Finally free

“Twice I enrolled in Geography,” he tells me. “And both times I had to drop it midway.”

We are sitting across each other in a dimly lit eatery in Babaazar, a few hundred meters away from Tri-Chandra Campus.

“So I joined Sociology the third time,” he adds.

From Banepa, he commutes three hours to and fro daily to Tri-Chandra to take classes in MA Psychology.

Madhav Khatiwada is 43 years old, and father of two. Academic pursuit became his passion when he was a boy of 10. Geography was a discipline of his dream, of imagination and memory, psychology, an outcome of circumstances.

A bright, senior student in his small remote village in Illam, who had studied Geography, got an opportunity to study in Norway. This caught his imagination and, in his mind, he weaved academic success and adventure as interlinked entities.

So he pursued school with passion, turning into a promising student. That passion and promise brought him to Kathmandu after high school. He enrolled for a double degree at Ratna Rajya Campus – in English and Geography.

He tells me that within a year of this began his agonizing struggle with anxiety and depression. Now, the smile stretching across his long face hides all traces of his painful past – a past that ties him to bleak health statistics.

WHO says that 350 million people globally suffer from depression, and in 2012, it found that almost a million suicides occur every year, most due to depression. The organization estimates that, by 2030, depression will be the leading cause of global burden of disease. Nepal’s medical practitioners put the data on depression for the country along the same line. Unfortunately, depression and other mental illnesses are also the most stigmatized illnesses. Hence, over two third of those who suffer from depression globally never seek help.

Stories like Khatiwada’s, therefore, can act as resource, as light for those trapped in the darkest tunnel of depression.

“I suddenly woke up one night and found myself staring in the dark, frightened and sweaty,” Khatiwada recounts the first time he had anxiety attack.

He lived alone in a small, rented room in Kathmandu.

“I thought it was a bad dream. But it kept repeating every night.”

“Didn’t you share?”

“Who would I tell when even I didn’t know what was happening? I felt scared and alone.”

He was 22.

He found some solace in alcohol. But soon its soothing sensation waned and nights became drearier. Slowly, the heavy toll of anxiety spilled beyond the nights, affecting him during the day as well.

One evening, over drink, he revealed his predicament to friends, who suspected the hands of evil spirits. But no shaman they took him to could heal him.

He had been putting off seeing a doctor. “There’s this myth that once you take psychiatric drugs, you depend on it all your life. This had me scared. Also, going to doctor meant being labeled ‘mentally ill’. I didn’t want that.”

But as fear and suffering took their toll, going to the doctor became his only hope. The doctor handed him prescription whose strong side effects impacted him severely at mental, emotional and physical level, sending his condition on a downward spiral. More doctors entered the picture and with them, newer medicines and bigger confusion.

His family and friends accepted his condition and supported him. And he found a life partner in a friend’s sister who also knew about and embraced his condition. Yet, nothing could console him. He says there was immense suffering, frustration and loneliness, a sense of fallen self-worth, a feeling that life had no meaning, guilt, no joy in sunshine, and no grief in loss. In his struggle for equanimity and calm, everything else became secondary. With a sad heart, he gave up college because that was too mentally draining.

“Didn’t you feel the tiniest bit of hope?”

Shaken by a relentless stream of negative thoughts and guilt, he even had suicidal thoughts. “I came from a humble family. I felt I was putting financial and emotional strain on my parents when I was supposed to be supporting them.”

“I will also study Geography. I will also go to Norway,” he had said in his mind when the senior in the village received the scholarship. Because it was a child’s determination, it got embedded in his psyche.

When he had to drop out of college, that’s what replayed continuously in his mind. Although later he understood that there was no direct connection between getting opportunity in Norway and getting a degree in Geography, this determination was what had fuelled his passion to study.

“It broke my heart,” he says. “My mental picture about my future, my life rested on my academic pursuits.”

But the emotional turmoil couldn’t snub off that passion. On the contrary, when he recovered, academics became one platform to explore, to understand the suffering he had undergone.

“Emil Sinclair, the protagonist of Demian by Hermann Hesse, undergoes immense mental suffering. His recovery comes gradually, until in the end, his consciousness transforms to blissfulness,” Khatiwada says explaining that it’s this transformation that his MA English thesis explores.

His recovery too came like Emil Sinclair’s.

It took seven summers to pass since his diagnosis before, like a miracle, he stumbled upon medicine that cleared the bleakest haze of his inner turmoil. And as this happened, he was also confronted by the harsh reality of transformations situations surrounding him had undergone.

“I was a young man with my dreams. And here was a man in his 30s,” he says. “That’s an age when family and society expects you to settle down with a good job, and fulfill family obligations. My friends had graduated from college and were pursuing their dreams. But where were my dreams?”

He could fall all over again into the same dark pit of depression from where he had just crawled out. To prevent this, he had to reconcile with these feelings and situations.

“I felt that if I were to recover completely, I had to channel my energy to adopt a lifestyle and attitude that breathed positive vibes in my life. I felt medicine alone was not sufficient,” he says.

Yoga’s philosophy of simplicity, its connection to positivity and peace appealed to him, and he took it up. “It helps to cultivate positive thoughts and feelings. A unity of thoughts and stability that it motivates directly addresses needs of mental health patients.”

Yoga got his body moving, everyday, even if they were simple stretches of fingers and toes. Small efforts they seemed sometimes but, in subsequent days, those efforts added up to give him some sense of inner stability.

