Psychotherapy in India. A Personal Perspective on Women as Therapists, Clients, Caregivers in Urban India

Mini Nair

As the world continues to battle the effects of war and a pandemic that has ruptured lives and livelihoods and exposed power equations like never before, the need for psychotherapeutic support has increased exponentially and India is no exception.

Pre-covid surveys showed that about 130 million Indians required mental health services. The median number of psychiatrists was only 0.2/100,000 population compared to a global median of 3/100,000. Similarly, psychologists, social workers, and nurses are 0.03, 0.03, and 0.05/100,000 population. The demand-supply ratio would most-likely be skewed further now.

The work scenario is further accentuated by a multiplicity of languages, religions and ethos. I can speak 7 languages by virtue of being taught three at school, my mother tongue and the languages spoken in the states I have lived and worked in so far. Tolerance and understanding of different religious practices- the fundamentalism and moderation in each, enabled me to exhibit greater levels of empathy. The ethos varies based on factors such urbanity, socioeconomic, educational status even within religious groups and of course the client’s and therapist’s sensitivity to the caste system.

Illiteracy and misconceptions surrounding mental health and the stigma associated with mental illness are other walls that are slowly being broken. India also has its fair share of temples, churches and dargahs that claim to heal illnesses of all kinds. These don’t make the work of a mental health professional easy or financially rewarding in India.

Personal experience has shown that for every 10 male psychiatrists there is only one female psychiatrist. Psychiatry is not a very popular specialisation amongst medical graduates. The medical doctors are only now realising the need for psychotherapeutic training. So far, they considered themselves superior practising pharmacotherapy and called themselves as eclectic and tended to look down upon psychotherapists and psychologists. Their lack of interest in therapy seemed to spring from their desire to finish consults quickly, so more patients could fit into their hours and thereby the earnings could be increased. This arguably affects the quality of patient care and empathy shown. Expecting cooperation or respect from a psychiatrist for psychotherapeutic work is like asking for the moon. The Indian Psychiatric Society, a body of psychiatrists, has less than 15% of women psychiatrists. A shining beacon amongst them was India’s first woman psychiatrist Dr. Sarada Menon, the longest serving head of the Institute of Mental Health, Chennai and founder of the SCARF- Schizophrenia Research Foundation, who passed away at the age of 98 in 2021.

In urban India for every one male therapist/counsellor/psychologist, there are 40 women professionals. This can be attributed to gender stereotypy in a patriarchal society with women expected to be and brought up to be more caring, listening, supportive, comfortable with emotional “blabberage”. Often clients too are more comfortable speaking to female therapists. The places of employment are Mental Hospitals, Non- governmental organisations, Schools- Municipal and Private. Corporates have opened now, through covid and post-covid, to the mental health care of their employees and are incorporating wellness initiatives.

Gender disparity is critical to the kinds of issues that bring women to seek therapy. The most successful movies and TV series are reflective of regressive female characters who are “good, virtuous” against all odds imposed on them in their marital homes or maiden homes or are path breakers as they seek a larger purpose in life. New age entertainment, however is attempting to emerge from the beaten path and present stories of live-in couples in urban India and reduced gender prototypes. The constitution grants equality to women and empowers states to discriminate in favour of women. Education and employment of women, especially in urban areas, has caused a reorientation of roles, responsibilities and power between genders, a welcomed shift for many women.

Despite the shift in new-age India, the issues of women largely stay the same — depression, somatoform, dissociative disorders, not linked exclusively to biological vulnerability but to social circumstances, socio-economic disadvantage, role-related stressors like the disproportionate burden of care giving and violence against women, being married, divorced, or widowed, domestic violence. Thus, there is biological vulnerability and social factors such as lack of partner support, culture of son preference, strain from difficulties with work-family balance are all equally responsible in causing psychological distress in women especially following childbirth.

An uneven understanding of human rights is also prevalent wherein women are seen to assume the caregiver role when husbands fall ill, while men are found to let the wife’s family take care of her when she has health problems. It is quite common to find men citing mental illness of the wife as grounds for divorce. Inpatient care facilities allow the discharge of men who have recovered from a mental health condition at their own risk but not so in case of women. The lopsided understanding of healthcare for women was evidenced in the forcible hysterectomies on mentally challenged women in a governmental home in Pune in 1994.

However surveys conducted in the covid era show a new urban India with increasing levels of awareness of mental health, a willingness to seek therapy, a belief in psychotherapeutic treatment and recovery. Therapy has become deliverable online, in person, via phone, and more and more urban therapists are becoming gender affirmative. There is now a surge in mental health start-ups by women entrepreneurs. I hope and look forward to an India that pays its women entrepreneurs and therapists better, where women clients find safety, solace and support in society and equal opportunities to dare and dream and achieve and fail and rise again!

Mini Nair is a consultant psychologist and psychotherapist. She currently practises privately in Mumbai, India, and offers both in-person and online therapy. She has worked across various Indian cities and currently also caters to the Indian diaspora worldwide through the online modality. She practises Rational Emotive Behaviour therapy, and has developed keen interest in group work. She is an avid reader, writer, Bharatnatyam dancer (a form of Indian classical dance). She has been extremely passionate about her work for the past 22 years. You can reach her via www.nairmini.com