A 55-year-old medical doctor, who wishes to remain anonymous, asked her husband, also a medical doctor, to see a therapist. He, she says, was getting increasingly moody and angry. His behavioral changes made her suspect something was not right and she wanted him to seek help.

But her husband felt insulted by her “insinuation that he was crazy”.

“This is how many of us still perceive mental health in our society,” she says. “If doctors can’t accept mental disorders as health issues that need some form of intervention, then what hope is there for the rest?”

But psychiatrist Dr Arun Raj Kunwar says there is light at the end of the tunnel. He says that there is definitely more awareness regarding mental health, especially among the new generation. However, what is needed is greater awareness and acceptance in general.

Dr Arun Raj Kunwar

“No one likes being sad, anxious or agitated. But it’s a disease, one you have no control over, just like any other biological issue you may have. That’s the bottom line that most people are yet to understand,” says Dr Kunwar.

Kirti Agarwal, counseling psychologist and lifestyle coach at The Blissful Mind, says not many people are aware of the symptoms of mental disorders. Most behavioral changes—in themselves and those around them—are attributed to habits or stress. This is perhaps what makes mental health problems so difficult to diagnose and treat.

Kirti Agrawal

It’s also our collective failure to accept mental illness as any other health ailment that leads to stigma which, in turn, has many people suffering in silence. Tell your family and friends that you have a fever and they will check on you often, but tell them you are anxious and feeling a bit rundown, and they will probably flippantly tell you to relax or, worse, to snap out of it. And then it’s never brought up again.

Lend a listening ear

Meenashi Pokhrel, counseling psychologist, says though it’s very difficult to identify if someone has mental health issues, significant behavioral changes can be a sign that something is wrong.

Meenashi Pokhrel

According to Pokhrel, as mental disorders can stem from a variety of reasons—from abrupt lifestyle changes and hormonal issues to biological and psychosocial causes—anyone, despite of their lifestyle and circumstances, can suffer from them.

The best way you can help someone struggling with a mental health condition is by being available to just listen to that person. It’s not giving advice, or trying to “talk sense” into them.

“Listening, without judgement, is one of the greatest things you can do for someone who’s not in a good frame of mind,” says Pokhrel. This often has a cathartic effect.

Junu Chaudhary, psycho-social counsellor, agrees and says creating a conducive environment where someone with a mental disorder feels acknowledged and heard often prevents a mild or moderate problem from escalating.

Junu Chaudhary

Sometimes, she says, just being able to talk to someone about your problems can help put things in perspective. This is also why therapy is extremely important.

“Not everybody can talk to their family members and friends. It helps to have a third person who you can share things with and who, you know, you can trust to keep your secrets, should you want it to be that way,” she says.

Dr Kunwar adds that not all mental disorders can be dealt with in isolation through therapy but there are 50 to 60 common diseases where evidence suggests that therapy is as good as medicines.

More than mood swings

Chhitiz Kiran Shrestha, counseling psychologist and management consultant, says he is optimistic that the society will in time address mental health issues as any other health issue. The trend of appointing counselors in schools and colleges is a hopeful start. And surprisingly, he adds, during this Covid-19 pandemic, there have been many 50-plus men and women signing up for the counseling sessions that Shrestha has been conducting online.

Chhitiz Kiran Shrestha

However, Chaudhary says that there’s still this steadfast denial to accept mental health problems as anything other than mood swings. Some people with mental health issues APEX spoke to confessed that everybody around them kind of expects them to shrug it off and move on.

A 35-year-old woman, who lives and works in Kathmandu, once told her parents she was thinking of seeing a psychiatrist as she mostly felt miserable. Her mother expressed concern but her father told her she needed to make productive use of her time. That was a year ago.

Today, she is undergoing therapy and is on some medications as well.

“My parents don’t know this because they never asked,” she says.

According to Shrestha, that can mainly be attributed to a culture that doesn’t encourage us to freely express ourselves. We are always told to keep our feelings to ourselves, lest they bother others around us. No matter how horrible we might be feeling, our response to the question, “How are you?” is almost always along the lines of “Okay”.

“I believe there will be fewer mental health problems when people are allowed to talk openly about their feelings,” he says.

This was quite evident after the 2015 earthquake in Nepal, he adds, when people could talk about being scared and anxious. They felt they were justified in doing so. That is also what is happening during the current Covid-19 pandemic—people are talking about how they are feeling without the fear of judgement and scorn.

Shrestha says that most people feel the need to have a “valid reason” for their emotions.

“But the thing is if you are scared or sad, you should acknowledge that feeling irrespective of your circumstances. You should be able to express it even when there isn’t a natural disaster or a pandemic to blame it on,” he says.

Agreeing with Shrestha, Pokhrel, the counseling psychologist, adds that the need to be in tune with our changing feelings has never been greater. And, at the same time, we should understand that sometimes our moods are beyond our control.

Time for action

Experts are of the unanimous opinion that we’ve been talking about mental health issues for a while now but with little effect. It’s time to take it up several notches and have these conversations within families, schools, and communities for greater impact.

“Mental health issues don’t just affect an individual. If someone in your family is suffering, everybody will have to deal with the consequences. It creates a ripple effect,” says Agarwal adding that’s why she, at The Blissful Mind, also focuses on counseling the family members so that they are better able to deal with their own mental wellbeing while lending adequate support to the ones in need.

Agarwal says that, most of the time, one doesn’t know how to help, further complicating matters. Apart from recognizing the signs and symptoms of mental disorders, it’s also imperative to understand how you can help someone heal. Not everyone, she says, is looking for the same thing.

So, what’s the right thing to do?

Pokhrel says it’s asking the person suffering from mental health issues what kind of help they need and lending that support instead of doing what you feel is right. Chaudhary, on the other hand, says you shouldn’t try to find a solution but rather listen to what s/he has to say with a non-judgmental attitude. And they both agree that seeking professional help, whenever possible, is perhaps the best approach.

Agarwal adds that government initiatives to address mental health problems and remove the stigma through awareness can also help build an empathetic society; one that is better equipped to deal with something as sensitive and serious as mental health.