Mental Health in India’s Adolescent Girls

At ten years old, at the delicate intersection of childhood and adolescence, I lost my father.

The sudden, swift loss of a loved one left my family with a vacuum that felt insurmountable. Fear, inordinate sadness and hopelessness enveloped our home. Our South Asian family was heavily steeped in cultural norms. Showing one’s wounds to others was viewed negatively.

Crying was looked down upon, and seeking help would be an impermissible acknowledgement of weakness. Therapy was not a word in our vocabulary.

As I was expected to, I placed invisible bandages over my pain and suffering. I walked to school one week later with a forced smile pasted on my face. When asked how I was feeling, I quickly redirected the conversation, replying, “I’m okay.”

This external reticence surrounding my feelings and emotions continued throughout my adolescent years. While I experienced intermittent jolts of sadness and depression – likely as result of all that I had concealed and bottled up – I never once considered the option of therapy.

Now, as a pediatrician, I recognize the need to end the stigma and silence surrounding mental health in South Asian communities.

I have seen again and again the multi-generational consequences of mental illness, particularly depression. I co-founded Girls Health Champions, a non-profit training adolescents as peer-to-peer health educators, because I have seen firsthand that young people have significant unmet needs surrounding mental and physical health.

We know from both anecdotal and empirical evidence that adolescent depression and mental illnesses are on the rise, specifically for young women. Girls are over three times more likely than boys to experience depressive symptoms. The extent and complexity of mental illness among youth in India continues to be understudied, and the support for young people is stagnant.

Our suicide rate is a public health crisis – India accounts for 36.6% of suicides globally. Additionally, among Indian women and teenage girls aged 15–19, suicide has surpassed maternal mortality as the leading cause of death.

We have ample evidence to show that frank discussion and dialogue must start early and occur frequently. However, addressing the mental health of adolescent girls requires a thoughtful, multi-pronged strategy.

We must address cultural attitudes when approaching girls’ mental health education.

We know that South Asians, including young people, share a cultural resistance towards legitimizing mental health as a medical need. According to Dr. Nidhi Kosla, a mental health provider, South Asians “fail to report their [emotional] pain to avoiding burdening others or being seen as weak.” This might explain why many South Asians do not utilize resources such as therapy or psychiatric care, even if they are aware of them.

Additionally, in India, mental illnesses such as depression have often been equated with words such as “pagal”, or crazy. This language intensifies the shame and stigma young people experience. As a result, discussions of mental health must not only focus on awareness raising, but also on addressing and overcoming prevalent stigmas.

Mental health remains an underdeveloped and understaffed field in India’s medical practice. It is time to start building India’s mental health infrastructure.

Out of the 936,000 doctors in India, there are only roughly 4,500 psychiatrists to serve a population of 1.3 billion. In comparison, the USA, with a population a quarter the size of India’s, has 7,000 psychiatrists of Indian origin and 28,000 overall. 

India’s mental health infrastructure is also severely limited, with only 43 government mental health hospitals across all of India to provide services for the estimated 70 million people living with psychosocial disabilities.

In addition, most general practitioners and pediatricians are not adequately trained in identifying or managing mental health illnesses. These are often the people who serve as the first medical ‘touch points’ for young girls. Many providers may even hold negative attitudes towards mental health conditions themselves. Investment in training for frontline health workers is essential.

In both my experiences as a pediatrician and with Girls Health Champions, I have learned that a majority of young girls do not feel they can turn to their parents when it comes to discussing mental health-related issues. 

Parents play a critical role in providing a supportive climate around mental health.

We must educate them to have understanding, empathy, and awareness of mental health-related issues. Parents should develop the capacity to identify potential issues in their children and recognize when it would be appropriate to seek help.

I want our young people to know that it is okay to feel, to reach out for help, or even to say, “I am not okay”.

Day after day, I diagnose young girls with mental illnesses, including depression. During these visits, we often talk about the importance of removing the invisible bandages. We talk about the fact that ultimately, opening up is a sign of strength.

Depression

Sitting in his passenger seat
Enjoying chocolate ice cream in the scorching heat
I felt my heart pound
Like I was being drowned.

This feeling, so strong
Like everything was wrong
Taking my breath away
As though it was my last day.

Opened the window, gasping for air
Suddenly lost in regret and despair
He didn’t notice what I was going through
How could he? It came out of the blue.

