How to Take Care of Pakistan’s Mentally Ill

Posted on February 6, 2008
Filed Under >Irum Sarfaraz, Society
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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…..

14 Comments on “How to Take Care of Pakistan’s Mentally Ill”

  1. February 7th, 2008 1:07 am

    Very informative post about a very serious problem from which our society is suffering badly. The peoples in our society espeically in rural areas, majorely, are against the women education especially about their own problems. I’ve saw many cases, in which minor dieseas caused serious problem due to traditional (desi) null or incomplete treatment.
    It’s true to some extent, that our society, is also suffering from ‘aamils’ and ‘pirs’, who for the sake of money, try to taunt and hurt peoples especially women. And this bad thing was also done by the women too, mostly some relative of some girl due to bias or some other factor.
    Your suggestion are appreciateable and we all, especially men take care of their problems and understand them.

  2. Rafay Kashmiri says:
    February 7th, 2008 1:41 am

    Irum Sarfraz,

    Taboo-subject, Pakistani institution’s references might
    have some doubts, with their figures.
    I don’t consider them reliable, the Hospitals, Clinics,
    Colleges, Universities.
    Can we trust their estimations ? any recognized official
    survey approved by medical Board in Pakistan and not in
    USA or UK ?
    “44% women” gives me some doubts about “feminist”
    discriminations, politically based tussle between Freudians and antis, particularly Freudians urging launching a major campaign against ” jinn factors ” by ‘educating’ the masses
    to believe in imported material, so a jinn factor verses Sigmond Freud apparently a Human spicies, but
    of course, no “educated” master mind dares to approve the
    “jinn factor ” confirmed by Quran.
    Do I Need to mention here the qualifications of Freud in the field of psycology? Perhaps we should go back to our
    sub-conti socio-psychology ? I was told !by Germans.
    The social disorder in Pakistani mental health generally,
    should be proned into thru the follwoing:

    Genetic disorder-risk : marriages with first-cousins, same tribes, clans, zaat and ‘caste’.

    Wrong medicins, treatments, therapies and abuses of
    overdoses of heavey (experimental medicaments ?).

    Social changes imposed on Pakistani Eastern muslim
    environments. On the contrary, ancient social customs strange to “normal” muslim culture of Pakistan is the
    major current issue of enormous contradictions, these
    2000 years old “Hindu traditions” have been inherited
    while obtaining freedom.
    We have to get rid of them, and all of them.

    The transition from old joint family system has its bizare
    consequences, not knowing what to adopt ? we are systemacally brought towards single choice, the famous
    “be western, speak western, eat western, behave western ”
    obssesion. The cheap “American dream a la Pakistanaise”.

    And the Criminal absence of responsibility of ministry of health and allround social healthcare system which was
    one of the basic Islamic rights that all Pakistanis would
    have enjoyed, but then Pakistanis have non of those promised Islamic Rights.The seculars are simply not at all
    interested in social justice, The leftist failed 100 times,
    bla bla bla bla, even roti, Kapra aur Makan were confiscated
    by the same slogan-hurlers.

    No wonder your ” estimations” might shock many of us, but
    lets face the reality. My older sister is a Ph.d child psychologist from Swedish University, her thesis on psychoPakistan was revealing.

    Peers and Aamils are equally for Jahils and educated

  3. February 7th, 2008 2:52 am

    This article reminds me of an old lady scavenging for food amidst a war zone….

    who cares about this old lady in a war like this….

    I totally agree with the pagal-talaq-shuda-’syndrome’, ive seen first hand cases of such.

  4. temporal says:
    February 7th, 2008 3:17 am


    you wrote on a serious issue that is almost shoved under the rug

    agree with your assessment

    awareness should be highlighted

    and treatment should be made available

  5. Tina says:
    February 7th, 2008 9:54 am


    kudos for your courage in writing this kind of an article. I would point out that women make up the majority of mentally ill people in all countries in the world, including the States. However in countries where gender segregation is practiced the difference becomes remarkable. Whereas in the States a slight majority of mentally ill people are women (although women make up 70% to 80% of sufferers of certain disorders), in Saudi Arabia 95% of the inmates of asylums are women!

    A lot of work to do worldwide.

    I agree with the poster who states that family intermarriage inflames genetic tendencies to mental illness.

    Unfortunately, I too have witnessed both men and women married off to seriously mentally ill people, but it was hidden until the wedding was over. In one case the girl was married off to a man who had been diagnosed as bipolar in the States and his family even knew he was apt to be dangerous, so they brought him back to Pakistan to be married. On the other hand, I know of a couple of men who were married without their knowledge to very sick girls.

    I heard about, but did not know personally, a family who married off a son with Down’s syndrome to a girl without the knowledge of the girl, and the girl’s family was quieted with expensive household gifts.

    These cases go to show how much the attitudes need to change. It’s an uphill battle to be sure. I wonder if the answer will be what it is in America, to just flood the population with cheap antidpressant drugs and leave everyone stupefied into a “normal” state.

  6. Irum Sarfaraz says:
    February 7th, 2008 11:54 am

    I hear what you are saying Tina, but ironically there is not only a glut of anti-depressants in Pakistan but also no need for prescriptions to get them. The only problem is total lack of awareness. The mere mention of

  7. Tina says:
    February 7th, 2008 2:16 pm

    Hi Irum,

    I too understand your point, but anti-depressants are powerful drugs meant to alleviate the symptoms of clinical depression. In the case of situational or environmental caused depression they only mask the problem and they do not “cure” any depression. They are dangerous for pregnant and nursing mothers.

