healthier decisions which result mostly in happier futures.

How much does it cost to get a diagnosis? What are the various tests that take place, and what are the costs and requirements for the same? Where can people access help for free to lower prices?

Psychological tests differ in price range just as physiological tests do. It also depends on the seniority of the practitioner. We now have in-house psychologists in various schools and many workplaces. There are independent companies such as Mind Mandala which deliver mental health care services, from psychological testing to therapeutic interventions. Government hospitals do these tests for a very low cost or sometimes for free. However, private practitioners will have their professional charges. One should be as open to getting care for the mental health as they are for their physiological health. It is an investment for a healthy future.

What are some challenges when it comes to raising awareness about psychology? Anything you’d like to highlight?

Currently, the stigma still stands where people tend to label others as "crazy", "mad", "weak", (and say) "you will get over it. It’s just a phase." It may not be a phase and you may not get over it. Get the help. It does not make you weak. In fact it will be the most sensible thing you would do for yourself or suggest to someone who needs it. It is a human life at the other end which has to be handled with care.

We live in an era where women are travelling space or climbing mountains and men are the best chefs or leading makeup artists. People, whether family or friends, need to help each other by supporting and channeling each others energy into becoming the best version of themselves.


Havovi Hyderabadwalla completed her Masters in Forensic Psychology Studies from the University of York, UK and her Masters in Clinical Psychology from SNDT University. She has taught at National College, Bandra, and SNDT Women's University.

*This post was updated on March 12, 2018 to reflect that Havovi Hyderabadwalla is no longer teaching at the National Association of the Blind.

Disclaimer: Material on The Health Collective cannot substitute for expert advice from a trained professional

If you would like to share your story, do write to us here or tweet us @healthcollectif


The Phantom Pain Monster: My Battle with PTSD and Fibromyalgia


By Sohni Chakrabarti

How do you begin to chart the cartographies of pain? Where do you really start? Is there ever a starting point to your pain? A certain location within the map of your mind where you can pin-point and say this is where it all started.

As I started to think about this piece, I felt confronted by a desire to trace my memories of pain – work through the muddles of fragmented, distorted and displaced years of accumulated pain – to find its origin. And, this is not the first time that I have tried to do so, I have revisited these dark depths of my mind repeatedly through the years, sometimes consciously and at other times unconsciously, to give it a shape or structure. I often try to structure my pain because it feels like the only way for it to have any meaning or to make sense just so that I can find closure and create that tiny space of healing. However, pain is that treacherous monster that rebels furiously every time you try to tame it. It is that phantom that escape whenever you try to contain it, only to reappear later to haunt you. The frightening ghost devours every vestige of your sanity and leaves you empty, hollow and exhausted.

Photo by Volkan Olmez on Unsplash

The vicious ghost monster that I have chosen to face is Post-Traumatic Stress Disorder (PTSD) and Fibromyalgia – two conditions that over the years have fused together to attack my mental health with episodes of anxiety, depression and a feeling of impending doom. My very own Chimera – the ominous creature that unleashes his wrath and fury whenever I challenge his existence. The PTSD forms his body or the central force that drives it forwards, the fear and the panic emerge from the back of his head and the disorientation and melancholy lash out from his tail. I move with his rhythm, pacing back and forth in my mind, spellbound in his dizzying grip. I hope for him to go away, far away, yet I seek him out and invite him back in – for he has become a vital part of my identity. I am conscious of all the other parts of my identity that come with its own sets of privileges and limitations. I am conscious that I am a woman but also heterosexual, a person of colour but also an upper-caste, disabled but with adequate socio-economic advantages – all of these different identities flow through me and come together to shape my Chimera.


PTSD is clinically defined as an anxiety disorder that develops after exposure to some traumatic event; it was earlier known as “shell shock” or “combat neurosis” experienced by men who came back from the wars. But as a woman I do not need any statistics to know that many women have silently suffered from this crippling disorder for centuries. While our bodies were subjected to violence, we were hunted down as witches for expressing our pain and trauma. Our piercing cries and melancholic wails dismissed as the symptoms of the hysterical mind. Hence, it was only when men of sound characters began to experience the clinical symptoms of PTSD – panic attacks, nightmares, flashbacks and depression – symptoms associated with womanhood, that we finally unravelled the mysteries of PTSD.  

