Dealing with anxiety health difficulties in Kerala, India – an account

A man from Kerala in his 30s shares his experiences of anxiety disorder, including the difficulties it, and some of the treatments, has caused him in his education and employment. The state of Kerala has the highest literacy rate of any state in India, and yet, according to the National Crime Records Bureau, it has the fifth highest suicide rate in the country with 24.3 deaths per 100,000 population. According to a survey by the state mental health department in 2020, at least 15% of the youth between 18 and 25 years suffered from depression and other mental health problems.

I started my yoga classes towards mid January, will complete one month on February 20th. I attend the evening session of the online class. This class was recommended by one of mom’s friends. There hasn’t been much noticeable change during the daytime, where I feel tired, often (which could be due to my medication for depression/anxiety). I do feel the absence of the heaviness, after the yoga class is over.

The class is about roughly 45 to 50 minutes of exercise involving warm-ups, bending, stretching, coupled with breathing etc, ending with 15 to 10 minutes of relaxation, lying supine on the mat (or in my case, the floor) and following the guided meditation.

I mentioned the daytime tiredness to my instructor, (he also knows about the medication). He said that the effects of the class will show, only after a few months of continuous practice. He advised me to attend the morning session also (doesn’t have any additional charges).

The yoga class hasn’t yet helped me in the ways that I expected but it has its temporary benefit, in that, after the class, I feel more positive, light headed (in the good kind of way).

After the treatment for my back pain, I was afraid of bending forward, as I thought it would would worsen my slipped disc problem. Now during my yoga class I bend forward to try and touch my toes, as much as i can. I am encouraged to do the exercises. My instructor says that the stretching and mobility exercises are necessary to strengthen and reduce the inflammation in my back. (The pain is due to the inflammation, he also advised me to apply some anti inflammation balm at the affected area).

I feel refreshed after the yoga practice. But I don’t feel it helps in the sluggishness during the daytime. Maybe I need try some of the breathing techniques to relieve myself from the sluggishness.

The doctor had increased my dose initially, but then agreed to a slightly lower dose after I mentioned the tiredness. I feel okay with the current dose as far as symptoms go. Maybe the tiredness that I am experiencing now is the due to the absence of timely breaks. I wonder whether I can avoid feeling tired if I take regular scheduled breaks, before it sets in. I’ll try and time things, maybe it will work out.

~

I don’t know what really helped with the anxiety, there is the medication, then was an occupational therapy program some years back, that I attended. I used to be really anxious about going out by myself. But at the OT program, it was suggested that we, at least try out the fear inducing situation and if we cannot cope, then we can leave the situation. If we managed to go through it then it is a gain. Like this, bit by bit, proceed towards normalcy.

It’s been around 17 yrs since I first had these problems. Over the course of which I went to different doctors, who prescribed different medications, which seemed to produce its share of problems. Finally it was at the last place, where I did the OT program that I found some relief.

It was a mental health center that was part of a medical college. The medication that was prescribed there had much lesser side effects. But now I am seeing a different doctor, since this college is quite far away, around 11 to 12 hrs journey by train. The present doctor did his course at the same college, so he seems to have a similar approach, less medication with adequate counselling. He’s is comparatively much nearer, about less than half an hours journey by road.

I do have social anxiety sometimes, but I manage to move through it. I think the medication has helped significantly. I am also attending some Yoga classes.

My sister works as a mental health counsellor in Canada. she sent me a link to a website that had a few tips on coping. The link is https://www.anxietycanada.com/articles/how-to-do-progressive-muscle-relaxation/ I try to remind myself to do deep breathing when I faced with anxiety.

I do have a problem understanding social cues sometimes, its sometime I am anxious about. But I manage most of the time. But there are awkward moments sometimes.

I seem to sometimes lack the appropriate sense of humor, to respond to playful bantering. I just smile in response. I starting having my problems, when I was doing my Degree course in Engineering. I wasn’t able to attain my degree. I still don’t have a Degree, making my employment options limited. I don’t have much of a consistent work activity to show for all these years, quite a bit of which was spend dulled, due to the medication.

So it could be that all the frustrations have made me a bit bitter, so as to lose my sense of humor. its just an explanation which I have thought of, I am not sure about it though. My Doctor has advised me to count my blessings, it does help. But not always, especially when the frustrating thoughts overwhelm me.

