Anshu Bahanda: This is Anshu Bahanda on Wellness Curated. Thanks for joining me on this podcast. My mission is to empower you with health and wellness so that you can then go and empower others. Dr. Anvita Madan-Bahel, who’s going to be talking to us about how to deal with mental health issues. Dr. Anvita holds a PhD in Counselling Psychology from Columbia University in the US. She has 15 years of experience, she has a private practice. She works with the NHS and she teaches counsellors and trainees. She provides therapies to survivors of violence, both gender based violence as well as trauma. Here’s something that really stayed with me. Let’s get straight into mental health. How come there are mental health issues?
Anvita Madan-Bahel: That’s a great question, because people ask that and I see it as, do people ask, “why do you get a headache?” The reality is that all of us live a life and in life, there is always going to be ups and downs. There will be loss and loss doesn’t always mean death. It can mean loss of a job or loss of a relationship, loss of a dream, loss of ambition, loss of a career. There could be so many kinds of losses, or we might be stressed about something, or there might be anxiety. And that in some ways, I would call life, that’s life. Things happen. However, at times we might be faced with too many things, or we might not have the capacity to deal with things. We might not have enough and that’s when we face mental health issues. So when somebody says, I broke up with someone and I feel depressed, I feel actually that’s a really normal reaction to a breakup. Okay, so those things are mental health. But what happens is mental health is something that we don’t talk about, but I really want to normalise it. Emotional well being is the same as physical well being. We never ask, “why do we have a physical ailment?” And I really want to remove this myth, it’s really normal to have emotional problems then, just the same way we have physical problems.
AB: I love what you’re saying about trying to normalise mental health, because that means more and more people can come out and talk about issues. And even what you say about a headache- one day you might have it, the next day you might not. So it doesn’t mean that this is something that we’re stigmatised with for the rest of our life.
AMB: And we take care of it, right? Like, if you have a headache, you know what has to be done, and it’s just giving tools to people. The problem is people don’t talk about emotional well being, so sometimes they don’t have the tools. We learn if we have a headache, it might be dehydration or lack of sleep or something, but we don’t have these conversations at home about mental health, so we never learn about the tools around it.
AB: Then tell me, why are there so many more mental health issues today than they were, say, 10 years ago, 20 years ago?
AMB: I don’t think they’re more. I think people are willing to talk about it just like anything else. There is more awareness, there’s more conversations around these things. I think, people were still struggling, but very few people were talking about it. Having said that, I do believe that younger people today have way more pressures in life than we have. The outpouring of social media really makes it an open platform. And the best example I always give is a photograph. When we clicked it, we put it in an album, we chose the selected people we were going to share it with. We knew these people were safe, we could share it with them. And now young people post their pictures, or everybody posts their pictures on a social media platform and there are no filters of feedback. So reality is that is pressure. Can you imagine that hundreds of people are looking at your photograph and commenting and all? So you have to be very resourced to not be impacted by that. So I think it’s both- It’s talking about it. But also I think today’s context or circumstances are the most stressful as well.
AB: And sometimes what I find from people is that they don’t recognize mental health issues till it’s become a lot more advanced. So my question to you is, how can we help people recognize them? I mean, is there a way of describing to people what they might be feeling? And how do these symptoms possibly show up? So people know that, okay, this is not normal. This is something where I need to tell someone, ask for help.
AMB: Expressing emotions is the healthiest thing that anybody could do. So there’s so many times when people try to hold back tears. I love tears flowing because it’s such a release of emotion. When I start crying, like tears start rolling, I know I will feel better because there is a release in some way. So expression of feelings, I think, is a really important thing and it could be tears, it could be anger, it could be frustration, it could be whatever. But share with someone, share with someone and talk to someone. Because the more we hold it inside, it’s the classic example of if you keep putting rubbish in a bin after a point is going to stick, right? And that’s just how emotions are. If you keep collecting them inside and not taking them out, they will cause problems.
You should always have in your support system people, friends, family, partners, anybody who you feel safe enough to, who will not judge you, who will be supportive, who won’t be critical of you, if you’re struggling with someone. So have that support network around you. It’s an interdependent thing. You’ll share one day, they’ll share one day, so have that.
