INTAR India - arrival and day 1

Between 25 and 30 November 2016, I was in Lavasa, India to participate at the conference of INTAR: International Network Toward Alternatives and Recovery, http://intar.org/ . This was the 7th conference of INTAR, yet it was my first attendance. The conference was organized by Bapu Trust, http://www.baputrust.com/index.php/news-networks/intar-india-2016

On 23 November 2016, I had obtained my visa for India on the last minute, which was actually quite stressful, but I managed to get it in time, and so I left home very early morning on 24 November, to travel from Eindhoven to Amsterdam to New Delhi to Pune and then to Lavasa. The trip took about 20 hours in total. The last part of the trip was by car, and I had the joy of watching the beautiful sunrise over the foggy valleys in Maharashtra, India. I had a good journey.
It was Friday morning 25 November when I arrived at the Mercure Hotel in a beautiful and sunny Lavasa. I went to my room for a little rest, and around noon I took a walk in the beautiful but also strange town. It is actually a privatised project, meant to be a luxurious resort, surrounded by the beauty of India’s nature. But the majority of buildings are unfinished because of a disputed dam, which led to a stop on further constructions. So now Lavasa looks like a partial resort embedded in a kind of ghost town. Yet it was a beautiful and friendly place to be. Surrounded by beautiful nature, in a valley at a lakeside, a quiet and peaceful resort, and actually it was a perfect place for a conference.

I was informed that a lunch was being served for the INTAR participants at the Convention Centre. There I met several other participants, and I found some nice company for the rest of the day. In the early evening, after styling my hair, I joined a group of INTAR-participants going back to the Convention Centre for a dinner buffet, which was very nice. Since most of us had had a long journey, nobody stayed up late. I was also exhausted and I went to bed around 11.30 PM. The wifi access was rather complicated, so I decided to skip updating my blog that day. I slept very well.

*

On Saturday 26 November 2016, at 9 AM, the INTAR Conference started, titled: Trans-cultural dialogues about mental health, extreme states and alternatives for Recovery. 140 participants of 40 different countries, including many Asian countries, were represented in the room. I was very happy to be part of this inspiring event. Today’s theme was: Experience, existential crisis, and responses.

The conference was opened by the sound of Indian singing bowls, and then Bhargavi Davar (Bapu Trust) warmly welcomed us all. She spoke about the symbolism of the cactus, which live in full diversity, and in harsh environments, and they survive, live and even nourish others despite their hard lives. This image is reflected at this INTAR conference, where many people with different perspectives and backgrounds are present to share their experiences together, on surviving, living and nourishing others, to identify universalities, and to create a stronger movement toward new models and ‘alternatives for recovery’ together. A special interest goes out to article 19 of the UN Convention on the Rights of Persons with Disabilities, on living independently and being included in the community, and to identify how to support inclusion and community based support in the field of psychosocial disabilities. This is especially important to counter further expansion of medical-model-oriented psychiatry over the world.

The second word of welcome was done by Asha Pillai (WCCLF). She spoke about the diversity of views on mental health, including Indian traditional views, such as on spiritual awakening, growing wisdom, search of the soul, and mindfulness. There are many different perspectives on life and its meanings. Yet, western science tries to put everything in boxes, which diminishes the holistic and spiritual approaches. It is now time to pick and choose the wisdom and models, and select only those that are useful to us, to move to alternatives for recovery.
She then explained a bit more about mindfulness (mind training): opening up to the beauty and joy that surrounds you, and wishing that everyone may have the opportunity to see and enjoy this in their lives, and to share and reflect the beauty and joy in every action in your own life.

This was a beautiful and deep opening. It immediately cracked up the western fixed models of “mental health and wellbeing”, and opened up to other levels of reflection on life and wellbeing. I was already very much inspired.

Then, we lit certain ritual candles which were placed on all tables, to wish our aspirations into the world.

Peter Stastny (INTAR) also welcomed us, and reminded us that India has been the centre of the world’s development regarding justice and human rights, pointing at the important role of Mahatma Gandhi in the world’s history. The goal of INTAR is to be a platform to learn, by sharing practices, knowledge and experiences of alternatives and recovery. The word “alternatives” is not ideal, since “alternatives” are not to be seen as add-ons or complementary services to the current psychiatric system, but alternatives are in the core really fundamentally different, and offer an alternative conceptualization and approach of wellbeing, growth and support. This INTAR-conference brings initiatives and people together.

