Contributing Factors
Psychology uses a multidimensional, integrative model to explain the causes of psychopathology. This means that it is a combination of genes, emotional and cognitive factors, social and environmental factors, and behavioral factors that influence the cause of a disorder. Discussed next are some of the major social, environmental and behavioral influences contributing to the depression experienced by the people I talked to.
Academic Pressure
“My parents were, like, pressurizing me to study a lot,” said Shruthilaya Hariharan, a second-year Bachelor of Engineering student at Anna University in Chennai.
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When students reach their 10th and 12th standard years, the board exam years, it is common for academic pressure to build up. The pressure to get the highest possible marks in the board exams and get an acknowledging rank in your school or your whole state comes from parents, teachers, as well as from the student’s own goals and mindset.
Shruthilaya Hariharan
Switching boards and not meeting expectations
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This pressure is not limited to the board exam years. In Hariharan’s case, she faced this during her 11th standard year as well.
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“I was scared that I won't meet their expectations,” she said, the emotion of fear trickling into her voice. “I was scared I'm not meeting my own expectations of myself because I got really good grades in 10th. I felt like a failure for a lot of time because the first few months I was trying to cope up with state board thingy and all and I was not good at it. I got like comparatively less marks and I was feeling more anxious and all.”
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Having switched from the Central Board of Secondary Education (CBSE) to State Board in 11th standard, Hariharan was already struggling with adjusting to the new curriculum pattern. This added stress and anxiety to her already present fear of not meeting expectations set for her both by her parents as well as herself.
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There is already a stigma existing in Indian society that the depression students are experiencing is due to academic pressure and stress, which I observed may lead to a closed loop. However, it is important to note that while academic pressure is surely a contributor, the multidimensional model of psychopathology and the other factors discussed here show that stress is only one of many factors that influence the development of depression.
Calls to helplines spike around exam time
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Connecting NGO, a suicide helpline in Pune, told the Times of India in February 2018 that they receive the most calls during exam seasons: February through March, and June through July, and the callers are usually 15 to 25 years old. This means that their callers are mainly high school and college students.
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“Most, if you see the suicide record of students in Tamil Nadu,” Paveethran Ravichandran, a third-year engineering student at Anna University, said, “mostly it'll be because of their studies. Education. Because accordingly to people here, for them, those who score good marks, they'll go to a good college, like that. So if you didn't get enough mark or if you didn't get what you wanted, education wise, they attempt suicide.”
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The phenomenon Ravichandran talked about happens every year during exam and results seasons. When students in India who didn’t perform as well as they wanted to or were expected to, they may attempt suicide.
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The domino effect is very much understood by Indian society, in fact to a detrimental extent. The belief is that if you get good grades, you get into a good college or university, and that will lead you to land a good job. A good job means good pay, which means a happy and comfortable life in the future for you and your family. This end goal is what has historically led Indian parents to pressure their children into becoming doctors, engineers, or lawyers.
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Whenever I tell Indian aunties and uncles that I am studying journalism, I am often met with surprised expressions. Once, when I told someone I am majoring in journalism, they exclaimed, “Oh, so you’re the atypical Indian!”
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But due to the domino effect, students and society alike attribute bad grades in your board exams to affecting the rest of your life, which is a lot of pressure to put on 16 and 18-year-olds.
Loneliness
Hariharan switched boards after 10th standard. Moving to a new school was met with loneliness and a lack of friends.
“When I was in 11th, I didn't have any friends, she said. “New school and all. And I just felt lonely since I had no one.”
Not having anyone to talk to, on top of the stress, anxiety and fear from academic pressure she was dealing with, is what Hariharan said led to her depression.
Social Anxiety
Contributing to loneliness, the fear of talking to new people and making friends in a classroom full of strangers is something Ravichandran faced.
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Ravichandran went to a school that had both CBSE and State Board syllabus in the same school for 11th and 12th standards, but on opposite sides of campus. When Ravichandran realized all his close friends who he had studied with since 6th grade were choosing to continue in CBSE for 11th and 12th, he tried to convince his parents to let him take CBSE too, but to no avail.
