04 April, 2015

On the causes of depression and suicides in south India

South Indian states are known to have the highest levels of suicides in the world, which is starkly different from north Indian states. Suicide is the culminating state of an intensely depressed mind.

I have been to hell and back myself, including attempts to take my life during my school days back in the '80s. Since then, I have tried hard to understand and model what is happening around us. And what I have learned is if anything, even more depressing. The roots of our depression problem go deep.

Worldwide, there is a stigma around depression and other mental illnesses. There are several well-intentioned initiatives to address this stigma by calling depression as just an illness. Like this video for example, which basically repeats several oft-heard statements about depression, like women suffer are more likely to suffer from depression than men, and it is an illness that can be treated.

But look at the statistics from the NIH study linked earlier, in south India, men are almost twice as likely to be driven to suicide (44.7/10,000) than women (26.8/10,000).  To put these numbers in perspective, the worldwide average for suicides is less than 3 per 10,000.

And if I've understood our dynamics well, calling depression an ``illness,'' is not likely to reduce the stigma -- it is only going to make things worse.

Studies and theories on clinical depression that are considered authoritative have been predominantly developed in the Western world, studying for example, the high incidence of depression in Scandinavia.

However, the causes of depression in south India are characteristically different from that of Scandinavia. According to the NIH study, the main causes of depression induced suicides in India are: "individual, family, and societal level factors." While in Scandinavia, depression is a result of vast changes in the physical climate and weather. This is also called Seasonal Affective Disorders (SAD).

Physical factors lead to neurological causes for depression like degeneration of cells, stunted growth, etc. On the other hand, depression triggered by social factors are caused by having forced into an intense emotional state like frustration or submission or helplessness for long periods of time. 

Imagine someone getting locked up in a cell for several years for no fault of theirs. They go on to become depressed. This depression is not due to the physical surroundings, but due to the intense emotional state of desperation they stay in for a long time. The paucity of light inside their cell is no more a cause of depression, than the intense emotional state of having been confined to a cell for no reason.

An emotional state results in the release of specific sets of hormones, And staying in an intense emotional state for a long time results in a hormonal imbalance. This is characteristically different from depression caused by physical factors leading to neural or other forms of cellular degeneration.

So why did our society become so deadly unto itself? 

The main social factor leading to depression is our cultural emphasis on deindividuation. Our culture is based on instilling a sense of social membership in the individual and encouraging them to work towards collective good. This has several desirable outcomes. Our society is characterized by its strong dynamics around religion and spirituality, sensitivity towards other living beings including the environment and emphasis on harmonizing with the environment, rather than taking charge or control. 


However, over the last several decades, with increasing education, awareness, technological advancement and connectivity with the rest of the world, our society has seen a lot of changes taking us away from these collective ideals. To counter this, and to maintain homeostasis of our earlier social state, these collective ideals are pursued with renewed intensity and vigour.

Beyond a certain point, emphasis on the collective starts to de-emphasize the importance of the individual and the individual autonomy. "Selflessness", deindividuation and self-deprecation become virtues. Right from a young age it is common to see people being shamed or morally admonished into compliance to the collective. 

Moral admonishment like shaming is the cognitive equivalent of throwing acid on someone's face. The damage it does is basically irreversible. For some reason, we have not understood how potent a weapon it is, and tend to bring the moral lens into everything. 

A sense of individual identity is very important to face challenges of life and to keep one's body, mind and spirit together. Without a sense of one's individual it is very hard to just convince oneself to keep breathing and be alive. 

In south India at least, deindividuation afflicts both men and women. Statistically men, are more likely to be driven to suicide, as any attempts by them to portray their problem will only subject them to even more moral admonishment.

Calling this form of depression as an "illness" makes things even worse. An illness carries no less a stigma in our society. 

Besides, an "illness" is something that can be "cured" by treatment. But a hormonal imbalance created by social pressure, cannot be "cured" by restoring the hormonal balance. It is not some form of a deficiency created by the physical environment, that can be replenished by medicine. 

To really counter the problem of depression and suicides in south India, we need to comprehensively infuse ideas in the society that respect the individual. We need to help the society understand why people pursuing their individuality does not necessarily result in collective misfortune. In fact, if the collective ideals are so good that people voluntarily associate themselves with the collective, then it only makes the collective stronger, not weaker.