For many patients at the Sanjali rehabilitation center in New Delhi, why they are there or how they lived before chronic mental illness took over their lives cannot be understood.
They are among the lucky few in India to receive regular treatment in a country where mental illness carries a huge stigma and psychiatric hospitals can be severe and frightening institutions.
AdvertisementExperts estimate around 20 million Indians suffer serious mental disorders, with most hidden from public view by their families.
For many Indians, their first instinct when symptoms of mental illness begin to manifest themselves in their relatives is to seek a spiritual explanation for the sudden change in behavior.
Families in denial will often take their loved ones to temples or faith healers, both of which abound across the country.
India does have some half-way houses that serve as temporary shelters for destitute and homeless mentally ill people, but there are few long-term options for families who are unable to look after their kin.
Nimesh Desai, head of psychiatry at the New Delhi-based Institute of Human Behavior and Allied Sciences, estimates India has fewer than 4,000 psychiatrists, and even fewer general mental health professionals.
"The lack of psychiatrists is bad and the shortage of psychologists, social workers and counselors is even more alarming," said Desai. "It meets about five to seven percent of the projected need."
One reason is a reluctance among young medical students to pursue a career in mental health. While India prides itself on churning out thousands of world-class doctors and surgeons, there is no prestige in psychiatry.
"The shame and stigma that is attached to mental illness is also attached to a mental health doctor," said Naveen Kumar from the Manas Foundation, a mental health charity.
"Though we have one of the largest pools of medical professionals, they are not geared toward dealing with mental health problems.
"It leaves mental patients at the mercy of the faith healers who exist on every street corner and in every village of India (who) are supposed to have magic healing powers."
Common treatments include inducing the patient into a trance or even physical abuse, said Kumar.
While many mental health problems can be easily treated at the primary care level, general practitioners are not adequately trained to tackle them and are unable to refer patients to specialists.
Kumar said only five to 10 percent of Indians are "psychologically aware" enough to seek help in the first place, and many families believe going to a doctor for mental illnesses is a sign of weakness.
Instead, age-old religious rituals and superstitions that have passed through generations are often relied on, and religious shrines are regularly packed with devotees looking to rid a family member of a "curse".
"Only when you find that the person is not improving or there are other complications will you even consider going to a general practitioner," said Kumar.
Here at the Sanjali center patients suffering from schizophrenia, bipolar disorder and psychosis are unfortunate in their illness but lucky to have families who have recognized their problems and sought professional help.
Sanjali offers a varied day therapy program aimed at helping patients live as normally as possible outside the clinic, said co-ordinator Simrita Chaudhry.
While patients take medication to curb symptoms, the center's goal is to rehabilitate people so they can re-enter society and the workforce, she said, adding however that by the time many are brought here it is often too late.
"Only a small number are discharged every year," said Chaudhry.
In an airy, clean environment, the day patients join in musical activities, games, drawing classes and light exercise such as bowling in a makeshift alley.
Among the center's regulars is 64-year-old Pallavi, not her real name, who had a bright future as a junior doctor until she suffered a nervous breakdown and was eventually diagnosed with schizophrenia.
Now receiving a combination of medication and therapy, she remembers nothing about her life as a young wife and mother, but is quick to express the paranoia symptomatic of her illness.
"People don't respect me," she whispered, her eyes darting around the room.
The secrecy surrounding mental illness in India, plus the serious shortage of mental health professionals, means many people must suffer in silence.
Most patients at Sanjali come from wealthy families in south Delhi who can afford the daily fee of 100 rupees and have some understanding of the problem.
Denial cuts across classes, but Desai said attitudes are slowly changing, partly thanks to government and private education campaigns, as well as the impact of globalization.
"Even so-called middle-class, educated people will first go to a shrine such as Ajmer in Rajasthan if there's a mental health problem," said Desai.
"But Indian society and government is becoming more and more internationalized in its outlook (and) one of the positive fall-outs of it is the acceptance of issues of mental health."
At Sanjali, the huge burden of mental illness on families is clear.
Jagdish, also not his real name, is a 48-year-old schizophrenic who has been coming to the center every day for 11 years.
He trembles as he slumps forward in his chair, but cheerfully says: "I like coming here."
Yet as secure and tranquil as it seems, Sanjali's safety net cannot be taken for granted.
"We don't have any facilities to offer life-long, full-time rehab," said Chaudhry.
"Tomorrow when the families are no longer there to look after them at home, what happens to these people?"
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