I didn’t know what it was
I thought loneliness could be the cause
Ignoring the symptoms like nothing happened
I never knew depression could make me so saddened.

Now I stay awake for countless hours
Struggling to sleep under beautiful stars
I think of that day in his passenger seat
Enjoying chocolate ice cream in the scorching heat.

Read more of Fatima’s poetry

Tips for Supporting Someone Experiencing Depression

After I shared a list of the tools helping me handle depression, I started to think about what my experience has taught me about helping other people.

Do you know someone suffering from depression? If you do, it can feel difficult to know what to say or what to do. Based on what I’ve learnt so far, here are my tips for supporting someone you care about.

Dont…

…tell them to toughen up. Believe me, they are already trying their best. Being told to “fight back” or “be stronger” only makes you feel much, much worse. It is difficult to trust someone who clearly believes that you are not trying hard enough or that you are just ‘pretending’ to be miserable.

…judge them for taking medication. You can be sure that they have discussed doing so with professionals and made an informed decision. They don’t need you to decide whether or not their pain is ‘important’ enough. Someone once shouted at me and said she didn’t think I could be ‘unwell enough’ to need pills. Luckily for her, she was not in my head, so she could not feel my pain. None of us can really know what is best for someone else. 

…force them to go out, party or cheer up. Some days, it is simply impossible to fake it. So, unless you want to see them break down in tears in front of everyone at the party, drop it. Let them choose to hide for a while, be gentle. Just show them you are listening to them and there for them no matter what.

Do…

…be patient. Accept that they will have bad days, that their mood might change, and that they might refuse to tell you anything for now.

…pay attention and ask questions – gently. Check if their appetite has gone up or down, ask them about their sleep – a lot of symptoms are invisible. No one around me could ever even imagine that I have had suicidal thoughts, but I have. Try not to make assumptions about your friends, some people are really positive and enthusiastic, but it doesn’t mean they are at peace within themselves. Some of us have become masters at hiding pain.

…remind your friends to take some ‘self-care’ time and do it with them. Sometimes watching a movie, sharing nice food and going to bed at 9pm with your friend is just perfect.

…encourage them. Congratulate on every little step. Sometimes getting up in the morning is so hard. Opening up about their pain and feelings is hard. So if they trust you enough to open up to you, be grateful and proud of them.

…remember you don’t have to say anything. It’s very hard to find the right words to comfort someone. Sometimes it can be ok just to listen and be present.

…break the stigma. Every time you hear any of the followings, please speak up. For the sake of everyone, let’s make these false statements stop: “people who are depressed are weak”, “depression is a white person’s problem”, “you must experience difficult or traumatic external conditions for your depression to be valid”

One final point – remember to check on the men and boys around you. They feel pain too but gender norms and inequalities might be making it very difficult for them to open up about it!

Opinions and experiences published on girlsglobe.org are not medical advice. If you are struggling with your mental health, please seek professional help from a doctor. 

If you are experiencing suicidal thoughts, or if you know someone who is, please reach out for help immediately. Suicide Stop has a list of suicide hotlines worldwide, which you can find here

These Tools are Helping Me Handle Depression

Ok everyone, I have never ever said it publicly but here it is: I have depression.

I want to share a little bit of my story. I want to focus on the positive and contribute in my own little way to fighting stigma and promoting mental health awareness.

In recent months, I have tried every possible tool I could find to feel better. Counselling, medication, exercising, yoga, hillwalking, travelling, journaling, meditation and mindfulness, etc.… The good news is that some of it is working. Slowly, very slowly, but every step forward counts. Getting better is a journey.

First, you have to make the difficult first step: becoming conscious of how you are feeling, accepting it and making a decision to try to change it – to grow out of the pain and find balance again. After that you need many, many more little steps, time, trial and error, endurance and faith in yourself.

None of this is easy, I know. I am still trying and learning myself, but here are a few tools and tips I would like to share. Remember that depression is a very subjective experience, you need to find what works for you.

Commit to yourself. 

Choose to invest time, effort and maybe even money in your recovery. It will be worth it, I promise. Maybe instead of burying your pain in a pile of brand new clothes, use that money for a therapy session if you can? Make choices that will help you feel better inside.

Remember that you and only you can make the necessary internal journey to get better.

Not your medication, not your therapist, not your friends, YOU. I know you might feel totally unworthy, meaningless and discouraged, but remember you are not broken. Nothing in you wants to hurt you.

