A bipolar patient welcomes the passing of the Mental Health Care Bill in the Rajya Sabha
Shreevatsa Nevatia | 01 Sep, 2016
NINE YEARS AGO, in July 2007, I woke up with my hands tied to a hospital bed. I had no idea where I was. The tubelight flickered and the tiles in the room were a dirty green. For a month, I had survived on hardly any sleep. My thoughts had raced at a frightening speed. Connected by patterns that had been imperceptible before, the world seemed like my creation. I was Shiva. I was the Second Coming. I had littered the streets of Delhi with pages from Virginia Woolf’s diary. Protesting control. The state, in particular, seemed despotic. Incarcerated, strapped, my question to the orderly was a very obvious one: “Have I been arrested?”
A psychiatrist, portly and bespectacled, soon walked in to reveal to me my diagnosis. “You’re bipolar,” he said, “but that’s good news because you’ll win a Nobel Prize.” He rattled off a list of personalities who shared my affliction—Vincent van Gogh, Winston Churchill, Emily Dickinson, Sylvia Plath, Leo Tolstoy, Ernest Hemingway, and most serendipitously, Virginia Woolf. At that point, I had little idea about the depression that would follow. The Lithium hadn’t made my hands tremble yet. My mania hadn’t resurfaced. I didn’t know that one in every four Americans was estimated to suffer from some form of bipolarity. Today, I’d ask that doctor, “For every bipolar genius, aren’t there hundreds more who suffer a crippling paralysis?” In that moment, though, the myth was comforting.
I left that Mumbai hospital 10 days later, but dramatic as it admittedly sounds, I don’t think I was ever released. Since that day, I have been institutionalised thrice again. I have had another five manic attacks and have changed as many jobs. The unpredictability of my illness has impacted my relationships and it has taken me nine years to forsake that ‘why me’ victimhood. On 8 August, however, something altogether momentous happened. The Rajya Sabha passed the Mental Health Care Bill (MHCB). First introduced on 19 August 2013, the Bill had survived adjournments and neglect. All of 134 amendments later, I was being given an agency that had, until then, been elusive.
IN 2009, HAVING rejected my diagnosis, given up my medicines, high on Foucault, Freud and Facebook, I ended up in a Delhi mental health hospital. Catching the security personnel off-guard, I climbed the high gates, spikes scraping my thighs and barbwire bruising my palms. A man running full throttle is conspicuous. It didn’t take long for six burly men to drag me back down the street, kicking and screaming. The MHCB gives me an opportunity to preclude such possible moments of humiliation. I now have the right to specify how I would like to be treated in the event of a mental health situation. A removal from society often becomes essential for those of us who are prone to losing sight of social mores, but force and fear should certainly not be a cure for our excesses.
On two later occasions, intervention came to my doorstep in the form of men in white coats. Bouncers, I learnt, are the new straitjackets. Modern day rehabilitation centres and mental health institutions still conform to an age-old stipulation—the asylum is placed outside the order of civilisation. In my case, I ended up in Delhi’s Chhatarpur and then Maharashtra’s Vasai. Finding yourself surrounded by addicts, schizophrenics and other bipolar patients reduces suffering to a denominator that is common. I have seen a geeky adolescent throw himself down two floors. A cocaine addict had to be restrained after he broke a television in a fit of rage. A fellow inmate would appear dazed on certain days. “They give me shock therapy,” he once confided. A schizophrenic poet had been confined for months because her paranoia had become too cumbersome for her cousins.
Cigarettes and conversation are the only things that help break the monotony of an internment that could last for weeks. Almost everyone that I spoke to repeated the same grouse. They had been placed in these institutions because their presence in society was inconvenient to their immediate families. Like me, many of them carried scars from their childhood and an altered mental frame had made them revisit experiences of abuse and punishment with a renewed keenness. Surprisingly, a therapist at one centre told me, “If you never said ‘no’, then it’s not abuse. It’s incest.” Worse still, in some cases, the abusive relative is himself responsible for making decisions on behalf of his victim. Thankfully, the MHCB, if passed by the Lok Sabha, will now give a mentally ill person the right to nominate a representative who could make decisions about his or her treatment and hospitalisation.
My bipolarity disrupts lives. Those who I hold most dear pay a heavy price for my ravings. The bills are expensive. Social embarrassment is inevitable. My reclusiveness is a front
The manic mind moves from an all-encompassing expansiveness to a constricting hostility within a matter of days. Parents and friends, who are first embraced with a boisterous extroversion, are soon looked at with suspicion. Lovers perhaps suffer the most. The secrets of intimacy are soon contorted enough to wound the other. There has been many an instance when I have found myself pleading— “No, that is not what I meant. That is not it, at all”—but some accusations are unforgivable. The burden of making decisions for someone so incensed may well be too heavy a cross to bear. So, while it is prudent that a Mental Health Review Commission will be able to review, alter or cancel my advance directive, it’s admittedly still enabling to know I can fashion the treatment of my madness.
After a laborious process of trial and error, I have been prescribed a cocktail of seven pills that affords me a hard-won lucidity. When I surrender to nostalgia, however, I find my mind is now cloudier. The weight gain (18 kg in nine years) is written off as irreversible. Statistics inevitably make these complaints about side effects seem like a rich man’s problems. In 2005, the state last checked its facts. It was then estimated that 6 to 7 per cent of India’s population suffered from mental disorders, and mental health practitioners believe that 80 per cent of those afflicted do not have access to sufficient treatment. With the promise of mental health services in every district, the MHCB now makes a utopian promise the Centre and state governments ought to collectively keep.