    The only “cure” for situational depression is the hard work of life change (difficult if you’re a woman in a traditional society).

    But like you say, you do what you have to do. You were probably right in your assessment; I hope your friends are doing well now.

    In the States they may as well be over the counter…everybody can get them. The average time in a doctor’s office to get a prescription is three minutes. So it’s pretty useless to crib about the pill situation in Pakistan when it is so bad in a first-world country (overuse and misuse of antibiotics is rife in the U.S. too, although, unlike in Pakistan, they are only available by prescription; hello superbugs!).

    There is no answer to this problem as long as families feel shame and are in “cover up” mode about every imperfection in their family member’s lives. It will just take time. It will change. It’s just the glacial pace of the change that is so frustrating.

  8. February 7th, 2008 3:07 pm


    What a brilliant post on such a vital issue. You have brought spotlight on a taboo subject. I do believe improved education for the masses is the answer and I hope the next government makes their numero uno priority.

    Keep up the good work



  9. Rafay Kashmiri says:
    February 7th, 2008 4:58 pm

    @Irum Sarfaraz,
    In Pakistan,
    the proportion of women, as compared to men is higher,
    but ofcourse the type of desease, depression, is it similar ?
    I mean intensity or symtoms, play any role in age-factor,?
    girl’s young age, then marriagable age, then marriage,
    kids, husband gives surprise or vise versa, but women,
    how do they assume such change of age factor e,g, after or
    during pragnancy, birth, time passes then comes menopaus
    which is around 40sh, what are pragnoses ? and always the
    same person, you don’t go back with age, you go farther,the
    problems of harmons, thiroides,testosterogens, oesterogene
    (man) I think in a humanbody all the organs functions
    similarly, but women have some different functioning with
    My query would be, do we have in Pakistan an stablished
    system or routine that the person in question is aware
    about the changes, is the word dipression known there,
    or even menopaus ? and of course their treatments, I
    remember already in 60s we were told to consume salt but
    with iode to balance thiroid etc etc

    What about mentally sick men & women, their treatment
    doses, side affects, cortizones expanding the muscles on
    your face.
    Ministry of Health is responsible to start a system
    like we have here in Europe very stable, helpfull e,g, pysichotics can marry another type with the desease.
    Pak Pagal Khana is it just like a musafirkhana ? or
    there people get treated regularly with all equipments,
    nurses,pychiatrist and pyschologist and gyno.
    Awareness is the key-word.

  10. Zeeshan says:
    February 14th, 2008 7:54 am

    Dear All,

    I have the true experience of having an ill person with in my family. I can very well understand the devastating effect on the patient and family. Above all the cure is so expensive that an ordinary person can

  11. Fatima M says:
    February 18th, 2008 10:14 am

    Dear Irum.

    I’m the editor of a soon to be published magazine. I was surfing the net for research on a mental illness article I needed. What a surprise to find an article that said everything I wanted to say and more! I would love to publish an article similar to this in my medical magazine. The magazine is an initiative for raising the standards of medical education and awareness. If you’re interested then do email me back.

    Take care. Awaiting your reply.

  12. Irum Sarfaraz says:
    February 18th, 2008 12:33 pm

    I hear what you are saying. I would suggest you look into homeopathic medicines as they can prove to be a wonderful alternative not only cost wise but with lesser side effects than the others. With chronic mental illness, the side effects are just as, if not more, dangerous than the illness itself. My father is pyschologist/homeopathic doctor and he terms neurotic medicines nothing but ‘poison’. I have first hand experience with a myriad of mentally ill people.

  13. Paul McMahon says:
    January 5th, 2009 2:26 am

    Hi, I would just like to say well done for highlighting the necessity of mental health in Pakistan, especially among women and girls. As a psychotherapist I have learned how the streses, environmental pressures & expectations of life can take its toll on the mind and body, we are limited after all.I have learned aslo how a safe trustful environment and practical cognitive and behaviour techniques taught not only to the client but to their loved ones can be a source of hope and healing. Ideally we need to make our young people and children aware of their mental health. Paul

  14. Watan Aziz says:
    July 14th, 2010 8:31 am

    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.

    And this is assuming you live in one of the major cities and have resources. For the rest of them, they have not even seen a health assistant in their lives! They would not know how to sit in a dental chair! Asprin, what is that?

    …undermine the ‘credibility’ of the ‘jinn’ factor. …

    Yes, there are jinns in Pakistan. Yes, they demand the three goats. And yes, they demand three goats heads if not the whole goats. Do you know why? I think that criminal and bogus pir was on to something. These jinns live in “I-slammed-everyone-else-abad”, Lahore and Karachi. These jinns have “possessed” the people of Pakistan by stealing the resources and by establishing non equitable distribution of nation’s wealth. They come and take whatever they want, whenever they want. All of it if they want.

    And btw, my lovely and sage wife has long considered me “pagal”. She tells me that I am wasting my time. They no one is interested in fixing anything. Everyone wants loot and “gahsoot”.

    She too may be right.

    Nothing will change. There is apathy.

    But me? I have audacity of hope. I have faith in the goodness of the majority of people of Pakistan. I have confidence in the hard working and honest people who have been sold the wrong bill of goods. Who have been mislead for decades by selling the wrong problem; presenting the wrong solutions.

    If only the educated of Pakistan will come around and fix the mess; we broke it, we need to fix it.

    I have audacity of hope with fierce urgency of now.

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