Getting Help is Resistance

"Depression lives and breathes in within the walls of family life."

Mysore Castle, Photo Cred: Pooja Lakshmin

“I really want to talk to someone – but I just don’t have the time.”

This is the typical refrain I hear from patients, and also from friends and even colleagues about why they can’t (or, won’t) seek therapy. When depression or anxiety hit, the idea of taking time out of your day to seek support can almost feel counterproductive — who has time for that? What usually brings women to my (Zoom) office is when their suffering starts to affect those around them – their children, their partner, their friends and family.

As a psychiatry resident at George Washington University, I conducted a small ethnographic research study working with rural Indian woman who lived on the outskirts of Bengaluru, India. These women were all mothers seeking treatment for depression or anxiety at a community clinic through the National Institute of Mental Health & Neurosciences in Bengaluru. Interestingly, the majority of women had daughters, not sons, and their average level of education was 4^thgrade.¹

Our project was qualitative, meaning that we conducted in-depth semi-structured interviews and a focus group with the women. We were not so interested in their diagnosis, symptoms, or medications. Instead, my attention was on uncovering a nuanced understanding of the experiences of women living with depression and anxiety in a country where there is tremendous discrimination against mental health and against women. We wanted to understand how they made sense of their depression: what was the problem and what did they believe caused it? What had them finally decide to get help?

The women spoke almost exclusively about their interpersonal lives. They attributed their illnesses to problems with their husbands (philandering and drinking away household income) or their mothers-in-law (overworking and belittling them). And, lest you jump to the conclusion that this was all in their heads – the evidence backs it up: Gender disadvantage factors like sexual violence, low autonomy in decision making, and decreased family support are independently associated with an increased risk for developing depression and anxiety in South Asian women. We know that depression lives and breathes within the walls of family life for women in India.

What surprised me was these women from rural Indian villages had similar motivating factors for getting help as my patients back in Washington. They conceptualized their illness within the structure of motherhood, and their treatment seeking within the framework of being a good mother. Children, and taking good care of them, appeared to be a socially sanctioned means for women to assert agency in the face of a patriarchal family structure. In other words, it was difficult for women to be open about getting help. It could be dangerous and bring shame onto the family. But if they made the choice for the sake of their kids, then treatment for mental illness became valuable, even a priority. One interpretation of this phenomenon is that it is a protective defense mechanism. These were the resilient women – the courageous few who traveled hours, sometimes secretly, to get treatment.

You see, I hear this type of thinking over and over again from my patients. It's hard to ask for help and speak up unless you feel you're doing it on behalf of someone else. It seems impossible to justify spending time and money on your own mental health. It might even be self-indulgent! What is it about being a woman that makes it hard to admit to yourself and to others that you are suffering? Why is making that admission easier when it also unburdens someone else?

I should be clear and state that I'm not equating the suffering of rural women in low and middle-income countries with that of upper-middle-class women in the West. What I am pointing to is when I look underneath, I find a kernel of truth that exists in both worlds.

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Your Therapy Takeaway

You don’t have to wait until you’re in a crisis to get support

What if we reframed asking for support — whether its from a friend, a family member, or a mental health professional — as a skill we all need to build? What if receiving support is something that you can do even when you’re not ready to collapse?

Consider what outcome you are trying to control by avoiding help

Usually it’s something like a worry about losing productivity, or, if you’re a mom, feeling like you’re still the go-to for childcare, so what’s the point. Yet, when we avoid seeking help for our problems, small issues have a way of turning into much bigger issues, and ultimately, you may find yourself in a worse situation than the one you were trying to control in the first place.

Keep your attention on the systems of oppression

Oppression and misogyny make you feel small on the inside – no matter what continent you live on. It feels like you don't matter. Like there is no space for you. Like being you is a burden to others. Certainly, many of these feelings could be symptoms of clinical depression. And, they also describe what it's like to be a stigmatized group who has learned to survive by catering to the powers that uphold the system.

xo,

Pooja

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In honor of the launch of REAL SELF-CARE in the UK and international markets on Thursday, I’m sharing this gorgeous blurb from Pandora Sykes, the British writer, broadcaster and former co-host of the No.1 women’s culture podcast in Britain, The High Low.

If you have not preordered REAL SELF-CARE yet, please go for it! This preorder link takes you to Harriet’s Bookshop, a Black owned, woman owned, Philly bookstore. You’ll get the book delivered on March 14 if you are in the US.

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For only $5/month— access to 5 digital courses and threads facilitated by Gemma experts.

Join us in the Gemma Beta Membership. All of our courses are built by women's mental health experts, and, in the Whatsapp threads you're in community with Dr. Pooja Lakshmin, MD, Dr. Kali Cyrus, MD, MPH, and Dr. Lucy Hutner, MD.

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1. Later, as a faculty member at GWU, I would return to NIMHANS to present the findings of this research project at the Marcé International Perinatal Mental Health Conference, held in Bengaluru in 2018.