You Are Not the Only One: India stares at a loneliness epidemic

The article by Asad Ali and Tabassum Barnagarwala was published in the Indian Express on April 29, 2018.

Most people will presume that throwing a bunch of hangers on the bed is a harmless act of venting. Akanksha Joshi knew it was the tipping point for her. Her mood swings had become more mercurial and she had been lashing out at people close to her or simply shutting herself in her room, watching Netflix for hours. But that day was different. “I had opened my cupboard and a hanger fell out. I don’t know what happened to me, but I suddenly picked up all the hangers and threw them on the bed in rage. The impulse lasted for 30 to 40 seconds, but it left me shaken. I had changed my job recently. It was a good one with great pay. It was what I wanted. I was in a relationship, had a bunch of close friends. I couldn’t figure out why I felt so angry or so lonely,” says Joshi, 32, who had moved to Mumbai from Dehradun in 2008 to look after her ageing grandparents and to work with a business process outsourcing firm.

The first inkling of trouble had come when her three-year-old marriage ended in divorce in 2013. Joshi underwent counselling for nearly two years, and, slowly, life seemed to get back on track. She entered into a new relationship, moved up the job ladder, formed new friendships. But the anger and the loneliness wouldn’t go. “To anyone looking at me from the outside, I seem like a fairly successful woman,” she says. But it has come at a cost.

In 2004, the National Sample Survey Office reported that 4.91 million people in India were living alone and suffered from loneliness. More recently, the National Mental Health Survey of India (2015-16) reported that high suicidal risk is an increasing concern in India; that children and adolescents are vulnerable to mental disorders; and, mental disorders, including depression and anxiety, affect nearly 10 per cent of the population. In 2016, the Centre for the Study of Developing Societies in partnership with Konrad Adenauer Stiftung conducted a survey of the attitudes, anxieties and aspirations of India’s young population (aged 15-34 years). The findings, released in April 2017, revealed that 12 per cent of the youth reported feeling depressed often, and 8 per cent said they felt lonely quite frequently.

“Youngsters who move from tier-II and III cities to metropolises find a sudden change in lifestyle. Even if you have friends, it is difficult to meet them in a city like Mumbai. Having a social life does not mean they have good social support,” says Dr Vishal Sawant, who is currently treating Joshi. When she first approached Dr Sawant, Joshi had great reservations. “Opening up to treatment makes you feel vulnerable. I am at a senior marketing position. To talk about mental health issues is also to put myself out in the open at this point in my career. But I knew I needed intervention,” she says. Now, after six months, she says her reactions to situations are more even.

In January this year, British Prime Minister Theresa May announced a minister for loneliness to address the condition that afflicts 14 per cent of UK’s population. In Japan, it has been an affliction that has affected generations. In India, though, conversations around mental health are only getting started. Apart from a lack of information and widespread social stigma, the cost of treatment also remains prohibitively expensive. Each session, depending on the therapist, may cost between Rs 2,000 and Rs 7,000. Besides the cost of medication, therapy and consultations, there is also the possibility of reduced work efficiency. In addition to these, despite multiple reports and surveys indicating that there might be a serious health problem at hand, the conversation around loneliness doesn’t go beyond conventional markers, such as the isolation of the elderly. But loneliness can be an equally debilitating experience for other demographies, including the youth. A 2010 research in the Indian Journal of Psychiatry finds that women suffer more from depression than men. The National Mental Health Survey (2015-16) in 12 states of India covering 39,532 people found that one in 20 people suffers from depression. “Depression was reported to be higher in females, in the age-group of 40-49 years and among those residing in urban metros,” the report observes.

In India, psychologists say, conversations around loneliness need to expand in scope and look at the condition born out of conflicts in gender identity, class, or isolation even within the framework of a family or a relationship. When 18-year-old Harshit Patel (name changed), a resident of south Mumbai’s plush Charni Road, visited psychiatrist Dr Sagar Mundada at his Fort clinic last November, he already had suicidal thoughts. He lived in a joint family of 10 in a well-to-do Gujarati household. He had just joined engineering college and was struggling to find his feet. Patel had tried discussing his feelings with his parents, but they had brushed it off as adolescent mood swings. They also refused to entertain thoughts of therapy when a tutor brought it up. Patel had called Mundada on his own, seeking help. The doctor advised him to call whenever he felt suicidal. Within 10 days, a call came: “Nobody notices me at home. What is the point of living?” Patel was contemplating throwing himself in front of a train, he said. Mundada immediately called him to his clinic and got in touch with his parents.

The road to therapy has been littered with obstacles for Patel. His parents are still not entirely convinced about therapy and refuse to attend sessions at the clinic. Instead, they meet at a McDonald’s outlet near the clinic.

Even as a 10-year-old child with a physically abusive father, Dharmesh Mekala knew — through all the loneliness and trauma that he hadn’t yet developed a vocabulary to articulate — that he had to escape. He wrote the entrance test for Navodaya Vidyalaya in Nalgonda, Telengana. “I just knew that I had to leave home somehow,” says Mekala, 29, a freelance artist, now based in Delhi. The arc of his loneliness had started developing early in his childhood — the beatings he received; the bouts of sadness that enveloped him; the isolation he felt from his family; and, finally, the suicidal thoughts that he had all the time.

Mekala made it to boarding school, but the reprieve that he had sought did not come to pass. His sense of isolation grew more acute when Mekala started discovering his sexuality, much later, he says, than his friends. By the time Mekala reached college he knew he was homosexual, but could not bring himself to admit it. “Being homosexual in a hetero world is a lonely life in any case, but when I first came to Delhi in 2010 — a dusky South Indian man with an accent, not well read or fluent in English, with far too little money — I felt adrift,” he says.

Dr Neetu Rana, psychologist at the Vidya Sagar Institute of Mental Health and Neurosciences, Delhi, says, people like Mekala are more prone to mental health issues. “When we can’t find our social anchor we feel lonely. It could be a result of bullying, isolation and being ostracised, but it could also reflect changes in the family structures due to urbanisation and a shift towards an individualistic society,” she says.

More recently, the National Mental Health Survey of India (2015-16) reported that high suicidal risk is an increasing concern in India; that children and adolescents are vulnerable to mental disorders.

The UK-based National Society for the Prevention and Cruelty to Children (NSPCC) released data in 2017 on the number of calls received by its helpline to deal with loneliness. In 2016-17, the helpline counselled 4,063 children on loneliness, 73 per cent of whom were girls. Parul Tank, a psychiatrist who counsels students studying in a foreign country, says, many Indian students who venture abroad for higher studies, come to her with complaints of loneliness and depression. “In the US or UK, students have no structured classes. They lead an isolated life, the only idea of socialisation is to go out in cafes or pubs. Many do not know how to deal with this lifestyle,” she says.

Sahil, 45, a media professional, remembers how things started spiralling out of control for him when he went to London for a post-graduate degree. He had lived in Mumbai all his life and found London disconcerting. Soon, he wanted to “remain in my room all day” or spent time in the college library “figuring out a way to kill myself”. A friend took him to the university psychiatrist but the drugs he was prescribed didn’t help. By the time he came to Delhi in the mid-’90s for a job, he could barely hold it together; he had also become addicted to drugs and alcohol. “You feel lonely, and then you drink, and you feel even more lonely,” he says. Around this time, he got married. The thoughts of suicide receded somewhat, only to be replaced by an insatiable appetite for sex. “You don’t talk about things like loneliness when you are married. My wife and I never discussed my sex addiction either, though she was aware of it,” says Sahil, who is undergoing therapy at Sex Addicts Anonymous.

According to the Economic Survey 2016-17, the inter-state migration of workers in India has increased to 9 million annually during 2011-16 compared to previous years. A large section of these people leave their families behind in search of better prospects. In the hierarchy of visible discourse on loneliness, perhaps the migrant worker is the most affected, says Surinder Jodhka, professor of sociology at Jawaharlal Nehru University, Delhi. “The family structure is non-existent in the urban cities, and even in rural societies, there has been a disintegration. So, their feeling of loneliness is more pronounced.”

