How he began:
I’m intimidated by the thought of this appearing online. I worry about how people who know me would react once they see what’s written (most of my friends and family do not know about my “overthinking").
And then he said:
The stigma must stop somewhere.
I spotted Suhail Rasheed from a 5-word-comment he made on one of my blog posts. His comment caught my eye. How does this Indian man based in Dubai know about Scott Stossel's book The Age of Anxiety? I wrote him and offered up the secret handshake. He responded in kind, referencing generalized anxiety disorder with a subtle understanding. I wanted to know more. I asked him if he would be willing to answer some questions about his experience growing up with anxiety in India, and he agreed.
One thing to know: Suhail is a writer. He's worked in media, and he knows words. Though he's nervous to have his story out in the world, he says, "After reading others' experiences and after going through what I have gone through, I must not encourage the stigma around talking about mental health." To me, this is the epitome of courage.
BV: Where did you grow up? What was your town or city like?
I grew up in a village called Valapattanam in Kerala, India. That's not entirely accurate. I had to move around a lot in between. But, for the most part of my childhood, my earliest memories tell me that I lived in Valapattanam longer than in any other town.
My father used to work in Oman and I lived there for a few years, even went to school. In between, for about five years, I also studied in a boarding school in Trichur district, about 300 kilometers south of Valapattanam. After that I moved to a different state in India for my engineering education. As an engineer, I then worked in Kerala and finally moved to Bangalore in 2009. Bangalore was second home to me, one of the larger cities in India.
I lived there for about 6 years until 2015 when I moved to Dubai seeing a new business opportunity and also to avoid the rising anxiety in my job in Bangalore.
BV: How did you first get diagnosed with GAD?
Before I got diagnosed with GAD, I never thought about “thinking" as a symptom for anything.
I have dealt with thoughts, both positive and negative, for most of my adult life and perhaps parts of my childhood. (When I say dealt with thoughts, it is difficult to define in words the number of thoughts I have in a minute.) These thoughts would race past me and I would try to catch hold of just one and wish that thought would remain with me, but it would soon give way to another and another and another until I didn’t know which thought to pick or which thought would stay.
Around 2011, I first sought help regarding this. I was in a job for the third year, and I was tired of the job. I was feeling misused and underused. I was constantly feeling that many of the things I was doing in my job wasn’t right. To top it, somewhere along the line I had picked the thought that I was not in the right career. I was missing something. I needed to get out.
I had a good network in Bangalore. One of the people I knew was the Chairman of a large IT firm called Mindtree. I mustered some courage to write to him about my career worries (I had read in one of his books about people who frequently changed jobs were unprofessional). He invited me over for tea to his house unlike earlier occasions when we met at his office. Over a period of more than one hour, we talked about many things including my job.
At some point he asked me the question, “Has there been any instance of mental health issues in your family?”
I didn’t know.
He very slowly communicated to me the possibility that I may need a little help. He was very good at clearing the stigma.
Until that day I had looked at all mental illness as schizophrenia and I thought of psychiatry as a pseudo-science. He was helpful in explaining to me that we did not need to see mental illness as something to be ashamed about or something difficult to face. He explained it as a kind of chemical imbalance which can be corrected with therapy or medicine or both. He referred me to a psychiatrist (also, a professor) in NIMHANS Bangalore, which is the foremost institute for mental health in India.
In his email to the doctor, he mentioned that I may be having a serotonin disorder. I thought about it a lot but did not go to the doctor. And then I forgot about it. I did not even do a second reading about the subject then. I trusted my mentor friend, but I wasn’t sure how I would handle a visit to a mental institute.
A few months later in the same year, my thoughts got worse and I ended up being very frustrated, angry and depressed a lot of the time. A lot of the anger was due to family circumstances. My wife implored me to go for a joint family counseling session. The person we met with was a clinical psychologist. After about two hours of pouring out our frustrations, he turned his attention completely towards me. He had practiced in US and he came highly recommended by a friend. This psychologist went on a different trajectory though. He ran several tests over the next few days. He ended up diagnosing my case as bipolar disorder! I know. We were stupid then. We didn’t talk to anyone about it. We believed him. Totally.
Until I got over that phase.
