DISCLAIMER: Please read our previous article, ‘Is Mental Health political?‘ to understand this article better!

In our previous article, we discussed how mental health is political. We discussed what we meant by the word political and how we fall under the various categories of the society (Class, caste, religion, gender and sexuality). Like we mentioned before, when we say that mental health is political, it does not mean politics of political parties. It means addressing the problems that are in society, especially for people living in the margins. Realizing that this was a difficult for many to understand, we asked our therapists at Pause if mental health really is political. And here’s what they had to say.

Question: What do you mean by ‘mental health is political?’

Shazia Ahmed, one of our therapists, puts forth her point beautifully. She says, “Once you start understanding the ways systematic and institutional inequalities are perpetuated and maintained, it’s not difficult to discern how mental health is political. Those who are kept in the margins struggle to keep proving their humanity to those in power. The act of dehumanizing itself takes such a toll on physical as well as mental health. We know that the African American population in America suffer disproportionately from hypertension, diabetes, heart attacks and even higher rates of mental illnesses which have been directly linked to the ongoing trauma they face.

Unfortunately we don’t have comprehensive data around this in India, where caste and religious identities also mean severe marginalisation and denial of humanity. A person who grows up experiencing untouchability grows up with the idea of not being worthy or even human just because of circumstances of birth and thus of course will grow up fighting demons higher caste people will not.

Thus those who are not faced with trying to fight for their most basic rights, not trying to claw their way out of structural poverty, those who aren’t discriminated against for their religious views or made to feel inferior for the circumstances of their caste identity, gender identities or sexual orientation do not necessarily fight the same battles these people do.”

Adding to the previous point, Pooja Agarwal , our counselor and certified mindfulness trainer says, “Mental health is political because we don’t live in isolation, we live and move in a socio-political context and that means that our lives are deeply impacted and influenced by social, economic, political systems. What we experience is a response to the systems we live in and the power dynamics we grapple with and so our well-being becomes political. The governance, laws, systems of caste, class, religion, gender, patriarchy, heteronormativity all have direct impacts on our mental health and those living in the intersections of these systems experience further marginalisation, thus impacting their mental well-being and even their accessibility to resources to care for their well-being. Further the dominant idea of what constitutes “health” itself is political- in the capitalist world we live in the idea of health is ableist- defines one’s ability to be “functional”, “productive”,etc.”

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Our therapist, Syeda Rafath Unnisa explains it in a crisp way. She summarized the points and said,

“It means that an individual’s mental well-being is influenced by their context and can be located in the structures of oppression around us more than the individual themselves.”

In a nutshell, it means that humans are social beings. We always have been and that’s how we have survived. And as we kept evolving, we kept dividing and started to cluster ourselves into these groups. This division has kept many groups of the society isolated from the majority groups. And this isolation has adverse affects on our mental health and cannot be ignored.

If mental health is also political, does it mean it comes up in therapy? Do people come in and talk about the structures of the society? How does that work, then? So, we asked our therapists just that:

Question: If mental health is political, does it show up in therapy? How so?

Shazia Ahmed continues, “The political nature of mental health can be seen in something as simple as who can afford therapy. Those who need it the most may not be able to afford therapy. They may also find their concerns dismissed and devalued.
If we look at the history of psychology and even therapy as a discipline, we see overwhelming that it is a science that is flooded with the opinions of cis-het white males. Over the years, those who were once considered “eccentric” became pathologized. Women’s oppression and their subsequent valid mental breakdowns were renamed hysteria. LGBTQIA+ Community was deemed deviant and mentally ill. The African American population, stolen from their own lands  were “proven” to be genetically inferior, thus legitimizing the treatment meted out to them.
Even in early therapies, you see mental health and healing decontextualised from the person’s circumstances, “the person is in control” is an approach a lot of them hold. Lauding themselves as giving “agency” to their clients without ever talking about their struggles against institutional and systemic inequalities. While therapeutic practices continue to be decontextualised, cis-het and predominantly Caucasian, they will keep holding political power over the mental health of the marginalised.”

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Rafath Unnisa also adds her point of view, “It does, in many ways. Each time a person talks about how these societal expectations of having a perfect job a perfect marriage, a perfect life, a particular self-concept, an ideal relationship or even a particular desired way of living and how these expectations brings about stress or experience of being marginalized, it can be seen how political mental health is. A lot of distress experienced by people is a result of the context that we live in and them either striving to belong or trying to resist this. So this does show up in therapy more often than not.”

Adding in another perspective, Pooja Gupta says,

“In therapy, it shows up as shame, guilt and self-loathe. It makes you think you’re not good enough, not human enough. You don’t fit the list, the prescription. Why? That doesn’t matter. What comes in the way? That is not even considered in the definition. So, either you fit the list or you don’t fit the list, the rest doesn’t matter. It comes up as an absolute. It makes you want to believe that you’re lacking. That you’re not enough. In a space where someone else is dictating whether you’re mentally healthy or not, you’ve already lost agency over yourself.”

