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Aishwarya: Welcome to LonePack Conversations! I’m Aishwarya, hosting this session today, along with Ms. Ruchita Chandrashekar, a licensed clinician, presently working for a federally funded program in the United States. She’s also a trauma therapist and a seasoned writer at some platforms like The Wire, HuffPost, and The Print.
Ruchita: Hi, Aishwarya. I’m happy to be here.
Aishwarya: So, let’s get started with the interview. To start with, let us talk a little bit about your background. Can you tell us what motivated you to pursue a full-time career in a field related to mental health?
Ruchita: Sure. So, I worked in advertising before this; I was a copywriter with an agency. And, I think as I saw people my age go through a lot of stressors, and saw my friends have mental health concerns, saw myself have mental health concerns, I realized, or at least noticed, that we didn’t have as many resources or even as much knowledge or any kind of understanding. There was a lot of stigma in households to be able to talk about it. But then, my experience was just that, “Oh my god, there is no place to just go to, to understand, to know what is happening,” because physical health is always treated so separately from mental health.
Aishwarya: So true.
Ruchita: So, this was in 2015, and at 23 I realized that’s not something I wanted to do. That’s when I shifted to social work, where I worked with this organization called Prerana that strives to end inter-generational prostitution in the red-light areas of Bombay. So, I used to work there as a social worker and a research assistant for about six months just to understand if trauma work was something I was, 1) built for, 2) I enjoyed doing, and what really was my role in working with these populations, these severely traumatized populations. I enjoyed it thoroughly. I think I learnt a lot about systems, I learnt a lot about building communities, with healthcare and things like that. It was a very intersectional experience for me. And, by then was when I applied for my Master’s for my graduate school. So that was when I transitioned to the US once I got my admission, and then got trained, licensed, and have been practicing since.
Aishwarya: That’s great to know. I think what I really like about your journey is how you were able to map each step, because it’s more like this connecting-the-dots style where you were able to reason out why you wanted to get into doing it all through your personal experiences as well the experiences that shaped you around. So, that’s really interesting to know the thought.
Ruchita: One thing to also highlight is, because I was switching careers and how that is not necessarily normal in a lot of Indian households to be allowed to do, it was almost like I had to prove something to my parents, that this was something that would make sense, which is unfortunately also a kind of stress that a lot of young Indian folks go through – like they have to be stuck to one thing that they have to do and cannot transition to something else. So, a lot of that possibly just came from that. Thank you.
Aishwarya: I think you set an example this way. I mean, not only being a clinician. I think you set an example from the career path you’ve taken, and the story behind the whole career path. So that’s something that motivates others around to probably look up to you as an example.
So, a counseling psychologist – that’s very interesting. What does a day in the life of a clinician look like?
Ruchita: So, I’ve had multiple ways in which this has functioned. I work at a residential facility now, so I’m seeing folks all day. But I’ve also had places where I have worked at where people have set appointments and they come in. So, depending on the setting that you work in, you possibly have a case load that you set for the week, you see a number of folks in a day, you have your case notes to finish, you have your consultation meetings to do, so it’s usually pretty packed. A lot of times, because of how underfunded mental health can be, even in parts of the US, you’re just doing back-to-back sessions, often which tend to take a toll on you. But, yeah, that’s what it is – it’s just packed. And, I think what is important to highlight is that the role is so different from anything else that you do in the corporate world, because you are having interpersonal interactions about people’s pain, about people’s trauma, about people’s symptoms, as you are assessing and as you are being a source of support and treating them. So, it’s a lot of emotional labour that goes into each hour. So, that is what a usual day looks like.
Aishwarya: That’s nice. So, I think a majority of your work involves, or rather, revolves around meeting people and getting to know them and making an impact in their lives in a subtle way. That’s nice to know. There are many stereotypes about what therapy looks like. How accurate is it, and what’s really involved in a therapy session?