Then the first session started with a Plenary Panel Conversation, which was titled: Experiencing mental health crises and personal critical responses. There were 3 speakers:

Will Hall (USA) spoke about the oppression of diversity throughout American and European history, where social norms have divided the population in stereotypes of “standards” and “deviants”, based on gender, race or origin, religion, sexual orientation, disability, and so on. It is important to realise that each of the oppressed groups have to fight for their rights, and in fact, we all fight for the same: to recognise the uniqueness of each individual and to create a world that embraces and celebrates our differences, and doesn’t attempt to make us “normal”.

Gayathri Ramprasad (India) started by explaining the deep meaning of the Indian expression: Namaste, which means: the light inside me welcomes the light inside you. Then she shared an impressive personal story about a breakdown, followed by horrible forced treatments, including ECT, medication and exorcisms, and deprivations such as solitary confinement. She survived. After this experience, she wanted to offer support and hope to others, and to transform the discourse for others. Then she started the organisation ASHA, which means Hope in Hindi. The power of personal stories can change people’s lives.

Jayasree Kalathil (UK) spoke about the double discrimination faced by persons from black minority groups in the UK, who face an aggravated lack of perspective and hope, and often a doubled fear to speak out, since racism also occurs in the mental health domain and in support spaces. Bigger issues in society are also present in services and support systems, and there needs to be special attention to foster inclusion of persons from marginalized groups across all domains and services.

After a brief discussion, there was a coffee break, and then at 11.45 the Workshops started.
I joined the workshop: Responding to alternative realities creatively , led by Reshma Valliappan and Jhilmil Breckenridge. They illustrated with their own beautiful artworks and poems, how art and creativity can offer a way of expression and support, including in extreme and alternative states. Creativity has no boundaries and offers a safe space for alternative realities and meaning-making, by letting it be, instead of supressing it as the medical model does. Many people in India have no relation with the medical model of psychiatry which addresses distress as chemical imbalances, but they would rather address their experiences as spiritual awakenings and initiations. (For example, in Yoga and martial art every breath symbolizes life and death). So, in times of distress it is more logical to nurture the whole being, and the chakra’s and spiritual pathways and so on. Art is a great tool for expression and relief. Yet it should not be called “art-therapy”, which is stigmatizing and belittling, and insinuating rejection of the present. It is art, as true as art can be, recognizing the diversity of realities and deep meaning of self-expression of each person.

This was again a very inspiring presentation, especially because of a fully non-medical view, and so true to human nature. To me, this really made sense from A to Z. I loved this inspiring workshop.

Then it was lunch time, and I enjoyed the nice buffet in good company.
In the afternoon there was another Plenary Panel followed by a workshop.

The Plenary Panel session was about: Community alternatives in globalizing mental health.

The first speaker was Vikram Patel (psychiatrist and researcher), who spoke about the “prevalence of mental disorders in India” and about the “treatment gap” in developing countries, where treatment or support often isn’t available, and about “mental health illiteracy”. As a solution for the “supply problem”, several programmes have been started in India, including by training community workers for basic treatment delivery.
I certainly heard some mixture of the old paradigm language in his presentation.

Sumeet Jain (researcher in Social Sciences) spoke about access to care, and about needs versus provision, about globalization (which is in fact currently mainly a north-south flow) versus local sensitivity. The western models of mental health services assume that access to biomedical services (medication) will lead to instant and linear recovery of individuals, and they do not address other support needs for living in the community. Simply scaling up these western medical models into developing countries is not the solution. It is merely a matter of adaptation to local needs, such as providing other and diverse forms of care, and also including other forms of evidence.

