Well-being in a mad world

In the verdant and serene surroundings of Dollu in Kathmandu, a small group of doctors, researchers and students from across South East Asia were discussing the political economy of mental health with the Indian academic Ketki Ranade (KP). KP was addressing the group in her session on mental health in the week long International People’s Health University (IPHU) held in Nepal from 17th-23rd February 2020.

KP encouraged the group to think critically about the nature and content of the global discourse on mental health, who was setting the terms of the discussion and the programs, and why mental health had become an issue of global concern in the last decade. She questioned the wisdom of viewing mental health purely in terms of disease, illness and medicine, and emphasised that the prevalent paradigm of the biomedical model of mental health, which dominates global policy and legal regimes, was only the partial truth. It neither explained fully nor could fully address the problem. Mental health of persons and communities is inextricably tied up in their conditions of living, embedded in their social and cultural realities. This is something that has been captured viscerally in Sama’s research Interrogating Interruptions which looks at why young women felt mental distress. The study focused on women from rural communities in Uttar Pradesh and Rajasthan, and sought to understand the impact of structural and societal violence on their mental health. The women, through honest and raw sharing of their most personal struggles, articulated how the stranglehold of culture, patriarchy, poverty and caste shaped their lives and made them feel powerless, helpless, sad and full of impotent anger. 

The theme of the last session of the day was “towards mental wellness”. How are we to imagine mental wellness? What should the strategies and programs (in our very business-like civil society lingo) be for achieving mental wellness for all? Is mental wellness possible? How can one even achieve mental wellness in a world marked with rising inequality, conflict and growing spread of extremist and authoritarian Governments? Not to forget the very real existential threat posed by climate change which promises to drown our homes, set alight farms and dwellings in furious forest fires, batter us with heat waves and cyclones and collapse our food and water supplies.

We live in turbulent and uncertain times. As I write this, COVID-19 has spread across the world, claiming thousands of lives, sickening tens of thousands of people, putting an unprecedented burden on Governments everywhere to contain the disease and provide healthcare through overwhelmed health institutions. There is collective panic and a sense of deep foreboding that we are heading into extremely dark and dangerous times. It’s all very overwhelming.

How can I begin to imagine mental wellness in a world like this? Where do we look for hope? Is hope an act of madness? 

Perhaps the remedy lies in the wise words of Samah Jabr, a Palestinian psychiatrist. KP told the group that Jabr has studied and treated mental health issues of Palestinians. Palestine is considered to have some of the highest rates of mental illness in the world, including depression and Post-Traumatic Stress Disorder (PTSD). Living as they do in a situation of chronic conflict and ongoing trauma, Jabr believes that fellow citizens’ symptoms of ‘abnormal’ behaviour is in fact a ‘normal reaction to a pathogenic context’ and the illness lies in the context and not the person.1Goldhill, O. (2019, January). Palestine’s head of mental health services says PTSD is a western concept. Quartz. She says that good mental health is when one is able to have critical thinking and is able to empathise with others. 

This is a strangely hopeful and empowering way to understand mental health. It is within our power to think critically and objectively, to apply reason and rationality to guide our lives, to be empathetic and compassionate to people around us. These are things within our control and they are powerful ways to do good and feel good. As we stumble into what may be the beginning of a months-long pandemic, we should remind ourselves of Jabr’s words and strive to live thoughtfully in a sick world.

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