Thursday, January 28, 2016

Say no to the idea of Rohith's depression -- until further evidence

A prominent columnist claimed that Rohith Vemula's suicide was not caused by oppression but by depression. After circuitous arguments, he arrived at the confident conclusion that Rohith was clinically depressed. Furthermore, if Rohith had been depressed, then how could the cultural cartel have oppressed him? Impossible!, he declared. According to him, the two conditions are mutually exclusive.

But it makes no sense, you say? Gentle reader, it didn't make much sense to me or a number of other friends, acquaintances, and well-wishers, either.

So to counter his 'either/or' verdict that came down heavily on the side of "clinical depression" driving Rohith to suicide, I wrote the following:

[Rohith's death] is a multi-factorial story with several predisposing factors (examples: his neuropsychology; class; caste; awareness of self; personal perception of limited possibilities for his dreams and abilities; social connectedness or lack thereof; perception of limits to his upward mobility or at least social mobility) and one or two precipitating factors (examples: the latest events such as his expulsion from university; his likely sleep deprivation given he was out on the streets; his perception that he may never recover from this setback; his debts). I am not claiming that I know his personal, unique story precisely, but I am aware, from population studies in different countries/professional groups/subcultures, that just a single variable change could have potentially given him an opportunity to rewrite his life-story (example: if he hadn't been alone that night or, in the Indian context, if he felt like he had something yet to live for, or if he knew he could fly to another country and start a new PhD program, or get a science writing job without a degree but just with 'English with a capital E' and connections, or an uncle in business who will have given him a managerial job). In other words, inequities in life follows you into your preparation for death.
I know no clinician who will isolate one factor from the other in an individual case, but you've managed to declare precisely that from just sitting at your desk and typing a few words. You didn't even consult with somebody who studies depression or suicides in mainstream populations and in socioeconomic subgroups.

But this was three days ago. I've had some time to think and I now wonder why, in my eagerness to emhasize the socioeconomic effect, I failed to completely dismiss the idea of his depression. Yes, American statistics dictate that about 90% of suicides can be attributed to depression and/or substance abuse. But this proportion can vary in different cultural groups. But even that high number leaves at least 10% of suicides unexplained by depression. Had there been a history for Rohith? Nobody who is following his story from a distance, after his death, knows. If we know nothing about his medical history, then why assume depression? Is it because he killed himself? (Does that mean, the four friends who were expelled along with him are not depressed, because they are with us still?) Is it because Rohith was Dalit? Studies have shown that marginalized communities and people with lower socioeconomic status are depressed at higher rates than their mainstream and better-off counterparts. Even P. Sainath, who is reminding people to look at the suicide note in the context of Rohith's suicide, noted that some castes and classes in India experience depression at higher rates than others'. 

Still, no amount of population-based numbers will help one understand definitively whether a particular individual with all the risk factors was depressed. Clinicians use risk factors to guide them in screening their patients, but definitive diagnosis can be made only by collecting and integrating the individual's information.  

So when I saw another prominent writer, one that I respect, acknowledge that social and political matters can lead to or aggravate depression which in turn can push a person to take his own life, I wrote the following:
I want to understand why we assume [Rohith] was "depressed." Why do we not assume that he was stifled, made to or chose to extinguish himself; the social and the political directly acting on him, without any comodifying (i.e., encouraging) effects from depression? Because as far as I know (from public reports of his lifestory) no healthcare professional has ever counseled him; he didn't seek medical help; nobody who knew him personally suggested mental health issues while he was alive. One journalist qualified to write well (but without the necessary health professional background) has made a suggestion of depression, nay, declared a verdict of depression, and none among us has dared to wonder why this may NOT be true in Vemula's case at all.

It is true that epidemiological studies suggest that socioeconomic deprivations play a role in depression manifestations and that societies should work on removing inequities to reduce the proportion of deaths due to *suicidal depression* tendencies occurring along with low SES. But this does not necessarily always translate into one individual's life in any of the many possible directions. For example, suicide is not always preceded by depression (there are a few times when the motivations leading to suicide are defined and varied, even culture-specific) and depression does not always lead to suicide (people even get over a depressive phase if they have the necessary resources and adequate help). And this emerging picture of Vemula suggests that he was a highly resilient individual tapping into as many inner and external resources as was possible for him, until his last few days.

"Depression" has become part of the common lexicon in a facile manner, while the label/diagnosis should actually be given only by a qualified professional. I think the reason we all accept the possibility of "depression" is because it is still seen as this mysterious personal responsibility, a personal crisis -- something an individual has to take care of in the privacy of his/her mind (and with a doctor, if one is lucky enough to have one). But socioeconomic and political conditions, all reasonable, compassionate people will agree, are society's collective responsibilities. By speculating "depression," we just hand society and ourselves yet another assurance that we can all turn our backs and walk away when a struggling youngster (with or without a history of depression) feels he has come to the end of his rope.

My point was that it is possible even for individuals from marginalized communities to never experience chronic depression or suicidal depression. Each one of us may know such exceptional people from our own personal lives. Then why is it not possible for Rohith to have been one such person? In the absence of evidence of a history of depression, why are we stripping Rohith of yet another layer of his truth when he is not here to explain for himself?  Already, his merit achievements have been questioned or ignored under the shaming attitudes towards "quota students"; his Dalit status was suspected and scrutinized after his death; his scholarship was assumed to have been awarded due to nothing more than his "Dalit" credentials? Now his resilience despite his rise from his difficult background, so well described by Sudipto Mondal here, is also questioned? The odds were stacked so steeply against him even before he was born. Yet, he persevered. And by sheer hard-work and temerity, he arrived at the one place, a place of higher learning and intellectualism, where he hoped he would come to belong. From all public accounts, he was exceptional, extraordinary -- he was the one who aimed for Carl Sagan's stars -- and he accomplished this journey mostly on his own. Does he sound like he was prone to depression to you? Whether you answer, 'Yes', 'No', or 'Don't know', let me tell you: none of us know the correct answer.  

So why do we as a society insist on seeing past visible acts of exclusionary politics, tangible discrimination, and systemic indifference meted out to students of marginalized communities, only to search for excuses and latch onto explanations about a little-understood, invisible-to-the-naked-eye, intangible mental health issue that may or may not have existed in one who was not examined for it?

Until, a healthcare professional who examined him in his worldly life comes forward with a diagnosis that was made previously, say no to any speculation of 'Rohith's depression'. Emphatically.

                                                                     *****

Here are two examples of people from different walks of life who appear to not be afflicted with depression. Their approach to life is very different from that of the average middle-class person.
Stephen Batchelor, a secular Buddhist, has said:  
Death is certain, its time is uncertain. So let me live this day as if it is the last day of my life.

The portrait of this young lady from New Delhi, India, on Humans of New York has received 249,779 'likes' as of this day. She says: 
I don't have any dreams. What's the point? I'm poor. I don't have any skills. I wash the utensils in the kitchen-- that's what I do. But I like the girls I work with. We make fun together. I tell jokes. They tell jokes. I'm happy-- it's in my nature.

Who is to say Rohith could not have been like them -- adopting a pragmatic, forgiving, and no-unnecessary-sweat approach to life? A Carl Sagan admirer, he must have cherished this saying, 'Aim for the moon, even if you miss, you will fall among the stars'. I join Pratap Bhanu Mehta in concluding that at the time of his death Rohith Vemula was 'yearning for a space beyond power and rancour.' And maybe even beyond depression.

                                                                        *****