Ruchita: So, the one thing that it isn’t is that it’s not like talking to a friend. Often, it gets misconstrued for, “If you have a friend, why do you need a therapist?” Talking is a modality that is used, but that is not the only modality in the pathway to therapy. You have stuff like EMDR, you have other features to talk therapy, and you have other things that also get added to it to make it a treatment process, firstly. I think it is important to acknowledge that therapy is a treatment science and it is not like talking to your friend, it’s not like talking to your mom, it’s not similar to those aspects. The similar features of you talking to people in your life and you talking to a therapist is that you should feel supported, which should be features of most interpersonal relationships in your life, that you feel supported, you feel cared for, you feel important, you feel validated. What you feel from both of those relationships can be similar, but the methods and means with which they’re conducted is very different. Therapists are not giving you advice; they’re literally trained with how questions have to be asked to you, with open-ended and close-ended questions, with how we rephrase. Therapists are trained to, you know, not go into all of it—be able to strategically decide where someone might be at, and that’s something, and to pack it up again before the session is done. It is a very meticulous form of treatment that is done. Talking is a modality that is used, because it’s not like when you go to see your general physician and they just have a stethoscope to you and are able to check your eyes – that is their modality. Modality for therapy is you talk; you’re able to communicate. It is more reliant on you as a human being, as a patient to be able to deliver what is bothering you, and then to be able to receive, assess, and strategize what might be helpful to you. It is extremely intimate, because there are things you may sometimes share with your therapist that you might not share with anybody at all. Confidentiality is essential, which is not something interpersonal relationships in your life might guarantee, but a therapist-patient relationship should guarantee that. I know that doesn’t happen sometimes, but that doesn’t make it okay.
So, there are a lot of interpersonal relationships outside of therapy are, which I think are stereotypes which I just wanted to address. Secondly, it is something that will take time, because you’re literally working through parts of your life, you’re understanding the ways in which you’ve been conditioned. So, it is an intimate process that takes time for you to get by.
Aishwarya: Totally. I think those are two valid points that you’ve stated. I think everybody needs to understand that therapy is no longer a taboo, or it’s no longer a simple thing that you can do with any person you meet, or rather any friend or a family member. And, that point about getting to know what really goes through each other’s minds, and a therapist has all the tools and all the abilities to bring that out of people’s thoughts; that point is really valid and I feel people would now understand more because it’s coming right from a mental health clinician who’s actually practicing it. So, I think now people will really get to understand why it is important to actually consider therapy as an everyday activity. Thanks so much for shedding light on that.
So, moving on, not just a clinician, but you’re also a published writer and a columnist. How effective a tool is the pen in mental health and what inspired you to take it up?
Ruchita: I think it’s effective in creating conversations. I specifically write for India and I write with Indian publications. I also try to push it more in India, because my hope is to destigmatize mental health in South Asian communities, which is why I treat that as my audience whenever I put anything out. The way I started doing this is through Twitter threads that I would do, and the one thing that I noticed was people started talking to each other more than what they were asking me. So, it became like this community that they were building where they were like, “Oh, I’ve been through this,” or, “Oh, this has helped me.” Now, you also have to recognize that, systemically, India doesn’t have many resources right now – when it comes to mental health – that are accessible. It is extremely expensive and not something you get in all the cities, all the villages, and all the communities. And, we have an extremely high suicide rate, we have a lot of mental health concerns that you see across the age groups, and it’s an untreated population. So, a lot of times, people tend to turn to their friends and family for some kind of support. What I noticed under these threads that I used to do was strangers started turning to each other, like, “My family doesn’t understand, but, okay, you saying this doesn’t make me feel alone.” So, it started developing more conversation, and I went beyond, writing symptoms of panic attacks and everything also with the environments that will trigger you, like emotional abuse in South Asian households – things like that that I think are very normalized because of culture and can trigger a lot of symptoms. And, no one talks about it because it’s a shame for you to talk about anything in South Asian cultures.
Aishwarya: Totally.
Ruchita: So, I noticed that that was something that was picking up more. Then, I started doing long-form pieces on that front, also because I think there is value in someone writing from a field about the field. Like, you would rely more on a doctor telling you about symptoms for migraines, and telling you what to do for a migraine, or providing more education on migraines. So, as a mental health clinician, it started feeling like my responsibility to provide what we call psycho-education. So, if you turn to WebMD and you Google something, maybe there’s a part that brings up something I’m saying, that might provide some kind of insight, that might just be worthy in you showing it to someone, saying, “Hey, this is someone who treats people, and they’re saying this is happening, so maybe it is valid.”
