How politics is making us sick. Literally. An in-depth look at the Election Stress Disorder (ESD) that's hitting India

From demonetisation to lynchings, the social media barrage to constant polarising news, Indians are under palpable strain caused by politics.

 |  12-minute read |   30-11-2018
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If I say that your stress is likely to affect the political future of the country, chances are that you will guffaw.

After all, we Indians, in general, do not pay as much attention to mental wellbeing as our Western counterparts. 

However, there is a real chance that you carry around some stress over the political direction of the country. And, counterproductive as it sounds, that stress could force you to skip casting your vote in the 2019 Lok Sabha election.

Welcome to the world of Election Stress Disorder — ESD.

Highly polarised political environments tend to raise the stress levels of those who feel threatened. But, on a wider scale, it could also affect anyone who holds a mobile phone in this news-here-and-now age we live in.

Election Stress Disorder hit global headlines in the run-up to the 2016 US Presidential elections (surprise, surprise, Mr Trump). The American Psychological Association reported in October 2016 that 57 per cent of Americans found the political climate of the country has “very” or “somewhat significant” sources of stress. In April 2016, the poll conducted by Washington Post-ABC News revealed that 69 per cent of Americans reported feeling anxious about the possibility of Donald Trump being President of the United States.

However, we in India were not too concerned with the American ESD. After all, we already had (and still have!) enough on our plates with our very own desi brand of divisive politics and polarisation — all of which are only increasing as we edge closer to the 2019 Lok Sabha election.

main_modi-trmp-ap_113018023804.jpegBirds of a feather? The tenures of Donald Trump and PM Modi have coincided with higher stress and anxiety levels. (Photo: Associated Press)

And here is another one of the most Indian things — we have a tendency to be the first in everything. The first to discover ‘zero’, the topper in school is always a hero. From discovering gravity to the cure for leprosy, and now the ESD — we are the first in everything.

We have known about ESD for years now — we just didn’t brand it as the Americans did.

Way back, in 1997, when the current crop of first-time voters were not even thought of, Jaipur-based psychiatrist Dr Shiv Gautam led a team of three doctors who did a study in Rajasthan and published a paper titled ‘Election - A Stressful Life Event’.

They analysed 54 patients who sought consultation after developing psychiatric troubles following local panchayat elections in Rajasthan. The conclusion drawn was that the elections were stressful not only for the candidates and their campaigners but also the organising bodies (like the State Election Commission). The researchers followed this up with another study in 2009 — this time around the general elections. The result was very similar, says Dr Gautam.

However, what had not changed in the 12 years between the two tests seems to have undergone a paradigm shift since 2014.

While there has been no concrete study conducted, mental health professionals say there has been a fear psychosis observed as a common thread amongst minorities, employable youth, freethinkers, liberals, civil society and the common person waiting outside an ATM. Some have been voicing concerns over the eroding of civil rights, environmental norms, free speech and rational thinking.

“Unlike the West, where there is a strong emphasis on mental health, in India, we have always brushed psychological and psychiatric disorders under the carpet. The fact that the very first National Mental Health Survey was conducted in 2015-16, and that it covered only 12 states of India, speaks for itself,” Dr Arpit Parmar, a psychiatrist at New Delhi’s All India Institute of Medical Sciences (AIIMS) told DailyO.

While the fear of persecution in the minority community has been noticed since the last quarter of 2013, freethinkers and liberals were the next to face stress. ATM cardholders have been the latest victims of anxiety because of the political and economic climate.

Murders of rationalists like Narendra Dabholkar, MM Kalburgi and Gauri Lankesh as well as the shocking ‘celebrations’ over the death of Jnanapith awardee UR Ananthamurthy — all of whom were vocal in their dissent from the BJP-government — and other attempts by assorted groups to silence dissidents has further threatened an atmosphere of free speech.