Fibromyalgia, a little-known psychosomatic disorder manifests itself quite commonly in patients with a history of PTSD, especially in women patients. In fact, women are twice as likely to be diagnosed with Fibromyalgia – a chronic and widespread pain disorder that brings with it disorientation, memory loss, sleep problems and excessive fatigue. I was diagnosed with Fibromyalgia a few years after my official diagnosis of Rheumatoid Arthritis; I was told that it is common for people with chronic diseases to develop this phantom pain monster. However, I believe that it is my PTSD that has caused my Fibromyalgia – the Rheumatoid Arthritis merely acted as a catalyst to unleash this monster. I say this because pain is perceptive, there is no objective measure for your pain – it is expressed through your imagination, thoughts and language. My expression of the physical pain of fibromyalgia cannot be dissociated from my experience of the psychological pain of PTSD.


Gender plays a huge role not only in the way we are diagnosed and our problems medically managed but also in the way we come to articulate our problems. There are no easy ways of mapping women’s histories of pain; no way of finding that place of origin because we learn to experience fear, shame and guilt from the time that we are born – and these experiences only worsen if we find ourselves in the lower end of the hierarchical power structures of society. However, pain is always deeply personal and isolating, hence, it is always easily to get caught up with your own pain. It is far harder to go beyond your personal pain. The one thing that I would tell my younger self is to look beyond yourself – everyone has their own monsters to fight. And, the only way to tackle the monster is knowing that there is enough pain out there in this world: always remember that you are not alone.


Sohni is a doctoral researcher at the School of English, University of St Andrews, specialising in contemporary diasporic women’s writing of the United States. Her research is a cross-cultural exploration of narrative spaces in diasporic women’s fiction with an added emphasis on gender and feminism, critical race, diaspora studies and postcoloniality. In her free time, she likes to write, paper quill, collect sea shells, cook, trek and travel.


Disclaimer: Material on The Health Collective cannot substitute for expert advice from a trained professional

If you would like to share your story, do write to us here or tweet us @healthcollectif


Life Beyond Trauma: A Therapy Guide

The Health Collective/ Image courtesy Raw Pixel


By Scherezade Siobhan

The recent months have seen the emergence of a resounding global movement that is countering the unfortunate prevalence of sexual, emotional and physical violence against women and woman-identified folks. There is a developing social consciousness that is rightly affirming a zero-tolerance policy against exploitation and harassment of women in all walks of life.

Of course, this is not an isolated movement and we must truly pay homage to women and particularly women of colour who have been leading the charge for women’s rights for decades if not over centuries now. However, it is also an undeniable fact that the current global, cross-cultural climate has shown a very quickly moving form of resistance that has been aided -- in small parts -- by the presence of social media and the campaigns that have come out of it.


There seems to be a feeling of solidarity that has also helped quite a few women recognise and reach out for help with their mental and emotional health after having survived sexual and other forms of trauma themselves. On the flip side, there has also been retraumatisation -– surfacing of past memories pertaining to trauma on account of new triggers – for those who have fought their own lengthy battles for survival and resurrection. As a psychologist and therapist I have seen a sharp spike in the number of women coming in to seek counselling for trauma-related conditions during the last few months.

Living with trauma that occurs in the aftermath of a sexual assault often translates into dealing with toxic memories that can jump up without warning. A lot of times one might feel helpless or assume that repression is the best way to handle the pain but that can only cause further schisms in the mind as well as lead to more emotional and psychological dissonance. The right therapeutic journey can provide a necessary healing path and accompanied closures so that a person can live a fulfilled and engaged life without being at the mercy of their past.