That was the first time I visited a mental health professional. Soon after though, before the year ended I stopped going to him for the therapy. He was very expensive (this could be a deterrent to many people suffering from mental health issues).
Treatment and therapy were expensive for the middle class Indian family.
The other reason was that I felt a lot better already and I no longer believed that I had bipolar or any mental disorder for that matter. Towards the end of 2012, I switched jobs, this time without placing too much thought on it, planning to move to an exciting new career in branding and advertising. I was fired from the new job the same day that I joined. I didn’t give up though. I worked as a freelancer communications consultant and did a lot of different gigs to stay afloat. However, without my wife’s knowledge, without anyone else’s knowledge, I was crumbling inside. From 2012-2014, I went through the most depressing days of my life. I have had sleepless nights before. But the sleeplessness of 2012 and 2013 trumped every other period of sleeplessness. I would sweat terribly several times during the day, despite the cool weather of Bangalore. I would palpitate frequently. My wife was having sciatica around the same time. She was undergoing treatment in an alternative medicine system known as Ayurveda. That put all the more pressure on finances in a jobless position. And through it all, I hesitated to look for another permanent job. I didn’t know whether I could handle it. Would I fit right back in? What would people think when I went back to working in my old position? Had I failed?
In 2014, I finally went back to a job reporting to a very senior architect in the city of Bangalore. I took on a role somewhere between the role in my earlier company and the role of a branding manager. Within the first two weeks, I realized I had reached a terrible place. My architect boss would not accept anything I turned in. He would comment and criticize every single thing I did. I began to withdraw into a corner - quite literally, as I was assigned a dingy dark corner in that office.
I would stay low - as low as possible. I would try not to appear in front of my boss. His mood swings would throw me off even when he was angry at someone else. In the evenings, he would sometimes take me to parties and encourage me to mingle with other well known people in the city. However, I was not made for that kind of stuff. At some stage, I started feeling… well, anxious. I once thought I am good. I thought I was talented. I thought I was a writer. Yet, I felt worthless at that moment. I worried that I would never amount to anything. I wouldn’t achieve one-tenth of what I once thought I would achieve. I was failing. My wife now back from her treatment, and pregnant with our third child was stressed due to all this. She suggested it to me first: why don’t I go back to the psychologist?
The psychologist who thought I had bipolar disorder still thought the same. He was quick to point out that all this was my fault.
I didn’t continue the therapy.
Now it was too late to sustain on therapy alone. I would have to take medicines.
“Don’t think of them as strong medicines. If you go to a psychiatrist, they will prescribe anti-depressants for you. I am only prescribing mood stabilisers for you.”
I went back home. A few days before, I would have balked at the idea of taking medicines for a mental illness. Yet, this man was telling me to and I was ready to take medicines. I had a feeling this would impair my creative senses, affect my imagination. But I needed help. I needed to sleep and I needed to get rid of the thoughts in my head. And I was willing to let go of whatever senses I thought it would affect. My wife disagreed. She wanted to take a second opinion. She called a psychiatrist cousin in Australia who talked to me over Skype one evening. She couldn’t tell much from our conversation. She told me one thing for sure though: this wasn’t a case of bipolar disorder. Definitely not. She suggested that I take this seriously though and that I visit NIMHANS, which was the best institution in India for anything related to mental health. She also said that I might still have to take medicine but it wasn’t going to affect my creativity. She said a lot of creative people take medicines related to mental health and they are still being able to work under the effect of such medicine.
That is how I reached Dr. Y. C. J. Reddy’s team. He wasn't the doctor I was referred to initially. NIMHANS had a highly efficient system of diagnosis and scheduling each patient to a doctor. NIMHANS had a long queue of people waiting to be diagnosed mostly people from a lower income group. The charges in NIMHANS (a government institution) were highly subsidized and I paid next to nothing for the consultation. The doctors did a thorough analysis. First they put me on some medicine to get me some sleep. A month later, they did a detailed study of other symptoms and in the end, Dr. Reddy himself came and talked to me about GAD. Generalised Anxiety Disorder. I was hearing the term for the first time and I was relieved because it sounded so much better than bipolar disorder. I started taking two medicines: one for sleep and the other for the anxiety (escitalopram). It was a small dosage with no noticeable change except that I was sleeping too much. Anyway, that’s how it was diagnosed.
