The new urban epidemic in India
Rahul Pandita and Lhendup G Bhutia | 14 Jun, 2018
EVERY MAN IS an island, she says, paraphrasing John Donne. She is a software engineer, and lives with her husband of six years in a ninth-floor apartment in Gurugram. In the morning, there is no time to talk. They return from work around the same time and say polite things to each other, like “How was your day?” and “God, it is too hot!” They usually have dinner together and then watch something on Netflix in their bedroom. Sometimes she asks him if he will have an ice-cream; he often reciprocates by asking her if she needs something from the kitchen as he gets up to go there. During the day, her smartphone keeps flashing group messages on WhatsApp—from her college friends, family, and husband’s extended family. Her mother calls her every other day from Lucknow. But she says she feels no connection at all. “I am in a dark well of sorts from where I am trying to reach out and I cannot, and now I have given up,” she says.
We are meeting at a café near her house. She is a friend of a friend, who responded to a post we had put up on Facebook asking people to get in touch if they felt lonely. Within an hour, we were flooded with private messages from those who said they did and wanted to talk about it.
In the café, the software engineer orders a latte and shows a private blog she started a few months ago on the advice of a counsellor she went to. He asked her to put down all her feelings on it. “Don’t get me wrong,” she says, “I have everything: a successful career, supportive parents, a smart husband, and a nice house that we jointly own. But there is a hollow within.” She wants to talk but feels that no one is really listening. A few months ago, she says, the feeling of loneliness became like a black cloud over her head and she broke down in the office bathroom. It is then that she looked up the internet and sought an appointment with the counsellor. “Basically, I just paid money to speak to someone and feel that somebody is really listening to me,” she says.
That ‘black cloud’ is hovering over an increasingly large number of people, young and old, in cities across India, according to mental health experts. “It is an epidemic,” says Dr Rajat Mitra, a Delhi-based clinical psychologist. “One major reason is that many among us are feeling alienated from our roots and are unable to find meaning in our lives,” he says. As old family structures break and more and more people find themselves in cities, pitched in the middle of modern life with all its entanglements and toxicity, people are turning into tiny islands floating amidst a mass of people, many of whom may be islands themselves.
In the West, loneliness has received a lot of attention. A recent article in The New York Times quotes Vivek Murthy, the former United States surgeon general, saying loneliness and social isolation could cause a reduction of one’s life span as much as smoking 15 cigarettes a day could. In her research, Lisa Jaremka, director of the Close Relationships and Health Lab at University of Delaware found higher levels of inflammation in the blood samples of lonely people; this has been linked to heart disease, arthritis and Type 2 diabetes. Recently, Britain appointed its first minister for loneliness. But in India, many still consider it a part of the mental health spectrum that any mention of remains taboo. According to John T Cacioppo, a psychologist at the University of Chicago, being surrounded by friends and family, like the software engineer who lives in Gurugram, is no guarantee against loneliness. A 2012 study at the University of California found out that most lonely people are married or live with others. Mental health experts say that in many cases, such feelings may be a direct result of modern marriages. “We often copy our parents and imbibe their ideas about the opposite sex. But in the modern world, the traditional roles of man and woman have changed. So the institution of marriage needs to be redefined. Marriage now has to be a supporting institution. When it is not, the husband or wife or both may feel lonely,” says Dr Mitra.
Consider the case of a fashion designer based in Hyderabad who owns a small boutique. She is in a relationship with a research scholar, but feels “terribly lonely”. “I have friends and we meet often for movies or for a drink or for shopping, but I always feel tired after meeting them and have found myself avoiding them, of late,” she says. Her partner, she says, is unable to pay her attention even for a minute. “It is not that I have to share some big things with him every day. But I want to tell him what is going on in my life—the small and the mundane—and he seems to be least bothered about it,” she says. Has she discussed it with him? “Yes,” she says. “But he always says I am over thinking.” Now she is no longer sure whether she wants to marry her boyfriend.
In response to our Facebook post, we received a message from another acquaintance, a professor in Jaipur. “I am 42, I am married and I have a child. And yet I feel lonely,” he writes. Later, when we ask him to say more, he says he is no longer comfortable sharing his story.
That people are feeling lonely in today’s world seems ironical. We are better ‘connected’ than ever—at least on social media. Today, one gets the instant gratification of sharing something with others and watching the ‘likes’ and comments come in. Duke University psychologist Jenna Clark and her team have pointed at the superficiality of what they call ‘social snacking’, where one browses the Facebook timelines of other people for a sense of belonging. “Social media just gives the appearance of intimacy,” says Dr Vishal Sawant, a Mumbai-based psychiatrist. “A few years ago, if we got bored in a place like Mumbai, we would go call a friend. But now we open our laptops. Something has got to give.”
