S01Extra06: Practicing Collective Care

Interview with Aparna Joshi and Tanuja Babre from iCALL

Introduction: As the lockdown continues in India, we reached out to iCALL, an initiative of the Tata Institute of Social Sciences. It’s a service that provides professional and free counselling through telephone, email and chat. 

On Sunday, April 19, 27 people joined in as we spoke to Aparna Joshi who is an Assistant Professor at TISS and Project Director of iCALL, and her colleague Tanuja Babre who is the Coordinator of iCALL. 

The idea was to understand the psychosocial impact of the Corona virus, the impact its having on how we’re all feeling and responding. And more specifically, to talk about care and what collective care means in this time. 

We began the conversation by asking Aparna: What is the psychosocial approach? How is it different from mental health? How do we understand what’s happening in terms of Covid-19 using this lens?

Aparna: I want to differentiate between mental health and psychosocial discourse. That’s also an important distinction. I suspect that the mental health discourse is going to take precedence very soon. We have been dialoguing with several development organizations, government, NGOs to talk about psychosocial care, but everybody understands mental health. 

Unfortunately, it’s very diagnostic, very sometimes pathological, very illness driven whereas psychosocial distress or the psychosocial framework is a very different framework. First of all, I think our assumption is our psyches are not floating somewhere in vacuum. They are situated in the social context in which all of us are embedded and these currently are not only context of the disease but I think three impacts that the disease has had on all of us and I will talk about it later on more in detail, but apart from the health scare, it is also creating other effects.  For example information-misinformation is one, isolation is another one. The lockdown itself has some impact and the last one is also uncertainty about future.  All of this is also linked with developmental issues of poverty, job loss or domestic violence or substance withdrawal, or caste or religious politics.  All of that. 

So it’s not just situated within the individual. It is situated within the context of all of this that is happening interpersonally, communally, socially and globally also. So therefore the link between the individual and social has to be understood, therefore psychosocial. I think we will have to say that if we understand this distress, this anxiety, this panic, psychosocially, the response also has to be integrated and cannot be individualistic or taking care of individual anxieties. It is very much a step needed, but I think we need to fix what is happening socially, globally and at the country level, so that’s why psycho-social. 

So when understanding or conceptualizing people’s narratives, we take care of listening to not just what’s happening within the individual but what’s happening around the individual. Some of the dominant scripts of how women in Covid-19, for example, should take care of household in ordinary circumstances, but now doubly. So even such small examples, we are listening to all of that and we are not listening to them passively but while responding to those we are not only unpacking people’s internal phenomena such as cognition and thought but also linking people to say, hey some of these scripts that you are using and not just your own scripts, but they seem to have filtered through these larger structures.  That is one example of what psychosocial means. But the second example, through iCALL, we are also trying to demonstrate how psychosocial Services need to be delivered also in an integrated fashion. So if people call us, we’re not just providing emotional support for them, which we do. That’s the job of iCALL. Bu t we are also asking them what other help they require. So if they require food, if they require shelter, if they require safety, if they require, you know some help for violence, if they require us to connect to some ground level services, you’re mobilizing all of that. If there is violence, we are mobilizing help. So we are not just helping the individual but also the several factors or barriers that are existing at different levels of ecologies, and we are trying to provide an integrated approach.

Deepika: Thank you. So what you’re saying basically is that the lens helps us understand that we’re all living in a particular context and because we’re living in that particular context, we can’t think of ourselves in isolation from all the things affecting us. You mentioned news, you mentioned distress that everyone is feeling. You touched upon care and how you can’t therefore respond to care in isolation. 

Would you approach care in a way that is therefore multi-layered and webbed? So would you say that care is just as distress is something that is because of the social context we live in, therefore care is connected to those same webs. And how do you view them? 