BV: Did you talk about it when you were diagnosed?
I mentioned it to my father who didn’t think it was anything serious or anything that required medicines. My sisters too, who believed the same. I didn’t talk about it to my mother as she would have refused to believe it totally. A few friends here and there. None from my wife’s family or the rest of the public.
BV: Do you know other people who also deal with anxiety?
I have found a lot of people in my family dealing with different forms of anxiety disorders including OCD. Even my father deals with a lot of anxiety which I discovered recently as I started working closely with him. However, no one I know has ever taken help or felt the need. I think either that none of them have gone through what I went through in 2014, or they are being really tightlipped about it.
BV: How is anxiety seen in India? What do people say if they hear you are anxious? Is there a common cultural response to it?
I guess you have got the picture from what I have told you so far. There is a lot of social stigma surrounding mental health in India. Yet, due to various socio-economic factors, we are hardly free from mental disorders including depression, anxiety, and even mania. There are a lot of initiatives off late encouraging people to talk about it. One initiative doing quite well is White Swan Foundation promoted by Subroto Bagchi (Chairman of Mindtree, referred to above as the person who first talked to me about mental health) and his wife and a lot of other business leaders. Another one I hear about is promoted by Indian actor, Deepika Padukone, who personally went through anxiety disorders and depression.
Yet, the work is nowhere near complete. When I say I am anxious, it is most often connected to my faith. It is conceived that because I haven’t enough faith in Allah I am anxious. I have been repeatedly asked by a few friends and members of family to turn to Allah for help. At some level spirituality helps, as does meditation and prayer, but to gather the concentration and mindfulness required for that sort of devotion demands a little less anxiety and lesser thinking.
BV: What happened with medication for you?
I will never discourage anyone who follows medication. I personally stopped medicines after taking it for 8 months. My dosage was also 10mg. At first, with permission from my psychiatrist, I stopped the sleeping pills. I was sleeping way too much to be able to handle my daily work pressure. After some more months, I had to stop escitalopram. I was having feelings of vertigo, nausea and a lot of other symptoms, which I couldn’t handle. I started feeling that it was the medicine and its side effects. Against the advice of my psychiatrist, I stopped the medicines abruptly one day. Needless to say, I couldn’t go back to the psychiatrist again. For one thing, it wasn’t Dr. Reddy anymore. Dr. Reddy referred me to a doctor closer to my home. He felt that the long waits I faced in NIMHANS would be too much for me to handle. There would be patients with different needs and some of the cases would be depressing. This new psychiatrist would just listen to me talk and prescribe me medicines. He did not offer any recourse other than medicine. He didn’t recommend therapy. When I finally stopped taking the medicines, I stopped seeing him altogether. This was in January 2015. I had already changed my job by then and re-joined the company I left back in 2012. I thought I wouldn’t face anxiety again.
Stopping the medication was a bad idea though. Medication should never be stopped abruptly. The dosage has to be brought down gradually and only under the advice of the psychiatrist. I faced the side effects of stopping the medicine for about a month or so. If the side effects of taking the medicine bothered me, the side effects of stopping bothered me even more. Nausea, dizziness. I’d rather not think about it.
Having said that, I do not intend to go back to medicines. I prefer working with other methods.
BV: What happened after 2014?
Shortly before my third daughter was born, I took a month’s off from work and travelled to Abu Dhabi, where my sisters lived. The idea was to find a way to relocate to either Abu Dhabi or Dubai. The vacation was a big relief for me. Our family still refers to that vacation as “that September”. So many things happened then. So many events close to my heart. Some disturbing. Some good. We had a lot of fun: me, my sisters, my cousins.
I didn’t find the opportunity I was looking for but I returned a happier person. Three days after I came back to Bangalore, I resigned from my position in the architecture firm. My boss was furious. As much as I admired him as an architect and visionary, I couldn’t make an impression on him and the way he continued to shout at me would depress me. With luck, I was able to get back into a larger company where I had worked earlier from 2009 to 2012. I felt relaxed having made this decision.