~~

The breathing exercise is more clearly outlined here: https://www.sunrisertc.com/distress-tolerance-skills/ It is called box breathing. it is handy in certain situations where u start to feel light headed, shortness of breath , etc. due to anxiety. It can provide a temporary relief.

Each breath interval will be four seconds long. Take in air for four seconds, hold it in four seconds, breathe out four, and hold four. And then start again. Continue to focus on this breathing pattern until you feel more calm.

I don’t follow the technique exactly as it is mentioned. For me it has become more of a subconscious process, where I breathe in slowly, hold for a bit, breathe out slowly again and then repeat (an outcome of martial arts training done years ago). With this, I find that I get relief from some of the light headedness and am better able to respond to the situation. But I used to find my technique un-useful, before when my anxiety levels where much higher, but now maybe the medication is helping. Maybe, the proper technique as outlined, must be adhered to, to get optimal results.

As for the for the progressive muscle relaxation technique, I found myself lacking the patience to do the whole thing. My mind tended to wander while doing the relaxation technique. So i feel reluctant to do it. Also it is not feasible for situational anxiety. But splashing cool water on my face can be a relief. I don’t consider these techniques sufficient to alleviate my psychological problems. So i am still searching for other techniques which might be helpful.

~~~

But I have been dependent on my family for a long time, that sometimes I feel too helpless to try and attempt something. I have had these career objectives for some time, was working for a small (one-man) firm, where I was occasionally sent on CCTV work as a technician (yes, this establishment had work related to security systems also), I had joined the firm as a web developer (did a small course prior to this).

Anyway the end result was that I ended up working as a CCTV technician, for a few years after the firm winded up. I stopped installing cameras after I developed dust allergy (drilling in concrete was bad for the allergy), also had prolapsed spinal disk. Still I occasionally do some configuration work for CCTV systems, when the work comes up, not often though. Now I am trying to get the web design/development idea running again. Been trying to do so for some time.

But the effort is not persistent, can’t seem to find the motivation always when needed. That feeling of being positive about the future isn’t always there, it is quite often overshadowed with self-doubt, as to whether it is the right decision, whether I would succeed, whether I am capable enough for it. The field which I have chosen, requires me to put in a lot of consistent effort, to study (there is a lot of stuff I need to familiarize myself with, and which I keep forgetting) and be creative. Sometimes the idea of such a career feels overwhelming. In addition to this I have my inherent psychological problems.

I don’t know if it’s a response to my anxiety, but sometimes I feel anger inside me, maybe its due to frustrations piling on. I am somehow able to act calm on the outside, when I go out. But I seem to sense some sort of hostility from others, not everyone.

Like pointed remarks, not directly towards me. But there is a change in the tone and volume, and talk describes some sort of violence. Maybe I am just imagining. But then afterwards my mind goes into spiral of thoughts regarding the remarks. Sometimes I manage to reason my way out, but sometimes its there in the back of my mind.

I tried the breathing techniques, but it wasn’t effective. Maybe I should let it run its course.. and then try the breathing technique. I felt better after sometime.

What I meant about the change in tone and volume is that it seemed like a taunt, but not addressed directly to me. On the other hand, it could have been a conversation with the other person, where the speaker became emotional when describing how he would physically deal with someone else, if there was an altercation. I didn’t listen to the entire conversation. Like I said, I could have been imagining it was directed at me. Maybe it is because of my own fear and vulnerability.

I had a bad experience, years back, when I was in a hostel during my college years, some of my batch mates ganged up on me with taunts, taking my clothes and walking around in them, even after I protested. They stopped short of physically abusing me. Subsequently I became an insomniac which affected my psychological well being later on.

All the subsequent psychological problems affected my studies and I was unable to get my degree. These experiences made me sensitive to physical/verbal taunts either direct or indirect. (By indirect, I mean a conversation amongst certain people, near me, which may seem was carried out to evoke a response from me. Of course, this might be my imagination.) But I don’t react. I have always avoided getting into an altercation by taking passive stance.

I can’t avoid going out, I live with my mother, who is aged. I have to go out for supplies and on other necessary errands. Its not always bad, its only sometimes that I meet with such experiences. But when it does happen, it shakes me up, my morale goes down and it takes a bit of time to recover.