“Social media as a supplement is great,” says Dr Mitra, “but it cannot be a substitute. Physical connection with people is of utmost importance. Normal human contact results in the release of endorphins. This is why in the US today, we have a poster which reads: ‘Did you hug your child today?’”
Many people in their twenties and thirties feel lonely due to the lack of social support and meaningful relationship in big cities. This sort of urban isolation often harms their physical and mental health
In cities, many people are coming to terms with loneliness and slowly accepting it as part of their lives. A 30-year-old teacher at a college affiliated to Delhi University says that loneliness is just another aspect of her life, like her academic job. She has been in Delhi for eight years now, finishing her doctorate, after which she began to teach. “My father was in the Central services, so we kept on moving from one place to another. So I felt very detached from everything; the idea of home was lost,” she says. In the last few months, she has felt lonelier than ever. Some close friends of her recently decided to move out of country. “I see my students who are young and all they talk about is ‘Netflix chill’. And I wonder what human connection will they have?” she says. Does she see marriage as an antidote to her loneliness? She speaks of some of her friends and colleagues who are in relationships and yet have the dating app Tinder on their phones. “I will settle down, as my relatives call it. But for that I don’t necessarily need to get married,” she says.
Kavita Suri, member of the J&K State Women Commission, has also chosen to be single. “Do I feel lonely? Yes. But now I have gotten used to it,” she says. Suri remembers a time when, as children, she and her siblings and cousins would spend a lot of time together. “We were so close to each other,” she recalls. But something has changed, she feels: “We have become insensitive and desensitised. Couples married for two decades are getting divorced.”
ACCORDING TO EXPERTS, people who feel lonely may not be clinically depressed. But in some cases, loneliness has been linked with depression.
It was sometime last year, when a marketing professional we spoke to realised she needed help. She was working in a stressful environment in Mumbai then, and had always had a fierce temper. She would find herself snapping at people at the slightest provocation. But this time, her anger was different. It had no identifiable cause.
A clothes hanger had fallen to the floor as she reached for something in her cupboard. “I don’t know what came over me then,” she says. “I just got really, really angry.” For about a minute, in a blind fit of rage, she began to grasp and hurl all the hangers to the floor. “When this happened, I knew it was something else. I needed help.”
With the breaking down of old family structures and the toxicity of modern life, more and more people are turning into tiny islands floating amidst a mass of people, many of whom may be islands themselves
She consulted Dr Sawant who diagnosed her with depression. Various factors could have contributed to it. Her marriage had ended in divorce a few years earlier; job stress had taken its toll over the years, and she would have little time for herself even on weekends. Away from her parents in Dehradun, she lived in rented apartments with flatmates in Mumbai. But one of the biggest causes, she says, was perhaps loneliness.
She has had a small circle of friends for several years. In the period leading to her diagnosis, she remembers how she would often feel extremely low for no apparent reason. “I used to be moody, low, not as productive at work… And I was in a relationship then, but I was very needy even in it,” she says. “I realise now what it was. I was lonely and I had no self-love.”
During that phase, although by outward appearances everything looked well—she hung out with friends, went for parties after work—inwardly, she found herself retreating further and further into herself. She remembers how for some periods she fell into a certain pattern of repetitiveness. Hit the bed, go to office, hit the bed, go to office. Wash, rinse, repeat. And then when she wasn’t at work, she would find herself alone at home, spending countless hours in front of the TV set, watching show after show on Netflix.
She had come to Mumbai in her early twenties. She recounts with nostalgia her arrival in Mumbai with her grandfather, who was undergoing medical treatment in the city; how she was charmed by the freedom the city had to offer a young woman like her. But 10 years later, she felt the vastness of the metropolis, one that’s so easy to vanish into, had begun to consume her.
According to Dr Sawant, cases like hers are not rare. Many people in their twenties and thirties are increasingly coming to see him with complaints of loneliness and depression. “In cities, there is no real social support. It is great if some of them can get into meaningful relationships. But otherwise we are getting more and more inward.” As he describes it, many young people now feel extremely isolated, which often means their physical health declines and some of them even resort to substance abuse.
Rachana Iyer, who heads the corporate social responsibility department at a financial institution in Mumbai, was diagnosed with depression and anxiety with symptoms of borderline personality disorder last year. As a teenager, she would frequently undergo phases of feeling very low, she says, but last year she began to get anxiety attacks at work during the day. ‘I realised that this feeling was physical and not in my control,’ she says over email.
