How to keep calm in Kolkata

Life can be stressful in Kolkata - the crowds, the poverty, the heat, the constant cacophony of car-horns. And that's just for me, a pampered western tourist. So how do the locals cope? More to the point, to what extent do locals seek therapy for mental health problems like depression, or for general life advice? To find out, I interviewed two Kolkata therapists, Mansi Poddar (left) and Charvi Jain (right), both of whom have successful local practices. 

Why did you become a therapist?

Mansi Poddar: Since I was a kid, people have come to me to tell me their stories. When I was studying in Boston, I had a brilliant therapist, and she encouraged me to become one too. I did a masters at NYU, then came and started practicing here.

Charvi Jain: I come from a business family and was expected to go into business too. But I worked with an organization called Make a Difference, which works with underprivileged children, and that showed me I wanted to work around people, helping them. I did a masters at the Tata Institute of Social Sciences in Bombay. It was 95% women on the course, five men, and only one of them Indian! It's still a woman's job, because men feel more pressure to make money. After the masters I specialized in Cognitive Behavioural Therapy (CBT). It's not a very well-known profession - I often have to explain what I do. It's a bit easier after Dear Zindagi [a Bollywood film last year about a young woman who gets therapy]. But some of my relatives still don't approve, they say it's a waste of time. But I'm doing well - my appointments are fully booked for the next two weeks and I'm thinking of expanding.

How normal is it for people in Kolkata to go to a therapist? 

Mansi: It's not very normal. There's a lot of stigma. People who do come feel a lot of shame about it, like it means they're weak, so I have to work to remove that stigma for them.If you want to insult someone, you call them crazy or a psycho. Parents would say 'if you don't behave, we'll send you to Ranchi [a famous psychiatric asylum]. People see beggars in the street with psychiatric problems and worry they'll end up like that. There's a fear of poverty, of family not accepting their problem. Families contribute a lot to the stigma by denying the reality of mental illness.

Charvi: People in their 20s or early 30s are more open to therapy, partly through exposure to American TV shows like Suits or Two and a Half Men, which mention therapy. But people in their 30s or older tend not to come unless there's a serious crisis. Often, people won't tell their family or close friends they are getting therapy. Students may not tell their parents, and can't pay for the sessions. Families can strengthen the stigma - you often hear 'it's all in your head'. I'm seeing a teenage girl with depression, and initially the family were supportive, but then when she didn't get better they labelled her as lazy. People think they're weak for not being able to cope without help. I tell them it's the opposite - they're strong for seeking help. Or they trivialize their problems - they say 'do I really need therapy?'

And they still don't know the distinction between a therapist and a psychiatrist. Many clinical psychologists here still have a very medical approach - their room is like a doctor's chamber, with a table in between them and the client. That's why I called my company Over A Cup of Tea. If people have been to counsellors before, often their experience wasn't good - they get labelled, judged, with lots of morals enforced on them.

Mansi: Psychiatrists can also enforce their moral judgments. You still get psychiatrists recommending conversion therapy for homosexuality [which is illegal in India]. Or doctors saying 'stop thinking about stuff so much, it's not a big deal'.

Indian culture may not be very aware about therapy, but it does have a strong spiritual and religious culture - meditation, yoga and so on. Is that helpful? Do you draw on that in therapy?

Mansi: If people have a spirituality, it can be a great support system. Those who combine Cognitive Behavioural Therapy with their spirituality or faith tend to have a better outcome. On the other hand, spirituality can be too positive, it can encourage over-detachment. It can be like a drug - you keep needing to go to another workshop or retreat, and if you stop, things start falling apart.

Charvi: People sometimes bring in their religious or spiritual beliefs. If you can connect the therapy to that, it works better. For example, if someone is a Jain, like me, you can connect the therapy to the Jain idea of the 'power within'. But usually people have already tried to get better through yoga or meditation. So if you mention it, it's like a cliche.

How applicable have you found Cognitive Behavioural Therapy to Indian culture and Indian minds? 

Mansi: It's quite applicable and works quite well, partly because it fits with older Indian spiritual ideas [indeed, the inventor of CBT, Aaron Beck, was quite influenced by Buddhism and the Dalai Lama has said it's very close to Buddhist theories of the emotions]. Mindfulness-CBT is obviously close to Indian spirituality, though it's still very new here. I sometimes recommend clients use Headspace [a British meditation app].

Charvi: People find CBT very intriguing. Often they have Googled their problems, self-diagnosed, and found that CBT is effective for depression or anxiety.

Is therapy just for the well-off in India? 

Mansi: I'm trying to create awareness among the less well-off but awareness is greater among the better-educated.

Charvi: Therapy is quite reasonably priced here, around INR500 a session [about $7]. I see people from lots of different classes.

India scored quite low in a UN global happiness survey last year - below Somalia in fact. And it has one of the higher suicide levels in the world, particularly for young people. Is it quite a stressed, unhappy culture? If so, why? 

Mansi:  I think a huge amount of depression goes unreported in India. I see a lot of depression among women, due to gender inequality in our culture. They are encouraged not to be individuals, to live purely for the happiness of their husband and his family. If they have a good husband and in-laws, it can be fine, but if not, it's hellish. And if they have 'home-maker depression', there's not much I can do for them, it's a systemic problem. They can't afford to divorce and be financially independent, and their families might not have them back. There are extreme cases of abuse, but in general it can be an insidious abuse where the mother-in-law makes their life hell. It comes from the man not supporting his wife, wanting to be a good son instead. Some women are standing up and breaking out of this. Maybe they demand more autonomy within the marriage, maybe they get divorced and start an independent life. It can be a huge struggle for them, but once they get there they enjoy better mental health. As for men, they often report problems at work, where office life can be very hierarchical and they feel bullied by their boss.

Charvi: There's a lot of discontent - Indians tend to compare their life with others' lives, with their friends or neighbours, and feel they're not living well in comparison. There's always someone doing better. Status anxiety is also very prevalent - people rely on external validation to feel they're OK and doing well. I think a big problem is that, in the context of families and relationships, boundaries are very blurred. If you want to follow your passion, that comes with a lot of guilt - people feel obliged to be with their parents. But if they obey their parents, they feel they're missing out and their lives lack meaning.

How about student mental health? Is there a lot of pressure to do well in your exams?

Mansi: A huge amount. I worked on a campaign, Release the Pressure, about exam pressure and how harmful it can be. People think their exam results define their worth as a human being. I hear people say 'she got 98% in her exams' about a 36-year-old. Now there's a slight change, parents are backing off a bit, or trying to expose their children more to things like the arts, outside of school.

What about sex therapy? 

Mansi: I used to get a lot of work for sex therapy, and still get some. But I've had some bad experiences around it. A woman therapist working with me - I wouldn't be able to handle that.

So how can public awareness around mental health be improved in India?

Charvi: There's more talk about well-being in the media, in weekend supplements and things. But it tends to be more about physical health. I use articles and videos to try and increase awareness. [Mansi also often writes articles on mental health].

Here's the video for the Release the Pressure campaign: