When we talk about mental health, we often use ideas and terms that come mainly from Western psychiatry and psychology. Modern psychiatry has made enormous contributions to understanding mental illness, including diagnosis, medication, psychotherapy, and brain-based research. But mental health is not experienced in exactly the same way everywhere.
In a place like Kerala, a person’s understanding of mental health is shaped not only by their individual thoughts and emotions, but also by their family, relationships, community, religion, culture, education, work, and financial situation.
Therefore, understanding mental health in India requires more than simply applying a diagnostic label. We also need to understand how people in our communities experience distress, explain it, and seek help.
Myth 1: “Mental illness is mainly a Western or modern problem.”
Fact: Mental health problems exist everywhere.
Depression, anxiety, substance-use problems, severe mental illnesses, and other psychological difficulties affect people across cultures and income groups.
In India, the burden of mental health problems is substantial. The National Mental Health Survey and other studies have shown that a large proportion of people who experience mental health difficulties do not receive professional care.
Today, people are also facing new pressures. Students may experience intense academic competition and expectations about marks and careers. Young adults may struggle with employment, relationships, migration, and financial uncertainty. Parents may experience pressure to provide the “best” education for their children. Older adults may face loneliness, health problems, and changing family relationships.
So, mental health is not a problem of one particular culture or social class.
Myth 2: “Mental health is only about the individual.”
Fact: In many Indian families, mental health is closely connected to relationships.
In some Western psychological models, individual independence, personal choice, and self-fulfilment receive considerable attention.In many Indian families, however, a person’s well-being is closely connected to the family and community.
For example, when a young person is struggling emotionally, the question may not simply be:
“What is happening inside this person?”
We may also need to ask:
- What is happening in the family?
- What expectations are being placed on the person?
- Does the person feel accepted and understood?
- Are there conflicts at home?
- Is there financial or academic pressure?
- Does the person have supportive relationships?
- What role do family and community play in recovery?
This does not mean that individual needs are unimportant. Rather, individual well-being and relationships often influence each other.
Traditional Asian philosophies have also developed their own understandings of psychological balance. For example, Chinese approaches influenced by Confucian and Taoist traditions have emphasized balance, harmony, relationships, and the connection between the individual and the wider world.
Myth 3: “Mental health problems look the same in everyone.”
Fact: People express emotional suffering differently.
Imagine someone experiencing depression.
One person may say:
“I feel hopeless and empty.”
Another person may say:
“I am constantly tired. My body aches. I cannot sleep. I have no energy.”
Both may be experiencing significant emotional distress.
Researchers use the term “idioms of distress” to describe the culturally influenced ways in which people communicate and experience psychological suffering. In many communities, including parts of South Asia, emotional difficulties may be expressed through physical complaints such as:
- Headaches
- Body pain
- Tiredness
- Stomach problems
- Sleep difficulties
- Weakness
- Palpitations
This is why a mental health professional needs to listen not only to what the person says, but also to how the person describes their experience.
Understanding the person’s cultural background can help us avoid misunderstanding their symptoms and can make assessment and treatment more meaningful.
How Do We Understand Mental Illness in Kerala and India?
Mental illness is not always understood through a medical or psychological framework. In some families and communities, psychological difficulties may be explained through beliefs about:
- Karma or past actions
- The evil eye
- Black magic
- Spiritual influences
- Possession
- Supernatural causes
- Astrological factors
Because of these beliefs, some families may first approach a religious or spiritual person, faith healer, or astrologer rather than a psychologist or psychiatrist.
It is important to understand this without immediately judging the family.
For many people, these beliefs are part of their cultural and family worldview. A mental health professional’s role is not to insult or dismiss the person’s beliefs, but to understand the person’s explanation of their suffering and, when necessary, help them access appropriate professional care.
Research in India has identified stigma, lack of awareness, concerns about treatment, family attitudes, and other social and practical barriers as factors that can delay help-seeking.
The Family: Both a Strength and a Challenge
One of the important features of Indian society is the strong role of family. Family can be a protective factor. A supportive family can provide:
- Emotional support
- Practical help
- Financial assistance
- Companionship
- Help with treatment
- Encouragement during recovery
A person who is struggling does not always have to face the problem alone. But family pressure can also become a source of distress. At times, families may be concerned about:
- “What will people say?”
- Marriage prospects
- Children’s education
- Family reputation
- Social status
- Fear of being labelled “mentally ill”
Because of stigma, some families may hide a person’s difficulties or delay seeking professional help. Therefore, family involvement can either support recovery or, when combined with stigma and excessive pressure, become a barrier to care.
Stigma and lack of awareness
Sometimes the biggest barrier is the belief:
“What will people think if they know I am seeing a psychologist?”
A person may be willing to take treatment for diabetes or blood pressure but feel ashamed to seek help for anxiety or depression. Mental health should be treated with the same seriousness and compassion as physical health.
These factors can all influence how a person understands their distress and seeks help.
The goal is not to choose between “Western” and “Eastern” approaches.
The goal is to take what is scientifically useful from modern mental health care while also respecting the cultural realities, family systems, beliefs, and lived experiences of the people we serve.
A Simple Message for All of Us
Mental illness is not a weakness. Seeking psychological help does not mean that a person is “mad.” And talking to a psychologist or psychiatrist does not mean that something is permanently wrong with you.
Sometimes, people simply need a safe place to talk, understand what they are going through, learn healthier ways of coping, and receive appropriate treatment when necessary. Mental health care becomes more effective when we understand not only the disorder, but also the person, the family, and the world in which that person lives.
References
Arahanthabailu, P., Praharaj, S. K., Purohith, A. N., Yesodharan, R., Rege, S., & Appaji, R. (2024). Exploring barriers to seek mental health services among patients with severe mental illness and their caregivers in a modified assertive community treatment program: A qualitative thematic analysis. Indian Journal of Psychiatry, 66(7), 621–629.
Chakrapani, V., & Bharat, S. (2023). Mental health in India: Sociocultural dimensions, policies and programs – An introduction to the India series. SSM – Mental Health, 4, 100277.
Cork, C., Kaiser, B. N., & White, R. G. (2019). The integration of idioms of distress into mental health assessments and interventions: A systematic review. Global Mental Health, 6.
Wang, K. (2022). The Yin–Yang Definition Model of Mental Health: The mental health definition in Chinese culture. Frontiers in Psychology, 13, 832076.