Here is a short therapy guide for treatments that can be incredibly useful when you are looking for solutions and a specific healing plan: 

Eye Movement Desensitisation and Reprocessing (EMDR)

EMDR is a trauma therapy developed by psychologist Dr. Francine Shapiro. EMDR primarily involves recalling a stressful or traumatic past event and learning how to “reprogram” memory with the aid of a positive, healthy, self-compassionate and willingly chosen belief aided by a mental image.
This is done while using rapid eye movements to facilitate the entire process. Usually, after a person experiences traumatic incidents, there tends to be an accumulation of mental and emotional energy that is locked into the originating event and its fallout. A person can experience feelings of anxiety, depersonalisation, fear, and panic, as well as depressive lows from time to time and particularly so if there are triggering events that serve as sudden or constant reminders.
EMDR tries to confront and redirect those memories in a way that allows the brain to not feel imprisoned by them. The facilitation process in EMDR consists of a collection of hand and eye movements, tapping actions, buzzing sounds to create somatic grounding and works on the principle of dual simulation which involves talking about a painful memory or event while focusing on a therapist’s hand movements. EMDR has shown significant success particularly for clients and patients who deal with PTSD. This is best used when the trauma isn’t fresh and the client has the capacity to handle bad memories from their past else it can cause incremental trauma. It is also advised that you consult with a seasoned therapist who has had plenty of practice with EMDR before you initiate your own therapeutic process.


Cognitive Behavioural Therapy (CBT)

An offshoot of Dr Aaron T. Beck’s cognitive therapy, CBT is perhaps one of the most widely practised forms of psychotherapy in the world. It is an evidence-based therapeutic practice that takes into account the combined effects of an individual’s actions (behaviours), emotions, and cognition (thoughts) while working with them.
Central to CBT is the belief that an individual can feel better and thwart negative patterns of thinking and associated behaviours through cognitive restructuring – a process where a person learns to replace unhealthy or negative thought patterns with healthier ones.
One also learns coping mechanisms for emotional regulation so that the old patterns slowly are phased out and newer ways of handling emotions come to recognition. CBT can prove particularly useful for handling depressive cycles that emerge from trauma. It is not a trauma-specific treatment model but since it takes into account both internal and external environments a person has to deal with, it can be moulded into a bridge to work with folks who have experienced trauma especially if they also experience clinical depression and perhaps wouldn’t be as comfortable or ready for a more direct form of exposure therapy such as EMDR from the word go.


The Health Collective

Mindfulness Based Stress Reduction (MBSR)

This intervention was originally developed by the renowned Mindfulness expert Jon Kabat Zinn in the 1970s and has since been used widely for working with a host of mental and emotional challenges. Central to MBSR is creating a mindful awareness about a person’s own presence in the world. MBSR uses meditative techniques including body scans, muscle relaxation et al to create greater awareness about the present moment and calming the mind to fully experience it. There is a pronounced spiritual aspect to MBSR since it is influenced in parts by Buddhism as well as yoga. MBSR on the whole cannot prevent recurring memories from stopping immediately nor can it be used a curative method to work with trauma survivors. However due to its underlying components that help create a sense of serenity both mentally and physically, it is often a good practice when used in combination with another more direct approach.

Scherezade Siobhan is an award-winning Indo-Rroma Jungian scarab turned psychologist, mental health advocate, community catalyst, and a writer. She is the founder of The Talking Compass -- a therapeutic practice that provides in-person, at-home and online counselling for people who need help with emotional and mental health. She is the creator and curator of The Mira Project, a global dialogue on women’s mental health, gendered violence, and street harassment. Send her puppies and cupcakes at

Coming Soon: Surviving Trauma - Alternative Therapies

Disclaimer: Material on The Health Collective cannot substitute for expert advice from a trained professional

If you would like to share your story, do write to us here or tweet us @healthcollectif

Ask the Experts: A Psychologist's Journey

The Health Collective/ Image courtesy Raw Pixel


This Women’s Day, as part of our special series, we’re bringing you more from and about our wonderful contributors. Here are edited excerpts of an interview with Kamna Chhibber, Consultant Clinical Psychologist and Head, Mental Health at Fortis Healthcare’s Dept of Mental Health and Behavioural Sciences.


1) Tell us more about your journey -- What interested you in psychology?