Aparna: I think we will talk about care as the conversation develops, but I just want to definitely say that while we are focusing on individual care, healthcare. First of all, I think it’s extremely important to integrate psychosocial care. And we have been lobbying with several governments, organizations to say that right now the healthcare seems to be very very important, but please integrate psychosocial aspects. But as I said that it cannot be pitched only at an individual level and it cannot be about fixing emotions. It cannot be about fixing thoughts or fixing behaviors which are situated within the individual but it is also fixing networks. It is also fixing domestic violence. It is also fixing households. It is also about fixing jobs, it’s also fixing the discrimination which is initiated against certain communities because of social perceptions and it’s also not just self care which is a very privatization of care, but it has to be a community care with all of us come together, as against the language of warriors and fighters, I think if we can create a language of community care, I think that’ll go that’ll help us along. 

Deepika: I think that really brings me to the next question which is what are the kinds of calls you’ve noticed in terms of iCALL and what iCALL has been receiving? What are the changes you’ve observe before the lockdown and now?

Tanuja: We have been working a lot in terms of concerns related to domestic violence, increased conflicts within families. You may be stuck with family and not be getting along with them or especially if you’re living with them for such a long duration after a long period of time. Students who have been forced to go back home.  Women, who there may not be conflict or there may not be violence, but at the same time are struggling to negotiate with family members, loved ones, the responsibilities of household work and managing working from home on top of it; caring for children, caring for family members. We also get a lot of concerns coming in with requests for food, groceries, concerns related to feeling suicidal, extreme concerns with regard to engaging in self harm. Even getting a couple of requests from migrant workers who may be stuck away from home in exploring the sources whether they can go back home or how is it that they can go back home. 

We’ve been working with clients who are struggling to negotiate rents with their landlords, are struggling to negotiate, medical healthcare workers who are struggling because they would be discrimination, stigma, violence from other members living in the community. And at the same time we’re also getting a lot of concerns from clients who may not be affected by something happening right now but the anxiety of what is coming next and what this lockdown will bring and how is it that they will get through it. All of these concerns if you see, I mean of course distress is a huge component for why they choose to reach out to us. But they are so connected with their social environment, so connected with what is happening around them too. The feeling of helplessness sort of increases because you feel you don’t have control over what is happening around you. 

Deepika: I think that’s a nice segue into what we actually wanted to focus on in this conversation, which is looking at care and when you talk about care, and you’ll have explained also how we’re all part of a larger ecosystem and a larger social context and space. So there’s multiple things that affect us, but if you could now speak specifically to understanding what the role of care is in this time because we’re all, like you said, experiencing multiple levels of distress, but speaking to it at the level of individually, what does that look like? At the community level what does that look like? And at a larger level in terms of our connections to you know vulnerable groups that you mentioned. What does that mean? And how do we actually practice connection right now?

Tanuja:  Even going by my own personal experience of surviving the past few days or floating through it. I think it’s been really, I mean, it’s led to a lot of questioning as to how we understand care how we make meaning of care for ourselves. I also feel that when we talk about self-care. I mean, it’s also a lot of times, you know, a very upper class or a very privileged version of where you take a vacation or have a spa day, or you know, not everybody has the opportunity or the resources to be able to do that. So I think we really had to Define and redefine care in what it looks like for different communities for different intersections, even the kind of identity I come from. 

Again, I think going back to what we were saying earlier that when we’re looking at care it’s not only just making meaning of how I look after myself emotionally or even physically. It’s even things that how I continue to carry on my connections with others, how I choose to respond when there is stigma or discrimination around, how I choose to self educate myself with regards to what is.going on around, how I choose to consume content with regards to what is going on. I mean everything that is happening, right? 

So I think we have sort of been, even through iCALL, really having the conversation with different people about what c are means to them and what is the importance of having this personalized care routine, or engaging in self care. I think a very interesting thing we also focus on is, see, in a way the healthcare system is also talking about self-care. Right now, more than ever, the focus is on how is it that you identify your own sentence? How is it that you pay attention to what you’re feeling physically, how is it that you sort of go on to maybe recognize those symptoms in yourself and go on to seek care for yourself? So making people more self-aware and making people take responsible for their own care. 

