Late in the night on 16 December, a friend – let’s call her Suman – messaged me.
“Is political depression a real thing?” she asked.
“I am listening,” I replied, slightly alarmed.
“I’m not doing well. I haven’t slept for days,” she said. “I haven’t felt a sense of alienation as strongly ever before as in the last year. I am just finding it harder and harder to deal with all this.”
The previous night, Suman had spent a couple of hours outside a police station in New Delhi, trying to help a group of university students. They had been detained for allegedly participating in violent protests against a new and bitterly divisive law. Media reports later said that the police had barged into the university library and started "beating students and firing tear-gas shells", leaving a trail of broken glass and blood.
The law that sparked the unrest – the Citizenship Amendment Act – simplifies Indian citizenship for Hindu, Sikh, Christian, Jain, Buddhist, and Parsi refugees from India’s neighbouring Muslim-majority countries: Afghanistan, Pakistan, and Bangladesh. Supporters of the law applaud it on the grounds that it offers safe haven to minorities who face religious persecution in these countries. But many in the border states in India’s northeast worry that it will open the floodgates for immigrants, overwhelming local communities. Critics have also pilloried the law for excluding Muslims, violating India’s constitutionally enshrined secularism.
Those fears have fuelled a wave of student-led resistance, rioting and arson, and complaints about police brutality, even deaths at the hands of law enforcement.
Suman, a Hindu, has many Muslim friends. She told me she felt extremely guilty for taking her ailing mother on a short vacation at a time like this. “Like I am betraying everything and everyone.”
My gut reaction was to want to tell Suman to talk to a therapist. That’s what I planned to do. In fact all week, while despairing over the nightmarish news, I made a mental note of all the emotions I intended to unload onto my brilliant therapist, Anamika (again, not her real name).
That’s when it struck me: Anamika and I never really talk politics. We have processed all kinds of messy feelings in her chamber, but the helplessness caused by politics-gone-awry isn’t among them.
Four months ago, I too had felt the kind of acute guilt that Suman was experiencing when an ex-colleague of mine, a Kashmiri Muslim, lost contact with his family for weeks after the Indian government decided to cut all communication lines in Jammu and Kashmir.
But I never brought this up in therapy. Somehow, discussing matters of state in this space never felt right.
Taking on politics in therapy
The world over, politically triggered anxiety is surging, and it’s showing up in the therapy room.
“What’s happening to psychotherapy may be unprecedented,” writes the psychologist Bella M DePaulo about the spike of mental distress in the US under the Trump presidency. “Counsellors, clinicians, and life coaches report that their clients are showing up with exacerbated experiences of ‘paranoia, hyper-vigilance, anxiety, depression, intrusive thoughts, somatic complaints, difficulty concentrating and sleeping, and nightmares’. The therapists aren’t exempt, either; some say they just can’t stop thinking about Trump.”
In Chile, protracted political unrest is pushing people into “crisis mode”, and the country’s huge mental healthcare deficit is beginning to take its toll.
In Hong Kong, after the pro-democracy protests of 2014-15, the prevalence of depression was at least eight times higher than the general norm.
All this is challenging a long-held, sacred principle of therapy: neutrality, and skirting social and political issues. The profession’s code of ethics asks that therapists remain like a blank slate during sessions, and deflect any exchange that might betray their personal bias. So if a client raises a political subject, the therapist is trained to steer the conversation inwards – towards the client’s personal life.
Let’s say Donald Trump’s tweets give you panic attacks. A psychoanalyst like Anamika might describe it as a symptom of a deeper malaise. What does Trump symbolise for you? Perhaps he reminds you of a nasty authority figure from your childhood? The theory, simply put, is that you can be rid of your anxiety only by teasing out and confronting its root cause, which is hidden within you.
I have personally benefited from this form of therapy. But the premise that most problems and their solutions can be traced back to something inside you – and are therefore in your control – can undermine legitimate feelings of helplessness around complex crises such as climate change or authoritarian nationalism, which dwarf any sense of individual agency. To anyone anxious about such issues, glossing over their social and political nature can feel like gaslighting.
