“My life has become a rat cycle. The word ‘exhaustion’ would be nothing, compared to what I feel!”, says Anita*, an employee working with a top MNC in New Mumbai. She has been a “good” employee, she tells me. Sarcastically, after a few minutes of conversation with her, she reveals that “her goodness as an employee comes from not saying ‘NO’ at her workplace”. Had Anita drawn the boundary, would she not feel exhausted?
I am sure that there are many individuals like Anita* (name changed on request) with whom we can consciously relate. Her story is not new. It won’t last either, sadly.
Poor mental health among employees costs Indian employers around USD 14 billion annually in absenteeism, lower productivity, and attrition, according to Deloitte’s Mental Health Survey (2022). Over the years, mental health issues have seen a steady rise globally, accentuated further by the onset of COVID-19 (2019–2021). According to World Health Organization (WHO), India accounts for nearly 15 percent of the global mental health burden. This should make us believe that avoidance of mental health issues is the biggest pandemic.
After sharing the above information with Anita*, she felt ‘self-pity’. I could do my best in undoing her ‘imposter syndrome’ (a psychological occurrence in which an individual doubt their skills, talents, or accomplishments and has a persistent internalized fear of being exposed as a fraud) which I sensed during this conversation but she feels it’s too late for her to alter her consciousness and behavior because “she feels she is dead already!”
Her confession reminded me of Mark Twain’s thought: “Most men die at 27, we just bury them at 72!”
Albeit the brouhaha of the 21st century, like sex education, mental health issue continues to stay stigmatic. People often link mental health concerns with asylum or psychopathy. At the same time, mental health awareness at school or the workplace is rare to be found. Consequently, on a national level, India’s approach towards its own citizens over mental health is quite lethargic and also expensive. To begin with, not more than 10% of the total population (130 crores) can afford mental health assistance. When the annual health expenditure of India’s GDP is 1.15%, despite the staggering rate of suicide rates in the world, Indians are respectively eligible for .33 paisa (less than one dollar) in space for mental health assistance. The amount spent on mental health assistance is comparable with what Indian billionaire Mukesh Ambani makes in just 3 hours or a day’s expense of a trip abroad by India’s PM Modi.
According to the 2016 National Mental Health Survey, 83% of people suffering from mental health problems in India did not have access to adequate mental health treatment. The same year, India had three psychiatrists for every million people and even fewer psychologists, according to the World Health Organization (WHO). India currently has 9000 psychiatrists, 2000 psychiatric nurses, 1000 clinical psychologists, and 1000 psychiatric social workers. The country would need an additional 30,000 psychiatrists, 37,000 psychiatric nurses, 38,000 psychiatric social workers, and 38,000 clinical psychologists. According to a study published in the Indian Journal of Psychiatry, it will take 42 years to meet the requirement for psychiatrists, 74 years for psychiatric nurses, 76 years for the psychiatric social worker, and 76 years for clinical psychologists, for providing care for the total population. The same goes for hospital beds as well. It’s thus socially natural for people to misunderstand the importance of mental health and many easily come to a harsh judgment i.e. “I am dead inside!”
Elizabeth Plumptre, a mental health writer, says: “For anyone who has never experienced it, feeling ‘dead inside’ can be hard to imagine. And, those who have struggled with it might not always have the right words to explain the confusion, sadness, and numbness that comes with this feeling. To feel ‘dead inside’ is to find it difficult to process emotions like happiness and sadness. When you feel ‘dead inside’ feelings take on the same dull tone and are hard to appreciate no matter the situation. Feeling ‘dead inside’ might cause life to seem like a boring event, one that has no purpose or end in sight. It can cause a very nihilistic approach to everyday life.”
For most people, a sense of purpose provides the drive to get up and go in the morning. Whether it’s contributing to end global warming, helping the homeless population, or reaching the healthiest version of yourself possible — knowing that there are tasks to be carried out every day to draw closer to these goals can be a source of motivation. But when a person feels ‘dead inside’, this purpose is missing. Every day appears with a question mark on the next 24 hours. These feelings can make daily life tedious and unappealing. Katelyn Hagerty, a medical reviewer based in the US, hints at unearthing the structural-functional reasons for this feeling, “Feeling ‘dead inside’ doesn’t mean you’ve maxed out your emotions. It’s a sign you’re not feeling them at all. And that can be dangerous to your mental health in the long term. If you’re feeling ‘dead inside’ right now, consider what you really mean by that. Because depending on how you describe the feeling when asked to elaborate, it could indicate very different things.”
People who feel ‘dead inside’ are likely experiencing a different outcome of major depression or another mood disorder. But it’s important to note that feeling alone isn’t enough to diagnose depression. For example: If you were broken up with, a few hours ago, you have every reason to be temporarily emotionally unbalanced, cry your heart out, or just feel totally shut down. But when that feeling becomes the default setting, it’s a sign you may have a depressive disorder. ‘Emotional numbness’ can be caused by a number of triggering factors. We might feel ‘empty inside’ because something is so emotionally crushing that our brains choose not to engage with it. We can also feel empty when something that could bring us joy isn’t available or accessible, like if a person you love is unreachable.
To draw an analogy: a man’s suffering is similar to the behavior of gas. If a certain quantity of gas is pumped into an empty chamber, it will fill the chamber completely and evenly, no matter how big the chamber is. At its core, the emptiness is a disconnect with your emotions, often self-imposed by a part of your brain trying to protect you from pain. There’s a term for this weird ability your brain has to protect itself from emotional pain: depersonalization.
I have come across three types of individuals in my life: 1) people who exist, 2) people who survive, and 3) people who live. The 1st type is simply existing for the sake of it. They are almost numb, whereas the 2nd type keeps themselves busy to merely survive. The 3rd type is the ones who have found a ‘middle path’ to live mindfully, to enjoy every moment of the present, without regretting the past and feeling anxious about the future. This segmentation may or may not be universally true, but it can be easily related to our standpoint experiences.
“What keeps us alive?” is a good question, to begin with, whenever we feel numb. To compensate for this, other than pushing for professional mental health assistance, or CBT (cognitive behavior therapies) and Buddhist meditation like Anapanasati, Mettabhavana, Tonglen, and Qigong, I recommend my students to often read the book “A Man’s search for Meaning” by Viktor Emil Frankl, a holocaust survivor. The book provides a vivid account of an individual’s experience as a prisoner in a Nazi concentration camp. It focuses on love, hope, responsibility, inner freedom, and the beauty to be found in both nature and art as means that help one endure and overcome harrowing experiences. He also describes his psychotherapeutic method, which involves identifying a purpose in life to feel positive about, and then immersively imagining that outcome.
“Once you find a meaning in what you are going through, then it is no longer suffering.” — Viktor Emil Frankl
