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The Hindu
19-06-2025
- Health
- The Hindu
Behind the maligned Muyalagan
Recently, I visited the bronze gallery at the Government Museum in Chennai. It consists of three floors, and houses of some of India's most exquisite ancient sculptures. The mezzanine is almost entirely devoted to bronzes of Nataraja, the dancing form of Lord Shiva. Sometimes referred to as 'the thief who stole my heart', on my visit it was not Nataraja who caught my attention but Apasmara, the figure upon whom the Lord stands. It is he who stole my heart. Depicted across the centuries in a variety of 'trampled poses', sculptors have almost always had him point at the viewer — his direct gaze seeming to say something. This pitiable figure led me down a rabbit hole of reading, to explore his symbolic role in the grand iconography of the lord of dance. Understanding Apasmara Apasmara is the name given to the figure in iconographic texts. It combines the words smara, meaning memory, and apa, the negation of it — together meaning forgetfulness. Forgetting is a common human lapse, so why was it depicted as something trampled underfoot? The metaphor's gravity intensified when I learned that in Tamil, Apasmara is called Muyalagan, which translates to epilepsy. In Ayurveda, I discover, the word is described as 'a psychosomatic disorder involving memory, intellect and mind, and present with cardinal features such as transient loss of memory, abnormal movements of body and blackouts'.Ayurvedic texts list it among the eight mahagadas or most dreadful diseases. This deepened my confusion. Did a neuropsychiatric imbalance truly deserve such harsh treatment? Apasmara is also said to represent ignorance, arrogance, abnormal movement, spiritual inertia, delusion, attachment to the material world, and ego. These symbolic meanings invited deeper reflection, especially on how the law treated mental imbalance. What the law says The legal framework governing mental health in India is currently defined by The Mental Healthcare Act, 2017, which replaced the Mental Health Act of 1987. The addition of 'care' in the title signals a shift towards supporting individuals needing mental health support. This change was influenced by India's ratification of the Convention on the Rights of Persons with Disabilities and its Optional Protocol in 2007, which came into force on May 3, 2008. Section 2(1)(s) of the 2017 Act defines mental illness as 'a substantial disorder of thinking, mood, perception, orientation or memory that grossly impairs judgment, behaviour, capacity to recognise reality or ability to meet the ordinary demands of life, mental conditions associated with the abuse of alcohol and drugs'. It excludes mental retardation, described as 'a condition of arrested or incomplete development of mind of a person, specially characterised by subnormality of intelligence'. Given the complexity of human behaviour, how does one apply this broad definition? Section 3 states 'nationally or internationally accepted medical standards (including the latest edition of the International Classification of Disease of the World Health Organisation) as may be notified by the Central Government' to be the determinant factors of mental illness. The Act clarifies that a person's background, or non-conformity with prevailing social, moral, cultural, work-related, political, or religious norms cannot qualify as grounds for diagnosis. Unclear standards More than eight years after the Act's passage, the Central Government is yet to notify specific criteria for determining mental illness. When questioned in the Rajya Sabha, the government cited health as a state subject, sidestepping its obligation under Section 3 to refer to internationally accepted medical standards, specifically those set by the World Health Organization (WHO), for defining and diagnosing mental illness. The WHO's Comprehensive Mental Health Action Plan 2013-2030 defines mental disorders broadly: depression, bipolar disorder, schizophrenia, anxiety, dementia, substance use disorders, intellectual disabilities, and developmental or behavioural disorders like autism and epilepsy. It highlights the concept of vulnerable groups — individuals or groups made vulnerable by their social, economic, or environmental circumstances. These include households living in poverty, people with chronic illnesses, maltreated children, adolescents exposed to substance use, minority and indigenous populations, the elderly, those facing discrimination or human rights abuses, LGBTQIA+ persons, prisoners, and individuals affected by conflict, natural disasters, or other humanitarian emergencies. This expansive definition is worrying as the 2017 Act provides no definite criteria of determining who may avail of the legislation's benefits, leaving the decision to psychiatrists or nominated representatives. The strengths and gaps The 2017 Act empowers those with mental illness, allowing advance directives on care and treatment preferences and easing access to medical establishments. However, these directives don't extend to matters concerning property. When it comes to legal rights over actions and property, 'person of unsound mind' remains a key term. While Indian law has long provided safeguards for such individuals, courts hold that not all mental illnesses qualify; 'legal insanity'refers to a condition when 'the cognitive faculty must be so destroyed as to render one incapable of knowing the nature of his act or that what he is doing is wrong or contrary to law.' The ambiguity is concerning because some provisions could restrict fundamental liberties, such as forced admission to mental health facilities, or may be misused to evade responsibility. I sought to understand how law and the Lord view mental instability. The 2017 Act discourages segregation, promoting integration into mainstream society. Yet the Nataraja iconography draws a stark contrast between the poised deity and the unstable Muyalagan. This separation is literal — Muyalagan is crushed underfoot. But if the intent is control over instability, wouldn't the Lord have held Apasmara gently in his hand? Control is distinct from conquest. If Apasmara stands for arrogance, isn't arrogance often a prelude to justice? If he represents ignorance, does not ignorance precede wisdom? If he signifies inertia, is movement not born from stillness? And if he embodies ego, isn't it needed to appreciate humility? If Apasmara is not a demon to be destroyed but a metaphor for a mental state, then does the iconography of Nataraja risk making him the much-maligned Muyalagan? The Bengaluru-based writer is an author and curator, and a lawyer by profession.
