How to Take Care of Pakistan’s Mentally Ill

Irum Sarfaraz

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If one was to analyze the worst of all afflictions of the Pakistani society, then mental illnesses and the stigmas attached to it would, in all probability, top the list.

Perhaps not so much for the actual damage they render to the suffering individual but for the other spin-off consequences that result as a direct cause of mental problems. The shame associated with mental illness, even if just depression, permeates every class of the society indiscriminately and the women are the worst casualties of it.

Estimates put the figure of the total mentally ill at 14 million and the larger percentage of this is women. They suffer gravely if it is their husbands or other family members who are suffering from the mental illness and they suffer even more if they themselves are ensnared in it. One can understand the reasons for the ‘shame and dishonor’ it entails for the uneducated rural masses but to realize that the same level of degradation is associated with any form of mental illness in the urbanites as well seems unfathomable. But it is nevertheless, sadly true.

Though it is a fact that there is a dearth of help for the mentally ill in the country, it is also a fact that unless the ignominy associated with it is eliminated, no amount of help can actually ameliorate the crisis. According to Lahore’s University of Health Sciences Vice-Chancellor Malik Hussain Mubashir Pakistan has only one psychiatrist for every 10,000 people, one child psychiatrist for four million children who are estimated to be suffering from mental-health issues, only four major psychiatric hospitals in a country of 165 million and only 20 such units attached to teaching hospitals. Pathetic indeed but again, people’s outlook of mental illness needs to be changed before they can actually avail any treatment facilities in the country even if these facilities and doctors were made available.

Assuming that there are didactic steps being taken by the government to enlighten the public obviously they aren’t doing any good because Allama Iqbal Medical College’s Ijaz Haider reported at a seminar to mark World Health Day in October, 2007 that mental illness had actually increased from 6 to 9 percent in the country. Untreated depression is leading to a rise in the suicide rates as well. Pakistan Association for Mental Health reports 44 percent of clinically depressed women, the prime reason for their condition being socio-economic factors. In 2006 alone the 1717 cases of suicide are evidence of the extent of desperation and depression amidst the population. Murad Khan of the Agha Khan University in Karachi in his paper in the Journal of the Pakistan Medical Association in 2006 also confirmed that suicide has become a major public health problem in Pakistan over the past few years.

Some of the ways with which the problem can be solved would include mass public education about the issue and also by some major campaign to undermine the ‘credibility’ of the ‘jinn’ factor. If one was to assess the situation objectively it would be unambiguous that the escalating rate of mental problems in the country correlates directly with the equally fast ‘mushrooming’ emergence of the ‘aamils’ and ‘peers’ in the country. Every nook, cranny and corner of even the major cities are crammed with these ‘jali’ peers who are eroding the mindset of the population and exploiting their fear of public knowledge of any mental illness in the family. No doubt the ones who suffer the most are the mentally ill who direly and seriously need help but depend instead, secretively and uselessly, on the potions and taveez of these top-notch thugs. Over time not only does the mental illness gets worse but the ones around the individual also start to suffer, and in many instances, themselves become in need for treatment, mostly for clinical depression.

According to a new poll done by a Hong Kong’s family advocacy group depression is a very common problem among the family caretakers of the mentally ill. The best suggested response for such depression is to see a doctor for, in most instances, Cognitive Behavioral Therapy and medications. But in Pakistan that would be a fool’s dream. We will be lucky if ones who are really ill can get the help they need let alone the family members who suffer along with him or her. The poll was carried out from June to September 2007 by a Hong Kong alliance promoting mental health policy and interviewed 113 people and found 70 of them to be depressed, some very seriously. Patients’ rights activist Pang Hung-Cheong of the Society for Community Organization stated that the results of the poll showed that family members who live with the mentally unstable patients are under worse pressure than the ones who are living apart. With over 85% of Pakistani families living in the joint family system, the rising rate of mental illnesses can be easily understood; for every one undiagnosed, untreated mentally ill person in the country we will probably end up with three or more who become sick because of him.

The larger percentage of the mentally ill being women is also due to the fear that once any such disease, even minor depression, is diagnosed in a girl she will be labeled ‘pagal’ for life and no one will marry her. True that the same would apply to the males as well but call it another tragedy of our social system that the boys and men are liable to get away with anything, even murder in the name of honor. What aggravates the situation for the girl is the frantic need of the Pakistani family to get their daughter married off hence forcing parents to turn a blind eye to her mental illness lest any label of ‘pagal’ will avert potential suitors. The results are way more tragic because even when the girl is married off, she is unable to cope with the demands of her new life and ends up in a worse mess than she would have faced at her parents home. If she had been treated she would at least become a happy and healthy functional part of society even if unmarried. But married off with a sick state of mind her life spirals out of control. In most instances she returns to her parents divorced and with two pitiful labels for a girl in Pakistan; pagal and talaq-yafta. This is not a hypothesized situation but sorrowfully a very true incident.

Considering the current love affair of our citizenry with the television, one solution would be to advertise just as fervently about mental health issues as we have started doing about family planning issues in recent years and to have more writers bring in this theme as part of the dramas that the women particularly love to watch. People need to understand and recognize the signs of depression in themselves and in the ones around them. They need to realize that it is a disease just like any other disease and has cures just like most other diseases. They need to understand that a healthy mental state will lead to a healthy home and will them the stamina to deal with the stresses of life and relationships. They need to learn to shed the humiliation and discredit that our society so religiously slaps on the mentally ill. And last but not least, they need to understand the guile and fraud of the ‘pirs’ and ‘aamils’. The poor working women who come to work at the homes of the more educated should be talked to by the begums as well. These less fortunate don’t have access to education and proper health facilities but they do interact with other educated women who can take a few minutes of their time to talk to these poor women about the stark reality of mental illnesses. Sometimes all these poor women want is someone to talk to and someone to lighten their heart with. If talking your heart out to someone was no solution, the shop of the psychiatrist would not be so ‘garam’ at all…!!! Needless to say, the problem won’t go away over night but a journey of a thousand miles…..