“The psychiatric hangover around us makes it difficult to reimagine therapy as a political act.”

By Saransh Bisht:

Interview with Rashi Sinha, a mental health practitioner:

Rashi Sinha is a mental health worker driven towards social justice, and an ardent believer of hope. She has worked in Delhi for three years and is currently running Injor, her online psychotherapy practice, from her home in Lucknow. Her most authentic state is nostalgia, so she likes her long conversations, old songs and has more elderly friends than those of her own age.

In this interview, Rashi talks about her thoughts on the need for intersectional mental health services. She also shares with us her vision of advocating for a mental health perspective geared towards social justice through her initiative – “Injor”.

Introducing Rashi Sinha

Q. Tell us a little about your work.

My name is Rashi (she/her) and I provide psychotherapeutic services under the initiative – Injor. ‘Injor’, a word from my native language Magahi (spoken in Bihar), refers to the rays of light that enter through the cracks or perhaps an ajar door- it can come from anywhere.

I have 4 years of experience in working with individuals facing emotional challenges. Drawing from Narrative Therapy and Acceptance and Commitment Therapy, my approach as a therapist is to understand the problem and the self through anecdotes, stories and metaphors. I also work as a facilitator for various awareness and well-being oriented workshops. As a mental health worker geared towards social change, I have consciously engaged with work opportunities around community mental health.

Q. What impact is your work making in the mental health sector?

Being a private practitioner, one often wonders whether these one-on-one engagements can contribute to any significant impact, when we look at the bigger picture. I do not know about the life of my client after we have completed the therapeutic journey. There are occasions when a client shares how they have been able to carry forward the courage we discovered together in therapy and thereafter able to negotiate with the oppressive structures in their own life. That strengthens my own faith in psychosocial support systems.

I am invested in developing a reliable set of tools and techniques for therapeutic interventions while working with persons at the margins. I am constantly looking for individuals and organisations I can collaborate with to bridge this gap .

Q. Which populations do you primarily work with?

Most of my practise consists of womxn dealing with loss of identity and relationship concerns. By virtue of my own social location, some of my clients are also from the Dalit-Bahujan community.

Q. What is the end goal of your initiative/collective work?

My personal project is to make mental health more accessible and relevant to people hailing from the Hindi heartland, who remind me of my community while growing up in Patna.

Understanding intersectional mental health

Q. How would you define ‘Intersectional Mental Health’?

Intersectionality is the content usually written in boxes at the end of chapters or as side notes – employed by authors and course leaders who have decided these are auxiliary themes. It is deserving of an honourable mention – to talk about the ‘other’ identities, minority religions, oppressed class and castes, the value of community work and so on. But it isn’t something that will be empirically validated by our very own scientific processes. Indeed it can never become the gold-standard for practise. It is like the cousin who is asked to sing at parties but doesn’t really have any say in the family.

The biopsychological perspective is what takes up the most space – so much that we fail to integrate the social context. Such kinds of treatments have some significant repercussions in the way we explain personal emotional states. For instance, when we look at a person facing poverty, we are bound to think that ‘They are lazy and impulsive’. I was at a women entrepreneur’s forum last week where a keynote speaker made a comment – ‘Only you have the power to let anybody else make you feel small’. Notice how ‘laziness’ and ‘inferiority’ have been rendered as isolated behavioural abstractions. This has led to a pejorative view of distress and many of us have adopted such a view.

Intersectional Mental Health is a framework that rejects this simplification and attempts to locate the reason that is beyond the individual, in the psychosocial domain. It encourages us to understand how social contexts of gender, caste, class, sexual orientation combine at different life stages. It asks us to understand these emotional states within the context of power and privilege.

Q. When did you first realise the importance of an intersectional approach to Mental health?

When the conventional therapeutic mechanisms failed to bring around ‘change’. After a year of on-ground practise, it became apparent that one-hour private-space therapeutic experience is hard to achieve for a lot of populations. Apart from the design, the therapeutic schools did not equip me with tools to capture their experiences holistically . Growing from such experiences, I realised that I was trying to treat everyone ‘fairly’. In my attempt to be inclusive, I resolved to listen intently and only respond to emotional pain. This is what I was trained for – to empathetically connect and create a safe space that allows everyone to open up, no matter what their identity is. I was pretty proud of myself to have this skill as a multicultural practitioner.

I did not realise how I was invisibilizing the history and culture of the person by trying to see them just as a ‘human’. I was not being culturally-sensitive, I was being culturally-blind and that is not the goal. The goal is to see the person, see their identity, and communicate to them that I see their pain and what brings it around. In my personal practice therefore, I will not dismiss their reality; I will educate myself how these dominant systems are embedded in the depths of our society, and how it contributes to the lived experiences of an individual.

Questions about a possible solution

Q. What is the first step towards building an inclusive mental health mechanism?

At a personal level, one has to know that this endeavour is going to take time and effort. However, moving forward it would be really helpful if we can find our anchors in our resistance to achieve social justice, individuals and organisations who understand and support inclusivity.

We need to find such anchors because otherwise our commitment is going to be extremely short-lived. The psychiatric hangover around us makes it difficult to reimagine therapy as a political act. One can observe such hegemony when one joins an online group of Indian Psychologists on social media platforms. We are expected to be more clinical in our approach, and that is what the field of psychology recognises and/or rewards. Such a view propagates that if we are not clinical in our orientation by training, we may end up harming the person. Rather than accepting this position, it is crucial to recognise the harm one is causing by covertly going back to biology to treat this pain and suppressing the social context in which this pain emerged. It is harmful and emotionally devastating if we fail to provide the necessary tools to our clients to deal with that systemic injustice. Apart from clinical spaces, there are some questions that other professional and non-professional spaces should address – ‘Will we be talking about caste? Will managers be ever expected to be equipped to deal with mental health and inclusion?’

Q. How will the other minority communities benefit from such initiatives?

The shame from my own backward caste identity was witnessed by my therapist. She helped me process some of these feelings. I was not even able to talk about it in-depth within my friend circles. That brave space helped me make a choice that I would have not made otherwise. I do not want to glorify my personal experiences to make a case for inclusive practises, but I just wanted to share what also makes me stand by it.

Through affirmative psychotherapy practices, adopted by inclusive therapists, we are moving beyond our work of processing emotions. We are directly challenging systems that put pressure on our identities – who we think we are allowed to be. That has outcomes for a lot of factors: on how we look at our past experiences, our future hopes, desires, fears and fantasies. Also how far we want to bargain for them.

A recent American study reported that signs of anxiety and depression have more than tripled in Black and Latino communities last year, spiking after the murder of George Floyd. We don’t have such similar research studies to conclude the same about DBA communities but surely DBA communities are affected by the ever-prevalent caste based violence. The lack of accessible mental health care services in these communities cannot be ignored.

Q. What are your future courses of action vis-a-vis the social population you are currently working with?

The need of the hour is for mental health professionals to identify their own personal biases. The first action therefore is to commit towards understanding how my own social locations contribute to my therapy practice. , This is not a one-time thing but rather will forever be a work in progress.

The next action point is committing to the existing resources available on caste identity. Unfortunately, a lot of such important resources are not made mainstream but it is vital that we collaborate and learn because that cannot happen in therapy sessions – the burden of teaching should not be on the client. I really appreciate the recent open-source database of resources on caste curated by Belongg Mental Health collective for this endeavour.

I am in the process of crystallising some of my experiences and learnings as a Bahujan therapist. I’m looking for some thought-partnering and if you are interested, please write to me at rashi@injor.in

Check out Injor’s work here: https://www.injor.in/