“I guess I knew my car would not fit. But it was so hot, I couldn’t just sit there anymore. I tried to squeeze my car into the gap between a bus and a bike and ended up hitting the bus,” Subhash recalls. Then he had a verbal spat with the bus driver, despite knowing it was his own fault. While Sarkar got away with minor scrapes, the incident got him thinking about his mental health. “It was like I had a panic attack, but I also felt very angry. It felt like my brain had melted,” Sarkar says, adding he has no history of mental health or anger issues. Subhash has since sought psychiatric help. In the throes of an unprecedented heatwave in India, people like Sarkar might be facing new challenges. While heat deaths are an annual reality, one look at the impact of heatwaves on mental health in India indicates the problem is not just skin deep.

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Too hot to live?

The onset of an early heatwave with 33°C being the average temperature this March made it the hottest March since 1901 in India. By April, temperatures had touched 46°C in states like Rajasthan. The record-breaking heat has caused an increase in heat strokes. In Maharashtra alone, 25 heat stroke deaths were recorded, but experts feel there’s a serious under-reporting of heat stroke deaths.

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Crop failure and agrarian losses due to the heatwave are known to cause farmer suicides in India. A 2017 study of the linkage between ann-ual farmer suicides and climatic conditions by Tamma Carleton from Berkeley University found that in India, the rate of farmer suicides increased in the hottest months, as high temperatures brought on crop failures. The problem has been particularly acute in regions like Vidarbha, Maharashtra. This year, the heatwave even affected farmers in Punjab that is known for its agrarian bounty. “This is the first time Punjab has reported heatwave-driven suicides. The heatwave severely damaged the wheat harvest, and many farmers who depended on it chose to take their lives,” says Mansa-based agrarian activist Kiran Kaur. In 2016, Kaur’s fat-her killed himself because he was unable to clear his debt following failure of his cotton crop. Kaur has since been working with families of farmer suicide victims in Punjab. “I wanted to understand what reasons can drive a person to end it all. In most of these cases, there is little understanding of why they do it,” she adds. Kaur says while heatwave-driven farmer suicides may soon become common in India, the authorities are yet to recognise the problem. “The NCIB (National Crime Investigation Bureau) stopped recording farmer suicide data. There is no real data or introspection as to why these suicides happen. Many times, these are not even recorded as suicide,” Kaur tells Outlook.

The physical impact of heatwaves includes deh-ydration and heat strokes that add to prolonged physical and mental ill health of farmers and daily wage workers. “Heatwaves can cause dehydration due to the intensive sweating and a fall in blood pressure. When both happen together due to prolonged exposure, we call it a heat stroke. If acute and untreated, it can even cause death or long-term health impairments that add to the economic burden of vulnerable sections like daily-wage labourers,” says Dr Rakshit Garg, Senior Medical Officer at Lok Nayak Hospital, Delhi.

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Hot-headed mess

Intense heat does not affect the body in a vacuum but creates a cyclical chain of harm that hampers physical, mental and social well-being. According to a 2021 study titled, Correlating Heatwaves and Relative Humidity with Suicide, heat can have detrimental effects on mental health. Studies show that with every 1°C rise in temperature, there is a 2.2 per cent increase in mental health-related mortality and a 0.9 per cent inc-rease in mental health-related morbidity.

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Psychiatric and mental health institutions across India this year have noted a spike in rel-apse cases of manic phase bipolar disorder and acute psychosis, as reported by Down To Earth in April. One cause of such relapse is the way heat affects the intake and impact of medicines administered to counteract symptoms of mental health disorders, Dr Basudeb Das of Central Institute of Psychiatry, Ranchi, explains. Such medicines can inhibit the body’s natural ability to adapt to extreme temperatures. For instance, severe heat can cause problems in bipolar pat-ients who require lithium medicine doses. As lithium causes sweating and dehydration, pat-ients stop or reduce the medicine’s intake. In summer, excess lithium without enough water intake can cause lithium poisoning or a low dose can cause a relapse.

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As per data, mentally ill persons are three times more likely to die due to heatwaves. Das confirms that patients report increased relapse of manic episodes or behavioural disorders, and schizophrenic tendencies in summer. Further, intense heat can lead to a biochemical reaction and cause ‘heat stress’ that can stimulate liminal mental health symptoms and disorders like depression, anxiety, and post-traumatic stress disorder (PTSD). According to Dr Nimesh Desai, former Director of Institute of Human Behaviour & Allied Sciences in Delhi, much like the seasonal affective disorders in European countries (winter depression), tropical and temperate climates exp-erience the reverse of these disorders in ext-reme heat. “It can increase irritability, anxiety, mood disorders, and may lead to micro and macro aggressions such as road rage,” he adds.

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Heat-induced aggression and its impact on law and order has long been a subject of study. In 2011, researchers C.A. Anderson and M. DeLisi studied FBI records and found a positive correlation between heat and a spike in violent crimes such as homicide, assault and domestic abuse. Researchers have now linked climate change to violent personality types. Heat, however, does not discriminate between the criminal and the cop. In 1994, researchers divided 38 Dutch policemen into two groups and put them in lab-controlled burglary simulations with varying temperatures to study their reaction under stressful conditions while being armed. The study found that 85 per cent of the cops in the warmer room were likely to perceive the aggressor as hostile and pull out their firearms as opp-osed to 59 per cent in the cooler room.

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Assessing the impact of heatwaves on mental health in India is not simple. In a deeply stratified society, the experience of heatwaves is subjective to class, caste and gender. For ins-tance, in Rajasthan, one of the hottest states in India, women have to lug water over long distances every day to run the household. With global warming predicting hotter summers to come, these socio-economic gaps are only set to become more glaring.

(This appeared in the print edition as "It’s All In The Head")

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