However, what happens after a point is that the emotions become so much or that they have started to impact our daily life. We are unable to sleep sometimes or we are unable to take care of our children. So if I think of severity, you yourself will recognize saying, “okay, I’m struggling”. I’m struggling with these emotions, and I’m struggling to feel happy at times or at peace at time, or calm at times, or content. Happiness sometimes is an overrated word. It’s more about feeling settled or feeling comfortable. And if you’re not managing that, it might be good. And talking to friends and family is really not doing it. It might be time to go and speak to somebody. Always remember that professional help looks very different to friends. Not being able to go to work or you’re not being able to do your daily chores, you’re not being able to do things that you enjoy, then that is really a time to definitely seek professional help. In the same continuum, if you were to expand it and it gets more complex, you might have to actually see a psychiatrist or a GP or somebody who can actually prescribe medicines for you to just support that. Like everybody thinks, if I go see a therapist, I must be crazy. What I will say is all of us are crazy. So I think you can just start seeing a therapist tomorrow because we are all crazy.
AB: I also feel that sometimes when you’re very troubled about something before it becomes an issue, if you’re mulling over something, if something’s really consuming you, there’s no harm in getting help before it becomes an issue.
AMB: See, like I was talking about a loss or a breakup or a medical issue or any of those things. So many things are connected to psychology or mental health or emotions. And what is therapy? Therapy is a place where somebody is helping you understand the situation better. They are providing you tools, how to deal with it. In some ways, I always, and I don’t say it in a bad way, but I always say we as therapists are the dumping grounds. So you’re holding something and it’s tricky and it’s prickly and it’s hard and it hurts. In my head, I just go and drop it at my therapist and say, now you hold it. It was too much for me. And the therapists are trained to hold it, to take care of it a little bit. But you’re just sharing the burden. If you feel like you’re just feeling exhausted dealing with all these emotional things and things that are happening in your life and you just want one hour where you can actually just destress and give it to somebody and share with somebody and process with somebody, that’s your hour.
AB: Now tell me, is science able to shed any light at all on the causes of mental health concerns?
AMB: Yeah, another great question, because I would like to break another myth. People believe that you can only be depressed if there’s something wrong with you, like mentally. And I’ll just share a short story, and this was a principal in Bombay. I’d taken my son like, I think, 18 months, and it was the first time he was going to school, and the whole idea of separation anxiety, he was crying. I was crying, and he wouldn’t stop crying. And I left him crying and I left, and I literally was shaking, and I needed something. So in the afternoon, when I came to pick him up, I was just like, okay, look, I couldn’t deal with it. Maybe this is not a good idea. And she said to me, what is not a good idea? He was leaving his parents or mother for the first time to meet strangers. What an absolutely normal reaction to have to cry. And I was like, that’s true. When he gets comfortable with the new environment, he will stop crying. But actually, it’s the most normal reaction to have. That was my best life lesson in some ways, and that’s how I see mental health. What a normal reaction to have that I feel like crying when I’m upset about something or something bad’s happening in my life or need to speak to somebody or to share with someone how uneasy I’m feeling, how anxious I’m feeling, how stressed I’m feeling, because whatever my life circumstances are and whatever I’m dealing with, life or emotional imbalance happens because of something chemical in our thing is somewhat of a myth. Does it impact our mood like chemical imbalances or neurotransmitters in our body? Yes, they do. Neuroscience today is a beautiful science and a part of psychology that is really expanding and telling us more about neurotransmitters and chemical balances and everything. And they help a lot with pharmaceuticals around mental health.
AB: If someone is feeling like they’re not well mentally or you see a family member or a friend suffering, could you explain to us what action should be taken? What is the process of getting help?