When I entered Psychology in 2002 it was not a much talked about field (here in India). People were largely unaware of it and mental health certainly did not feature as a priority for a majority of people. My first encounter with Psychiatry and Psychology was through books. A Sidney Sheldon novel titled 'Tell Me Your Dreams', where multiple personality disorder was talked about, was my first encounter with mental health. When some family friends suggested I consider Psychology it all came flashing back. I enrolled myself in Psychology and once I was exposed to the subject matter and recognised the relevance and impact it has on the lives of people, the pervasive manner in which infiltrates all aspects of our lives, I was hooked...

Till date I have not come across a field of study and practice which can have the effect that Psychology can on the lives of everyone.

In particular, Clinical Psychology and Mental Health have been the domains of my interest. The complex ways in which people exist and the varied factors that impinge upon our beings make it a complicated, engaging and enriching field to be associated with. Many questions still remain unanswered and the field within our country has enormous potential, which keeps me enraptured given the nascent stage at which psychology is, and the multitudinous areas where it can find its application, but which remain untapped.


2. How far do you think Indians/ urban Indias have come when it comes to awareness about mental health/ illness, and the need to seek qualified help?

There has, undoubtedly been, a significant shift. The levels of awareness that exist within metropolitan cities is much more than what used to be a decade ago. It is not close to what it needs to be, but every step forward is a moment to celebrate and motivation to do more.
The number of individuals who are willing to seek help -- not just for clinical disorders or illnesses but for aspects of self growth, developing better skills, for relationship issues -- has increased drastically, which is a big positive indicator of the levels of awareness among the urban, educated individuals.
The manner in which mental health was previously forced to be on the fringe, and mental health problems were stigmatised, has also changed and people are more empathetic towards the mental health concerns people may have.  

3) What are some misconceptions that remain that you would like people to address?

Despite all the shifts, awareness and understanding, there continue to be many misconceptions...
Ranging from who should seek treatment, to it being a life-long process, to therapy just being about talking and medications causing dependencies and drowsiness or impacting cognitive processes, people continue to harbour many misconceptions.
Often individuals and families believe that once someone is ill then they are ill for life; or that if someone has a mental health disorder it is guaranteed that one's progeny too would be affected. Sometimes mental health illnesses are looked upon at weaknesses and at other times they are believed to be the result of spirits and 'oopri hawa'.

We still have a rather long way to go before we are able to get rid of these misconceptions that plague our society and mental health is looked upon the way physical health related illnesses are. More so, there is a still a long time before we reach the deep recesses of our geographical area and the populations which are far removed from mental health (access to healthcare).

Art by Kishore MohanHealth Collective

4) Is there something specific to women/ gender when it comes to mental health/ illness? Anything you'd want to say about stigma? Or when and how women come in for treatment or help

Mental health is largely relegated to the background and when it comes to women this is more so the case. Steering away from the debates around the gender divide, it is a known fact that there are certain mental health concerns which statistically impact more women than men.

It is known that women during particular points in their lifetime are more predisposed to developing mental health problems. These are things we need to make people aware of. It is important to take care of one's self before one can look to fulfilling roles and responsibilities towards others. Women in our society and across the world have multifarious roles and in order to enact them to the best of their ability it is imperative that they take care of themselves first. No doubt the precipitating factors, stressors and ways of coping are different for women as compared to men. But the fact is that if mental health is impacted so is overall health, well-being and productivity.


5) What is the number one thing people should know to equip themselves and their families to protect their own mental health -- including carers/ survivors?  

Mental health disorders occur due to neurotransmitter imbalances, many times in the face of stressful situations that we find difficult to cope with. What is perhaps most important is to build support systems around oneself to buttress against the stress and develop a second line of defence beyond the self. Having people around - friends and family - or in the form of experts who can be supportive, can go a long way in ensuring that one is coping better with stressful situations, be it as a person experiencing a mental health concern or a family/carer for someone who has a mental health related problem.

Kamna Chhibber is a Consultant Clinical Psychologist and Head, Mental Health, Department of Mental Health and Behavioral Sciences at Fortis Healthcare. You can read her last piece for The Health Collective: 6 Things to Know Before Entering Therapy.

