Insights: Talking mental health beyond the metropolis
What does talking about mental health outside of urban India look and sound like?
When I was growing up in Dhanbad, a tier 2 city in the state of Jharkhand (earlier Bihar), there was a common taunt in Hindi used by people around me: “Ye Ranchi se chhoot ke aya hai”— meaning, “This one is a runaway from Ranchi.” Unable to decipher the reference, I asked an adult what this meant. I was told that Ranchi was famous for its pagalkhana — or madhouse.
According to a paper published in the Indian Journal of Psychiatry, the “Ranchi Institute of Neuro-Psychiatry and Allied Sciences (RINPAS) [the so-called ‘madhouse’] is the first mental hospital in India established by the British purely for Indian patients as well as the second oldest functioning mental hospital in India.” Tracing its origin to a lunatic asylum that was established in 1795 in Munghyr, Bihar, built to incarcerate ‘mad sepoys’ at the behest of the Commander in Chief of the Bengal Army, the asylum was shifted to Patna in 1821, and its name changed to Patna Mental Hospital. By 1925, all its patients were shifted to RINPAS, an asylum in a small town called Kanke in Ranchi.
While a lot has changed since the colonial-era Indian Lunacy Act of 1912, which considered mental illness through the lens of custodial control, phrases like ‘pagalkhana’ and ‘Ranchi se choot ke aya’ betray how such language still shapes attitudes towards mental health care in India today.
My own journey of seeking therapy began in my mid-twenties. The isolation of living in big cities on my own for ten years had taken its toll. This, combined with the traumatic experience of losing a parent, pushed me to take a career break and return to my hometown. Having the privilege of education and employment meant that I had both the awareness and the financial capacity to seek help and treatment. However, undertaking this process while living in my Bengali and Hindi-speaking home, made me realise that, in every therapy session, I would only speak in English.
Since then, I have always wondered about the discord between the discourse on mental health — something that is produced largely by English-speaking urban centres — and how it plays out in rural and small-town contexts.
What does talking about mental health outside of urban India look and sound like?
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My grandmother, who never went to school and only speaks one dialect of Bengali from the southern regions of West Bengal, often uses the word chinta to describe her state of mind. Chinta is a word used widely across India, acting almost as an umbrella term for anxieties, fear, concerns and sleeplessness.
Without technical and clinical terms — and far-removed from the current wave of therapy-speak we see online — vernacular languages contain entire lexicons for financial, familial, substance-use and gender-based concerns that function as triggers for mental health distress.
Take, for example, shuchibai, a Bengali colloquial term for what is usually clinically diagnosed as a form of obsessive-compulsive disorder, or OCD. OCD is defined as a disorder in which a person engages in repetitive behaviours (compulsion) caused by recurring thoughts (obsessions).
During a conversation about shuchibai with Mou, a friend from my hometown, she spoke about a woman who would take a shower every time she went to use the bathroom. Her habit of purification would also include washing all her clothes including the rubber band she’d wear to tie her hair. While the symptoms may look simply like a fixation with cleanliness, it is also important to consider how, in Indian society, notions of pollution and purity are ingrained in the minds and bodies of women.
Shuchibai is one of the many culture-specific syndromes of Bengali society. It is often housewives, older aunts or grandmothers who are associated with this “purity mania”, as it is termed in the Indian Journal of Psychiatry 17 (1975). Like hysteria, shuchibai has gendered connotations, which reflect the way society stereotypes and categorises women’s psychological struggles.
Interestingly, while talking about a male colleague whose actions portray similar notions of purity and cleanliness, my father used a different word — baatik, which roughly translates to a habit or fixation. The colleague would go to the outhouse toilet of the running room (the resting area for railway crew members), wearing nothing but a gamcha, or cotton towel, even in the middle of winter.
However, the word batik does not hold the stigma that surrounds shuchibai. In shuchibai, the woman’s behaviour is considered a ‘sickness’ while the same behaviour displayed by a man is seen as a quirk.
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As a first-generation English speaker, I have always wondered about the gap between the conversation around mental health and its lack of visibility and understanding in regional languages. While regional lexicons exist, it is equally important for medical knowledge to be made accessible outside of English.
Modern therapy-speak has inundated the internet, and the study of psychology is still largely dominated by a Western colonial linguistic framework. Furthermore, most mental health professionals in India are trained in English-based pedagogy. This leads to a significant lack of communication in the field, where trainees working in rural or semi-urban communities must relearn their practice. Pratyusha DV, an independent mental health consultant from Bengaluru says, “Basic explanations are required in non-clinical terms for every layperson. The same thing can be done in any regional language.”