Being in a large company had its benefits. Had its drawbacks too. It seemed as if I came back to remind myself why I left in the first place. I hated this job back in 2012. And nothing had changed. I kept blaming my dependency on money for having taken the job again. And now I hated it even more just about three months after I came back. There was no authoritative boss. It was a great company and it did well internationally. Yet, I found myself craving for something I couldn’t explain. I wished for an end to the boredom. I would pace about in the office from one end to the other and back. (This feeling coincided with the time I had stopped taking escitalopram). In February of 2015, my father sensed the discontent and made me an offer. He was planning to expand his business in Oman to Dubai and would I be able to set up the new base? At the same time, he was planning his retirement and he needed someone to take over things.
I didn’t decide on this until April. During those couple of months, my wife was doing a lot of research on her own and got in touch with a family-related department of NIMHANS. A clinical psychologist conducted a screening and asked me almost the same questions that Dr. Reddy’s team had asked less than a year ago. She took about a week to get back to me on the next steps.
She referred me to a research fellow and said he would be able to help me. He was conducting a research on the application of emotion regulation therapy in treating generalised anxiety disorder. He was looking for subjects to take part in the research and he asked me if I could take part. I got interested in this and said yes immediately. This was a lot different from taking medicines and involved several mindfulness exercises he would share with me over the period of about two months. His methods taught me for the first time how to identify different emotions I felt in different situations. Identifying these emotions helped me get rid of a lot of my anxiety. The mindfulness exercises helped me. I couldn’t complete the course as I had to travel abroad in the middle of all this. He must still be wondering why I never returned.
Emotion regulation therapy worked for me quite well. Even months after the course, I would go back to the notes and follow some of the mindfulness exercises and it would still help me stay clear of my thoughts.
One thing I learned I still follow: I would watch my breathing pattern. If I was tense, I would be holding my breath. A lot of the times I am holding the breath. Even as I write this. I keep checking myself to make sure I am feeling alright. This practice of looking at me from the outside as if I am a different person has helped a lot in identifying my emotions.
BV: How are you doing with your GAD now?
I came to Dubai in June 2015. Things didn’t go as planned. Over a year has passed and we still haven’t kicked off the core part of the business I came to set up. I’m trying my best to pull through, but I can feel my knees give in. I keep getting feelings of having failed, lost and worthless. I worry that the rest of my life is going to be as hapless as the last few years. I try the therapy by myself when I can find the solitude. Sometimes it works. Sometimes I get frustrated and shout out into the ceiling or sky depending on where I am. Help is difficult to get in Dubai and much much more expensive than in India. I keep thinking that I must go back for a few months to do something about it but little nothings keep me busy. I know I can find help in NIMHANS. I just don’t know when I can go though. This is the part where I stop being a warrior, I guess. [In my response to his first set of questions, I told Suhail that I thought he was a warrior and I admired him.]
I still struggle with a lot of situations. I can’t handle traveling in an airplane. I sometimes lose my peace while driving. I can’t handle queues anywhere I go. I panic in a situation where I have to face a lot of people from family or friends. I find it difficult to go to college reunions. I go to networking conferences and just come back without having spoken to a single person. Watching most types of movies raises my anxiety level.
BV: What do you do in your daily life to help manage it?
Some activities have helped me. I guess you could read these anywhere and yet I will mention them.
1. Writing. Writing. Writing. I try to be as candid and spontaneous as possible. And try as much as possible to write in a notebook, with a fountain pen.
2. Doodling. When I can’t write, I doodle. I love design and drawing. I would keep drawing abstract figures until it would feel like something recognisable.
3. Routines. Not a routine for everything, but a routine for small things. For a time, it was the ritual of lighting the incense burner at home and taking it around the home to spread the fragrance. I get really happy when I follow one ritual consistently for many days together.
4. Walking/Running. This has the best effect on me of all, not counting Emotion Regulation Therapy. When i continuously walked or ran for a few days, I became more positive and confident with myself.
5. Reading fiction also helps. The humorous kind and feel good ones.
6. Breathing. In absolute emergency situations such as when I’m angry/frustrated, I use the breathing technique. Breathing with belly instead of the lungs.
7. I avoid coffee as much as possible (even though I love it) as it propels my anxiety. I never take energy drinks either.
8. Spirituality. I try my best to pray regularly. If I miss a few prayers, I find that I am restless, on the edge.