Why Indians are reluctant to trust mental health advice

Many who do not conform to social norms say their experiences with therapy left them feeling disrespected.

Mental health in India still has a stigma attached to it and therapists do not always help to reduce this. | Photo Credit: Manpreet Romana/AFP

A student based in Mumbai sought therapy after coming out to her family as a lesbian. “It was a terrible time in my life. My father had disowned me, and I was guilty all the time. I felt I was letting my family down,” Alina, using an alias, told DW.

The 25-year-old said seeking help had left her feeling invalidated, uncertain, and low in self-esteem. “My therapist at the time told me that my father only wants what is good for me, and I should apologise to him. This made me feel as if I should be ashamed of my sexuality.” After a couple of sessions, Alina stopped seeing the therapist.

“I have now luckily found a supportive queer community and a better therapist,” Alina added. “A lot of counsellors and therapists advertise that they are queer-friendly, but they really are not. This is quite dangerous to the mental health of so many individuals, especially those coming from traditional or restrictive families.”

Same-sex marriage debate in India

As India’s top court debates same-sex marriage, the Indian Psychiatric Society has extended its support for the cause of equal rights. In 2018, the umbrella body issued a statement saying homosexuality was a variant of normal sexuality and not an illness, adding that members of the LGBTQIA+ community should be treated equally.

However, some practitioners still carry outdated views when it comes to sexuality.

“Psy disciplines are historically based on social norms, and treatments were used as a way to correct or punish,” says Raj Mariwala, director of the Mariwala Health Initiative. “Women used to be diagnosed with hysteria. There are remnants of it even now. The average just happens to be cis heterosexual and able-bodied. The discipline has not looked beyond making practitioners structurally competent, and there are massive gaps in the care provided,” he told DW.

Rising mental health awareness

According to estimates by the World Health Organization, 56 million Indians suffer from depression and about 38 million suffer from anxiety disorders. Mental health awareness is on the rise, especially in urban India. A study by UnivDatos Market Insights shows that the mental health industry is expected to grow at an annual rate of 15 per cent for the years 2022-2028.

Sriram, 30, shared his reasons for not having children with his psychiatrist. “After a few sessions, when the topic came up again, she said I didn’t want kids because I was selfish. I didn’t understand how it impacted me at that point in time. It was only when I went to a different therapist that I was able to understand what a terrible experience I had,” he told DW.

“She also discarded my porn addiction as normal. I wouldn’t recommend her to anyone. She would often share stories of other patients with me, which meant she shared my stories to others as well,” he said.

“Being single and, or, childfree, are choices that therapists are supposed to respect, just as any other choices that the client makes,” Harini Prasad, a consultant psychologist at Chinmaya Mission Hospital, told DW. “But if it’s a counsellor who hasn’t identified their biases and take supervision, judgments can creep into the work.”

‘Harmful’ advice

Ritika, a media professional, decided to get tested for Attention deficit hyperactivity disorder (ADHD) as an adult. After going through a range of expensive and time-consuming behavioural assessment tests assigned to her by a mental health clinic, she got results that did not mention the disorder. She was told that she had generalised anxiety and mild depression, for which she was already in therapy and taking medication for.

“I have struggled with neurodivergency my entire life, and I finally sought out the evaluation when every aspect of my life was being affected,” Ritika said. “But the psychologist I consulted had no practical knowledge of the condition at all. Moreover, these tests attempted to analyse me in ways that felt hurtful and offensive. It said I struggle with communication and therefore have trouble forming lasting relationships. I work in the communications field, have a strong support system, and have been with my partner for a decade. So I don’t know where the assessment was coming from. They could have gotten more from just talking to me. It was not only useless but also harmful.”

When Ritika questioned the fact that ADHD was not mentioned, she was informed that she “did not qualify” for it. “The entire process left me furious and invalidated,” she said.

She later sought a consultation from a professional who had been recommended to her and had a much better experience. “Now I only seek out professionals who come personally recommended by someone I trust,” she added.

The Indian Mental Health Care Act of 2017 provides individuals with the right to make complaints about deficiencies in provision of services.

The Mariwala Health Initiative (MHI) conducts a Queer Affirmative Counselling Practice course, through which it has already trained some 500 mental health professionals in India. It lists the names of practitioners who have completed the course on its website. “Being queer, caste, disability friendly cannot be limited to one course. Professionals in the field should practice allyship and update themselves regularly and consistently,” it says.

When it comes to “bad therapy,” professionals say people should not let this discourage them from seeking help.

“Clients need to trust how they feel around the therapist, counsellor, psychiatrist. The same person may not be a good fit for everyone who needs support. Ask for credentials, ask for what approaches the counsellor uses, and what their consent policy is. Most importantly, you—the client—should feel respected, your choices are respected, and communication is respectful,” said Prasad.