Pawan Hamal remembers that his mental health issues started five years ago when he was preparing for his grade 11 exams. Going from one day to the next had started becoming a challenge. He felt emotionally and mentally strained. Making things worse was that he couldn’t bring himself to share what he was feeling with his family and friends as he was worried that they wouldn’t understand him.

Originally from Kalikot, Karnali, Hamal had come to Kathmandu to pursue his higher studies, an opportunity not everyone back home enjoyed. He was deeply grateful for the opportunity and he was well aware that as the eldest child in the family, he had to set examples for his siblings and make his parents proud.

“I also didn’t want to worry my family by sharing my problems. I kept trying to go on with life hoping that I would feel better,” says 21-year-old Hamal. “But no matter how hard I tried to pretend I was okay and hoped for things to get better, I didn’t feel any better. I woke up each morning stressed and feeling heavy. I was always tired.”

When Hamal started having trouble sleeping, it was the last straw and he knew coping was no longer working.

“Every night I would stare at the ceiling and dread getting out of my bed in the morning,” he says.

That feeling was what finally led Hamal to seek help from a psychiatrist. “One day I was listening to a radio programme where they were discussing mental health and were talking about some of the issues I was dealing with. At that point in time, I just wanted to fix myself and get on with life. And so, I immediately booked an appointment with a psychiatrist,” says Hamal.

For many dealing with mental health issues, seeking medical help is the last thing on their minds, and the majority who do seek help, do so only when the mental discomfort begins to translate into physical discomfort and starts impacting their daily lives.

According to Jug Maya Chaudhary, Clinical Psychologist at Rhythm Neuropsychiatry Hospital, mental health problems often aggravate because people overlook their mental well-being. In our country, mental health has always come second to physical health, she says.

“There is this misunderstanding among people that it is wrong to feel a certain way in life. More than that, if you approach help for your condition, people assume that it is something you do when you are not sane. The derogatory lens of ‘this person is mental’ follows right away when we talk about mental health. This tagging is also what people are afraid of, and it is too deeply entrenched. So in most cases, when people do come for counselling, it is only when they are really battered by their problems,” she says.

Fifty-year-old Madan (name changed) knows it all too well what it is like to delay seeking a professional’s help. Madan first sought a psychiatrist’s help 15 years ago. After battling anxiety and stress for over a year, Madan finally gave up coping on his own and decided to seek help.

At that point in his life, Madan was juggling his time between his studies and job. The hectic lifestyle had made Madan stressed and anxious.

“I had this constant fear that I would fail in life, and sometimes that fear would get so overwhelming that I would experience breathing difficulty. I wanted to talk to my family about my problems but I held back as I felt like I could be judged and misunderstood,” he says.

But the first time he visited a psychiatrist, he felt validated, he says.

“When I told my psychiatrist my problems and how challenging things were for me, he didn’t judge me and told me that there are many facing the same problems. I felt a sigh of relief. I felt like I had found a safe place to talk to someone without the fear of being judged,” says Madan.

“And I think that is also why therapy works. When people find a place to talk about their problems in an environment free of judgement, where their emotional experiences are validated and their pain established, it empowers them to solve their problems and take steps towards healing themselves. That acceptance will mean everything to them,” he adds.

Although the pandemic has helped raise awareness on mental health and well-being, when it comes to seeking help, many still hesitate to do so.

Along with the anxiety of what people might think when one starts visiting a psychologist or a psychiatrist, most people undermine their problems and try to deal with it on their own without being aware of the tools, techniques and knowledge required to do so, says the psychologists the Post spoke to.

“When we do psychological counselling, we follow different techniques of understanding the person who has come for counselling. One of the main tools is communication by which we try to track down their problems thereby helping them solve their difficulties. And it is very much a collaborative effort,” says Bharat Gautam, a clinical psychologist with Transcultural Psychosocial Organization Nepal. Gautam has also been providing online psycho-social counselling during the pandemic.

“When people think of therapy as just communication, they misunderstand the processes involved in helping people do better. Yes, we do communicate with the people who come to visit us but that’s not the only thing we do. We follow structured scientific techniques to address the underlying issues,” he says.

Another misconception people have, explains Gautam, is that many people who come for therapy also assume that the results will be immediate.

“Going to therapy is not like taking a painkiller and you start seeing results immediately. But unfortunately, that’s what most people who come for therapy expect. When they realise that it’s not the case, many decide to discontinue their therapy sessions,” says Gautam.

In recent times, despite the focus media has given to mental health and well-being, both Chaudhary and Gautam believe that seeking help for mental health continues to be a subject of taboo.

Moreover, the misconception that therapy is only for people with mental health problems continues to discourage many from seeking help.

“But you don’t have to be identified with a mental health problem to seek therapy. Therapy can be useful to anyone. Doing therapy is like learning a life skill,” says Chaudhary. “And therapy becomes especially significant because in our daily conversations we don’t talk enough about how to deal with life. Many people who have taken therapy believe doing so has given them a sense of clarity about their problems and how they can go about solving them and that therapy has allowed them to better handle their emotions.”

So, when should one consider therapy?

According to Chaudhary and Gautam, the warning signs are when you are experiencing an uneasiness that doesn’t easily wear off and you are persistently feeling vulnerable and alienated from people. For some, it could be when their emotions are negatively affecting both their personal and professional lives. In some cases, the signs could be as severe as wanting to hurt yourself.

“It can be difficult to trace your signs because as humans we often portray different roles and give into situations. But if you find yourself often feeling overwhelmed and you are having difficulty doing things, you should think of therapy,” says Gautam.

In many cases, these signs can also be traced to people’s behaviour and their use of substances or an obsession over things.

“Therapy is the first step one can take to improve their mental well-being. It’s a step that is already indicative of their honest effort to heal,” says Chaudhary.

Hamal also believes that his honesty during his therapy sessions has helped him to come this far and build his capacity to tackle his problems.

“I knew from the get-go that if I wanted to help myself, I should be honest with my therapist. At first, I didn’t really feel like therapy was working for me, but as I continued, I started seeing changes in myself,” he says. “The treatment has felt expensive at times but I always knew that if I am to get better, therapy is one of the things I should go for.”

But one thing to always look out for when you are doing therapy is how comfortable your therapist makes you feel, says Chaudhary.

“If you are not feeling comfortable sharing your thoughts, and if you feel like you are being judged, then that therapist probably is not right for you. A good therapist will be able to gain your trust and make you feel secure,” she says.

In the initial days of seeking medical help, Hamal says he was not comfortable with the professionals he was seeking help from. “Some consultations lasted less than 10 minutes and I felt that many were more eager to prescribe medicines than to understand my problems,” he says.

During one period, Hamal found himself destructively dependent on the medications he was taking. There were days when he would not be able to get out of his bed and the severe headaches he experienced whenever he missed his medication made him realise that he was getting too reliant on his pills.

“I consider myself lucky that I have always been aware of my situation. I also think I have always made an effort to learn more about mental health problems. From my own experience, I have understood how good counselling can help. That is also why I am now studying psychology to help people like me. I think we still haven’t been able to understand the importance of our mental well-being,” says Hamal, who is now a first-year student of psychology.

Today, the pain Hamal feels isn’t as bad as when he was in his adolescent years, he says.

“I wouldn’t say I am completely recovered today. But I feel better than I was and the effort I have taken with my therapy has helped me do better in life. It has instilled in me some skills to cope with life,” says Hamal. “And that is one thing you need to do to prepare for therapy—you need to commit to it.”