~~~ ~

I used to collect stamps and currencies (still have them some where), I like rearing ornamental fishes (there’s just one fish now though), other than these I spend a lot of time tinkering with electronic stuff.

I also used a lot of English fiction, that was during my younger years, when I went to college, this changed to my course related books. Now I try to spend a lot of time on web design, I want to do development also, but am keeping that aside for the time being, focusing more on the design aspect for now.

During my childhood, I didn’t even have a computer. I didn’t take computer science as the optional subject in school. But I was always inclined towards technology, specifically electronics. My mom’s family ran an electronics hardware/servicing shop. So I grew up around it. I used to tinker around with electronic appliances. When I grew older, that is in high school, I used to go to the library and read the electronics magazine looking for electronic circuits etc. Like to try some of them out with whatever parts was available. I was obsessed with assembling my own music system and perfecting its sound.

These inclinations and the availability of a merit seat in a reputed college in the branch of electrical and electronics engineering (which I got through writing an entrance test), prompted me to choose that field.

Anyway I came away from the hostel about one year later. My sister acquired a computer in our house to do medical transcription. My focus shifted to computers, played some video games on the computer, played around with settings.

My anxiety was still there, I was reluctant to attend classes, used to have my thoughts spiral out of control. There was a lot of stuff that happened during this period, which will require that I write whole chapters to elaborate.

Was hospitalized once, when a doctor I visited promised me that everything will become alright if I get hospitalized to get treatment. This was during my second last semester, just before my exams. But that turned out to be a bad decision. All the medication I was given there broke my spirit eventually. There was a moment where I cried or rather bawled uncontrollably, and loudly. Anyway after coming from the hospital I had quite a lot of different problems, my hands were shaking couldn’t write properly, had trouble with memory, couldn’t read and comprehend even one sentence in my textbook . I remember trying to read a sentence, I would read a word and when I tried to read the next word, I couldn’t even find the sentence that I started to read. Such was my condition.

After getting a little better I attempted some of the exams, but could answer much of the questions, with the end result that I failed nearly all of them, with the exception of the lab exams.

After my course period in college was over, I spend a few years trying to clear all my papers, but it was no avail. as I couldn’t focus properly. Learning had become really difficult, almost impossible. So I joined a short term computer hardware course, where was taught about servicing computers. That I managed to complete. And I worked for a short while as a computer technician at few shops (firms). In the meantime I also attempted clearing my backlog, but still it seemed impossible.

So next I went to an institute to try and learn embedded electronics technology, as I still had some interest in electronics, but I found out that the minimum eligibility for such a course was a degree, which I didn’t have. So I enquired what other technology related courses were there, that required only a high school graduation.

They mentioned a course that involved web development. it was a basic level course, and I joined it. That was how I entered the web development field. But didn’t get my certificate there, before completing the course, a job opportunity as web developer came, at the small firm which I mentioned much earlier, and I took it.

I didn’t want to risk not getting a job when I finished the course, since I didn’t have a degree, so I jumped at the opportunity.

When I landed this job at this small firm, my confidence was a little better than what it was after my hospitalization days. Prior to having my psychological problems, I was pretty good at the subjects of my engineering course particularly those subjects which I liked which was mostly math related and electronics. I had a decent foundation in electronics when I joined this firm, and I could remember most of the concepts and methods involved. I could say that this was my strong point. So learning a little additional stuff like what a dvr was, what were the different type of camera sensors, lens etc , took only minimal effort compared to an engineering course. Troubleshooting the connections wasn’t much of a problem for me. I was pretty advanced compared to two other guys who came to work there as CCTV technicians.

~~~ ~~

I am unsure about my family’s attitude towards the difficulties of mental illnesses. My sister understands my problems from a mental health counsellor’s point of view. She urges me to go out for walks, read up on the anxiety coping methods and so on. Sometimes I feel that others should experience some of the symptoms of these problems to really understand it. But then I wish it wouldn’t happen to anybody else.

Counselling has helped quite a bit. I try to focus on my blessings, rather that my shortcomings. When I see others with less, continue to live on with hope, it inspires me to do the same, and hope for better.

