There is no health without mental health; mental health is too important to be left to the professionals alone, and mental health is everyone's business.
Vikram Patel
Prohibition of substances which give pleasure to people does not work. Addiction is a health problem, not a moral one, and there are many proven strategies which can reduce its burden.
In the end, I do not think we will find the neat boundary between 'normal sadness' and 'clinical depression,' if only because mood is an innate human characteristic, like weight or the length of our hair. However, to reject the very notion of depression as an illness on account of these difficulties is throwing the baby out with the bath water.
There seems little doubt in my mind that depression, in particular at the severe end of the experience of this condition, is as real a disorder as diabetes is at the severe end of blood glucose levels.
The current approach that psychiatry takes almost ignores social worlds in which mental health problems arise and tries to become highly biomedical like other branches of medicine such as cardiology or oncology. But psychiatry has to be far more embedded in people's personal and social worlds.
Most aid agencies do not even consider proposals to treat mental health problems; those that do think of it as a minor player, overshadowed by the pressing need to save lives by treating physical illness.
I learned so much in Zimbabwe, in particular about the need for humility in our ambition to extend mental health care in countries where there were very few psychiatrists and where the local culture harboured very different views about mental illness and healing. These experiences have profoundly influenced my thinking.
There is no evidence to show that prohibition has ever had its intended impact. Of course, just as banning beef has reduced beef consumption, banning alcohol will lead to reduced alcohol consumption. But, there appears to be little or no correlation between, say, domestic violence or household impoverishment and prohibition.
In my mind, depression is, like all non-communicable diseases, a physiologically expressed condition which is profoundly influenced by our social and cultural environments. Depression is a global crisis not only because it is common and universal, but because the vast majority of affected people suffer in silence or receive inappropriate care.
Those who believe that health is a commodity, on par with cars or computers, fail to grasp the basic economic lesson that health is very vulnerable to exposure to the markets, not least due to the profound asymmetries in power between the providers and consumers.
In 1993, when I landed in Zimbabwe, there were just 10 psychiatrists in that country of 10 million people. Nine of the 10 were foreigners who spoke no regional language.
I think the government must recognise that the wounds of conflict are even more grievous on the mind than the body, and indeed may even serve to fuel further conflict. Where conflict cannot be avoided, provision of adequate psychosocial services to prevent the adverse mental health consequences should take priority.
The difference in the quality of medical care received by people with mental illness is one of the reasons why they live shorter lives than people without mental illness. Even in the best-resourced countries in the world, this life expectancy gap is as much as 20 years. In the developing countries of the world, this gap is even larger.
Prohibition, like so many other policies imposed from the moral high ground, typically by those who do not drink, disproportionately affects the poor who resort to illegally brewed alcohol when they want a drink, not infrequently leading to their death, and are more likely to be harassed by the police.
India remains one of the few nations which still focuses entirely on an archaic de-addiction model, administered by the ministry of social justice and empowerment, to address drinking problems, adhering to a centuries-old idea of these problems being a moral disorder rather than a health condition.
In many parts of the world, chaining of people with mental illnesses is not uncommon, nor is seeing people walking around in clearly an unwell state, half naked, and no one takes any notice of them. It is tragic. There is a basic human right, which is not about just healthcare, but it is about the right to life with dignity, a right to citizenship.
I am passionate about swimming, which I try to do at least five times a week.
It is easy to lay the blame on successive governments for failing to address health as a fundamental right for the Indian people. But the real tragedy is that we, the people of India, have not taken our government to task for this catastrophic failure.
I trained in medicine in India, and after that, I chose psychiatry as my specialty, much to the dismay of my mother and all my family members who kind of thought neurosurgery would be a more respectable option for their brilliant son.
Most of the people who make decisions about global health are in the U.S. and Western Europe. There, the mental health care system is dominated by highly trained, expensive professionals in big hospitals, who often see patients over long periods of time. This simply can't be done in rural Africa or India. Who the hell can afford that kind of care?
No matter where you are, depression responds to the same treatment.
I used to be one of the lead actors of a theatre group called Hetu when I was in medical school. Prithvi Theatre was our stomping ground. I'd got many positive reviews.
If our children are becoming teenagers who are abusive, have mental health issues, and are committing heinous crime, it only means that we have failed them as a society. We have failed to give them a safe, nurturing environment to ensure that they are well-balanced, useful persons in the society.
Children have to be provided a nurturing environment to grow. Sadly, in India we don't have a robust mental health programme for children. There is also a lack of accountability in the public system.
I have known I was destined to live in Goa the moment I first stepped foot on the Panjim docks from the ferry from Mumbai, when I was 18.
Depression has existed as long as mankind itself, and certainly well before psychiatry, antidepressant medication, or the nation of America itself came into being.
Mental health can improve overall well-being and prevent other illnesses. And since mental health problems have a serious economic impact on vulnerable communities, making them a priority can save lives and markedly improve people's quality of life.