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“I was like, ‘I'm going to take CBSE,’” Ravichandran said, “and they told that, ‘No, it's not a good option’.”
The main difference between CBSE and state board is that CBSE requires the students to apply their knowledge whereas state board exams require the students to write word-for-word whatever the textbook says on their answer paper to get marks. The results for state board exams come out earlier than CBSE exam results, which affects student’s ability to get admission in college because seats start filling up quickly after state board results are out.
“So taking State Board is the best idea,” Ravichandran said. “So I had no other choice, so I took State Board and I had no friends. I was so alone.”
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Paveethran Ravichandran
Studies indicate that social support is an important factor in one’s resilience to stress and maintaining physical and mental health. In periods of high stress and pressure, such as the board exam years, having a support system of friends can be crucial.
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When I asked Ravichandran whether he attempted to make friends in his new class, he said he didn’t.
“I'm socially awkward,” he said. “I didn't want to talk with any one of them. Because I didn't know any - It was scary to me. They had… I just - whenever I see them, they… I felt like they are staring at me. So I was like, 'Oh my god, what is this’?”
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He went on to say that this isolation was the biggest contributing factor to his depression.
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“Most of the time I felt alone,” he said. “That's the thing that's coming to my mind. I was alone and I just hated everything, whatever that was going on to me. Like, whenever I go to school, I was like, 'When this day is going to end?’ That'll be the only thing that's running in my mind. So I'll just continue the day because I had to go. I had no other options. So I just stayed there. I don't know what to do and then... I was just there.”
Physical Illness
The trouble started with a single mosquito. It changed Anton Abilash Netto’s entire life.
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When Netto was in 10th standard, he was suddenly diagnosed with dengue, and not expected to live. He said doctors were astonished he was even able to stand when his parents brought him to the hospital.
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Netto survived the dengue, but he was left with rheumatoid arthritis, an autoimmune disease, and a life full of pain in every joint in his body.
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“Actually every day I have to push through my limits and suffer - I have to suffer for everything.” Netto said. “And because of pain, I get depressed.”
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Anton Abilash Netto
Chronic pain and suicidal ideation
The constant pain and not knowing how to control it has even led Netto to suicidal thoughts.
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“Even one time, I went to the terrace and thought, ‘Why should I live?’” he said. “That one second, if I think that I should end my life…”
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His voice trailed off.
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“You didn’t, but, you don’t,” I said.
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“I don't, because I don't want to lose to this world,” he said. “Because if I die, I lose myself. That's all.”
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And now his only wish is to live a single day without any pain.
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“There's only one wish for me,” Netto said. “At least a day, single day, without pain. I don't hurt, I have to enjoy with my friends, walk freely without any pain.”
Inability to Accept Failure
Netto’s life was going great until the dengue and resultant rheumatoid arthritis hit. A star student, he said he was expected to achieve the state first rank in 10th standard.
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However, due to the hospitalization and the following recovery process, he was forced to be held back a year and repeat 10th standard.
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Not wanting to let the arthritis take over his life, Netto worked hard to achieve a score of 495/500 in his 10th standard board exams. Scoring 99% is difficult enough already, and I was absolutely blown away by the fact that Netto was able to score that, given his circumstances.
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But even that felt like failure to him.
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“I don't accept failure because I don't go back on my word,” the avid anime fan smiled as he quoted Rock Lee from the famous anime and manga series “Naruto”.
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Even as Netto told me his story in that Cafe Coffee Day shop, I saw his eyes well up and him hold back tears multiple times. I realized even crying, showing that emotion, acknowledging that pain, feels like accepting failure for him, which he later confirmed.
Family Problems
Netto mentioned that family problems are also a major cause of depression. He described a news story where a boy in Tirunelveli who was preparing for his NEET examinations committed suicide after being upset over the frequent arguments with his reportedly alcoholic father, despite multiple attempts over five years by the boy to convince his father to give up alcohol.
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Netto also mentioned problems within his own family.
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He talked about his uncle, who survived a serious train accident, and multiple accidents and deaths in his family. Stressful events like that are contributors to Netto’s depression.