I think we’re hearing messages about self-care not only from friends, loved ones may be your therapist or maybe the communities that we live in, but I think people now are more in-charge or have been put in-charge of focusing on their own well-being of focusing on their own health. 

I mean even messages related to cleanliness or sort of your physical workout, or having the kind of food that is important for you. I would look at all of that as self-care, you know, because it’s not only curative but it’s also preventive and it’s very difficult to sort of balance both of those things because if you don’t to enough of either of them, it could lead to new experiences distress. 

Aparna: But I think while taking care of oneself, I think we at iCALL are being mindful of what resources are available to people in terms of taking care of themselves. When you ask social distancing to household where there are 15 people staying in a small room, one has to be very very careful what measures of self-care do you suggest also. Number two, self-care is also linked with the power that you have. For example, if you ask somebody to stick to the routine, but if you ask a woman who is already continuing with the routine for 20 hours and working for others, self-care has to be different for this woman. Then, self-care has to be for this woman to take some time for herself that is self care, and not just do the routine. So I think adaptations of self-care is also extremely important. We also have to include safety as well as keeping oneself emotionally, internally safe in terms of suicide, self-care or self-harm or distress.  And also interpersonally safe in terms of violence or some kind of discrimination. So I think all of that is self care,. We’re also telling people, please be grateful. I think Covid-19 has brought in goodness, but it has also brought in not so good picture of human nature also. 

I feel that the privileged unfortunately sometimes don’t understand what the privileges are. So it’s time to be grateful about the privileges one enjoys. At the macro level, I say, and by macro I mean at a community level, at the governmental level,  or at the health response level, I just want to say two or three things.  One, if you look at the WHO definition of mental health, it’s not an individualistic definition. It says optimal utilization of your potential but balanced by notions of justice and connection and societal balance or societal kind of a non-discrimination. So I think we need to aspire for that mental health, is first. Second, care has to be integrated. I t cannot be just taking care of your mental health. Again, people require jobs, people require livelihood, people require ration, people require safety from domestic violence. I think care has to include all of that. And that is why we are trying to do that at iCALL. 

Another thing is self care and caring for others is not antithetical. You can do both. Yeah, and you need to balance both right now. Just a few advantages that I wanted to talk about in terms of caring for others and community. One is I think all psychology shows that if you care for others the reward pathways get clicked in your brain and they lead to a warm glow of psycho-sociality in you and I think two other advantages is: psychology shows that if you care for others, if you help other people regulate their emotions, it helps you regulate your emotions. Particularly people who are facing anxiety and depression, research shows that there is a lot of self preoccupation, not self-centeredness, self preoccupation.  At that time, if you actually focus on others pain, it helps you manage your attention and your emotions and it gains another perspective. So there are actual definitions and actual evidence to show that if you’re depressed, get out of yourself self preoccupation. Easy for me to say, not easy to do, I understand? But if you push yourself it is beneficial to you. Right now, all of us are living in virtual bubbles. My clients are telling me that I was dreading lockdown, now I’m dreading lifting of lockdown because I’ve lost life skills. I don’t know how to talk to people. I don’t know whether I’d be able to drive. I don’t know whether I’ll be able to walk. 

So please start connecting right now to build your real muscle and let the virtual bubble shrink. That is why also connections are important and there is already research to show that power of gratitude and power of happiness, and all of these are contagious emotions. So if we can do that. Last but not the least, balance self-care with others. If you don’t do that, it may create its own set of problems.

Outro: If you or someone you know needs support or to access help, reach out to iCALL on their special Covid-19 helpline: 915 298 7820. They are available from Monday to Saturday from 10am to 6pm. 

You can also visit the resource page on our website www.thecuriocitycollective.org for details of organisations you can support who are working with vulnerable groups.

In our next episode, one of TCCs co-founders, Arpita, will examine what being quiet in the time of Covid-19 lockdowns has evoked, how it connects us to the planet, and what choices we can make when we remerge into the world.