Aishwarya: There is more credibility around it.
Ruchita: Exactly, which I, unfortunately, didn’t see a lot. A lot of times, I would see these panels and news channels on Mental Health Day, or this and that, and people were literally capitalizing on causes at this point. And, there are comedians on these panels, but you don’t see one psychologist, you don’t see one psychiatrist, you don’t see one person who is actually working with communities and actually working with folks and is able to be a credible resource. Why are comedians on this panel? Why are social media influencers here? Because then, what happens is, your sources of information become people who are literally capitalizing on these causes, and they’re not the most credible sources of information. Yes, there is validity in knowing that all these actors and actresses have anxiety, but what beyond that? How do you understand your anxiety now? How do you recognize that this is something that is happening to you and you need to do something about it? None of these panels and none of these mainstream areas are telling you that necessarily.
So, I think that is why I noticed that the stigmatization, yes there was benefit in exposure like that and it was breaking down a little, but there has to be actionable change. People have to know that they have strengths, that they have things that they can do, that they can try, that they can talk about to be able to help themselves. So, I think that is what became my driving force, which is what I still like to treat it as, so whether nor not I publish more with these areas, I still try to do more of those Twitter threads, I still like to do a poll every now and then asking people what they want to learn about so it’s not just me throwing jargon at them. Like, someone once told me, “I want to know how to help a friend going through things like that,” so I was like, “Okay, that makes sense, let’s do that.” So, I also often just use Twitter as a research tool to understand what people are looking for, what do they want to learn about, what are they trying to understand, and then just build it accordingly. It’s important that it helps them. It doesn’t necessarily help me.
Aishwarya: I absolutely love the motive behind the entire work that you’re doing, because this particular point about building a community; I think that is where the whole strength of social media, or be it any writing platform, is people themselves come in and then they use it as a tool to express their ideas and thoughts. And, the reason that you said, sometimes people are not supportive, sometimes family and friends are not supportive, but people are quite vulnerable, and that’s totally okay, they use these mediums as tools or as platforms to express their thoughts, and I think that’s a very, very valid point that you’ve mentioned.
So, according to you, how much of a connect do mental, sexual, and physical health have? When trauma affects one, do you think all the others get impacted as well?
Ruchita: Oh, definitely. Absolutely. They’re all interconnected. Health is very intersectional and, unfortunately, we need more conversation around that. Like, if you have persistent anxiety, and your Cortisol levels keep fluctuating that much with your brain getting overactive that many times, it can affect your immunity, which can then start affecting your physical health, which can then start making you weak. It’s in the smallest of ways. Like, why is it that when you look at middle-aged fathers, everyone has blood pressure and everyone is told that stress is the cause for this? Where does stress come from? That is your mental health. Stress is a natural bodily response that, unfortunately, when people are not trained to manage, it results in blood pressure, it results in diabetes. Like, look at so many of these physical health diagnoses and how many of them have stress as a major cause. It is extremely stupid to tell people, “Don’t get stressed,” because when has that worked? Now, you tell me—when someone comes and tells you, “Aishwarya, don’t get stressed,” has your stress just magically vanished? No, because stress is a natural bodily response to something. We have to be able to have tools that help us manage our stress, because it’s a response.
Like, you can’t control a sneeze; you will sneeze when you have to sneeze, but you will learn to manage a cold. So, it’s in things like that. And, I’m glad you brought up trauma, because trauma has a tendency to have debilitating effects on not only your mental health, your physical health, and your sexual health. Like, they all go together, depending on the type of trauma you’ve had, the age at which you’ve experienced it, the time in your lifespan that it has not gotten attention and not gotten treated, how much of that have you internalized, and how much of that has influenced the way you live your life which then gets attached to your lifestyle. A lot of times, say for example – it’s a very oversimplified example – sexual trauma, say childhood sexual trauma that a child has no awareness of, firstly, what is good touch and bad touch, to understand they’re getting traumatized and the powerlessness attached to that. Now, you have not said anything to anybody for years, so this is just an open wound that has influenced the way you grew up and started living your life.