Disclaimer: Material on The Health Collective cannot substitute for expert advice from a trained professional

If you would like to share your story, do write to us here or tweet us @healthcollectif

Mental Illness, Stigma and Gender Stereotypes

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By Shubhrata Prakash

Mental illness is tough on everyone, men and women, and even tougher on children; and so is the social stigma surrounding its various forms. No one has it easier simply because they are a man or a woman. However, there do exist gender-based differences in the way families and society, and even the sufferers themselves perceive the affliction.


Much of the stigma arising from mental disorders can be attributed to the fact that there is little to no awareness about their real nature. Society believes that mental disorders are choices that ‘weak’ people make. Few are willing to take a moment to understand that mental disorders are as real as physical ones, with documented changes in the brain’s structure, electrical activity and chemistry; and that no one, least of all the person suffering, has chosen to have that condition.


I think that men find it more difficult to open up and talk about their mental suffering, or even to accept their diagnoses, as doing so would be accepting that they are not ‘man enough’ or are not able to ‘man up’, as per social stereotypes. Consequently, many precious lives are lost to suicide, which could be saved if society were to become more educated, more enabling, and tolerant towards those with mental disorders.


Art by Kishore MohanHealth Collective


Women, on the other hand, open up more easily about their symptoms – but chances are that they may not be taken seriously.
‘Women always cry’ as we keep hearing… so who would take a crying woman seriously? Women are also often labelled ‘Drama queens’ or ‘hormonal’ if they display any emotion which society deems excessive. ‘Over-emotional’, ‘highly sensitive’, ‘can’t get over herself’ etc are some statements that are often heard about women.

In such a scenario, signs and symptoms of mental illnesses, in particular Major Depression or Bipolar Disorder, often get missed, because low and unpredictable moods are what these disorders bring, much like high temperature is what fever brings.

Women with mental disorders do face many dimensions of social stigma arising from existing gender stereotypes. Sometimes, mental disorders are seen as an excuse that women use for shirking work and responsibilities. Often, despite struggling with a serious mental disorder and the disability it brings, women are left to shoulder all family responsibilities, as families do not understand how real such disability is, and traditional familial structures discourage men from sharing household responsibilities.

Society also labels all mental illnesses as ‘madness’. Being labelled ‘mad’ is another fear that keeps both men and women from seeking help for their condition, or even accepting it.


Most ‘mad’ people have difficulty finding employment or getting married. Let’s not forget this is a society which looks for ‘perfection’ in our brides – read  tall, slim, milky-white complexioned, and flawless (ie not ‘mad’). It’s a society which prescribes marriage as a ‘cure’ for every perceived ‘ill’, including mental and developmental disorders, but even non-heteronormative behaviour! The unbearable societal pressure feeds the stigma, leads to denial, and is a very real force preventing people from expressing themselves or getting help. While it might be easier for a married woman to reach out for treatment, given a supportive spouse, a young girl may just be left to fend for herself, with her family ‘hushing things up’, all because of social stigma.  

Financial Concerns and Access to Help

While things are changing for the better for educated and affluent families, as far as awareness and access to help is concerned, poor and uneducated families tend not to have the resources required to deal with mental illnesses. A family that finds it difficult to take care of even their able-minded, may not be able to attend to the special needs of the mentally ill. Discrimination against girls here can be another factor in terms of access to help.

There are many ways out of the hell of social stigma, and each of these streets passes through the same landmarks – education and awareness about mental illnesses, coupled with a health care system that makes mental health facilities accessible, affordable and most importantly, acceptable.  

Shubhrata Prakash is an IRS officer, and author of ‘The D Word: A Survivor’s Guide to Depression’ (Pan Macmillan India, 2016). Read an excerpt here.

Disclaimer: Material on The Health Collective cannot substitute for expert advice from a trained professional

If you would like to share your story, do write to us here or tweet us @healthcollectif

Overcoming Depression: A Non-Stop Fight

The Health Collective/ Image courtesy Raw Pixel


By Riya*

I have had a difficult, tiring experience with depression. But I fought and overcame it all. Here is my story.

I was a brilliant student until my 10th standard, when I had a nervous breakdown. The doctors in Chennai diagnosed me in a scary way.

“She won’t be able to have a normal life,” they said.