Family History
The multiple accidents and deaths in Netto’s family lead to his mother being depressed for many years, he said.
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According to a paper on NCBI, numerous twin studies, linkage studies and association studies show that genetics play an important factor in the development of Major Depressive Disorder. The seventh edition of the “Essentials of Abnormal Psychology” textbook states that having a family member with depression has shown to increase the likelihood of you experiencing a major depressive episode.
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In fact, Kathleen Hall on Everyday Health stated that having a parent or sibling with MDD makes you two to three times more likely to develop depression than someone with no family history.
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So the fact that Netto said his mother clearly suffered with depression for years put him at a higher risk for depression as well.
Suicide or Attempted Suicide by a Close Relative
“My cousin said she wanted to suicide,” Hariharan said. “She actually brought a knife to her wrist and then she was like, 'I’m gonna cut my hand,’ and then her mother apparently convinced her not to do it.”
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Family history of suicide is another known risk factor for depression and suicide. While Hariharan’s cousin did not go through with it thanks to the intervention of her mother, Netto was not so lucky.
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Netto said his older cousin, his aunt’s daughter, was like him. He said she was depressed even at the young age of 10.
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Netto described how his cousin was a very timid girl and that her parents never seemed to care about her. He said that despite having a lot of money, his cousin’s parents never wanted to spend money on her.
Because of this, his cousin was very close to Netto’s mother instead. Netto and his mother would go visit his cousin whenever she was in town.
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“She just hugs my mother and she'll cry a lot and she'll say, ‘No one is caring me,’ like that,” Netto said.
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Anton Abilash Netto
In January 2017, during the Pongal holidays, Netto’s mother asked him to text his cousin, who they hadn’t seen in two years. His cousin worked in Trivandrum and often wouldn’t tell her family when she came to visit, choosing to stay at friend’s houses instead. Netto’s mother told him to tell his cousin that their grandmother is on her deathbed, hoping that will give her the incentive to come visit.
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At the time, Netto said there was an ongoing quarrel between his father and his aunt. However, Netto stressed in his messages to her that they didn’t want anything to do with that ongoing argument.
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But she didn’t respond to texts or calls. Frustrated, Netto asked her if it’ll kill her to call back. One week later, he received the news.
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“Treena is dead,” Netto said, the helplessness evident in his voice. “I was speechless. I don't know what to do at that time.”
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Netto then said he felt like he heard voices that day when he asked Treena if it would kill her to call him back. He said he ignored those voices, thinking it was strange. The way he described it, it felt like he was feeling responsible for Treena’s death.
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“Even after a month, I was like, thinking that if I called her, she would be alive,” he said. “ If she comes, we can do something.”
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Netto stated that Treena’s death was part of the reason for his depression. However, it didn’t make him consider suicide himself because he considers it a cowardly act.
Normalization of Self-Harm
Divya Prabha, a third-year sociology student at MOP Vaishnav College for Women, talked about a troubling behavior that caused her to not be able to recognize her own problem throughout her school life. The normalization of anxiety, depression and self-harm.
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“I mean like, if you ask around, you'll probably notice that there are a lot of kids, and like, self-harm is a very common thing here,” Prabha said. “Like that’s something people don't even take seriously. So as a result, really bad things like having anxiety, depression, or self-harming behavior, or manipulative behavior, something that could be potentially harmful, it's normalized. And it's not recognized in other people. Either for lack of awareness, or it's because people aren't comfortable with confronting that something might actually be wrong.”
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Divya Prabha
Prabha, who went to a Kendriya Vidyalaya school, mentioned that it’s something she noticed is more common in government schools and schools with people from a socially backward background.
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She recalled a time when she regularly talked to her cousin brother, who lives in Kumbakonam, when he was in 9th or 10th standard. She said he used to talk about things like his friends cutting themselves pretty normally, and that was very disturbing.
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“And the thing is even I was normal about it - it's only now that I see how problematic that was,” she said.
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Although she’s not sure how widespread this problem is, Prabha said the reason for this is that students don’t even consider self-harm as something that is wrong, problematic, or as something that warrants concern.