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Section 1 - History and Tradition

Descriptions of various emotions can be found in ancient Indian texts such as Vedas and related Vedic scriptures. For example, Atharva Veda describes in detail willpower, inspiration, and consciousness (Mishra et al., 2018). Upanishads, the philosophical-religious texts of Hinduism, detail various states of mind, theories of perception, thought, and memory. Moreover, Charak Samhita and Sushrut Samhita, two classics of Ayurveda, outline mental disorders and 14 causative factors, which include immoral behavior, a weak mind, stress, anxiety, and more (Mishra et al., 2018). These ancient Vedic texts also present some of the first examples of diagnosis, crisis intervention psychotherapy, and early herbal medicinal treatments.

With the rise of the Mughal dynasty, Unani medicine, which states that disease is a natural process and is presupposed by the presence of four akhlaat (humours) in the body (WHO, 2010), gained prominence. By 1222 AD, Najabuddin Unhammad, an Indian physician and Umani practitioner, described seven types of mental disorders and states of mind: Sauda-a-Tabee (schizophrenia); Muree-Sauda (depression); Ishk (delusion of love); Nisyan (Organic mental disorder); Haziyan (paranoia); and Malikholia-a-maraki (delirium) (Nizamie et al., 2010). The citations above illustrate the depth of which issues of psychology and mental health are part of India’s history and culture.

However, as Mishra and others point out, it is not until the British empire colonized India that we find remnants of a “modern psychiatric state” in the region. Specifically, the western conceptualization of segregating mentally ill patients into asylums began to take shape in the mid-18th and 19th centuries. These institutions catered mostly to European soldiers and were “more custodial and less curative” in function (Nizamie et al., 2010). In 1858, the Lunacy Act was first introduced, which offered guidelines for the management of psychiatric hospitals and emphasized the segregation of mentally ill patients from the general population as a protective order. During this time, drug treatments for psychiatric conditions were also introduced to India and were largely used to control patient behavior (Nizamie et al., 2010).

By 1914, World War I had significantly altered the new world order. The following years saw a gradual movement towards a more community-oriented rehabilitation approach in India with the creation of the Central Institute of Psychiatry in 1922. Alongside this, efforts to reduce stigma were enacted by renaming “asylums” to “mental hospitals” and shifting core treatment approaches to include occupational therapy and rehabilitation (Mishra et al., 2018).

After India’s independence in 1947, a new phase of psychiatry emerged, which focused on improving the conditions of existing mental hospitals and the creation of psychiatric units in general hospitals. By 1987, the Mental Health Act was introduced, and it “stressed the role of treatment and necessity to safeguard the interests of the mentally ill” (Mishra et al., 2018). However, it was not until 2013 that the government of India sought to ensure access to affordable and quality mental healthcare for all of its citizens and prioritize the rights of people who are mentally ill. In October 2014, a task force released a National Mental Health Policy, titled “New Pathways, New Hope.”

According to Sarin and Jain (2017):

The new policy document is the identification of cross-cutting themes and an acknowledgement of the nexus between poverty, social deprivation, homelessness and mental illness. This recognition of the social determinants of mental health and the undeniable role that these play may lead to what remains the ultimate goal of policy: making a change in the lives of people.

Yet, despite these policy-level actions, approximately 150 million Indians remain in dire need of mental health intervention (Vivek N.D., 2019). In other words, “nearly 70%-92% of persons with mental illness who require care either do not have access to services, or — if receiving services — cannot access quality care that is affordable, easily available, and satisfactory” (Mariwala Foundation, 2019). Described by Jain, Sarin, Ginneken, et. al (2017), “This mixture of an unresponsive government health system, an unregulated and frequently inaccessible private sector, and a few patchy NGO-led efforts means that most people with mental illnesses continue to be denied access to any form of treatment and poses a daunting challenge to contemporary Indian psychiatry.”

Why does this history matter?

We bring attention to the history and cultural lineage of psychiatric care in India as it provides critical context for the country’s current challenges. Specifically, decades of discriminatory policies have reinforced a generational stigma against mental health issues, leading to marginalization and neglect. Critiques of the “institualization” and western-centric, bio-medical model approach signify a lack of cultural and social specificity that takes into account the heterogeneity of states across India, a country that is extremely diverse in terms of culture, language, and more. Now, as the government commits to a more inclusive approach, scholars look to shift the current structures and systems to be more comprehensive and centered on social care needs (Mariwali, 2019). The narrative is thus again changing, exposing tensions between traditional and more modern value priorities.