Be a friend to yourself.

Remember when your best friend last had a heartbreak and cried in front of you? Did you shout at her and tell her to be stronger? Did you blame her for being so miserable? No (at least I hope not!). Use that same kindness and compassion you can show others and show it to yourself.

Go online.

There are plenty of great professional or community groups that can support you out there, you are not alone. Fill your social media feeds with accounts that make you feel good.

Read books, listen to podcast or TED Talks, watch videos about mental health.

The more you understand about what’s happening to you, the less ‘unusual’ and alone you will feel.

Don’t keep pain to yourself.

One of the hardest thing for me was to open up and talk about how I was feeling. Informing a few trustworthy friends made things a tiny bit more bearable. Choose people that make you feel comfortable, people who can listen and respect you even when you cannot be your most ‘fun’ or ‘happy’ self.

You don’t have to tell them everything and you don’t have to talk about it all the time. But trust me, on a day when you feel like bursting into tears, it makes it so much better to feel safe and able to express your feeling instead of trying hard to hide them. There’s also the option of professional help, like a doctor or a therapist.

Try new things.

Surprise yourself and explore things you have never done before. It doesn’t have to be something big. Maybe you can choose an interesting documentary on Netflix instead of your favourite romantic movie? Maybe you can try some crafts? Dance alone, sing in the shower? Maybe it will make you feel a bit better for a few hours and create new interests and new curiosities in you? (Maybe it won’t, and that’s ok too.)

Make lists.

Lists are cool. They help clarify things a bit and are easy to read. For instance, write a list of things that help you when you are down. Break it down into different categories (e.g. Physical: keeping a healthy body, doing yoga…; Social: the friends you trust, online communities; Spiritual: your meditation and mindfulness practice; Material: your bed, essential oils, anti-depressant medication, etc.).

Next time your mind hurts, check your list and find your best helper in that situation. Maybe you need a warm shower, a good cry and your bed. Maybe you need to call a friend and get some fresh air. Maybe you need to arrange a new appointment with your therapist. A list can remind you that you have plenty of options to support you – just pick one that suits you best in that moment.

Be patient with yourself.

There will be times where you get angry and disappointed at yourself. Days where you feel like you are not progressing at all, where you are backsliding. You will wonder if you will always be depressed, if there is really a way out, if this is who you are forever. Maybe you will even start thinking that this life is not worth living and wish to stop everything for good. That’s ok. The pain can be truly unbearable and overwhelming, so it makes sense to think these things. But please, don’t give up on yourself. You are a unique and beautiful person, trust and be kind to yourself. You are so worth it.

If you are experiencing suicidal thoughts, or if you know someone who is, please reach out for help immediately. Suicide Stop has a list of suicide hotlines worldwide, which you can find here

Opinions and experiences published on girlsglobe.org are not medical advice. If you are struggling with your mental health, please seek professional help from a doctor. 

Don’t be Afraid to Say ‘I Have Anxiety’

The other day, I was having dinner with some girlfriends when one of them opened up about experiencing anxiety episodes over the past few months. She was really embarrassed, confused and crying.

As our conversation deepened, 3 of the 4 people at the table revealed they have been coping with anxiety for a long time. I was one of them. I sat there thinking: how is it possible that I have known these people for my entire life and yet we’ve never mentioned that we suffer from this condition?

Everyone can feel anxious from time to time – it’s a natural reaction of the body and the brain to certain situations or events. But an anxiety disorder is something else.

Have you ever felt as though you spend every single minute of every single day worrying over the slightest thing? Have you ever felt as though your heart is bursting out of your chest? Do you tend to catastrophize every situation in your life? Do you have irrational fears? If you said yes to at least two of those questions then…congratulations! You may have an anxiety disorder.

You must be thinking, congratulations? I’m miserable!

But I congratulate you because recognizing and admitting you are struggling with a mental health issue is the first step towards dealing with it and feeling better.

We need to start acknowledging anxiety for what it is so we can eliminate the stigma around it. 

Anxiety disorder is the most common mental health condition in Mexico, affecting 14.3% of the population. To put that into context, there are more people living with anxiety in our country than there are people living with diabetes, yet we rarely hear about those in mental distress. Having an anxiety disorder can be debilitating and crippling at the best of times – add people calling you crazy or helpless and society judging you and things can become much worse.

