Doing more for mental health

By Zubeida Mustafa
Source: Dawn

Last week, the Pakistan Association for Mental Health (PAMH) observed the mental health week to coincide with the world mental health day on October 10 organized globally by the World Federation for Mental Health and WHO. This is an annual event.

Much as cynics might be tempted to brush it off as a ritual which has no impact, any discerning observer of the scene cannot fail to note the awareness which has been created in Pakistan, thanks to the endeavours of the PAMH.

True, the stigma attached to mental illness is still there. But mercifully, now more people than ever before know that just as physical diseases affect the body, mental illness affects the mind.

Similarly, there is a growing realization that just as physical ailments have to be treated if a person is to be cured, mental illnesses also require treatment. Moreover, it is now also understood that mental illness has an organic or biochemical cause.

This is an important breakthrough. Not long ago, even highly educated men and women stigmatized the mentally ill, viewing their illness as something shameful.

The unlettered believed the patient to be “possessed”. As a result, people who needed help – whether they were educated or illiterate – very often didn’t get it. Things are visibly changing.

Yet, a lot needs to be done as the high prevalence of mental illness in the country indicates. Nearly 10 per cent of the population suffers from severe mental illness, and if psychosomatic illnesses are added to the list, the figure jumps to 35 per cent.

Apart from the underlying causes, it is known that the social and cultural environment also exacerbates a person’s condition. Given the sense of insecurity created by rampant lawlessness, terrorism and crime the anxiety generated by economic problems and the fast pace of life, people are under tremendous pressure which makes them prone to stress-related and psychosomatic illnesses.

In fact, according to one medical expert, 40 to 50 per cent of the patients visiting a physician are actually suffering from some underlying mental stress which is giving rise to health problems. Medical science has conclusively established that stress exacerbates cardiac ailments, diabetes and problems of the digestive tract and kidneys.

The problem is pretty serious and the question to be asked is what do we do about it. The simple answer which health professionals, especially psychiatrists, have been suggesting (some of them for ages) is to increase mental health facilities in the country, create more awareness about mental illness, do away with the stigma at the social level, increase the course content of psychiatry (at present practically nil) in the medical curricula of the public sector medical schools, and, of course, implement the Mental Health Ordinance of 2001, which after a lot of foot-dragging replaced the Lunacy Act of 1912. All these are very important demands that need to be addressed immediately.

But there were other aspects of the mental health issue which came up at a very interesting seminar the PAMH organized in the course of this week. What clearly emerged from the discussion, in which there were quite a few health professionals, was that the doctors – specialists and GPs alike – have a very important role to play in alleviating people’s distress which they are not doing.

Dr Abdullah Mangi, a retired health planner and medical adviser to SESSI, pointed out that attitudes are formed early in life. A physician can shape his patients’ attitudes right from the start.

But for that he has to practise the science and the art of medicine. This requires a doctor to listen to his patient and besides writing a prescription also explain things to him and do some counselling.

Dr Mangi was of the opinion that doctors are only practising the science of medicine – dispensing prescriptions like “conveyor belt operators” – but the art of medicine has been taken over by quacks who exercise greater influence on their patients because they give them time and listen to them.

It was conceded at the seminar that some sympathetic hearing and talking by a doctor can cure more than half the ailment being suffered by the patient. In order to orient our doctors towards the art of medicine, Dr Mangi feels that medical ethics must be taught to medical students at the undergraduate level and paramedics, who have a closer interaction with patients, must be adequately trained.

Another important and sensible suggestion came from Dr Anwar Mangi, Dr Abdullah’s wife and a psychiatrist. She feels that a distinction must be made between mental illness, stress-related illnesses and emotional strains.

To remove the stigma, students in school should have courses on mental health in their classrooms. It was also suggested that our schools should have social workers and psychologists to counsel students when they are under stress and need to talk to a sympathetic adult.

This is important because a child cannot always talk to his parents, howsoever much they may claim to be his best friends. Sometimes a child may be having problems at home with a family member and may need to talk to an “outsider” who understands but will, at the same time, not betray his “secret”.

Some of the schools with fees touching the skies do have counsellors. But what do these worthies counsel their students about? They usually advise the youngsters about which would be the best American university to seek admission to, which would be the most lucrative subjects for them to study, how to do better in their examinations, and so on.

Not that students don’t need guidance on these issues, especially when the family and the society has charted out a course for them that will take them on the road of wealth and “success”.

But there are also many contradictions and conflicts a child has to come to grips with, and some sound and detached but sympathetic counselling from a person who understands children can do him or her a world of good.

Finally, the most important issue which was thrown up at the seminar and which calls for greater attention from people concerned about mental health as well as the welfare of the people.

It is the dichotomy in our society created by the contradictions in our speech and action. This creates severe stress. This is arguably a major cause of the malaise which is destroying our social fabric.

One has to acknowledge that to a large measure these contradictions are created by the role religion has been assigned in Pakistan. Maulana Ali Murtaza Zaidi, who teaches Islamic Studies to O-levels and Intermediate classes and was a participant in the seminar, made a very rational speech.

He admitted that there are people who are using Islam for political ends and undermining the credibility of religion in the process. He also pointed out that the liberals have allowed the religious leaders to gain ascendancy by attempting to sideline them in their discourse. Since our people are spiritually inclined, they turn to the religious leaders in the absence of an alternative, and not all the religious leaders are sincere.

This subject, especially the stress created by the Islam that is preached and the Islam that is practised, could have done with some further elucidation and discussion. But the maulana was in a hurry since he was getting late for his prayers and the delay was becoming stressful for him.

The seminar provided food for thought and as Dr Uzma Ambareen, the clinical director of PAMH’s mental health clinic and the coordinator of the seminar, pointed out that the stigma attached to mental illness causes more suffering than the illness itself and prevents patients from seeking help.