Mint
05-05-2025
- Health
- Mint
Not many claim mental healthcare insurance. Here's why
Mental health, after years of being overlooked in India's healthcare discourse, is finally beginning to receive the attention it needs. A major milestone in this shift was the introduction of the Mental Healthcare Act (MHCA), 2017, which came into force on 7 July 2018, replacing the outdated Mental Health Act of 1987. This Act redefined the rights of individuals with mental illnesses and made it mandatory for health insurance policies to include mental health coverage. In individual policies, psychiatric ailments are covered by default as all policies need to be compliant with relevant regulations. However, despite this legislation, a significant gap remains between policy and its implementation. Many employees are still hesitant to use mental health support at work because they are afraid of being judged or looked down upon. While some insurers impose a sub-limit on psychiatric ailments depending on the chosen plan, there are policies that cover these conditions up to the full sum insured. This contrasts with group policies, which are tailored specifically to the needs of the group. The coverage and sub-limits for group plans are determined by various factors, including budgetary provisions for health insurance, making them more flexible yet potentially less comprehensive than individual plans. With the usual age of onset of mental ailments being around 18 years, the incidence peaks at around 40 years, thereby affecting the most productive years of human life. In India, the incidence rate of common mental disorders like depressive disorders has been around 2.7 %, with a treatment gap rate of close to 85 %. This highlights the huge burden of the disease and the fact that only a very small percentage of the affected seek medical advice or have access to quality health care. Interestingly, even though mental illness-related claims for corporate employees account for less than 1% of total claims, there has been a notable 20% increase compared to last year. The most commonly reported mental health conditions include autistic disorder, conversion disorder with seizures or convulsions, unspecified anxiety disorder, phobic anxiety disorders, and depressive episodes are notable conditions. Remarkably, the top three disorders have experienced a 100% increase, which can be attributed to enhanced corporate insurance coverage and a growing willingness among employees to seek help. Although the Mental Health Act of 2017 has made it compulsory to make provisions for mental illnesses in health insurance policies, several factors continue to limit the benefits. Taboo still surrounds mental illnesses, deterring people from openly discussing or addressing their issues. Lack of awareness about early symptoms further prevents timely intervention. Even when policies do provide coverage, many come with sub-limits as low as ₹ 30,000, which makes treatment unaffordable in many cases. Also, several policies do not offer OPD cover—which is mostly the primary mode of treatment for conditions such as stress, anxiety, and depression. We have seen some progress over the years though. In 2023, the number of organisations covering psychiatric inpatient care (IPD) increased by 5%. However, psychiatric OPD coverage remains limited to just 7% of employers. Industries such as IT/ITES, manufacturing, and BFSI are leading the way, offering up to 50% of the sum insured for inpatient care and up to ₹ 25,000 for outpatient care. Another important step has been recognising substance abuse and alcohol addiction as mental health issues, so they get the proper care they need. Also, the new law (Bharatiya Nyaya Sanhita) has now fully put into effect the rule that decriminalises attempted suicide, which is another big move forward. Given the impact of mental well-being on workplace productivity and employee health, it is crucial that organisations treat mental health as a priority. Employees should be encouraged to talk about their struggles rather than suffer in silence, and access to professional help must be made seamless. Employers can play a pivotal role by organising mental health awareness sessions, investing in comprehensive insurance policies that cover both OPD and hospitalisation, and ensuring the confidentiality of employees seeking support. Expert-led training programmes, webinars, and seminars play a key role in addressing mental health challenges and breaking the stigma of mental illnesses at workplace. Additionally, with internal communication modes at firms to share mental health resources available, awareness drives, and most importantly, employee success stories can help in building a more informed and supportive workplace culture. Not only corporates, insurance brokers, too, have a significant part to play when it comes to mental health. With their knowledge of industry trends and available options, brokers are positioned in a unique way to help employers design customised and budget-friendly policies that provide sufficient mental health coverage. With their expertise, they can identify and address the disconnect between available solutions and employees' real requirements. The conversation around mental health in the workplace has begun—but it's time to turn awareness into action. By addressing stigma, increasing access to treatment, and providing better insurance support, Indian workplaces can build a culture where mental health is valued as much as physical health. The road ahead demands collective effort—from employers, policymakers, and employees—to create a supportive ecosystem for mental health at work. (Surinder Bhagat is head – employee benefits, vice president, large account practice, Prudent Insurance Brokers)