But those words didn’t come true. I went back to school and passed my Tenth (Exams) and continued my studies. Yet things were bleak and far from normal in my teenage years. I was a silent loner, had no good friends and never felt like venturing out to parties. My grades by now were abysmal too. Many teachers were mean. I could hear the whispers about me being an odd teenager everywhere.

Despite all this, my dear mother -- a single parent -- continued to show amazing patience and love towards me. My grandmother encouraged me to play sports and refused to make me dependent on prescribed antidepressants. Their belief in me gave me hope.


But things took a turn for the worse. I was unable to finish my 12th standard and write my Board exams. My classmates all went on to college. Me, I was forced to drop out of school and spend one whole year talking to therapists. But even in that dark time, I stayed positive. I stayed at home that lonely, dark year and finished school a year late. I shuttled from one psychiatrist to another. Yes, I was prescribed antidepressants, and taking them helped me on my path to becoming well again. But I refused to depend on medication. Reiki helped me greatly, healing my spirit. I knew people were laughing at me. I became an angry teenager who felt all alone. I knew the world was labelling me crazy but I knew inside that I would never give up -- a fighting spirit spurred me on.

I went on to college. Meanwhile, the intense ambition of becoming a novelist took hold of me. That drove my spirit on each day.

… Now I am a published author with a second novel coming out soon. Today I have a magical, lovely life.

Art by Pig Studio for The Health Collective
Inspired by Your Stories: Self Harm and Healing


I was afraid of how things would turn out as a teenager, but if I could look back and give my younger self advice, I would say this.

“Don’t worry, everything will turn out great in the end.”

Because it did.

 But one issue still pricks -- The stigma. This heavy stigma around mental health is sad. Being treated for these issues is nothing to be ashamed about, because millions go through it. Seeking professional help is crucial and you can emerge a winner. Some of my friends today want to help shatter this stigma and I will be honoured to help them. But it is sad to hear that families of some depressed girls in India cover up their issues and get them married off.

Why such shame? All those women can instead be told that they can fight and succeed in life.

Encountering depression taught me to face obstacles and fight. That strength spurs on my writing. My ambition to be an author was the magical goal that changed my life. Discovering the passion for writing was therapeutic and helped me out of depression. The constant willpower saw a positive finish to my journey. So I wield that as a weapon and continue to go on.

(*Name changed on request)

Disclaimer: Material on The Health Collective cannot substitute for expert advice from a trained professional

If you would like to share your story, do write to us here or tweet us @healthcollectif


Solo's Sadventures: Episode 5

Art by Solo for The Health Collective

Also Read: More Sadventures by Solo

Solo is a writer and cartoonist from Bangalore. She likes reading, playing video games and binge-watching Netflix. Her life would have been rather unremarkable had it not been for her BPD fueled imagination. She also has 4 cats.

Understanding Tourette's Syndrome

By now, you would have seen the trailer of the upcoming movie Hichki, starring Rani Mukerji, in the role of a character who has Tourette’s Syndrome, who finally gets a job as a teacher. While we'll leave the reviews for the bonafide critics, Shruti Venkatesh takes a closer looks at Tourette’s Syndrome.



What is Tourette’s Syndrome?

Tourette’s Syndrome is characterised by brief, stereotypical but non-rhythmic “jerky” movements and vocalisations called tics.[1] Tics can be classified as motor or vocal: Motor tics are associated with movements, while vocal tics are associated with sound. Common tics include eye blinking, grimacing, jaw, neck, shoulder, or limb movements, sniffing, grunting, chirping, or throat clearing and the severity of such tics follows a waxing and waning pattern. 

A diagnosis is usually made only after verifying that the patient has had both motor and vocal tics for at least one year. 

How common is Tourette’s Syndrome?

Tourette’s, which was once considered to be a disorder of rare occurrence is now found to be a common genetic condition with its inception in childhood. [2]

Tourette’s occurs in people from all ethnic groups. Consulting psychiatrist, Dr Avinash DeSousa tells The Health Collective, “The prevalence in India is relatively less with an estimate of 1 in 1 lakh persons. However, in cases that are seen, history of epilepsy is common in patients with Tourette’s.”