~~~ ~~~

Kerala, compared to a lot of other states in India, is much better run. Maybe, its because of the higher literacy levels, people expect more from the government.

I am not aware of the statistics related to suicide rates, in India, even Kerala. Even though I pay attention to the local news, they seldom discuss topics like mental health or related problems. Most of the health related talk shows are about physical well being, not mental or emotional well being.

From my personal experience, the attitude that I feel a large number of the psychiatrists have is, drug the patients, treat the symptoms and not the psychological or environmental causes of the problem. They are not bothered about the emotional distress caused by the medications combined with the patients environmental problems, such as social stigma, lack of empathy from those interacting with him/her, etc. The medications can make a person dull, slow witted, slow to respond, etc in any kind of interaction. This affects the person’s feeling of self worth which again causes more emotional distress. It becomes a cyclic process.

In the beginning, all the doctors I met were reluctant to talk about my problems or I was too drugged to really think and describe my problems. The only thing that they emphasized was that I take the medications regularly and everything will become ok. This was really disheartening . I began to lose hope . It was when I visited my sister in UK once, that I met a former student of my mom’s (who is mental health professional), who connected me with the OT treatment program in Vellore.

Coming back to the topic, regarding the higher number of suicides in Kerala, there may be physical, psychological, sexual abuses involved, also, there have been cases of whole families committing suicide because of financial difficulties. One of the reasons may be that people become reluctant to seek professional help, either because they are not aware of such a thing, or they are afraid of facing the social stigma attached to seeking help. Like I mentioned the changes which medication brings about in a person’s ability to interact with others, might also be a cause for reluctance to seek professional help. I am just speculating, since I have limited exposure regarding the perspective of others in this matter.

So on the one hand it could be because of reluctance on the part of the person, to seek treatment, while on the other, it may be treatment itself, which causes the person to lose all hope and take the extreme step.

As for the health services, that was a lot of initiative from the government during the initial phase of the pandemic, but that has seemed to have gone down. I have had only one occasion to visit, to visit a public health institution . That was when i visited the Regional Cancer Center (RCC), which was when I had the allergy , (before the doctor at the private hospital diagnosed it as allergy).

Other than that I mostly go to a private hospital, for any health related issues. As for other government services, I have had only limited interactions with the concerned departments. There may be some necessary paperwork to be done, to avail any service. Never yet had any occasion where I was asked for a bribe, although there is occasionally some bribery related news, in the television news or social media.

The Occupational Therapy is roughly a one month program. It was carried out at a Mental Health Center (MHC). I had attended it at a time when I was feeling really lethargic and had anxiety problems about interacting with others.

I attended it as an outpatient, my mom and i took up lodging at a motel (lodge) near the MHC. Every day I used to go to the MHC at morning, be there till noon, come back for lunch, attend the program afterwards, and evening we would have some games. There were others too who had various psychological problems. It was a group activity. One of the key aspects was establishing daily routine.

The patients are split into groups (maybe based on language they used). I was part of an English speaking group. The morning commences with prayer and exercise attended by everyone. Then there is newspaper reading where each of us try and read an article from the day’s newspaper, then we have a small discussion about those articles that were read. Another activity was intellectual activities were we can select from a choice of art (drawing), solving different kinds of puzzles, etc. (I used to choose puzzles mostly).

Then were games that promote teamwork. We also had classes on stress and its management, helpful coping methods and unhelpful ones, etc (its been a long time since i attended that program and I’ve forgotten quite a bit). Evening we used to have some sort of outdoor game, such as volleyball, catching the ball, etc. To summarize it was mostly to help us become functioning individuals with the medication on one hand and our effort on the other. It is called occupational therapy, because it was done to improve work skills, group skills, and stress management.

Jatayu Rock, Kerala

Self-sufficiency & resilience: Insights from an introvert from China

Enmerkar, a young Chinese woman from Jiangsu, shares her experiences of her life. She works in Shanghai and is currently studying for a role in the civil service.

I selected a position on this Monday and paid the fee. The test includes two written tests, one interview. If the candidate passes them, they will have a physical checkup and a political investigation because the government doesn’t hope to employ individuals who have terminal diseases or individuals whose relatives are engaged in overthrowing the government. Once all the procedures get done, the person will be a civil servant.