AMB: So finding their therapist all around you, it is a click of a button. Now to find yourself a therapist? Because there are a lot of therapists in your neighbourhood online. But yes, I hear what you’re saying that sometimes it’s easier to call somebody and say, “I need a specialist, I need a gastro specialist. Can you help me?” versus calling somebody and saying, “I feel really depressed all the time. Can you recommend a therapist?” I understand in today’s day and age, that’s a tougher conversation to have, but there are a lot of resources online. You can look at the BACP website or the UKCP website, or if you want somebody more from your cultural background than a Baton website. But why am I saying that there are all these resources? Because I think you will say, it’s easy for me to find a gastro surgeon. I look up “top gastro surgeon in London”, ten names come up, I pick one based on the hospital or whatever, and I go. So how do I do this for a therapist? This is where the difference occurs. Therapist is about what clicks with you. It’s like a marriage. It’s not about the degrees. It’s not about, if they have gone for one qualification after second qualification and this certificate and that certificate. A person with a thousand certificates might not click with you. What I will say is that when you’re ready to see a therapist, don’t feel shy about meeting multiple. See what works for you, see what feels right, like it’s about the right fit. And there’ll be therapists who will tell you very openly that that’s absolutely true. So they wouldn’t get offended if you say, actually, didn’t feel like the right fit for me. They’ll totally understand.
AB: That’s fabulous.
AMB: Being understood, it’s such a subjective thing, right? So mental health or psychology is such a subjective thing that you are really the true expert on who is best.
AB: Okay, you’re saying, look at websites like BACP, UKCP, Baton.
AMB: Yeah, So Baton is somewhere that basically people who might be of, like, black or Asian descent therapist, those are things that sometimes people want to consider. So there’s a big debate about people who are maybe coming out or thinking about their sexuality, who tend to want to go to somebody who might be someone who has come out before or have gone through the process of thinking about their own sexuality and they started a list called the Pink Therapy List. People who are part of the LGBTQ++ community are part of it. If you are dealing with a phobia, say, like something about, like a phobia of going out of the house, getting Cognitive Behavioural Therapy is the right type of therapy for you.
AB: Okay.
AMB: So this idea that came up, which was cognitive behavioural therapy, was this idea that we first have thoughts, they impact our behaviour. Then there are emotions in some ways, and they’re all connected in some ways. And what they basically thought was that if you can change somebody’s thoughts, somebody’s behaviours, or somebody’s emotions, then it’s cyclical and other aspects will change. If I am somebody who is feeling really anxious before going for an interview, I’m so anxious that I basically can’t even enter a room to actually give the interview. So my feeling is anxiety, which basically doesn’t allow me to do something. It doesn’t allow me to do an action. Just not a good thing for me to go for an interview. And my behaviour at that time might be I might start throwing up, for example, because the thought is I’ll always fail. Our behaviour is I start throwing up and then the end result is I can’t go for the interview because of my anxiety. What a CBT person will come and do is say, let’s change one of these things. So let’s change this thought in your head where you’re saying, I always fail. Is that really true? Is that really true? Is it always true? No. Sometimes I fail. Okay, already when you’ve changed it from always to sometimes you can see how you’re relaxing a bit so then you can work with yourself saying, okay, this one time I might do, okay, this one time might be okay. And you might then change the behaviour, saying, “okay, I’m going to have some water if I feel like throwing up” and then the action changes and you can go for your interview.
AB: Wow, that is fascinating. Now, what I’d like you to do for us is break up mental health issues on the basis of severity. If you’re not sleeping or if someone else is getting depressed, do we need to go to different people?
AMB: There is a correlation between how resourceful we are and like what are our management abilities at a certain time in life, right? So I might manage the biggest crisis of my life with such strength and power and beauty and everybody around me might think, “oh my God, this is amazing”. And so, for example, I had health issues. I was a warrior, I was fine. We’re getting a house constructed and it’s giving me sleepless nights. So it is my relationship with what I feel I can cope with and what I feel I can’t cope with. So I can’t cope with stresses around work and legal things and this, that and all that’s maybe what we can cope with and what we can’t cope with. What is it touching inside us where it just puts us off balance. And it takes a certain amount of work to understand. I’m really good at working with this issue, like don’t care, breakups, come, go, whatever. Oh, but if I have a loss, that’s the end of it. Like I can’t manage, it’s understanding of that relationship, and you can go for therapy for that. However, if there are big crises in our life, we have this book which gives a diagnosis called the DSM Five. So you might have a borderline personality disorder or other things, or bipolar disorder.
AB: Okay.
AMB: We are then going into the realm of psychological disorders, which are very severe. At that point you might need a team, so you might want to go to a therapist for talk therapy, but then you might want to go to a psychiatrist for medication.
AB: Okay.