Studies have found that males are affected about three to four times more often than females. [3] Symptoms of Tourette syndrome typically show up between ages 4 and 13, with the average being around 7 years of age. Approximately 10-15 percent of those affected have a progressive or disabling course that lasts into adulthood. [3] (The once understood rarity of its prevalence owes to when the disorder occurred only in 4.9 per 10,000 males and 3.1 per 10,000 females. It is now estimated that 200,000 Americans have the most severe form of TS, and as many as one in 100 exhibit milder and less complex symptoms such as chronic motor or vocal tics.)

ALSO READ: Understanding OCD

Associated Disorders

About 30 to 70 percent of patients with this disorder have substantial obsessive-compulsive (OC) symptoms [4] which may include symmetry, order, counting, and ritualistic repetition.

Attention-deficit hyperactivity disorder (ADHD) is also frequently diagnosed in children with Tourette’s, with a prevalence as high as 50 to 60 percent. [4] This comorbidity is associated with disruptive behaviours, such as aggression, inappropriate expression of anger, low frustration tolerance, adding considerable burdens to affected patients, including academic problems, peer rejection, and family conflict.

Individuals who suffer from Tourette’s also may report having depression or anxiety disorders, as well as other conditions which affect normal functioning that may or may not be directly related to Tourette’s. [5] Considering the range of potential complications, those with Tourette’s must receive medical care that provides a comprehensive treatment plan.

What causes Tourette’s?

The specific cause is unknown due to the complexity of the disorder but latest research points to abnormalities in certain brain regions, the circuits that interconnect these regions, and the chemicals in the brain responsible for communication. It was generally agreed that Tourette’s is genetically determined. However, more recently, a mixed model has been proposed in which it is suggests that infections and perinatal factors may also play a role. [6]

ALSO READ: Six Things to Know About Therapy

Can it be cured?

There is no “cure” to Tourette’s but people can lead a normal life and many don't need treatment when symptoms aren't troublesome.

Most patients experience peak tic severity before the mid-teen years with improvement for the majority of patients in the late teen years and early adulthood. Pharmacological treatment for the tics may not be needed unless they cause severe interference with social development. [7]

What are the available treatment options?

Medication has proven to be the most useful for tic suppression. However, the most common side effects include sedation, weight gain, and cognitive dulling. [3]

Dr DeSousa recalls the case of a 12-year-old boy with vocal tics (sounds similar to croaking) and sudden bursts of abusive language that were mistaken for poor behaviour at school in spite of the child’s report of it being uncontrollable and involuntary.

 Following the consultation with a neurologist and with the use of prescribed medication, the child’s symptoms drastically reduced in a month.

Dr. DeSousa advises, “The key to treatment for Tourette’s lies in a combination of long term medication and behavioural techniques in case of motor tics.” 

Habit Reversal Training and Awareness Training may be an effective treatment for tic reduction. [8] Cognitive-behavioral treatments, such as Exposure and Response prevention, continue to be a mainstay for the treatment of obsessive-compulsive disorder, especially when there is significant anxiety or phobic avoidance.

Stress has been proven to aggravate symptoms which can be improved with psychotherapy sessions. [9]  School adjustment, strong collaboration with school authorities, social coping and participation in extra-curricular activities can also help conditions. Advocacy groups focused on Tourette’s can educate and spread awareness for understanding the syndrome more accurately.

There has been significant progress in terms of research and pharmacology for Tourette’s in the last couple decades, however it is still not clearly understood. The best possible situation points toward correct diagnosis of not only the syndrome in itself but each associated comorbidity. Tourette’s requires the existence of a spectrum to avoid confusing debatable symptoms.


