Background India’s caste system is a 2,000-year-old culturally traditional classification encompassing a complex ordering of social groups based on ritual purity [1]. Despite the constitutional abortion of caste-based discriminatory practices, exploitation and discrimination against social groups, and the imposition of social disabilities is prevalent in the Indian subcontinent. Communities from discriminated social groups often endure […]
Background
India’s caste system is a 2,000-year-old culturally traditional classification encompassing a complex ordering of social groups based on ritual purity [1]. Despite the constitutional abortion of caste-based discriminatory practices, exploitation and discrimination against social groups, and the imposition of social disabilities is prevalent in the Indian subcontinent.
Communities from discriminated social groups often endure near-complete social ostracization. In some cases, ‘untouchables’, as they are called, are not even allowed to cross the line dividing their part of the village from that occupied by higher castes. This extends to not using the same wells, visiting the same temples, or occupying the same places in restaurants and tea stalls. Lower caste children are often made to sit at the back of classrooms. Though policy changes, social and economic advancement and strict legal measures exist, entire villages in many Indian states still remain completely segregated by caste. [2]
Caste Fault Lines
The natural disaster of the 2001 Gujarat Earthquake killed 30,000 people, and left over one million homeless. However, the subsequent man-made disaster of caste and communal discrimination in the distribution of relief and rehabilitation worsened the plight of the earthquake’s neediest victims. While resources had been equally allocated to members of all communities, Dalit and Muslim populations did not have proper access to adequate shelter, electricity, running water, and other vital supplies; whereas, upper-caste populations had access to far superior shelter and amenities [1].
Though marginalized castes make up for a significant proportion of the population, the current environment in India suffers from an upper caste and class gaze. This strongly limits the representation of marginalized castes at any level – be it media, government, or in education, especially of women, transgender people, or queer persons from these communities [3] [4]. Caste- based discrimination reflects a narrow picture of the communities in popular narratives and imagination. According to a recent survey by NewsLaundry, there are no Scheduled Caste/Scheduled Tribe editors in English media [5].
Caste plays a role in death, however – Rohith Vemula, a Dalit student, killed himself in 2016, leaving a letter which stated that he was institutionally harassed. Despite the severity of the situation, no investigation was raised, with newsrooms alleging the cause was only ‘depression’ [6] [7] [8]. Similarly, in 2019, Payal Tadvi, a Mumbai doctor from a tribal community, killed herself due to harassment by ‘high caste’ seniors at her hospital [9]. Amnesty International reports that 65% of hate crimes in India in 2018 were against Dalits, making them most vulnerable to prolonged stress, trauma, and several other mental health issues.
Speaking of mental health, many communities in the country have access to only upper caste therapists, making it extremely challenging to introduce topics of discrimination and violence in therapy rooms, let alone address the lingering pressure of inter-generational trauma that communities have passed down over the years. This repeated systemic and structural discrimination against the majority population has had an adverse reaction on the mental well-being of the population, both individually and collectively.
Prolonged Impact
An individual’s mental health is strongly influenced by surrounding sociocultural factors. It is crucial to build and maintain an environment that would revolve around the importance of mental health of marginalized communities to prioritize concepts of social justice, dignity, and empowerment. The current ‘treatment gap’ approach focuses on the individual rather than addressing the trauma and stress that is collectively experienced by communities [10].
Imposition of stigmatized identity from a young age can harm an individual’s self-esteem, perception of life, and self-identity. Surveys over the years have revealed that marginalized communities have worse mental health than upper-caste Hindu respondents (Figure 1). Data from 2007-2008 has shown that about 46% of scheduled caste respondents and 51% of Muslim respondents reported being mildly, moderately, severely or extremely depressed compared to only 41% of upper-caste Hindu respondents. Similarly, higher numbers were identified in scheduled caste and Muslim respondents, 57% and 60% respectively in the anxiety parameter, whereas upper-caste Hindu respondents experienced only 49% of anxiety [11].
Figure 1. Self-reported mental health outcomes, by social groups [11].
The links among discrimination, violence, and mental health outcomes are crucial in adopting policy frameworks to address social inequalities that impact mental health individually and collectively. The above figure paints only a partial picture of the current situation. The recent rise in discrimination and violence against minorities in India (rise in incidents of lynching, National Register of Citizens exercise in Assam, Citizenship Amendment Act riots) would have likely increased levels of depression and anxiety on marginalized communities as a whole, increasing the gap in mental health outcomes between them and upper-caste Hindus [11].
Addressing mental health issues begins with understanding the language used to talk about mental health and well-being. The current climate perceives mental health in western terms, failing to incorporate the most fundamental aspect of community well-being – nativity. Institutions and health establishments need to develop modules and resources that are based on community wisdom – past and present experiences of people from within the country- instead of relying on external teachings and ideas. To put this into perspective, most marginalized communities are familiar with the term ‘mental health’. While they are aware of the term, communities rely on their local language and dialect to communicate on issues related to mental health. For example, ‘chinta’ and ‘bhayamgaundi’ are local Telugu terms that mean ‘worry’ and ‘fear/confused’ respectively [4]. Similarly, the term ‘kalaa jaadu’ (black magic) is well-known in rural areas. Women from marginalized communities who suffer from mental health issues are often thought to be under the spell of a witch, and the woman who is branded as the witch generally belongs to a lower caste community. Patriarchy, caste exploitation, and ill-treatment of women are added catalysts to India’s declining mental health issue.