Since feeling anxious is common, anxiety isn’t often thought of as a mental health issue. I believe that this is where the problem originates. Anxiety is real and in Mexico it is still underestimated. Did you know May is Mental Health Awareness Month, and 14 – 20 May is Mental Health Awareness Week? If not, it’s not your fault: too often mental health is put on the back burner and seen as less important than physical health.

If you’ve experienced anxiety and wondered why it happens, anxiety disorders develop from a complex set of risk factors including genetics, brain chemistry, personality, and life events. There are several types of anxiety disorders, including Social Phobia, Generalized Anxiety Disorder (GAD), Panic Disorder, Obsessive-Compulsive Disorder (OCD), Post Traumatic Stress Disorder (PTSD), and many others.

Anxiety disorders are highly treatable, yet only 36.9% of those suffering receive treatment. If you are suffering, don’t be afraid to seek help or counseling. You may think you are alone and that no one will understand what you’re going through, but by opening up to people close to you and receiving the treatment you deserve, we will all be one step closer to breaking the stigma around anxiety. If you sense that someone close to you might be suffering, approach them in a way that makes it feel safe for them to open up to you.

It might sound like a cliché but it really is true: you are not alone. Speak up. 

Girls are Facing a Mental Health Crisis

According to the World Health Organization (WHO), around 80,000 people die by suicide every year. This means that one person dies by suicide every 40 seconds.

Suicide is “the second leading cause of death among 15 to 29 year olds globally,” and is not limited to developed countries: “78% of suicides occurred in low- and middle-income countries in 2015.Depression is “the leading cause of disability worldwide, and is a major contributor to the overall global burden of disease.

What these shocking numbers reveal is that while there are many serious global health issues that demand attention, mental health must not be left behind, and this is especially true when considering the current state of girls’ mental health.

In The State of the World Population 2016, UNFPA portrayed a worrying picture of girls’ mental health, stating that suicide is the “second leading cause of death for adolescent girls between ages 10 and 19.” In the United States, according to the Centers for Disease Control and Prevention, suicide rates among teenage girls reached a 40-year high in 2015.

In the United Kingdom, data on child and adolescent mental health from the National Health Service has revealed significant differences between genders. For example, “more than two-thirds of antidepressants prescribed to teenagers are for girls,” 90% of children admitted to hospital due to eating disorders are girls, and hospitalizations due to self-harm involving girls “have quadrupled since 2005.

The reasons for this global trend of worsening mental health conditions among girls are complex. A common cause given for such a dire situation is the negative effects of social media, especially in relation to body image issues. Though research has documented a link between social media and girls’ body image issues, this does not tell the whole story of why girls’ mental health is in crisis.

There are also serious issues of sexual harassment and abuse, domestic violence, and poverty faced by girls worldwide which have significant impacts on mental health. Research has found, for example, an increase of children living in poverty in the UK, and poverty has been found to be a risk factor for worsening mental health.

Not only are girls suffering from the most common mental disorders of depression and anxiety, but research has also found an increase in post-traumatic stress disorder in this demographic. And while links between suicide and a history of mental illness have been established, the WHO has highlighted the critical issue of high suicide rates among “vulnerable groups who experience discrimination,” such as LGBT and indigenous peoples, refugees, and migrants – and girls are included in all of these categories.

To address this crisis, organizations such as Girls Inc. are raising awareness of the importance of mental health for girls. Similarly, the International Bipolar Foundation has created a Mental Health Awareness Patch in partnership with girl scouting organizations that can be earned by Girl Scouts in all ranks to provide them with an opportunity to learn about mental health, how it’s portrayed in the media, and how to be involved in anti-stigma campaigns.

And if social media can be harmful to girls’ mental health, it can also be a source of help. For example, the Sad Girls Club is an online community for girls – particularly of color – dealing with mental health challenges. It was founded by Elyse Fox, who experienced depression herself, and officially launched in February 2017. The club goes beyond an online community, however, as it also holds real-life meetings.

The fact that mental health has been added to the UN Sustainable Development Goals under goal 3 is a good example of mental health being placed at the heart of the global agenda. The mental health of girls around the world today is without a doubt a complex and multi-faced issue. It requires an approach that takes into consideration the intersection of issues that have brewed this crisis, such as the role of social media in girls’ lives, poverty, and violence.

If we truly believe that ‘the future is female,’ then our girls’ mental health must be made a priority.