  1. American Psychiatric Association. Diagnostic and Statistical Manual, Fourth Edition Text Revision. Washington, (DC): American Psychiatric Association Press; 2000. pp. 108–16. (DSM-IVTR)

  2. Ludolph AG, Roessner V, Münchau A, Müller-Vahl K. Tourette syndrome and other tic disorders in childhood, adolescence and adulthood. Dtsch Arztebl Int 2012; 109: 821–288

  3. Tourette Syndrome Fact Sheet. (2012, January). Neurological Institute of Neurological Disorders and Stroke

  4. Theodore, D. D. (n.d.). Textbook of Mental Health Nursing (Vol. 2)

  5. Other Concerns & Conditions. (n.d.). Centers for Disease Control and Prevention

  6. Robertson, M. M. (march 2000). Tourette syndrome, associated conditions and the complexities of treatment. Brain, 123(3), 425-462

  7. Fernandez, H. (n.d.). Tics & Tourette Syndrome. International Parkinson and Movement Disorder Society

  8.  Tourette's Disorder: Habit Reversal Training - Topic Overview. (n.d.). WebMD

  9. Cohen S.C., Leckman J.F., Bloch M.H. Clinical assessment of Tourette syndrome and tic disorders. Neurosci. Biobehav. Rev. 2013;37:997–1007. doi: 10.1016/j.neubiorev.2012.11.013

Disclaimer: Material on The Health Collective cannot substitute for expert advice from a trained professional

About the author:
Shruti Venkatesh is an aspiring Clinical Psychologist and Research Assistant at De Sousa Foundation, currently in her fourth year as a student of Psychology. She has been trained in REBT, TA, Forensic Psychology and Clinical Psychotherapy, and volunteers at NIOS and SPJ Sadhana.


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What It's Like to Live With Anxiety and Depression

Do check out this incredible comic (created by Nick Seluk of The Awkward Yeti). I first saw it on Upworthy and was blown away by it -- like so many others have been. It is reproduced here with the kind permission of The Awkward Yeti.



This incredible comic was created by Nick Seluk, creator of The Awkward Yeti, based on a story told by Sarah Flanigan, and published on 

It is reproduced here with kind permission from The Awkward Yeti


Adolescents, Relationships and Stress

In India, year after year, we are almost inured to stories of students driven to extreme stress by board exams. At times, in the absence of learning coping mechanisms or other ways of releasing these incredibly high levels of stress, a significant number of them choose, tragically to cut short their young lives.


The National Crime Records Bureau report looking at Suicides in India (2004-2014) analyses the 'Percentage Distribution of Suicide Victims by Profession during 2014' to find that 6.1% of suicide victims in 2014 were students. (Another shocking statistic: 15.3% of suicide victims were found to be housewives; find an analysis of the data and concerns about under-reporting here on IndiaSpend)

There doesn't seem to be enough attention paid to causes of suicide -- often a web of causes, not just one simple cause.

Nonetheless, many counsellors I had spoken to over the years, including some manning exam helplines for Indian students, mentioned that frequently callers dial in to talk about relationship issues and relationship pressures. It's not just the stress of exams/ Board exam results and the massive pressure we've been socially conditioned to accept as normal, that is.


Noted child and adolescent psychiatrist Dr Amit Sen had told me years ago, about how kids are in relationships at ever younger ages -- think tweens or pre-tweens -- and aren't always able to navigate the complications of this; often relationships of course are due to peer pressure.

 Dr Amit Sen's own words on the context in India: 

"For the longest time we have found correlations between exam stress and rising depression in adolescents. There is no doubt in my mind that study and exam pressure takes a heavy toll on the minds and well being of teenagers in India. It robs them of other experiences that are vital for adolescent development. Paradoxically, as they begin to slip under the pressure, the system exerts even more pressure.

More recently, we have become increasingly aware of the close relationship between romantic relationship and depression. And indeed, as the article suggests, it is not only to do with break ups but also ongoing/"serious" relationships that often become too complicated for the mid-teens to handle. The cause and effect relationship is,however, not always clear. Its also true that depressed teenagers make themselves more vulnerable and tend to get into messy relationships more easily. A lot depends on the readiness/maturity of the person and clarity about what the relationship means and where the boundaries lie. In India, and perhaps in all places, teenagers often get widely conflicting messages about romantic relationships. This is where life skills and sex education (that is sustained and ongoing) might be preventive/protective of the many ills that plague our children today."

-- This was in response to this article in The Huffington Postwhich, among other things, raised some key points from a startling survey of more than 8,000 American adolescents on issues of depression and romantic relationships.




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