A couple mourns as they stand next to the funeral pyre of a relative who died due to COVID-19, New Delhi, May 10, 2021. Photo: Reuters/Adnan Abidi
Some time ago, as India was staring at the height of its second COVID-19 outbreak, and beginning to mull a third wave, a group of eminent psychiatrists published an open letter to the media. It was one in a recent spate of such letters that have navigated India’s healthcare divides, with good reason.
As of May 24 – around the time the letter was sent – India had reported more than 26 million cases of the infection and 3.03 lakh deaths, with the rest recovering. As with most diseases, both communicable and otherwise, the number of reported cases was an underestimate, reflecting only those people who had been diagnosed. The true number of cases was expected to be at least five-times higher, with a commensurate number of deaths and recoveries.
On June 6, there had been 172.6 million cases of and 3.7 million deaths due to COVID-19 around the world. These are large numbers – and they represent the experiences of large groups of people.
In this context, a lot of communication – public, private, academic, social, emotional or intellectual – has focused on the toll the pandemic has had on people. And if its coverage in the media has been disconcerting, it’s probably because the prospects of illness and death are deeply emotional and upsetting.
Our minds are wired to pay attention to matters that appear to be most salient at a given time and place, and to experience and express empathy with the suffering of others. So it would be profoundly worrisome if we didn’t find ourselves thinking or talking about COVID-19, or reporting and consuming news of it, at this time. It could mean we have lost our abilities to sense danger and empathise with suffering – both important to our meaningful survival as a species.
Effectively, by dismissing reality, censoring reportage of the crisis will only be disorienting.
Intrapsychic v. interpersonal suffering
The pandemic is expected to affect our mental health. Some people may meet the criteria for the diagnosis of a mental illness. Many more may not – yet still have subsyndromal symptoms like low mood, high anxiety, etc. Some may cope with the stress of the pandemic, and some may not. This is far from surprising: most people are unhappy in times of wars, political unrest, economic recession, famine, etc. The presence of such suffering in the face of disasters – natural or human-made – is worrisome, but its absence would be more so.
This said, there is merit in distinguishing between the intrapsychic and interpersonal components of mental health. Thoughts, emotions and behaviours in relation to suffering within the mind constitute intrapsychic suffering. Suffering as a result of stress is an interpersonal problem, indicating the relationship between ourselves and the people or the world around us.
The two domains are interconnected, and a disturbance in one affects the other. However, our approaches to treating them differ. Mental illnesses and distress may be treated with medicines, psychotherapy or a combination, but it doesn’t truly address things when the very real social problems that have caused them persist.
We can’t deal with women experiencing domestic violence or farmers dying by ignoring the socio-economic conditions in which they exist – so too with COVID-19. Emphasising being positive and platitudes such as “don’t worry, be happy” don’t help when humankind is in the throes of a planet-wide crisis and when basic healthcare needs have been going unaddressed.
Gendered and class
A small detour here: The psychiatrists’ letter uses the word ‘hysteria’. Derived from the Greek word hystera, it’s a pejorative at best. It refers to a ‘wandering uterus’ – an entity to which men attributed women’s mental illness and behavioural changes. Its use alludes to a culture in which gender inequality enjoys scientific and mental legitimacy.
Gender and mental health advocacy has discouraged describing behaviours in words that are reminiscent of women’s reproductive organs. They bear overtones of being out of place and needing to be returned to that place by those who ‘know better’. Referring to reporting as “hysterical” carries the same overtones.
The letter also talks about lockdowns causing people to turn to TV and social media “even more than earlier”, and that when they see disturbing images, they’re “pushed deeper into the abyss”. This is a false proposition that overstates the newness of our present crisis. We were in a terrible position last year as well. India’s second COVID-19 outbreak has hit the middle and upper classes hard; perhaps the letter didn’t think there was a crisis last year because ‘only’ the lower classes were very affected.
Mental health professionals often say that mass media has an important impact on mental health, with its ability to help generate awareness, channel resources, and address stigma and discrimination. However, we must not lose sight of the press’s primary responsibility: to collect, verify, organise and disseminate accurate information. This information is never more important than during crises.
The fourth estate is more broadly expected to uncover lapses in public administration and social injustice. To suggest that it not do so because this would upset people would be to miss the forest for the trees – at best. At worst, it’s a suggestion to condone injustice by turning away from it.
As an extension of this argument, should we also expunge wars, genocides, earthquakes, cyclones and droughts from history and social studies textbooks? Because they could be distressing to students! Or should we turn away from the violence being perpetrated in Kashmir and Palestine?
Having a conscience is painful, and it should be. Both individual and collective growth can happen only when we learn from our experiences and work through our trauma together, rather than leave our skeletons in the closet and choose to let cremations or funerals go unreported.
None of this means mental health is not important or that reporting shouldn’t be ethical or humane. After the death of Sushant Singh Rajput last year and the witch-hunt of Rhea Chakraborty, many journalists as well as mental health professionals violated several moral and ethical boundaries when discussing these events. At least some of these lapses were likely on the order of a one-time mistake; even the authors are no exception to such missteps, despite – or perhaps because of – good intentions. It’s important for all of us to learn from these mistakes and do better.
Shuranjeet, the founder of Taraki and a mental health researcher, recently noted how mental health professionals’ need to “educate” the people about mental health often becomes a euphemism for our need to “educate” the people about our opinions on mental health. We need to be aware of this difference and not assume that knowing about the small slice of the community we see in our clinics makes us the voice of the people. Such a view is paternalistic and infantilises the people and their very real suffering.
It is important to note that the psychiatrists’ letter, and others like it, came at a time of increasing recognition that the freedom of the press in India is threatened. India was ranked 142 on a list of 180 countries in the 2021 World Press Freedom Index. Reporters Without Borders’ secretary-general Christophe Deloire noted that journalism was the best vaccine against disinformation. India needs this vaccine just as much as any other.
Nisha Anthony and Sannuthi Suresh are practicing mental health professionals.