The written tests covers a variety of knowledge like spatial reasoning, general knowledge, Chinese language skills, maths, patience, reactions to stress, writing skills, understanding of the state’s policies.

I am very positive about my test. I’m not admant on passing it, it could not be any better if I secure the position, if I don’t, that is also fine. My current job is also fine. I can take the tests for several times every year, traveling to different places to take tests also broadens my horizons and fulfills of wish of sightseeing and tasting local food. The more tests one takes, more patterns of the tests one can catch.

I’d like to be a civil servant because I’d like to serve my people and to get the welfare provided by the government. It will be a lifelong position, the income is okay, most civil servants don’t have to work overtime. If I become one, I’ll have the time to further my education, to interact with my friends, to invest more time in my hobbies.

My other jobs are office work, from jobhunting applications. Most people here look for a new job by jobhunting apps.

~

I manage the database of test questions (primary school, middle school) in a company. Other information should remain confidential. My company doesn’t like employees revealing info about our projects to outsiders, they have signed a contract with us.

Difficulties? Difficulties don’t exist as long as one isn’t absent-minded when working. If the employees make mistakes for many times, he/she may be scolded by the supervisors.

Pleasures: free meals, snacks, fitness center, presents. I can also listen to Chinese lectures, documentaries, audiobooks on various fields, and friends’ group calls when working. Not working overtime won’t make managers feel disappointed about us.

My weekly working hours: 8×5=40 hours.

The workplace is far away from my apartment, it takes me 3.5 hours or so to go to work and to go home. I have a habit of reaching workplace 45 minutes before I start to deal with today’s tasks.

~

I no longer feel anxious about talking to people because I realize I don’t have to build bonds with the vast majority of people, they are merely passers-by of life. I mean I realized I don’t have to befriend every individuals I come across. Also there is no point in trying to being gregarious when one has their own circles of friends, and can get along with people who share nothing in common with them.

Social anxiety didn’t interfere a lot with my life, like most Chinese students I also spent most time at school studying together with my classmates, we didn’t really have many social activities. I was well-liked and had good friends when I was a student, and I am still in contact with them. As a hardcore introvert, I prefer to have a couple of friends rather than groups of friends, though due to my easy-going personality, I have tons of acquaintances whom I’m unfamiliar with online and offline.

I didn’t consider myself to have any mental issues, and I have never been diagnosed with mental health issues. I didn’t feel I was ill mentally, so I didn’t need a psychiatrist or a therapist.

I’m an inquisitive and curious introvert who seems heartless because I use heart less. Life trained me to be self-sufficient, resilient.

Introverts: people who aren’t energetized by interacting with many strangers or people they are unfamiliar with on social occasions, instead they will feel drained after socializing with tons of strangers. Introverts are also relatively reserved on social occasions.

I used to feel overwhelmed by social interactions. Now I tend not to participate in social interactions, because I have better things to do. I prefer to read articles on my phone than to initiate conversations with strangers.

I also pursue freedom and self-realization. I wish someday I could break yokes that were placed on me with my own will.

Self-realization: I think two Chinese sayings can explain it.

I. 修身,治国,齐家,平天下 which literally means Cultivate oneself, Bring order to the family, Govern the state, Bring peace. I’m an ordinary person from an ordinary background, so I am simply qualified to pursue a minimalized version of that saying.

II. 读万卷书,行万里路 which literally means reading a lot and travelling countless miles.

Freedom: freedom of doing things I’ve been interested in like furthering my education. I could have insisted on doing my master degree but considering my parents are very old, I don’t stand they making money for me for more years. I’ve saved money for the higher degree I’ll probably do once I get employed by the government.

I think the society here itself believes the importance of education, also the government has tried to rid the state of illiteracy and poverty. My parents’ mindset must be affected by the society, our Jiangsu province is relatively prosperous, the education is the most developed in China, when parents have chitchats with each other, they mention their kids’ rankings in class, grades.

My simply told me 书中自有黄金屋/ in the book there is a house of gold. My dad also got expired magazines and newspapers from a friend of his who worked in a high school. He let me read those publications when I was at home. Once he took a thick old Chinese dictionary home, I was very delighted to get it.

*Text within interview in italics are copied from Enmerkar’s InterPals online profile