08, Mar 2018 | Smita Sahay

Do you experience inexplicable sadness for long periods of time? Do you find it hard to sleep or hard to get out of bed? Have you gained or lost weight suddenly? Have you lost interest in sex? Have you developed irrational but paralyzing fears? If you are an urban woman, there is a good chance that your answer to most of these questions is yes.

In metropolitan cities such as Mumbai, anxiety, stress, aggression, helplessness and hyper competitiveness make up a large part of our collective emotional palettes. Remember the expressionist Edvard Munch’s painting, the Scream? Quite possibly the soundless, chilling scream emanating from the distorted mouth is an emotion we all know, quite possibly, it is one of the earliest depictions of urban neurosis.

The neatly separate chapters on ‘depressive disorders’ and ‘anxiety disorders’ in the DSM V might mislead you into believing that they are two unconnected sets of conditions. But in reality, anxiety and depression co-occur, and are, in fact, to use the cliché, two sides of the same coin – neurosis. In neurosis the primary emotions are fear and anxiety, marked by stretches of time when you experience an unidentifiable emptiness, combined as a loss of interest in previously enjoyable activities, insomnia or hypersomnia and fatigue and/or loss of energy.

Who does it affect and how

A 31-year-old housewife would experience severe anxiety every time her husband travelled for work. A 27 year old woman would get anxiety attacks every time her boss, later accused of sexual harassment in work place, would come into a meeting. A 32 year old woman in the first trimester of a planned pregnancy found herself plunged into clinical depression.

A large number of people seeking support with us, nearly 80%, were women between the ages of 25 and 40 years. And all of these smart, educated, independent women had experienced diagnosable neurosis, specifically, depressive disorder with anxious distress at one time of their life or another. Not only were they caged within their own fears, anxieties and feelings of emptiness, but they were also highly susceptible to co-morbid debilitating and life threatening physical conditions, such as elevated blood pressure, obesity, dysmenorrhea like pain, migraines, allergies, irritable bowel syndrome and PCOS.

Understanding Fear

Fear is not a negative emotion, it is our safety valve, our mind’s way of saving us in potentially dangerous scenarios. But anxiety is exaggerated fear, of an imaginary scenario expected to happen in future, typically out of proportion to the actual risk. Panic attacks are sudden periods of such intense fear that cause sweating, inability to breathe, numbness, palpitations and chest pain. These are unprovoked and unpredictable. Anxiety attacks on the other hand have similar symptoms but usually in response to a stressor. In neurosis, fear manifests in these exaggerated forms. And beyond fear lies the numbness of depression. Accompanying problems such as phobias, substance abuse, and a significantly higher suicide risk come in the way of day to day living and are some of the leading causes of broken relationships, lost jobs and disability.

Some causes of neurosis are developmental and other kinds of trauma and societal and familial pressures. Urban neurosis is a response to the loss of community – such as a shift from a smaller town to a new, big city or from joint families to nuclear families, being surrounded by high-rises – the effect of such corrugated space on psychology, reduced time spent with nature and finally being in a state of extremely high stress. Urban women typically manage jobs as well as households, often without the support of community. An already hostile workplace appears more so with wage gap and discrimination. Exacting standards of beauty, an ageist gaze and a culture of labeling women in binaries are also causes of stress and trauma.

Dealing with Neurosis

As a survivor of anxiety and as a mental health professional, I have found that a combination of medication, guided behavioral therapy and copious amounts of self-care including physical exercise, mindfulness, breath work, journaling, healthy eating and being close to nature can help one lead a full life – healthy and wholesome.

1. Behavioral therapy: Seek help from an experienced psychologist. You will learn tools and exercises to manage stress and improve thought patterns. Therapy will empower you by teaching you the language of your mind and body – emotions and micro-emotions and how to process them in a healthy way. Also you will have a safe space to converse for catharsis.

2. Medication: If your general physician feels that your symptoms need drug intervention, see a reputed psychiatrist. You must communicate the severity and frequency of your anxiety or depressive episodes and related symptoms. Once on drugs, be mindful of the effects on your appetite, urination, sleep pattern etc., share these with your doctor and request for titration of dosage or combination if needed. Educate yourself on contraindications and side effects of your drugs and follow your doctor’s advice.

3. Self-care: The celebrated feminist poet, Audre Lorde said, “Caring for myself is not self-indulgence, it is self-preservation and that is an act of political warfare”. In a culture where selfishness is considered a vice and sacrifice a virtue, women often take themselves for granted. It is important to differentiate between self-care and negative ideas of selfishness. This is easier said than done – you can only care for self when you have compassion for yourself.

• Compassion for self: Instead of berating yourself and feeling guilty for all the things you might have done wrong, think of yourself as a human being deserving love and compassion. Observe negative words in your self-talk and treat yourself with the love and respect you show to your friend.
• Healthy diet: Changes in weight and appetite or stress related unhealthy cravings will make it difficult, yet critical for you to eat healthy. Talk to your doctor or nutritionist and figure out a healthy meal and water plan for yourself. Avoid stimulants such as coffee, alcohol and tobacco.
• Adequate sleep: Ensure a good sleep. Avoid negative stimulation of television or newspaper few hours before your bed time. Use essential oils and soft calming music if need be. Weighted blanket could help you if you too.
• Cardio exercise: Walks, runs and swimming are some of the most effective exercises to combat anxiety and depression, and at the same time they help with a good night’s sleep.
• Time with nature: One of the most therapeutic experiences for me is walking barefoot on a beach. The grittiness of the sand, the crashing sound of waves and the expanse never fail to energize me. Treks, walks in forest trails, gardening, bird watching and picnics prove enjoyable and helpful too.
• Journaling: For months I handwrote a few pages in my journal – my first activity upon waking up. Most of the catharsis happened in those pages. Like brushing and showering for the body, this practice helped me cleanse and declutter my mind.

I hope that sometime in the near future city planning and psychology of space come together to build healthier cities, that community development is seen as an important public health activity, and that parks, sports clubs etc. become affordable and accessible. Until that time, read up, empower yourself and look after your mental and emotional health. They are as important as your physical health.

Wish you a very happy International Women’s Day!

((Smita Sahay is a poet and writer. She is the founder of Calm Space support group program and the Calm Space Master Class program.))

*** Feature Image by Amir Rizvi