A psychiatrist, Cognitive Behavioural Therapy (CBT) practitioner, mindfulness coach, and medical entrepreneur, Shefali Batra believes wellness has long needed a revised definition.
The author of the recently released book titled Why do I feel so Sad took time out to speak to My Kolkata about depression and other related issues. Excerpts from the conversation…
Having spent more than 22 years in child and adolescent medicine, adult psychiatry, de-addiction, tele-mental health start-ups, medical affairs, pharmaceuticals, clinical and behavioural research, and training corporates and schools; it’s even clearer that modernisation in healthcare delivery is the answer to most health problems.
What is depression, according to you?
If you ask people who actually suffer from depression, they call it a negative state of mind; one in which thoughts, feelings and emotions become unconstructive so that all colour is wiped off life’s palette and your existence becomes dull and low. In medical terms, it is a common, but serious, illness that interferes with mood, sleep, appetite, attention span, and ability to experience pleasure, rendering a person incapable of managing even simple everyday activities. It’s as if one is in a paralysed state, where everything becomes slow, monotonous, and needs immense effort. Many people think that sadness is the same as depression. However, sadness is just one component of this illness. Everyday sadness is fleeting; it could come and go. But depression is long-lasting. The worst part about depression that it could take away your life when it drives you to suicide.
Are cases of depression on the rise? If yes, why?
Depression is well-known to have a biological causality – a disruption in the internal electrical circuitry of the brain owing to a malfunction in the brain’s chemical system. However, this medical outcome is actually the effect of stress in the environment and how people react to such pressure. These days, life is unpredictable, competition is fierce, people’s mindsets are negative and rejection has become an everyday occurrence. People are often not equipped with emotional defence to fight these setbacks, so they tend to sink into negative mood states which, if left untreated, progress to depression. In 2020, bang in the middle of the lockdown, it was projected that nearly 30% of the world’s population was depressed. That’s almost one in three people.
Affluence does not spare depression and children, especially teens, in such families are often seen to suffer from depression. Why?
Children from financially well-off families are not saved from the demon of depression. In fact, they often suffer more. It was earlier assumed that wealthy children may not always receive the right emotional and behavioural support from parents who may be busy at work, however this is not the sole contributor though it does play a role. Research says that the pressure to achieve can link self-worth to accomplishments. Peer groups, college societies and clubs, social meetups, university admissions, sports achievements, relationships — everything becomes a contest and if they don’t get accolades, they are disheartened. At times, teenagers may take to drugs or gambling to cope with performance pressure. All of this lowers their self-esteem further, disrupts logical thinking, worsens academic performance and sucks them into a vicious loop of self-doubt, under- accomplishment, sadness and eventually depression.
What about people from lower-income families?
Decades ago, it was assumed that the stress of poverty causes depression. It’s true that the lack of adequate resources for survival is a persistent strain and can contribute to activation of the stress axis. However, it is the perspective and attitude of people that influences the actions they take to combat everyday sadness which either directs them to recovery, or a more long-standing major depressive disorder. Many people who feel low ignore their feelings and hide them from others because of shame and embarrassment but the worst is when people do not even know they are depressed. They become so conditioned to a half-hearted existence that they refuse to acknowledge that something is wrong and reject the help that is offered to them to make it better. This can lead to more complicated outcomes like chronic long-standing depression, lower the quality of life and even lead to suicide,ēspecially in lower-income group families.
How do you address such cases?
Depression management can never be a one-size-fits-all strategy. However, an important commonality in all depression sub-types and varieties is that people actually want to be heard and want to get help even if they externally reject it. The most important step is to battle the stigma around depression and have people open up about their feelings. A small dose of medication to manage low moods (when serious); alongside cognitive techniques like CBT, REBT (rational emotive behaviour therapy) and ACT (acceptance and commitment therapy) that help in challenging negative thoughts, change the outlook and enable people to see the world in a different light. I’m hoping that my new book Why Do I Feel So Sad? can be a companion and guide that will help people and empower them to challenge their negative beliefs to become the best versions of themselves.
Please tell us about your new book.
I have always focused on learning and applying behavioural and cognitive therapy principles in my practice. It became more and more obvious to me over the years how depression can cloud rational judgment and dull a brightly coloured world to a boring and listless grey. Cognitive therapy and mindfulness are instruments that can help people attack such negative thoughts and replace them with positive, meaningful, and convincing attitudes.
I’m a proponent of the use of self-help books for healing (bibliotherapy). I believe this advanced book will be able to hand-hold, guide and encourage the readers in a step-by-step fashion by providing thinking tools that nourish the incentive to transform people into the best version of their own self. The book has real examples of real people — I am certain that every reader will identify with their experiences and walk on their path to self-enhancement. The reader will most likely feel one with the characters, too.
Many books offer instructions and theoretical knowledge only, but one could consider this as a practical 101 for depression. I walk the reader through the visible signs of the problem and how to recognise symptoms, and then offer a structured, stepwise path towards the solution. The book is one of its kind, in that it offers applicable, actionable, and practical support.
The DIY (do-it-yourself) techniques are easy to incorporate into one’s life whether they are on medication for depression. It has statistics, medical data, case studies and real-life stories of people who implemented this advice and accomplished their goal of living happier lives. I help the user with worksheets and checklists to monitor their perceptions, thoughts, feelings, and behaviour. While I know that their moods are an effect of their genetic composition, brain chemicals, thinking styles and the environment, the easiest thing to change for them is the way they see their problems. Hence the focus on mindfulness and cognitive processing in this book.