By Zubeida Mustafa
IN a society where mental illness carries a stigma and is shrouded in superstitious beliefs, the Pakistan Association for Mental Health (PAMH) has done a creditable job of spreading some public awareness about disorders of the mind.
However, that is not enough. Even if a person’s problem is diagnosed, then what? Treatment is expensive. Psychiatrists are few in number in proportion to the sufferers.
There is little government support for this branch of healthcare as is evident from the Sindh government’s indifference towards its responsibility of drawing up the Mental Health Act to replace the Ordinance of 2001 and frame rules to implement it.
In the absence of an infrastructure for treatment, the patient is left to his own devices to treat his problem. How well or badly he fares depends on the support he receives from his family, the professional calibre of his healthcare giver and, as is the norm in Pakistan, his economic capacity to pay for his treatment.
As can be expected there are more and more people falling prey to the dark demons of the mind that refuse to be pacified as the situation in the country deteriorates. The growing number of suicides is a clear indicator of the dismal state of mental health in Pakistan.
Prof Haroon Ahmed, the senior-most psychiatrist in Pakistan today and the president of the PAMH, agreed to talk about the state of mental health in the country with special reference to depression which has been termed as a global crisis. It has been selected as the theme for the Mental Health Day today. Dr Haroon reminds me that the PAMH has observed the day without fail for a full two decades.
He confirms that depression has been on the rise. His has been an uphill battle all these years because Pakistan has never been a country where the environment is conducive to mental wellbeing and a sense of security.
Previously it meant most cases (70 per cent) he saw were people who were predisposed towards depression due to their genetic makeup, a family history and biochemical dysfunction. If diagnosed early they could be helped by being given anti-depressants.
The other cases which Prof Haroon describes as “normal depression”, are those related to external causes — a life event such as bereavement, loss of job, marital discord or failure in exams. One gets over an emotional experience of this kind in due course — sometimes with a helping hand.
What is disturbing is that one can no longer attribute most cases of depression to biochemical malfunctioning. Personal loss and environmental factors are today the major cause of depression. The ratio between the two categories has been reversed.
More people are now depressed because of the socioeconomic conditions: shrinking employment opportunities, loss of job, insecurity caused by violence and crime and physical hardships caused by the breakdown of governance. These factors lead to anxiety. An excess of anxiety actually has a negative impact on a person’s capacity to function. He shows symptoms such as feeling low, forgetfulness and lack of interest in his surroundings.
A survey conducted by the PAMH found that one in every four households had a member who was suffering from depression and needed help. Sometimes the depression is masked and its symptoms manifest themselves in other ways. The problem with such depression is that it requires the root causes to be addressed.
Psychiatrists cannot be expected to resolve the myriad problems that beset this country, unemployment and unbridled violence being the ones having the gravest impact on mental health.
Hence they try to give hope to their patients and counsel them on how to cope in these difficult times, while advising them to seek the company of their friends. Forming networks of support groups is another suggestion that is widely given. Prof Haroon feels sharing of one’s concerns and organising collective activities are the best therapy for depression induced by socioeconomic conditions beyond people’s control.
In Pakistan a redeeming factor could have been an inspiring leadership that showed the people the light at the end of the tunnel. But that too is missing. Its own role in creating instability in the country has been gargantuan. Small wonder the state of mental health is so dismal here and the leaders are held responsible for failing to rectify the mess. They have not been at the forefront in times of crisis.
A country without an inspiring leader is bad enough for the state of the mental health of its citizens. Contributing in equal measure to the spread of instability and anxiety is a juvenile electronic media that has still to mature. It serves to magnify and intensify news in an attempt to sensationalise it. It is shocking that this is being done in the name of freedom of information when actually what is at stake is profiteering.
The television channels fail to realise the damage they inflict on the mental health of viewers, especially children, by their irresponsible and graphic projection of images of death and destruction, violence and suffering.
The need is for people to rediscover some of the socio-cultural values that provided them strength in yesteryear. Instead of sitting in silence with their eyes glued to the television screen, families and friends would do better to revert to the time-honoured tradition of cultivating the art of conversation and sharing their fears and anxiety to reinforce their inner resilience.