My mentor — a socially and politically very aware educationist — says she feels she has lost her voice in the current political din. It broke me to see the lady who taught me to speak up 15 years ago, losing her assertiveness now.

main_mitron_113018023846.jpgStressed? No, sir, that's for us! (Photo: Reuters)

According to a very senior psychiatrist from a renowned government body on mental health, whom we'll call Dr K, because they refused to come on record owing to the same fear of persecution, the symptoms are clear and evident, particularly so within certain groups.

Significantly, there has been a marked increase of stress and anxiety disorders in economically backward Muslim patients.

“Economically weaker strata of the community have been targeted in phases — irrespective of their political beliefs. I have had patients, who have had no history of stress or anxiety disorders, yet are worried if they would be persecuted by virtue of their religion. The constant uneasiness and uncertainty in the life of a common householder develops into stress and subsequently into anxiety, leading to physiological complications,” says Dr K.

He asserts that the fears are not unfounded. “We have seen in the past that when it comes to violence on the streets, the rioters carry voter lists and target people based on concrete data,” Dr K adds.

What has come as another revelation to mental health professionals is how the average youth has to cope with greater stress in recent years. 

In its election manifesto in 2014, the Bharatiya Janata Party (BJP) said it aimed at creating 250 million jobs over the next 10 years as part of an economic development programme. However, the Centre for Monitoring Indian Economy (CMIE) claims that the country added just 1.43 million jobs in 2017. According to the reknowned psychiatrist Dr Om Prakash Singh, who is the editor of the Indian Journal of Psychiatry, the mismatch between the American dreams promised, and the Indian reality has taken a toll on the mental health of the youth.

According to research published in the Asian Journal of Psychiatry, 37.7 per cent of university students in India suffered from 'moderate' depression, 13.1 per cent suffered from 'severe' depression, and 2.4 per cent students were suffering from 'extremely severe' depression.

According to the Lancet Report, India registered one of the highest suicide rates among youth globally.

The primary cause of stress, says Dr Singh, is the uncertainty of employment and the fluctuating job market. 

That isn't even the only cause though. Mental health professionals and industry voices both express concern over the barrage of stress-inducing social media brought to Indians via their smartphones.

“The primary blame lies with the advent of the smartphone. The news is on every palm and there is a pressing urgency to consume it immediately.  There is no time to process the news and then react to it because everyone wants to be the first pundit on social media – we see a lot more political, communal and religious propaganda in the media now. This has led to stress on the cognitive economy of an individual — an increased pressure on processing efforts and resources. Earlier, the effort was restricted largely to everyday mundane matters like dealing with work, traffic, expenses, health, familial and social obligations, and to some extent, social responsibility. However, the onset of the Modi-regime has coincided with the spike in response to social media and consumption of news — real or fake,” says Dr D, a renowned psychiatrist based in Delhi (again, they didn’t want to be named). 

India is one of the fastest growing internet and mobile markets in the world. The number of internet users rose 324 per cent between 2010 and 2016, from 92 million to 390 million, propelled largely by smartphone use, according to data from the International Telecommunication Union, a United Nations agency.

The number of mobile Internet users was expected to reach 478 million by June 2018 — a rise of 17 per cent from December 2016 — according to a joint 2017 report by the Internet and Mobile Association of India & Kantar IMRB.

But is the expanding base of mobile internet users mere cannon fodder for ESD?

One could argue that the Indian internet user has been served the digital world on a platter — ranging from mobile banking, free access to educational tools, expanding employment opportunities. Yet, the fact remains that this has been the biggest contributor to the widespread fake news and rapid onset mob-violence phenomena, as the recent lynchings over WhatsApp forwards have demonstrated.

The meteoric rise in mobile internet users is largely because of dirt-cheap data plans and affordable handsets that flooded the Indian market. This, coupled with the low levels of digital and media literacy among the general population, has proved to be a lethal combination for young India’s mental health.

main_smartphones_113018052318.jpgThere needs to be a better digital literacy programme in the country to handle news and views responsibly. (Representational photo: Reuters)

 “As the 2019 general election approaches, there’s going to be a lot of fake news and rumour-mongering. There’ll also be a lot of real news and videos adding to the chaos. I really worry about the ability to spread rumours and fake news on social media right now. It’s a problem because people tend to trust social media since the content is coming from someone or a number you know, which makes it even more pernicious,” says Ravi Agrawal, the author of ‘India Connected: How the Smartphone Is Transforming the World’s Largest Democracy’.