A 2014 study in the Journal of Geriatric mental health found that various factors, from advancing age to the absence of a partner, were associated with an increased risk of loneliness
Loneliness, according to her, was a big part of her anxiety and depression. ‘Today, a year later [after visiting a therapist], I feel less lonely. But the times I do feel lonely, it manifests [itself] in very subtle ways. I start to wonder and feel like I am the only peculiar one with my emotions and ‘feeling too much’. It manifests as a voice in my head constantly leading to self-doubt, and I feel like I don’t deserve to be loved and in the company of people,’ she says.
Iyer took prescribed medication for a few months, but stopped it because although it helped with her panic attacks, she feels it started to make her feel apathetic and untouched by things she wanted to get excited about or feel happy for.
A year since the panic attacks at work, she says her mood still swings between extreme hyperactivity and excitement to feeling detached and low, but her anxiety is under control. ‘But the days I feel super anxious [it] would manifest in heavy breathing, breakdowns where I would cry and feel overwhelmed and most importantly small things that wouldn’t faze me on a regular day would seem magnified and out of proportion in my head. I would know deep down that I was over reacting to something but somehow my emotions would be overwhelming,’ says Iyer.
Iyer says she has significantly reduced socialising. She limits herself to a small circle of close friends in Mumbai and Bengaluru. She is part of a mental health community, filled with people who have various mental health challenges, which she calls her safe space. The group helps her not to feel alone. And whenever she breaks down, she reaches out to this group. ‘I binge watch Netflix on weekends, I run. I am training for a half-marathon this year. I talk to my therapist only during sessions because I do not want to be overly dependent on her. I talk to my close friends as and when the need arises too. But most importantly, my work is my saviour. I work in the social sector and am very passionate about what I do,’ she says. Sometimes when she feels like not talking to anyone in her circle or family, she signs on to mental health forums and chat rooms. Since there is no expectation of a stranger, she feels, it is easier to express oneself without the fear of being judged.
THE PEOPLE MOST at risk of loneliness are the elderly. In 2014, Dr Alka Subramanyam, a psychiatrist at Mumbai’s Nair Hospital, was part of a study that looked at loneliness and depression, and the link between the two, among both depressed and non-depressed elderly. The study, published in the Journal of Geriatric Mental Health, found that the phenomenon was much higher among depressed patients than the non-depressed. Compared to depression, Dr Subramanyam says, loneliness appeared as a distinct factor which seems to have a link with depression. “Loneliness is in fact an important distinct factor in predicting depression in the elderly,” she says. “It is a bit like the pre-diabetic stage, where the sugar [level] is border-line high. If you are able to spot loneliness, then you can intervene and perhaps stop full- blown depression coming over you.” Although the researchers specifically looked at loneliness and depression among the elderly, according to Dr Subramanyam, the connection between depression and loneliness is probably applicable to all age groups.
The study found that various factors—from advancing age, the absence of a partner and dependency to institutionalisation and health impairment—were associated with an increased risk of loneliness. “In some cases, we found that seniors living in old- age homes were better off and less lonely compared to those who live in families,” she says. This is probably because old age homes afford greater interaction and friendship among the elderly.
As Dr Subramanyam says, although the team of researchers only looked at loneliness and depression among senior citizens, the issue deserves attention regardless of people’s age. She cites various reports to say that India is among the countries hardest hit by a mental health crisis. “Our social fabric is really changing. Technology has further changed things,” she says, “There should be something like digital hygiene [where access to technology like phones and laptops is disciplined] like sleep hygiene, but that’s not happening, obviously. At least one meal a day should be consumed on a table with all the family together. But that too rarely happens.”
Iyer, who has always been gregarious, says she believes there is a distinction she has to make between being ‘lonely’ and ‘alone’. “I am slowly starting to enjoy my own company, unlike before when I constantly felt the need to speak to people and have someone around. I have always been a big extrovert and a very social person,” she says. This is why, she says, people often get shocked when she tells them that she has a mood disorder. “They think that because I seem so in-control, confident and strong on the surface, my mental health should be more or less stable,” she says.
There is a heart-wrenching story of a few years ago that Dr Mitra narrates about two young women from India’s Northeast, one of whom was abducted by a few men while walking along Delhi’s Ring Road and raped. During their counselling sessions later, the women said they were lonely and did not want to return too soon to their rented room after work. So they decided to go out somewhere, an eatery, to be among people.
What is worrying is that the black cloud is only becoming bigger, accentuated by a superficiality that seems to pervade our daily lives. A doctor who spoke to us said that he is concerned about what his young daughter watches on TV: images that shift so fast, he cannot make anything of it. He says he once asked the girl if she was able to hold on to what she saw. Her answer: “Is there a need to hold on to [something]?”