Earlier this month, The Times of India ran a story about an asylum in Behrampore, West Bengal, where 50 inmates were forced to remain naked. The MHCB gives mentally ill individuals the right to equality of treatment and protection from inhuman and degrading treatment. Dignity, especially in India, is a function of economics. The price you pay for not being chained in Ranchi, or for not being stripped in Behrampore, is a receipt from Chhatarpur that is often six-figures large. According to the MHCB, insurance companies will now be required to provide medical insurance to mentally ill persons. To pacify patients, psychiatrists compare bipolarity and diabetes. Insurance agents will now be forced to do the same. Troublingly, however, counselling might not be covered by their schemes.
Bouncers, I learnt, are the new straitjackets. Modern day rehabilitation centres still conform to an age-old stipulation—the asylum is placed outside the order of civilisation
British psychoanalyst and author Darian Leader ends his book Strictly Bipolar with the following conclusion: ‘We need to return to an earlier, more humane approach, one which attends to the particularity of each case, and which offers the manic-depressive person the chance to assume— however slowly, however painfully— what can be assumed of their history, and to find a way to live with what can’t.’ By not directly addressing the importance of counselling, the MHCB obliterates the importance of a therapeutic approach that prizes innate individuality over homogenous symptoms.
In the past nine years, I have spent more than 500 hours, sitting face-to-face with an analyst who knows when to play along with my whimsy and when to intervene. Though bipolarity has no known cure, psychoanalysis allows me my humour and my fancy. For the most part, I function in this world ‘normally’, and for that I have my prescription to thank, but also that dialogue. Therapy helps you encounter your mind and past in a language you invent. Mentally ill people first deserve a patient ear. The AIADMK MP AK Selvaraj lamented in the Rajya Sabha that only one psychiatrist was available for every 400,000 Indians. This shortfall needs correction, but we also need certified conversationalists.
When you’re manic, you feel like the smartest person in the room. This was a realisation that Carrie Mathison (Claire Daines) enhanced in the American TV series Homeland. Mathison, a bipolar CIA agent, throws away her prescription when she needs her productivity to have frenzy. I confess. I have been there and done that. Popular culture is undeniably overwhelming when it’s relatable. Even though Silver Linings Playbook (2012) has been criticised for its candy-flossed coating of the bipolar condition, it orchestrates a redemption for Pat Solitano (Bradley Cooper) that is efficacious. The ex-teacher’s community— family, friends, therapist, lover—participates in his madness. They don’t belittle his far-fetched constructs, they pander to them. I survive in the world, and sometimes thrive in it, because my support system indulges my incoherence. Societal stigma is a reality I encounter, but patience brings me resilience. If forbearance can’t be a right, it ought to be an ideal.
I now have the right to specify how I would like to be treated. A removal from society often becomes essential for those of us who are prone to losing sight of social mores
My mania makes me peripatetic. I board flights as frequently as I splurge my savings in bookstores. The depression I later sink into makes me equally sedentary. Calcutta is where my parents stay. This is where I recuperate. We live on the 13th floor of a high- rise and it is hard for me to count the instances when I’ve stood at my window, looked down and thought: ‘So if I were to jump, how quickly would gravity act? Will my head crack first? Can I land on my feet?’ These questions, though morbid, had always struck me as existentialist. Camus had ruined my adolescence. ‘There is but one truly serious philosophical problem and that is suicide,’ he’d claimed in The Myth of Sisyphus.
Suicide has always been a preoccupation for me, but foolishly perhaps, I’ve never recognised myself as suicidal. On 8 August, however, as I sat reading the fine print of the MHCB, I remember stopping. ‘A person who attempts suicide shall be presumed to be suffering from mental illness at that time and will not be punished under the Indian Penal Code (IPC).’ Devised by Lord Macaulay in 1860, Section 309 of the IPC criminalised a deed that was almost always an act of surrender, a thinly concealed plea for help. A year in prison or a punitive fine seemed like bizarre punishment for someone vying for freedom. Going back to Camus, the fall from a 13th floor window may not ensure a happy death, but the MHCB does give Woolf’s last walk to the lighthouse a modicum of absolution.
A LOVER LYING on the grass, inventing constellations, is a cliché that the less romantic amongst us pretend to avoid. But as my mind picks up speed in the first days of a manic attack, when a chemical imbalance forces me to connect Nietzsche, Kafka and the Puranas, I see no fault in the stars. My realisations manifest themselves as aphorisms. For a brief interlude, everything is illuminated. The religion that I imbibed as a child is no longer abject. The math I once despised makes fantastic sense. There’s a joke to be found at the turn of almost every sentence. Words offer themselves as puns and the unbridled confidence would put motivational self-help gurus to shame. The rest is simply dross.
In Crime and Punishment, Fyodor Dostoevsky writes, ‘Pain and suffering are always inevitable for a large intelligence and a deep heart.’ I now depend on this quote for consolation. In moments of despair (of which there are a few), it helps me believe that the light at the end of the tunnel is not that of the incoming train. But tempted as I sometimes am, I stop myself from saying that I wouldn’t exchange my madness for sanity. My bipolarity disrupts lives. Those who I hold most dear pay a heavy price for my ravings. The bills are expensive. My renunciation of the world sends my journalistic career into a tailspin. Social embarrassment is inevitable. My reclusiveness is a front.
Though the MHCB can’t change all that, it does give me the capacity to take back some control. My episodes—“meteor showers” as a beloved friend calls it—are hyphenated with stretches of clarity. It is comforting to know that our lawmakers might trust these spells enough to give me some ownership of my adversity. It took three years for the Rajya Sabha to pass this Bill. I am not hopeful the Lok Sabha will be quick on its feet. But for now, I will only swallow my Lithium and not my pride.
(Shreevatsa Nevatia is a freelance writer)