So, for example, when we talk about being womxn and the challenges that comes with it, we’re actually having a political conversation in a mental health space. It sounds interesting, doesn’t it? Every conversation in therapy comes with empathy and accountability, especially when it’s about people living in the margins. Our next question for the therapists is about this empathy and accountability in the conversations they have with their clients.

Question: How do you hold conversations of accountability and empathy in therapy?

Pooja Agarwal says, “Being aware of the privilege a person holds and of the marginalization an individual might face because of their position in the socio-cultural system, helps hold conversations that are emphatic but also invite and hold accountability. One instance of this that comes to mind is when working with children and families, children are often marginalized, their voices dismissed and their experiences trivialized, while holding conversations with the family in empathy for their struggles it also becomes important to invite parents and other stakeholders(teachers,school counselors) to be accountable for the power they do have because of their positioning and how they can use it to support and be an ally of their child.

In working with individuals as well, for example when a cis man is talking about the anger they experience, and their struggle in managing it, while we hold the experience in empathy for the distress it causes we also look at the impact of this anger, what is does- thus bringing to awareness that expressions of anger for cis men is often culturally sanctioned and furthers oppression of those around them, this enables one to take accountability for the anger as well.”

Pooja Gupta continues by adding her experience of being a therapist. She says, “Power dynamics make it extremely tricky for a therapist, a human being, to hold accountability and empathy in the same room. Knowing that mental health is political, that power is dictating how one should be, it can be extremely difficult to make this power play seen when a client is talking about their distress. Every client comes from a diverse lived experience, power playing out in different ways through caste, religion, socio economic status, language, location, psychological functioning, childhood experiences, traumatic experiences, sexual orientation, gender identity, physical functioning, to name a few; in their lives. So the power play is happening at various levels. Some ways, they might be privileged, some ways they might not.”


She goes on to elucidates her view, “It becomes important to hold these positions and see what is distressing them. Is it coming from a place of privilege or no? What if it is? How do you empathize with someone’s distress, who is more privileged in the said distressing situation? How do you hold them accountable for their position of privilege while being empathetic to their distress? I think what comes to my mind is the saying in Narrative Practices “The person is not the problem, the problem is the problem.” How do you locate the problem in the problem and talk to the person about the problem, so they see how they’re accountable but also hold space for the overwhelming emotions they might be experiencing is key. The person is in therapy because they’re not okay with something. It’s important to remember that.”

Our therapist, Madhuri Sampath shares her experience. She says,

I find it difficult to hold conversations of accountability and empathy in therapy sometimes. Making a client accountable feels like I am not being empathetic to their distress or emotional experience. Being a privileged person in the room (because I am a therapist and the client is here seeking something from the process), my position is already of power. I need to be careful not to make the client get defensive, offensive or feel judged.
The way I do it is, draw from the client’s experience of distress and their language around how they see it, the reasons, consequences and preferences. Then, confront them on how their patterns of behavior, responses, or beliefs may be impacting their life.
Being careful to not fuse the problem with the person is extremely important. We draw attention to the said problems/concerns and look at what they could be doing, being or saying to add to/ create the problem.
There is an event and then there is a response. There is stimulus and there is a response.
We could explore the way the client is responding, with a sense of agency, are their actions guided by values, their support systems, etc.

Adding to this, Shazia Ahmed narrated her experience as a psychological counselor,

“By recognizing the political nature of our work, we open ourselves up to being present for these inequalities. Who we listen to, how we listen to their conversations all hold power. We hold our own privilege and power as therapists. It is important to voice not only that this power exists, but also that power structures exist that have a direct effect on mental health, we can begin to hold ourselves and our privilege accountable. There must be greater transparency in our work and the conversations we hold around this.
As far as empathy is concerned, we must first look at our stance towards not just these systems, but also our own work and the stories we are privileged to hear. Once again, I feel listening with our absolute presence, even when these conversations call out our own privileged place in this system of inequalities, as difficult as they may be, will allow us to access our humanity and empathy.

Therapists at Pause believe that mental health is political and work for the inclusion of minority groups and marginalized communities in mental health spaces. Only if we address the problems in our society can we progress and move forward. In fields like mental health, it’s our responsibility to raise awareness and make our services accessible to everyone. We hope that this answers some of your questions as this is what we firmly believe in.

Pause for Perspective is a patriarchy deconstructing and a queer affirmative organization that offers mental health services, assessments and mindfulness sessions. We offer online sessions and work all week (even Sundays!) Message us on Instagram or Twitter to book a session!

Keep an eye on this page for the next part of this article where we ask our therapists on how the body handles these spaces. We take a look at the correlation between mental health being political and the diagnosis of a mental illness. Is there a correlation and if so, how does it work? In our next article, we also highlight self-compassion and how it comes up in therapy.

Omaiha Walajahi
Pause for Perspective