“It would actually be unethical, in my opinion, to treat the client’s anxiety without addressing the reality of the risk they face: as a political issue,” California-based psychotherapist Richard Brouillette, with experience in community organising, told me via email. “Whenever a therapist faces a political question, I would suggest they are actually facing two ethical questions. They should ask themselves, first, as a professional, what role do I play ethically for my client? Second, what is my ethical role as an individual, a member of the community, a person in the world?”
A therapist’s “clinical neutrality” does not prevent them from engaging in organised political activities which are in line with the ethics of the profession, he added, sharing the example of Hanna Segal, a psychoanalyst who questioned “the madness of nuclear policy”. I’ve also read about forensic psychologists in the US standing up for asylum seekers who were forcibly separated from their children by immigration officials, and Citizen Therapists for Democracy, a group committed to fighting “the ideology of Trumpism” by rejecting neutrality altogether.
When a client raises a political issue in a session, Brouillette said the therapist must ask themselves: how does this issue play out for the client’s treatment? “Any therapist who doesn’t believe this is a very common question in their practice is fooling themselves. Most immediate examples include: how does a client engage with your skin colour, gender, sexual identity, class? All political questions.”
Neutrality doesn’t mean silence
The times we are living in make it urgent to acknowledge that mental health is not merely about chemicals in your brain. Your identity, your place in the world, and how safe or unsafe you feel in it are as important – if not more –as your serotonin levels.
Seen from this lens, mental health is a matter of human rights, and as such, is intensely political.
Therapists negotiating this reality can learn from Médecins Sans Frontières, a global coalition of doctors who often work in conflict zones. “We believe that the principles of impartiality and neutrality are not synonymous with silence,” reads one of MSF’s core principles. “When [our] teams witness extreme acts of violence against individuals or groups, or when access to lifesaving medical care is hindered, we may speak out publicly. Our decision to do so is always guided by our mission to alleviate suffering, protect life and health, and to restore respect for human beings and their fundamental human rights.”
Increasingly, the mental health community is warming up to its role in politically fraught situations. In Hong Kong, a group of mental health professionals now offer voluntary, short-term services to those affected by the political turmoil.
In India, a campaign called Bridge the Care Gap, supported by a cross-section of mental health charities, non-profits, and service providers, went a step further: it lobbied two national political parties into including mental health in their election manifestos. The campaigners believe making mental health an election issue is the only way to guarantee long-term change.
Therapists can accelerate this change by nudging their clients to take action – without necessarily pushing them into specific forms of political activism or groups.
“Just as I may suggest a 12-step group for someone dealing with substance abuse, I may suggest to someone with climate anxiety [that] they connect with others to address the source of their anxiety,” said Brouillette. “Does this mean explicitly suggesting people join Extinction Rebellion or the Movement for Black Lives? No, but it does mean suggesting that getting together with others for peer support is of inherent therapeutic value. Therapists are not here to silence or anaesthetise people, but to promote self-aware, confident action with their clients.”
A fresh start
The day Suman told me about her depression, therapists, counsellors, and psychiatrists in various Indian cities were organising themselves on Twitter to support students and others traumatised by current events. Some of them, like Anna (she uses only that name), who helped compile a list of available professionals, were vocal about their opposition to the citizenship law.
“Not just in India, even in London I have seen that bringing politics into therapy sessions is frowned upon. Prominent therapists have this attitude: ‘Oh so you are a feminist, you are bisexual, let’s indulge you’. If this is the condition of private therapy, which most people can’t afford, you can imagine what it must be like in government hospitals with their overburdened staff,” she told me over the phone.
Anna, a filmmaker, is a user/survivor with a degree in psychology and is trained in queer-affirmative counselling practice. She told me that since tweeting her offer of help, she had received calls from several students.
“It’s wonderful that things are changing,” she added. “There are more and more therapists who are vocal and actively involved [with political issues]. What we need is some investment in shared ethics, in the idea of greater good.”
After chatting with Anna, I felt a lot more confident about discussing politics with Anamika.
“So … have you been watching the news?” I asked in our next session.
She seemed to have been waiting for me to ask.
“Uggh,” she said. “Yesterday, I had six back-to-back sessions, and everything was about what’s going on. By the time I went back home, I was in a rage.”
I asked her if she was comfortable taking a political stand. "You can’t be non-political at a time like this," she replied. "No. That would be wrong.”