Mumbai-based mental health practitioner Arya Prasad works with Dear Oliver Therapy Services. She tells me: “There is a structural and systemic problem, but on an individual level people have been making efforts to amend this. For instance, I have used a Malayali-translation of Plutchik’s wheel of emotion that was shared on social media by a trainee in my own practice. This turned out to be very helpful.”
The Plutchik wheel (or emotions wheel), created by psychologist Robert Plutchik in 1980, is a visual guide used in psychology to explain and recognise the eight basic human emotions, and the relationships and variations between them.
While such individual endeavours may be useful, they are not a permanent solution. Prasad says, “Take for instance, the Diagnostic and Statistical Manual of Mental Disorders (DSM), the most comprehensive and authoritative guidebook used by mental health care professionals for classifying issues faced by patients. It has not been translated into Hindi or other regional languages.”
This inaccessibility of the DSM, the foundational resource for diagnosis in contemporary mental health practice around the world, affects the majority of the population of India, where, according to the last census, only 10.6% of Indians spoke English.
To reduce social stigma surrounding mental health distress and improve access to care, language is the cornerstone of policymaking and research. Without a localised and legible lexicon for non-English speaking people to understand and communicate signs and symptoms of distress, and in the absence of translations and transliterations of the DSM, a large gap emerges, preventing critical access to mental health care for the majority of India’s population.
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In the absence of adequate translation, institutional support and infrastructure, care work still operates in semi-urban and rural communities — without following scripts of seeking therapy, which are accessible to only a privileged few. It may, however, still fulfil the need for care.
For example, in many rural areas, it is not uncommon to see people get together to discuss their problems in between and after their daily activities. In the West Bengal village where my grandmother lives, I have often noticed how women get together to spend their leisure hours chatting, discussing their problems, and weaving a form of embroidery craft called katha.
This is part of ‘adda culture’, a phenomenon unique to Bengali society, of gathering ‘just to talk’. Although usually associated with upper-caste men, it is engrained in the very fabric of Bengali life. During my three years as an undergraduate student in Presidency University, I’d often be part of such impromptu free-wheeling conversations, where the topics ranged from politics, cinema and literature, to even our personal lives. Through this habitual part of my life, I was able to forge close friendships that continue to act as support systems for me even today.
While these care-based community practices do exist, there remains a more vicious side to how a non-urban community can react to people facing mental health issues.
Growing up, I watched my mother struggle with her deteriorating mental health. One of the most searing examples that I can remember from those days is the impact of superstition on people’s perceptions of her. A neighbour’s mother, who had come for a visit, cornered me one day as I played with other neighbourhood kids. It took me a while to understand what she meant in the hushed voice she was using. But the gist of it was that she thought my mother was a victim of dark magic. Where I grew up in Jharkhand and West Bengal, a large section of society conflates mental health conditions with superstitious beliefs such as witchcraft.
Priyanka, another friend from my hometown, expressed a common practice prevalent in these hinterlands: how elders prevent you from putting your hand on your forehead or chin— gestures connected to sadness or stress. “They will tell us not to worry but never sit down to discuss what worries us.” Constraining physical actions that might signify any emotional or mental distress can inhibit people from sharing their problems and being open with their struggles.
Conversations with friends who also straddle two worlds like me — the English-speaking elite spaces of metropolitan India on the one hand and the rural and semi-urban spaces of our childhood where our families still live on the other — have also shed light on the lack of inclusive therapy available in the latter regions. A friend confided to me how her younger sister had a misogynist encounter with a mental health practitioner, who victim-blamed the 19-year-old after she shared her experience with sexual assault. In such cases, therapy actually does more harm than good and hinders people from seeking timely help.
Through these stories, I realised how different my journey was towards healing and finding a support system of people around me, compared to the experiences of many others who could not find the right support at the right time.
Till the end of her life, my mother’s struggle with depression was a hushed affair. Even today, I have routinely seen people around me dismiss any conversation around mental health with ridicule and shaming. In 2024, India ranked 126th out of 143 nations in the World Happiness Report. While this points to an insidious mental health crisis in the country, beneath this data there also lies a lack of access to mental health services in rural and semi-urban regions of India, as well as the stigma surrounding people with mental illnesses today.
I recently learned about Abu Zayd Ahmed ibn Sahl Balkhi, the 9th-century Persian Muslim polymath, whose work, Masalih al-Abdan wal Anfus (The Sustenance of the Soul) was recently translated by Dr. Rania Awaad.
During the early Islamic era, a time to which Balkhi belonged, healthcare centres were known as bimaristans — spaces for the sick. Reading Balkhi’s work, it was a term that captured my imagination. Unlike the cage-like imagery of the pagalkhana of Ranchi that had haunted my childhood days, bimaristan gives me hope. After all, if language shapes our narratives, perhaps a dialogue between urban and rural care practices, and a reconsidering of the words we use, can help forge the long path ahead.
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