Price of mental disorientation

By Zubeida Mustafa
Source: Dawn

OCTOBER 2 was observed as mental health day (instead of October 10 on account of Ramazan). As in previous years, the Pakistan Association for Mental Health (PAMH) used the occasion to create awareness about an important area of human health.

This year it decided not to hold a free camp as has been the past practice because it is running a free clinic round the year. The Association instead decided to focus exclusively on creating awareness and informed advocacy to remove the stigma that marks mental illness.

Hence, a walk was held which was a success in that 500 or so people participated and one hopes many more noted the messages on the banners. The key one was, “No health without mental health”. Later a seminar with specialists and physicians was held to sensitize and orientate specialists and general physicians towards mental illness, especially psychosomatic illnesses.

The afternoon saw an interactive session with the families of patients. But the stigma factor was clearly visible in the last session when not many people turned up to avail of this excellent opportunity to learn more about the illness which affects not just one person but throws its dark shadow on the lives of all family members. The meeting was also designed to brief the caregivers on how to handle their patient. Hats off to two patients of depression who turned up and were willing to talk about their problem.

Although the association has, since it started functioning in 1966, been playing an active role in creating awareness and understanding of mental health and illness, it still has a long way to go. The stigma is so strong that in spite of a general understanding that mental illness is like any physical illness, people find it difficult to come to terms with it. Many people, including the educated ones, still believe that mental illness is caused by “evil spirits” taking over a person. Hence, in their opinion the cure lies in driving out these forces by seeking the help of faith healers and others.

It is sad that the widespread prevalence of mental illness is not recognized because families try to conceal it. Hence not enough has been done to provide patients the health care they need. According to Dr Haroon Ahmed, the president of the association, a Harvard and WHO study found that of the 10 illnesses that severely affect the quality of life of people, five are mental disorders. These are schizophrenia, bipolar disorders, obsessive compulsive disorders, depression and drug/alcohol dependence.

In Pakistan the prevalence of depression is as high as 44 per cent. It is unfortunate that Pakistan has barely 350 psychiatrists and 5,000 beds — only 3,000 in the public sector hospitals — for mentally ill people.

With the government gradually disengaging itself from the social sectors, the health delivery system has suffered badly and more so the mental health sector. PAMH says that health is no longer a medical issue. It has become a political and an economic one. It has never received the importance it deserves.

The theme set for the mental health day this year was “mental and physical health across the life span” which underscores the importance of mental and physical well-being of people of all ages. This theme emphasizes two very important dimensions of human health. First, the physical and mental (as well as emotional) health of a person are closely linked and need to be addressed in an integrated manner. This would explain how a physical disease can lead to mental stress and vice versa. It is generally known how terminal illnesses such as cancer and disorders such as diabetes can cause the patient as well as his family members to become depressive.

Secondly, it is important that a person’s health and well-being are taken care of at all stages of life. The health of an individual operates in a continuum from infancy, childhood, adolescence, youth, adulthood through old age. Poor health at any stage can affect the state of health in the subsequent phases of life.

Although it is now generally recognized that psychiatric disorders such as schizophrenia, bipolar disorders and some forms of depression are genetic in origin, a person’s experiences and his capacity to cope with stress determine the state of his mental health throughout life. Hence a lot of importance is attached to the home environment especially factors such as love, stability and security that help in the emotional development of a child.

Today experts believe that stress-related illnesses are on the rise. According to Dr Haroon Ahmed, stress produces two effects. First, those with mental illnesses, who have been cured/are being managed reasonably well, relapse into their earlier state. Secondly, stress can lead to psychosomatic illnesses since it breaks down the defence mechanisms of a person. As a result, the diseases he may contract might be purely physical in nature such as cancer, cardiac problems and so on, or it may be of a psychiatric nature such as depression.

Be that as it may, experts are unanimous on one basic issue. Stress is caused by environmental factors such as a volatile social climate, growing incidence of crime and violence, unemployment, political and economic instability, spiralling inflation, urbanization, exposure to television images of violence, war and crime, gross injustices in society and the breakdown of social networks have led to an increase in stress in the lives of people. Hence the escalation in the incidence of illness — both mental and physical. It is the sense of lack of control over one’s life that can be devastating for the psyche of a person.

Stress management has therefore become the key factor in promoting the mental and physical health of people, says Dr Haroon. The people’s inability to cope with stress has affected their own and their family’s well being. People are now trying to drown their stress using three means. There are those who choose to opt out by taking recourse to drugs, alcohol, cigarettes or other addictive substances.

Others become activists, creative (artists, poets, writers), and productive in their work. Still others — by far the largest group — turn to religiosity. They reconcile themselves to their qismat as the will of God. Rituals assume great importance since they derive peace of mind from performing ceremonial and sacramental rites that help them cope with a crisis in their life. In this state of mind, some of them easily lend themselves to indoctrination of the worst kind showing no compassion for other human beings.

A lot of this can be prevented if government and society are geared to the mental health needs of the people. This would mean that the orientation of the education system has to be changed to ensure that children and youth grow up to be emotionally and mentally adjusted individuals. The media, especially television, will have to reappraise its programmes from the point of view of the impact they make on the minds of children and the youth. There is need to provide women the security and esteem that are their rights as homemakers and caregivers.

Finally, the government will have to be more sensitive about the civic and social needs of the citizens. Poor and corrupt governance creates undue stress in the lives of ordinary people breaking down their defence mechanisms and leading to illnesses.

Worse still, it is transforming the psyche of the nation leading to the erosion of their social and cultural values. Has it ever occurred to us that the rise in intolerance in our people and their tendency to resort to violence on the slightest pretext are on account of the growing stress the people are exposed to?