When his father died, Manik left his hometown in West Bengal’s Malda district for Delhi, more than 10 years ago. He was about 20 years old then. A distant uncle of his, a driver with a private company in the city, had promised to set him up with a job. But when Manik showed up, the uncle looked “surprised that I had actually come and grew distant.” Desperate, Manik began taking up odd jobs to survive. “I didn’t have friends and didn’t speak Hindi. The only person I knew refused to acknowledge me. I felt lonely and lost,” says Manik. He found a job as a cook/peon at a small company, but the pay was minimal and Manik says he spent it on “cheap alcohol and women”. “Otherwise, I’d be crying in my room all the time. I used to keep the radio on, not to feel less lonely but to not hear myself cry. I was so ashamed of my feebleness,” says Manik. He still can’t bear to be in a room without the radio on, but he doesn’t believe that his condition merits medical attention. In any case, it is a luxury he can’t afford. “It’s a personal battle, which only you can fight, no?” he asks.

A first-of-its-kind study conducted by Brihanmumbai Municipal Corporation, between October 2015 till September 2017 analysing patients in its major hospitals — KEM, Sion, Nair and RN Cooper — found that 31 per cent patients visiting these hospitals suffered from mental disorders. At least 1,70,000 patients attended these four major hospitals for psychiatric aid. Depression formed the second-most common mental disorder in out-patient departments forming 20 per cent of the total chunk. All of them came from a low income group. “We realised that there is a need to have more treatment facilities in primary healthcare centres for mental health. Rates of depression are high even in urban poor, and diagnosis shouldn’t be delayed until they reach a tertiary centre,” says dean of KEM hospital, Dr Avinash Supe. “For poor people, it is unemployment, frustrated political environment that affects their livelihood, that leads to depression. Take for instance, the farmers who are committing suicide. They feel isolated in the agrarian and financial distress, they have no one to seek aid from,” says Dr Vinayak Kale, head of psychiatry department in JJ Group of Hospitals, Mumbai. For affluent sections, he says, it’s the opposite. Steady career growth is not enough. The stress to win the corporate race often leads to loneliness.

One of the biggest contributors to loneliness, say psychologists and social scientists is our increasing reliance on technology. “One may have hundreds of friends on social media, but communication on that platform is virtual. Our culture is not individualised and we still need physical proximity. Social media has widened the gap of physical interaction,” says Dr Shubhangi Parkar, head of psychiatry at KEM hospital.

Nishant Shah, co-founder of The Centre for Internet and Society, Bengaluru, points out how “technologies have transformed what we understand as sociality, friendship and intimacy”. He says that young people — constant consumers of social media like Snapchat and WhatsApp — are “being told that they are always connected. Which means that they can, by definition, not feel lonely”. Yet, especially within the Indian context, says Shah, the pace of life and the rapid transformation of societies means that we no longer pay attention to the emotional needs of belonging, which actually alleviate loneliness. “We have replaced belonging with connectivity and this is going to have dire consequences in how we reshape our cities and lives,” he says.

Rachna Saxena (name changed), 31, agrees. Saxena migrated to Mumbai from a small town in Uttar Pradesh 14 years ago. “It was a big shift from the protective environment of home,” she says. She moulded herself to the demands of her new life once she joined the creative team in a multinational FMCG firm. She had been dating a Christian boy, but, at 28, when she finally broached the topic of marriage, the boy dithered on grounds of religious differences. The relationship crumbled, but something shifted inside her. “On Facebook, I’d look at photographs of my friends on their honeymoon. Everyone looked so happy, I felt depressed. I really wanted to get married, have a stable relationship. But that was just one part of my problems. I was a star performer at work, my social media feed showcased my ‘happening’ life, but no one could sense the immense pressure to live up to it,” she says.

Last year, a colleague she was close to died of a sudden heart attack at the age of 36. She saw his family squabble over property and his pregnant widow shunted out. “Another very close friend of mine, with whom I would share my distress, committed suicide. One fine day, he just shot himself,” says Saxena. She stopped meeting friends or inviting people over. In February this year, Saxena fell unconscious in her office. She had been sleeping fitfully and now had constant headaches. During her medical leave, she went home. “I ate and slept well, and, after a long time, felt happy. My parents are super supportive. But when I returned to Mumbai, it all came back. I realised I live two lives and I just couldn’t handle the stress of it,” she says. She started undergoing counselling sessions, and, a month ago, she deactivated her WhatsApp and Facebook accounts, choosing to travel and forge real friendships instead. “Now that I observe things more closely, I see that a lot of people around me are lonely even if they don’t look it. It can happen to anyone, you know,” she says.