Post-Mumbai anxiety taxing for mental health workers

Since the gruesome Mumbai terrorist attacks, mental health experts understandably have been in big demand here. But India, with 1.1 billion people, has only 4,000 psychiatrists, and efforts to provide adequate professional help for those traumatized by the rampage is proving a daunting task.

Psychiatrists say it’s not unusual to arrive at rural clinics and find 300 people waiting to see them. Each patient receives five minutes of attention at best. Many give up and go in search of more traditional forms of assistance.

Evening “relaxation and breathing” workshops, for example, are being offered in the immediate environs of the Chabad Jewish center that was among the targets of the attacks, which left more than 170 people dead and hundreds injured last month.

“We help ease people’s tension through breathing techniques,” said Ami Patel, an instructor with the Art of Living Foundation, which offers the sessions. “And people appreciate the feeling that someone cares.”

Then there is traditional healer Laksham Meshram, 61, who sits cross-legged on a Mumbai sidewalk a few blocks from the bullet-pocked Taj Mahal Palace & Tower hotel and the Jewish center.

Stretched out before him are 90 bottles of roots, bark and finely ground powder. The healer, who has been practicing his craft for 35 years, said people come to him for headaches and other problems, including some that may be psychosomatic. Even his potions may be no match for this crisis, he said, adding that there’s no cure for raw terror.

“Death may be the only medicine for that,” Meshram said.

Mental health professionals say they must battle deep-seated stigmas in some of the more traditional communities they serve, including the view that anyone who visits them must be “loony,” even as they navigate the shoals of India’s huge, diverse population.

Mumbai psychiatrist Anukant Mittal is a case in point. He shuttles among city hospitals, suburban clinics and primitive rural facilities, all part of a catchment area of 26 million people.

On any given day, Mittal sees patients varying from chief executives of high-tech multinationals, who pay $50 per visit, to illiterate villagers wearing nothing but strips of cloth over their loins, and pay a subsidized 5-cent fee.

Rural residents sometimes turn instead to a shaman.

“You know very well they’re going to go from your clinic to a witch doctor who will do black magic,” Mittal said. “So you have to say, ‘I know you’re going to need someone to exorcise this, but at the same time don’t stop taking my medicine.’ ”

Treatment espoused by traditional practitioners can be pretty brutal, doctors say, including cases of mentally impaired patients being assaulted in a bid to beat the devil out of them. Yet it can be a lot easier to tell your friends and family that a spirit invaded your body than to admit that the problem may emanate from within your mind.

Compared with more rural areas, India’s financial capital is well positioned to grapple with the psychological aftermath of this traumatic event. Mumbai is among the nation’s wealthiest and most progressive cities, with more than 1,000 psychiatrists and psychologists.

“I’m lucky to work in Mumbai, a place where psychology is much more accepted than almost anywhere else in India,” said Purvi Shah, a clinical psychologist with the elite Dhirubhai Ambani International School, several of whose students lost parents in the attack. “If you go to Varanasi or the northeast, the idea of going to a shrink is unthinkable.”

Handling the diverse Indian population ideally requires a knowledge of many cultures and tongues -- Mittal speaks seven languages and four dialects. Knowing a particular community’s religious stories, parables or fairy tales can go a long way when explaining some nuance to poorly educated patients or outlining the importance of a particular course of treatment.

One huge benefit for India in overcoming the disaster is its tightly knit family structure, neighborhoods and religious communities, which tend to provide much better grass-roots support than is generally found in the more individualistic cultures of the West.

Most of the symptoms mental that health professionals are seeing, including calls to loved ones every few hours to make sure they’re still alive and an inordinate fear of leaving the house, are normal for a population that has suffered such a harrowing shock. The test will come in a few months, the experts say, when some fail to revert to normal behavior.

One person likely to be tested is Hargovind Vaghela. The 11-year-old jumps whenever there’s a loud noise. She screams in the night, has no appetite and keeps reliving the sounds of gunfire and the explosions she heard when the gunmen took over the house next door. They littered her family’s property with bullet casings and left the smell of decomposing bodies seeping through the small kitchen window that overlooks the adjoining building.

Hargovind had seen the man next door, a foreigner wearing a beard and black clothing, walk through their neighborhood a few times. And once, on his toddler’s birthday, he’d given her and her sister some cake and a few rupees. “They used to cook food in the basement,” she recalled.

Little did she and her family realize until the fateful night of Nov. 26 that they were living next door to the Chabad center. Militants killed Rabbi Gavriel Noach Holtzberg, his wife, Rivkah, and four guests there; the Holtzbergs’ toddler survived.

Many have looked for someone to blame, with Pakistani and Indian elected officials high on the list. “Real Terrorists are our Politicians and Babu,” or bureaucrats, read a front-page headline in the Times of India.

The anger is a predictable response to trauma, experts said. “Any time you feel hopeless and vulnerable, you want someone to blame,” said Lakshmi Vijayakumar, a psychiatrist and vice president of the International Assn. for Suicide Prevention.

Psychiatrists must grapple with their own anger, which can hamper their ability to help others. Recognizing this, hundreds of counseling professionals across India started an e-mail “anger discussion group,” including some who expressed wishes that the attackers could be tortured or die a violent death.

“Psychiatrists are human too, so we express our anger and try to heal ourselves,” said Harish Shetty, a social psychiatrist with Mumbai’s Hiranandani Hospital, who was out counseling traumatized police officers and journalists before the shooting stopped. “It’s not always politically correct to admit anger, but in our epics -- the Ramayana and Mahabharata -- good kills evil. It’s part of our ethos.”

Mental health professionals say their treatment must factor in the strong role that fatalism has in Indian culture, including the view that whatever occurs is the result of karma or God’s will.

This has certain benefits. There’s often no particularly good explanation of why your loved one died in an attack, so fatalism can help people cope.

But it can also sap people’s will and leave them numb, said Shetty, part of the reason he sometimes encourages patients to embrace their anger and take more responsibility for their own fate.

“India can be a very fatalistic place,” he said, “even among the educated.”

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mark.magnier@latimes.com