“To a mind reeling under chaos for years, a sense of inner stability means a lot,” he says. Spirituality embodied in yoga also prodded him to accept his situation, which was vital for him to focus on the future.

With a newfound sense of energy, he dusted books off his shelves and went back to college, enrolling in BA in English and Sociology. And after completing MA in English, he enrolled to study MA in Psychology.

Madhav Khatiwada is 43 years old, and father of two.

An increasing sense of self-acceptance and fulfillment made him stronger on the inside, but a complete recovery would only be possible if he opened up completely about his mental health issue. He joined a peer support group at KOSHISH, an organization working for the rehabilitation of the mentally ill.

There he heard stories of other people, some similar to his own, some darker. And to them he told his own. “My family and friends had always supported me. But actually sitting every week and listening to people whose experiences were very much like mine further motivated me and reinforced my own recovery.”

His actual outgoing nature slowly resurfaced and he worked for KOSHISH, traveling across Nepal, talking to people with mental illnesses and documenting their experiences. He trained teachers on the issue of mental health as well. And he became a teacher himself, teaching English at a school in Kathmandu.

Khatiwada speaks about his journey with zeal, and his gestures and expressions suggest he has gone past feelings of fear or shame coming from stigma attached to mental illness.

“I’ve put all my engagements aside for now so that I can complete my degree,” he says. “I want to use my experience to work for others affected by mental illnesses,” he adds, explaining his decision to study psychology. “I learnt a lot from my experiences and even if it makes a little difference in other people’s lives, my efforts will be worthwhile.”

Breaking stigma a must

Jagannath Lamichhane was 10 when he began having suicidal thoughts. “I couldn’t tell my parents that I was having suicidal thoughts or that I got scared for no reason,” he says. “Instead, I casually told them I had a headache or that my eyes hurt.”

His parents would take him to a general physician or an ophthalmologist. But there was no improvement. “I feel that at one point they somehow realized that I had a mental health problem,” he says.

Now a leading mental health rights activist in Nepal, he understands the precise reason his parents were reluctant to open up about his condition. The reason ties to what mental health patients, their families, health workers and rights activists agree is the biggest obstacle in fighting mental illnesses – social stigma.

“Social stigma around mental health runs so deep that for anyone to admit that he/she or his/her family member suffers from mental illness becomes something akin to facing the biggest possible disaster,” says Lamichhane. “It’s important to understand that illness – whatever it may be – does not discriminate. It’s the people, the society that attaches labels and discriminates people with mental illnesses.”

Unfortunately, social stigma stands against a grim backdrop of increasing instances of mental illnesses globally, including in Nepal.

“Rooting out the stigma is the most important step to address mental health issues,” says Dr Saroj Prasad Ojha, senior psychiatrist and Head of Department of Psychiatry and Mental Health at the Tribhuvan University Teaching Hospital (TUTH). “And the only way to do this is by educating people.”

But he adds that there have not been enough efforts from the government to educate the public. He also feels that it is equally important for the public to take initiatives to change their attitudes towards mental health. He points that if people were educated enough to embrace mental illnesses just as they do other physical illnesses, the current scenario of mental health would not be so bleak. Due to lack of awareness, though, most people think that mental illness only means severe mental disorder such as psychosis.

“But most mental illnesses are not serious and can be treated in a short time,” he explains. “This includes most cases of anxiety and depression. Only few mental health patients suffer from major illnesses like bipolar disorder, schizophrenia and psychosis.”

But stigma deters most patients from seeking treatment. Even when they seek help, services are not readily available. The irony is, explains the doctor, that when not addressed in their initial stages, these illnesses become severe, and this only furthers the stigma attached to mental illness.

Integration of mental health education in schools is another significant strategy that Dr Ojha strongly believes would be effective to fight stigma. “School curriculum should include various mental health issues including different kinds of mental illnesses and their causes so that children are aware about this grave health concern right from a small age,” he says. “Educating children on mental health can be significant way of protecting them from mental health problems like alcoholism, drugs and suicides.”

Dr Ojha also stresses the importance of national laws and policies with specific strategies to raise awareness on mental health problems. “Although the Nepal Mental Health Policy was formulated in 1996, it is still in the draft Act stage, and the government is yet to own it by transforming it into a legislation. So lack of its implementation is also one reason why stigma is still widespread throughout the county.”

Lamichhane, who is also the founding president of Nepal Mental Health Foundation, holds a stronger view with regard to this policy. He says that although it was a good policy approach two decades ago given the time’s socio-economic, cultural and political circumstances and people’s awareness, it is inadequate for the current times.

“Tremendous changes have occurred in the last twenty years. People’s socio-economic, cultural, political awareness have increased, and they are more open about mental health issues today,” he says. “It’s time this policy is replaced with a new legislature more attuned to the current times.”

He says that another drawback of the policy is that it upholds the medical model of disability and only considers providing treatment and curing the mentally ill. For him, a better and more useful approach is the rights-based approach that views mental illnesses within the framework of disability. “Just as people with physical disability have to live with their conditions all their lives, many with mental health issues have to cope with psychosocial disability their entire lives,” he adds.

“Ultimately, if people begin to view mental health problems as a form of disability this could help in breaking stigma attached to mental illnesses since disability is a term that seems to garner social acceptance easily,” concludes Lamichhane.