Tied to this, history also serves to shed light on the influence of religion in early conceptualizations of mental health while also determining current customs of daily life. For example, the Bhagawad Gita acknowledges that time spent alone is an “essential part of the human experience” and necessary for liberation (Kala, 2018). Therefore, as several experts hypothesized, the concept and language of “loneliness” is emergent. The Indian tradition positions “free time” or “being alone” as a luxury of the human state. “People have always been lonely, and they will always be lonely. It just manifests itself in different ways,” shared Ramakant Vempati, Founder of Wysa. “Now, it is fashionable to talk about mental health, using medicalized terms. When in Hindi, there is no approximation for certain conditions, like ‘depression.’” This, in several ways, harkens back to observations we have made in previous research on the difference between solitude and loneliness. Vivek Benegal, Professor of Psychiatry of the Centre for Addiction Medicine at the National Institute of Mental Health and Neuro Sciences, offered the following distinction:

You can be lonely and that is very different from the concept of being alone. Being lonely is some sort of suffering. It leads to a lot of problems. Whereas being alone is something which is redemptive, which leads to regeneration. It's a strength.

Kavita Arora, co-founder of the Children First Mental Health Institute, underscores this point in her example of the Bengali song, Ekla Cholo Re, which encourages one to walk alone if you have a mission. “We have so many such inspirational songs and texts across India where the value of walking-alone, even if it makes you alone, has been lauded for generations. So what value is placed on being alone is very important to understand culturally because there’s a huge movement which advocates it,” she noted.

This begs the question: Is navigating loneliness about gaining the skills to cope with solitude? For some scholars, the answer is in cultivating resiliency and other abilities. For others, the answer is deeply intertwined with an individual’s identity and the various intersections that constitute it (e.g., gender, age, caste, religion). Again Benegal offers an acute observation:

The existential schools of therapy, describe this well. They suggest that some people who have not yet developed a sense of self—often referred to as ‘hollow people’—are more exquisitely sensitive to loneliness. While people who have developed a more comfortable relationship with their self along the way, people whose real selves are more congruent with their ideal selves, are better able to use that aloneness for redemptive learning about themselves.

This is particularly vexing for youth in India on a number of dimensions. For example, with increased digital access, young people are “exposed to the world and have the privilege to know their identities earlier,” commented Nikhil Taneja, Co-Founder and CEO of Yuvaa. “But, they still live in a traditional society and in conservative households. Kids may know more than their parents, earlier; but, they lack the lived experience that usually comes with that knowledge.” The internet and social media thus offers an outlet for youth to not just express their “sense of self” but also explore new language around mental health and illness. On the flip side, access and expression online may also lead to performative displays of the self. Research on social comparison and the fear of missing out suggest that both relate to the link between passive social media use, depressive symptoms, and self-perceptions (Burnell et al., 2019), though it remains unclear what might be driving such behaviors. The challenge then is to develop technologies that enable individuals to reflect deeply on their own identities and to safely share their experiences with others. More on this in the next section.

Adding another layer, one of the most pervasive themes of Indian life is social interdependence. These social ties manifest in every activity central to Indian life, including family, kinship, the caste system, economics, and theologically (Jacobson, 2004). But, as several participants highlighted, the rapid urbanization and shift towards a more individualistic society is challenging these long held traditions. Moreover, as Amit Malik, Co-Founder and CEO of Innerhour, notes: “There are so many determinants of loneliness that are expanding [in India] whether that is family structure, age, marital status, financial well-being all independently contribute to loneliness. And, as we enhance our socio-economic indicators, loneliness will also continue to expand.”

Regardless of life stage, these observations underscore a unique Indian perspective wherein solitude and loneliness exist in a continuum, and both are critical to the human experience. Thus, loneliness is not to be cured or solved for as the narrative of the “loneliness epidemic” would suggest. Instead, the key is in providing the right tools and skills for navigating the experience. Naturally, this brings us to the second half of our study. We now pivot to unpack if and how technology ameliorates and/or exacerbates one’s ability to maneuver this continuum.

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