AMB: So psychologists are people that provide talk therapy. They provide a space where somebody can go and share and process and they feel lighter and they feel better, and they might be given some tools to deal with depression or anxiety or sadness and other things. Whereas a psychiatrist is someone who prescribes medicines. They might help with the talk therapy and everything, but psychologists cannot prescribe medicines because they are not medical doctors. They are people who’ve gone and got a degree in psychology. They might be doctors because of their PhD, but they are not medical doctors. So if somebody needs to prescribe medicines or somebody needs to look at it more from a physical standpoint, like something’s happening in your body, psychiatrists do need to be involved because they are trained medical doctors who’ve done their MBBS and have chosen psychiatry as their specialisation. So depending on the severity of your symptoms, it might be sufficient to go to a therapist. But at any point where the therapist feels, things need support, things are not working, everything has been tried and it’s not working, that maybe we need support of a GP or of a psychiatrist. They will suggest. GPs are good people to go to as well for help and they will refer you on to the right person, ask the question and people will help you and they’ll suggest who you need to go to.
AB: Okay, so that was a very important thing that you’ve explained to us, that psychiatrists are people you go to to get prescribed medicine. They don’t do talk therapy. They might, but mostly you go to a psychologist for talk therapy.
AMB: GPs might also suggest some antidepressants to help you and just to help you manage the situation at that point. So just the way you start having a viral infection or a bacterial infection and you take antibiotics, similarly, GPs might recommend saying, okay, look, you’re going through a really tough time, let’s just support you here with some antidepressants. Personally, for me, what I do think is that antidepressants can be a way of life, you need to figure out ways to cope. They’re not wrong, I’m not judging them, but dependency on them means that you’re not resourcing yourself enough. So I think in conjunction, I truly believe that there should always be therapy with medication rather than just medication.
AB: Okay, the other thing I wanted to ask you was tell me, what mental health research are you most excited about at the moment?
AMB: Like I’m saying, there were all these traditional ways of working, these Eurocentric Western ways of working, where Freud came and CBT came and Rogerian came and all of those. But I feel like they were ways of coping with the Eurocentric mindset, for that community. And it’s not to say that mental health issues are not happening in cultures which are collectivistic, but what had happened there was that you always had in your extended family system, you always had an aunt or uncle or cousin or somebody who you could go speak to. As we are becoming more nuclear, people are seeking professional help. I sometimes feel these western Eurocentric ways don’t really fit culturally, like they feel alien concepts sometimes. And so what excites me most about research is that there is tons of research happening in new ways of therapy, be it narrative therapy, or art therapy, or dance movement therapy, body psychotherapy and so these are all these ways which are basically inviting other ways of healing than just talking, in the room. For me, most importantly, the field of multicultural psychology where people are saying wait, we need to consider somebody’s culture, we need to understand somebody’s system, somebody’s context, we need to understand what’s happening around them. It’s called the biopsychosocial medical model, where you’re looking at the biology, the psychology, what’s happening socially, what’s happening medically. So you’re looking at all aspects of an individual, a more holistic view of looking. I think that research is also very exciting.
AB: And lastly, Anvita, can we leave people with a piece of advice, Anything that you think will be valuable?
AMB: Asking for help is very empowering. There is a beautiful video if everybody could watch it by Brennan Brown on vulnerability. But what she speaks about is that she has seen people with maximum social power or empowerment who are able to be vulnerable with others, who are able to share what is going on maybe wrong in their life or where things are not working. They tend to be really successful and they seem to have a lot of social power and do liberally well. So the ability to be vulnerable with someone, it’s such a difficult thing. But people who are able to do it, I think it’s amazing. So what I would leave you with is to say don’t feel like people always see it as a weakness like “how can I show what’s wrong with me? How can I show what’s not working”, but actually it represents you as something, somebody who’s really empowered or strong. When you can be vulnerable, when you can share with somebody how things are not going right, just makes you more human, makes you just more real, makes you more approachable and accessible. Actually talking about the messes of life doesn’t make you a crazy person, it just makes you a person who’s actually taking responsibility, taking ownership to make things right.
AB: Thank you so much Anvita. That was an incredible chat. Thanks for joining us. Hope you enjoyed the Wellness curated podcast. Please subscribe and tell your friends and family about it. And here’s to you, leading your best life.