Similarly, in university spaces, even progressive groups fail to handle situations concerning the mental health of the marginalized, especially first-generation university attendees. Conversations on historical exploitation, current policies, and civil rights (such as reservation quotas) are often met with articulative attitudes such as “we choose to respectfully disagree”and “we should agree to disagree”,forcing respective individuals to exhaustingly explain their views, choices, and experiences – this further immensely impacts their mental health [20].
Education and awareness on mental health issues are scarce in most marginalized communities. Without the necessary knowledge to understand their mental health issues, people pursue ‘healers’ who exploit the existing stigma to their financial and personal advantage. The stigma surrounding mental and psychiatric illness has pushed people to pursue unconventional methods that involve illegal and questionable quacks rather than licensed practitioners [12].
Finding a therapist working at the intersection of caste and mental health in India is a real challenge. A 2015 study on mental illness, poverty, and stigma in India has shown that marginalized communities are far more susceptible to chronic illnesses, particularly those of mental health; In an increasingly capitalist society, individuals from historically oppressed groups can barely afford to check in on their mental health [13]. With unaffordability, on the one hand, there is the other issue of narrating trauma from one therapist to another till the person finds a caste-sensitive professional. For someone fighting a mental health issue, this uncertain journey will only worsen their mental and physical well-being.
While therapy is the first step, healing during and after counselling is dependent on economic mobility and a person’s support structure. However, with stigma and disparaging environments combined with a lack of genuine dialogue between social and medical sciences, historically oppressed communities are at the risk of deeming prolonged mental health issues as part of their new normal [14]. Even those from low-resource backgrounds who attempt to address mental health issues despite overcoming challenges are met with a myriad range of obstacles and limitations. In addition to addressing one’s shortcomings, the environment must create safe spaces that would be conducive to the healing of the affected.
Recent surveys indicate that India has only about 9000 (and counting) psychiatrists for its 1.3 billion people. In contrast, the US has 28,000 psychiatrists for a population of 325 million [15]. Alarmingly, the National Mental Health Survey of 2016 has suggested that low-income Indians have a 40% higher rate of depression than the national average. There have been reports of ignorance in the mental health space where upper-caste therapists have dismissed patients’ anxieties on prior caste-based discrimination and marginalization experienced as mere paranoia [16]. On the other hand, awareness on mental health is being addressed by both organizations and individuals who offer free counselling sessions, to discounts to installment plans. Still, an average session in India with a therapist sets back between Rs. 500 and Rs. 1500, making therapy sessions inaccessible for a larger population [17].
The general perception of looking after one’s mental health is joining a gym, doing yoga or practicing mindfulness, which is outside the purview of most marginalized communities. The language and outlook used to describe mental health in marginalized communities is pernicious and often discussed as an expense. Though the Budget 2020 saw a 7% increase in resources for healthcare, the government has not increased allocations for the National Mental Health Programme. The World Health Organization has estimated that the economic loss from mental health issues in India from 2012-2030 will top $1 trillion; Yet, the budget for mental health in India is just 0.05% of the total healthcare budget, whereas the average percentage of total healthcare budget allocated to mental health in developed countries is at least 5 per cent [18].
The Mental Healthcare Act, which was introduced to ensure all citizens have a right to access mental healthcare, is yet to make a distinct impression as the implementation aspects on a ground level have been rather insufficient. The conservative annual estimated cost on the government for implementing the Mental Healthcare Act, 2017 would be Rs 94,073 crore, according to a study by the Indian Journal of Psychiatry. However, the current annual spending is not even a fraction of the figure. [19]
The policy-making pyramid, which involves the government, policymakers, and the people who implement the policies, tend to leave out the most affected people from the decision-making process. The lack of representation and limited access to informed knowledge on issues of caste-based discrimination makes it extremely difficult for individuals to navigate the system [4].
Conclusion
The resistance and resilience of marginalized communities has truly been remarkable over the years. Marginalized communities have been experiencing systemic exclusion, caste-based discrimination and violence for generations in the Indian subcontinent. The forms of exclusion and violence range from subtle to insidious and are not limited to rural India. Acknowledging the need for mental health is challenging for these communities due to dominant caste groups’ deep-rooted vulgar social attitudes. For those who seek to address mental health issues, identifying professionally trained therapists who work at the intersection of caste and mental health is highly challenging and limited.
In reality, most therapists are not well equipped to address the issue of caste, and the environment lacks professionally trained therapists that understand the suffering of communities who have experienced intergenerational trauma. Moreover, the current environment of mental healthcare is overpriced, and with the influence of subtle and inherent prejudices and denial of social reality, deeply-entrenched caste hatred and denial have obstructed communities from realizing their utmost potential, and from leading a life that is free of anxiety and threat [20].
If a community is suffering, individuals from that particular community and beyond will face the trauma associated with it; Therefore, it is crucial for policy-makers to invest in resources that would disintegrate systems and policies that pose a threat to the development of a fair, free, and empathetic society that delivers the finest mental health environment.
Prepared by Ram
Research And Analysis
Hibiscus Foundation
References
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2. For more on caste-based violence and discrimination in India, see Human Rights Watch, Broken People: Caste Violence Against India’s “Untouchables” (New York: Human Rights Watch, 1999).
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