And then, as you grow up, you start having more interpersonal relationships, which is when you start having sexual relations, as well, possibly. And, the nature of how you conduct yourself in those can get influenced, the way you conduct yourself in relationships, the way you treat yourself as a human being in relationships. It gets very relational after a point, because human beings are social beings. And then it also, because it has been an open untreated wound for so long, can start affecting your physical well-being, as well, with how you treat your body, how you have understood messages about that. You can lose sensation in parts of your body because of sexual trauma.
Aishwarya: Totally. Now I see a complete picture of how each of these realms are influencing each other. You don’t have to have a checklist and say, “Hey, I’ve done these five things, and still I don’t find my mental health to improve.” It’s not a factor of ticking the points and seeing where you are, but it’s acknowledgment, it’s about acceptance, and it is to ensure that you are okay with the things that you’re currently going through. So, thanks for that point, Ruchita.
Ruchita: Yeah, absolutely.
Aishwarya: Can you tell me, so far what has been the most common type of mental health issue occurring in your patients? Do you see any common pattern in any specific age group?
Ruchita: So, a lot of times, anxiety and depression can be diagnoses, but a lot of times they’re symptoms as well. I think, specifically, anxiety is a very common bodily response that happens because the human brain is designed to protect you. So, the minute it realizes that something’s going to hit the fan, even if it assumed and there’s no danger anyway, it becomes what we call an irrational thought that come in, like, “No, I have to be afraid of this!” and you’ll have anxiety. So, a lot of times anxiety in those aspects can be its own diagnosis, but often it’ll also be like a symptom to something else. So, I will often see features of anxiety, or mood symptoms – that’s how I would put it, instead of just putting it as “anxiety and depression.”
Every time I assess folks, I always ask them, “How has your sleep been? How has your appetite been? How has your mood been? Do you feel tired?” And, often, that’ll paint a picture. So, the presentation of things. The features of every diagnosis are going to be different, like I always tell you. But mood symptoms is something that you might be able to catch. And, even those mood symptoms might look very different, because sometimes people’s brains are so… oh, the human brain is so fascinating! Like, the people may be so high that the mood will also not be able to tell you anything? But their sleep patterns might, their appetite might tell you something, things like, “Am I able to concentrate on things or not, can I focus on things or not, have I lost interest in things?” So, you look for very specific features on that front, and you also look for functioning. So, that’s the way I am able to assess.
With younger folks, you’ll see more features of anxiety that come up, but a lot of that can also be just appropriate anxiety, because you’re afraid of what you’re going to do with your life in this world and everyone in your life is telling you that you have to excel tomorrow, and that’s going to give you anxiety. So, there’s also forms of appropriate presentations according to your developmental stage and age, and then other forms like, “You seem too calm, or too regulated,” and, “Is there something to catch here? Because you’re possible too tired to care.” So, it’s always individualized, but culture plays a huge role, as well, in people’s presentations. But what I’ve noticed across the board is that people’s environments tend to influence their symptoms highly, which then goes to inform their diagnosis. And that’ll also be because I’ve worked with very diverse communities; I’ve worked with undocumented immigrant minors who’re seeking refugee status now, which is very different from an urban population or something like that, right?
Aishwarya: Yeah.
Ruchita: But those features, people’s environments affecting their daily functioning, is big that I see.
Aishwarya: So, the way I see it is you look for a few common indicators and try to map a whole journey and, as you said, experiences, culture, and environment. All of these are contributing factors that play a role.
Ruchita: Yes.
Aishwarya: So, a larger goal of LonePack is also to work towards helping suicidal individuals. Have you dealt with such individuals with suicidal tendencies earlier? What would be the right kind of approach to help them?
Ruchita: Oh yes, I’ve dealt with a lot of suicidal folks – some with active suicidal ideation, some with passive suicidal ideation, active self-harm tendencies, and everything. Oh, how do I put this? What I’ve noticed, and I think this is something I will first address to the larger community, because at some point in time it’s possible people are going to come across someone who has suicidal tendencies.
Aishwarya: Yes.
Ruchita: The fact that they’re informing you of their suicidal tendencies itself is a big sign that they possibly want help, and they may or may not do something in the next moment, but it is a good sign. If someone is talking to you about, “I have thoughts of ending my life,” or, “I have tried this,” or something like that, you treat is as something they’re going through and allowing them that space to express themselves. “Why are you feeling that way? How can I help you?” I think often people jump to advice, which is dangerous because if you’re going to start telling them how to live their life, then you’re also questioning how they’ve already lived their life, thereby reinforcing this, “Oh, I don’t know how to live my life anyway, so I should die.”
