Never too old for therapy: how middle-aged and older people are addressing mental health issues

In 2000, 62-year-old Lakshmi* was living with her husband, far away from her four children. She and her husband followed a set routine, almost like clockwork, when one day, she felt enveloped by a strange and overwhelming sadness.

She was listless, tired, and felt the need to be alone. As someone who welcomed guests in hordes, Lakshmi felt revulsed by household chores. She gave up cooking entirely and hardly ate. Her gentle husband, worried by the change in her behaviour, tried cajoling, and persuading her. Their children flew down from different corners of the world and were alarmed by the change in their mother’s demeanour–from a sprightly, talkative, helpful woman to one physically curled up in the corner of their home.

Years later, her grandson Aayush*, a student of clinical psychology, recounts what his grandmother went through, as told to him by his parents.

“My grandmother was clearly depressed. And this was diagnosed by a psychologist many years later. But at the time, no one was aware that she was depressed and needed help. So, they did what they thought was best–conducted a series of religious rituals, which they felt could make their mother better,” he says.

Lakshmi suffered for a few more years and did get better over a period when she opened to her family about her childhood trauma. But there was no question of seeking help from a doctor. Even a stray suggestion in that direction was dismissed by the family.

It’s 2023, and the perspective on mental health has not changed drastically, especially among older adults. When Neeraj*, a 50-year-old media professional confided in his father that he may be going through depression, he suggested that he take strength from religious texts to tide over the “bad time”.

Neeraj, who has always been open to the idea of therapy, says most people from his generation are still unwilling to do so. “I think if I post on my college group that I was going for therapy, they will probably pass it off as a joke--that they always knew I was “mental”,” he says.

“Currently, I am in therapy, and I hope this works out,” he adds.

Ritika Bhutani, Lead Clinical Psychologist and Supervisor at LISSUN, believes there is a lack of insight and understanding about mental health issues, particularly among older adults since they have been mostly exposed to the medical model of illness.

“Additionally, there is shame associated with reaching out at this age since they have grown up in a time when mental health issues were stigmatised, misunderstood, or not openly discussed,” she says.

Dr Neerja Aggarwal, Co-founder and Psychologist at Emoneeds, a mental health startup, says senior citizens often grapple with various mental health challenges, encompassing depression, anxiety disorders, and dementia. Depression may also emerge from factors like social isolation, physical health struggles, or the bereavement of loved ones, significantly influencing their general welfare and quality of life.

Dr Aarushi Dewan, a RCI licensed clinical psychologist, has older adults as patients, most of whom come through cross referrals from other doctors. The common diagnosis among these patients is geriatric depression. While she feels they understand and report experiencing stress, they are not aware of mental health disorders.

Seventy-year-old Ajit* decided to consult a clinical psychologist after his urologist asked him to. He was taking treatment for his physical co-morbidities and had gone into depression and lost 12 kg in two months.

“I was finding it difficult to get up from bed and follow my daily routine. My urologist suggested I speak to a therapist instead of a psychiatrist because I was already taking several medications for my physical ailment. Immediately, I started reading about therapy and the role of a clinical psychologist, and took an appointment at the hospital,” he says.

Ajit adds that if he was aware of therapy, he would have sought help 50 years ago as he has been experiencing extreme bouts of anxiety and restlessness for a long time.

“After talking to the clinical psychologist and understanding the process, I am hopeful that my symptoms of anxiety and constant overthinking will be relieved, and it will help in the recovery of my physical ailment too,” he adds.

There is awareness, but action takes time

Neeraj* admits being aware that something is wrong does not necessarily translate into action. It took him many years to seek therapy. He looked for therapists on his own, and a friend also shared a list. But somehow, he has not been able to stick to one because of various reasons.

“The first one contacted my wife without informing me to tell her what I was going through. A therapist I found on a random online platform came across as judgemental and there was another who didn’t seem to/try to understand what I was going through,” he shares.

Ambili*, a 50-year-old independent writer and researcher based in Kochi, approached a therapist at the suggestion of a friend. She had been feeling low, sad, and unable to get out of bed for some time.

“I thought that depression happened to other people, not me. I had seen a couple of friends who were on anti-depressants talk about side effects. However, my condition had reached such a point where therapy would work only if I consulted a psychiatrist,” she says.

She tried a couple of therapists–but one hardly gave her 20 minutes in a month and the other was dismissive of some of her symptoms.

On the insistence of her third therapist, she met a doctor and started treatment. Currently, she has tapered off medicines and continues with therapy.

“There are several exercises in therapy that have helped me. My therapist’s approach is very practical and understanding of my needs and comfort,” she adds.

The therapy approach

Dewan explains that therapy encompasses identifying one’s automatic negative thoughts stemming from the faulty schemas one holds (mental image, beliefs about themselves or others), which develops due to childhood experiences, family environment, parent’s attitude, and personal experiences.

“These schemas get rigid by the age of 18. Older adults show resistance to accept errors in their way of perceiving or interpreting the situation as they have lived that way all their life, so it takes more time to help them identify and modify their cognitive errors,” she says.

Bhutani says therapy with older adults, as with any age group, is typically highly individualised.

“Typically, with older clients, as a younger therapist, I feel it’s important to have a high regard for their life experiences since most of them take pride in that and like to talk about their younger selves. One must have an authentic, curious, and empathic approach towards older clients.”

Ashwini*, a 51-year-old journalist, says scepticism about the efficacy of therapy had perhaps slowed down her recovery process. She, however, took anti-depressants for close to 12 years.

“I have visited six therapists over a period of ten years, and it was terrible, reliving my trauma over and again. I read and researched about mental health too much, and this made me sceptical of every therapist I approached. Fortunately, I have been able to recognise my anxiety triggers and work on myself,” she says.

Towards mental well-being

Prajakta Harwande is a counselling psychologist at Khyaal, an agetech startup that delivers holistic care for the elderly by providing them with physical, mental, social, and financial support. 

“We offer emotional wellbeing sessions for our members in the form of workshops on selected topics. I present general topics on mental well-being, stress management, anger management, coping with grief and loss, etc. Over time, I have observed seniors speaking up, leading to a positive support group,” she says.

But Prajakta clarifies that she advises clinical intervention when a senior person needs it. “Since there is enough information available to them, they are open to this too,” she adds.

Neha*, a 76-year-old member of Khyaal, has benefitted from this “open” environment on mental health and well-being.

She attends Prajakta’s sessions regularly and says it has helped her to be calm and positive.

“I feel I am a quieter and a less anxious person now,” she says.

She also believes that people of her age group should be open to seeking help for mental health issues.

“If we have a fever, we go to the doctor, so why can’t we approach a mental health expert if we feel something is wrong with us mentally?” she asks.

Family support is key

Aggarwal reiterates that family support is paramount for older adults in therapy.

“Fostering open communication to discuss their therapy experiences and emotions creates a supportive and empathetic environment where older adults feel understood and valued. Importantly, staying informed about their therapy and mental health condition strengthens the process, leading to better outcomes,” she says.

Neeraj often discusses how he feels with his young son.

“The younger generation is more accepting and open about mental health issues and seeking help. I wish I had been this aware 20 years ago,” he says.

(*All names have been changed to protect their identities.)

(If you or someone close to you is facing mental health issues, you can contact the national 24x7 toll-free Mental Health Rehabilitation Helpline KIRAN at 1800-599-0019).