China Mills (UK) gave a sharp analysis on the global mental health movement and spoke about moving beyond medical models. She questioned how western psychiatry can consider “scaling up” while there is so much criticism on this medical model. The western psychiatric model is a mono-culture, offering only a single-sided story on distress as a chemical imbalance. Neoliberal frameworks label distress as an individual problem that requires prevention. The focus on medication-compliance is not addressing social determinants and is overtaking social justice. The WHO promotes drugs as a first choice treatment, even without consent, but the harmfulness is not told. And in practice, most community support clinics are only drug-dispensary clinics, and any other forms of support are absent. And while the western concept of “mental illness” is disputed continuously, the “burden of illness” is exploited as a market, regardless of other opinions. A dialogue is needed to ensure that big pharma is not dominating global mental health development, and to enable diversity instead of a monolithic approach.

This led to a very interesting discussion about the Global Mental Health movement, and their use of medical model diagnostics such as the DSM-criteria (illness-model), leading to pathologizing human behaviour, while any behaviour could also be seen as a normal response to a disabling society, and which is then to be addressed via social determinants and political, economic and cultural structures (human rights model), to enable inclusion and full and equal participation in the community. There are obviously many different ways of talking about mental health, yet the western medical system leaves no room for alternatives. It seemed that the large majority of participants shared this view.
A firm remark was made on the fact that, for example in India, the large and horrible psychiatric hospitals are remnants of past colonization by Europeans, and these are places of abhorrent human right violations, which clearly should get no “scaling up”. A reference was made to Robert Whitaker’s book: Anatomy of an epidemic (see http://robertwhitaker.org/robertwhitaker.org/Anatomy%20of%20an%20Epidemic.html )
And also some critical remarks were made about the current Indian law reform on mental health care, which unfortunately also includes options for forced treatment and forced institutionalization (despite India’s ratification of the UN Convention on the Rights of Persons with Disabilities). It would be good if more professionals would speak out openly against this law proposal.

I was impressed by China Mills’ contributions to the discussion. She spoke very eloquently and I liked her position a lot. So again, I became more inspired.

After another coffee break, the last session of the day consisted of workshops. Despite of other, more interesting sessions on the programme, I joined the workshop: Public health policy : paving the way for community voices, mainly because I wasn’t sure how many users/survivors were in this room. It appeared to be mainly service providers speaking about “co-production”. Right from the start, I noticed the difference between the grassroots and institutional approach. Words like treatment gap, action programmes, statistic prevalence of disorders, monitoring, “involvement of service users”, decentralized care, random-control trials, community interventions and service delivery again filled the room. To me, it wasn’t inspiring or innovative, and there wasn’t much room for discussion. And although all of the speakers tried well to outline “a need for fundamental changes in the system”, they mainly pushed within the margins of the existing models, and not really “out of the box”, so I didn’t really feel illuminated afterwards. It was a mediocre workshop to me.
In fact, afterwards, I somewhat regretted that I had gone to this session, instead of taking the opportunity to see some really interesting speakers, like Bob Whitaker and Will Hall, who do go out of the box. But nevertheless, I have no real regrets. It was interesting anyway. As a “reality check” that shows the real “gap” in mental health care.

After the workshops, there was a Plenary summary and round up of the day by Brian McKinnon. He spoke about liberation and interconnectedness, and he quoted his Yogi-coach: that we are all one and part of something bigger, and we are all perfect, it is all interconnected. Then, he expressed his respect to all participants, who are all pioneers pushing for change, tirelessly despite demoralizing barriers and very hard circumstances. INTAR shows that progressive work is still being done, despite these big barriers, and that in itself is very inspiring. Clearly, I had arrived back in the warmer atmospheres of the conference.

Then, from 7 PM onwards, a movie was shown in the plenary room: Healing voices (see trailer: https://www.youtube.com/watch?v=ZT46zOYxjnM ) I was too tired and hungry, and inspired, to sit still and watch the movie fully, so I left the room before its ending. I talked to some people, and then finally the dinner opened. I was really hungry, like many of us. I had a great evening, first at the dinner buffet in the Convention Centre, and later in the hotel lobby bar. I chose to postpone blogging and working again, and to use this opportunity to meet people. It was a great group of inspiring people. I really had a nice time, with good conversations, - such as about the repeated comparison with dead canaries in a coal mine, which used to be a warning sign for unsafe places, which is also symbolic to psychiatry - . A nice evening. I went to bed rather late, with a smile on my face. Again I slept very well.