So, it’s very important to come from a strength-space perspective, just allowing that space of, “Okay, everyone is going to die anyway, what makes you want to die right now? How can I help you? What is it that you need? I’m sorry you feel this way. Do you trust yourself to be around yourself for a while? I care about you. I love you.” Come from a strength space perspective like that, because I think one of the stupidest things people assume about suicide is that it’s an act of cowardice. No! It’s an act of exhaustion. There is nothing cowardly about attempting suicide or doing anything like that. It is a terrifying thing to go through, and they go through it.
So, to know that it comes from a place of exhaustion; if that has become your last resort, like, “Nothing is helping me anymore, nothing is working anymore,” you have reached your peak of exhaustion, you’re done. So, I think just acknowledging it like that, like that is their crisis and allowing them to just tell you what is happening, instead of you acting like this expert on suicide and things like that is important.
Aishwarya: Yes. So, in a way, it is approaching it in a more practical manner, and trying to be non-judgemental, and trying to say that you’re there for the person to listen to the person. And, it’s a good thing that the person chose the one they want to actually speak to and be open about their thoughts. So, that was a very good statement that you had told, and I’m sure that for the people who listen, I think now they understand how to deal with somebody who tries to come to them and speak about insecurities or suicidal thoughts or any mental health issues from now on.
Ruchita: Yeah, and I think, more importantly, it is empathy.
Aishwarya: Totally.
Ruchita: I think it’s horrifying that people stigmatize suicide only with attention. Yes, there are some people who do it, but that comes from deeper mental health concerns, firstly. But to assume that everyone is just doing this for attention? There are other ways to get attention, people don’t want to be shamed to get attention, everyone’s not into that kind of masochism, which is stupid. To just come from a place of empathy, that, “Oh my God, my loved one, this person is talking to me and is so exhausted. And, more importantly, to acknowledge your boundaries, but to put them forth in a healthy, kind manner.
To be like, “Hey, it looks like you are going through a lot right now, and I am sorry, this is really bad. But I don’t think I am equipped to help you. You are worthy of help. You are worthy of support in a way that I’m not qualified in this moment to help you with.” But if you’re going to assert those boundaries to communicate that, don’t abandon them. Just let them know that, “I think I cannot provide this for you, and let’s work together on another channel for you to get it from.”
Aishwarya: Yes. Thanks for putting it that way, Ruchita. I think empathy is a powerful tool that all of us need to develop.
Ruchita: You cannot have, like, five textbook techniques to avoid anxiety or anything, because everyone’s anxiety looks different, everyone’s depression looks different, everyone’s bipolar disorder tendencies looks different, everyone’s schizophrenia looks different, everyone’s grief looks different. Everything. No two brains are the same, which is why I think it is important to maybe spend time, like ten minutes in a day.
Aishwarya: I mean those are really golden words. I see self-aware is over self-care, because you need to understand yourself better first to see what really is more caring and nurturing for you. And, as you said no two persons are the same. So, understanding each of us have on our own cycles, our own ways to indulge in, our own ways to develop is the first and the foremost thing we need to do.
Ruchita: Yeah, and you’re an expert on yourself. Nobody is an expert on you. You are the only expert on yourself, so you know, that’s it.
Aishwarya: People can be there to support you, can be there to help you find and discover your interests, your passion. But again, in the end, I think you should be there for yourself. You are your own master, so yeah.
Ruchita: Yeah, mmhm.
Aishwarya: Thank you very much, Ruchita. It was wonderful to hear your experiences in being with mental health victims, a couple of anecdotes that you shared, and I’m sure listeners might pick up some ways to both practice and promote mental well-being.
Ruchita: I hope so.
Aishwarya: Today’s episode was an example of how clinicians like Ruchita together with mental health organizations like LonePack can work together towards shattering the stigma on mental health issues. Thanks for listening to our session. To hear more such sorts of discussions, keep tabs on the next episode of LonePack Conversations. Until then, see you all.