What he is talking about was on show during the 2014 military coup in Thailand. The country’s Public Health Ministry warned citizens that consuming too much news media could be harmful to their mental health. It also advised Thais who were stressed to follow only state-run news media. It also advised them to seek professional help if they had difficulty sleeping, had headaches or were irritable.

Dr D explains the two kinds of stress — eustress and distress. The ‘eustress’ is referred to as ‘good stress’ or the stress that has a stimulating effect on our cognitive response. The ‘distress’ causes a negative cognitive response and leads to tension and anxiety. “The body cannot physically discern between distress and eustress and reacts to both — our heartbeat begins to race, we are breathing faster and shallower and our muscles tense up. Owing to the positive link, eustress is less detrimental than distress,” he explains.

Radical changes in government policies have led to an increase in both — eustress and distress. For instance, a cut in taxes could lead to eustress and an announcement like demonetisation causes immediate distress — both are not healthy trends, he says.

Indeed, what took mental healthcare by storm was the reaction and impact on mental health when demonetisation was announced.

Dr SK Khandelwal, professor and head of psychiatry at AIIMS, says that there is theoretical evidence about extreme policy measures causing mental health issues. “At present, there is no empirical evidence on demonetisation and its impact on mental health. However, there have been studies on Afghan refugees and the impact on mental health. There are also studies on political coups in different countries that have impacted the mental health of a population. The sudden changes in regimes in countries have resulted in an increase in the burden on mental health. We will use this existing literature and study how demonetisation has impacted mental health,” says Dr Khandelwal.

A scientific paper on ‘Demonetization and Psychiatric Disorder’ was published in the International Journal of Recent Scientific Research, which elaborated the psychosis that was observed in the three case studies affected by demonetisation. In fact, the issue was debated extensively in the 22nd World Congress of Social Psychiatry (WASP) held in Delhi barely a month after demonetisation was announced.

Clearly, you were not alone in November 2016, when you were standing outside that ATM for five hours, with your blood pressure shooting over the roof.

main_atm-queues_113018050613.jpegDo they look stressed? Snaking queues post-demonetisation were as long as many tales of woe. (File photo: Reuters)

So what lies ahead?

It has been established that the more people are stressed, the less they come out to vote — that behaviour is a component of Election Stress Disorder.

According to the 2014 study by the team of political scientists, psychologists and biologists, published in the journal ‘Physiology and Behavior’, individuals who have higher baseline levels of the stress hormone — cortisol — are as a group less likely to vote. To put it simply, those anxious and stressed over a repeat result of the 2014 elections might actually make it a reality if they don’t make it out to the polls.

As a coping strategy to deal with the anxiety caused by the political climate, Dr Steven Stosny, a therapist based in Maryland and a victim of ESD himself, advises those affected by the election and its aftermath, “to reach out, connect, affiliate and show compassion for those similarly affected. Hold other people’s perspectives alongside your own. Weigh evidence, see nuance, plan for the future and replace blame, denial, and avoidance with the appreciation of complexity.”

After all, who can empathise with us right now better than the majority of Americans trumped by ESD?

“Stand up for what you believe. Write letters, demonstrate, lobby — remembering that you’ll be most effective (and feel better) when focused on the change you want to see rather than merely reacting to what you don’t like. For optimal psychological health, take the moral high ground and resist the urge to react to a jerk like a jerk,” Stonsy says.

Closer home,

Were we stressed back in 2014? Yes.

Are we stressed now? Very much.

Is 2019 going to be any better? Fingers crossed.

And by stress, we could mean either — eustress or distress. Take your pick.

Also read: Keep it cool: With Pakistan, India should never confuse deep friendships for the deep state

Writer

Rajeshwari Ganesan Rajeshwari Ganesan @rajeshwaridotg

Assistant Editor, DailyO

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