Seeking professional help to treat a psychological illness is no more unusual
SAHAR, 29, is unmarried, and her work is not rewarding enough. An adopted child, she found out in her mid-twenties that she is not a biological child of her parents. Her family does not understand her predicament. She has had bad experiences whenever she thought of getting married, which included being cheated on by a man, and a broken engagement. Her constant weight problem is a classic sign of depression. So is her smoking. She feels worthless, and envy gets the better of her when she sees girls her age settled down in marriage, with school going children, and their husbands paying their bills while Sahar struggles to maintain a reasonable lifestyle. Ask her how she’s feeling and you realize that under a self-assured surface is someone who is taking three different anti-psychotic drugs as tranquilizers. Her panic attacks are a routine. Her visits to a therapist are inevitable. And yes, this is a true story.
Prozac, shrinks, therapists, psychiatrists, counsellors, psychosomatic illnesses, manic depression, schizo, delusional, nafsiaati haspataal, mental health ... These words are oft heard these days in any course of conversation, be it at your hairdressers or your dentists, or a socialite evening. Or even at your work place. Urdu versions of the same words might even be uttered by your maid.
“Getting help” is a much more common phenomenon in Pakistan then it was even some five years ago. In a pre-dominantly conservative society like ours where talk of seeing a psychiatrist always conjured up visions of electric shocks used as a form of treatment, or images of an insane person sans clothes running on the streets while neighbourhood children trailed along teasingly, we are certainly coming of age. Though a majority would still prefer to keep this taboo topic undercover if they are seeing a shrink, the fact is that at the other end of the social see-saw we also have a growing majority who find talking about the therapist they are seeing as normal as names dropping. Not so long ago, a person would tell you to back off if you suggested to someone to go see a mental health expert. The common most reason for this seemed the pre-conceived affiliation of the word psychologist with the subliminal suggestion of insanity. Mujhe kya paagal samjha hai? Not so any more. Yes, we are on the brink of change.
What might have brought about this change? Are we, as a nation, more emotionally vulnerable, or are we simply more aware? The common most arguments are either in favour of psycho-therapy being a growing need, or against it. While a minuscule number feel the reason for this may be just because it is an “in” thing, a majority feel the growing stresses of life in the fast lane are responsible for it. It, therefore, is a genuine need of the day, also because new social problems are being discovered or re-invented each day. Awareness, on a positive note, is simply why we need therapy today.
Not so long ago, every mental ailment that re-surfaced in old age was attributed to “burhapa”. Hallucinations were considered part of growing old. Now, parents are taken by children to see therapists in the hope that it can help them.
Zubaida, 74, has just started her treatment with a psychiatrist. When her daughter is asked what’s wrong with her mother, she says, “Initially we thought its just old age. As time is passing, she has started feeling the whole world is plotting against her. She sees people in her room at night, trying to steal her bunch of keys. She cannot trust anyone. Not her husband, sons, daughters-in-law, servants, no one.”
Zubaida has started regular use of a medicine the psychiatrist prescribed for her psychosis. The doctor feels family support and regular counselling can help her, but as with any disease the sooner a psychosis is diagnosed, the easier the treatment. According to her psychiatrist, paranoia is a very hard thing to get rid of. But in time, the aggressiveness of such patients can be controlled.
The increasing scope of this science makes it imperative that we understand it. Psychology stands as a bridge between many worlds. At once, it is a helping profession, a field of social inquiry, and a basic, or natural, science. Psychiatry is defined as the branch of medicine that deals with diagnosis, treatment, and prevention of mental illness. When people think of psychology a variety of images may come to mind. For instance, they may picture a Freudian-like figure psychoanalyzing a patient on the couch. The activities of human beings — be they artistic, philosophical, or literary — are all appropriate subjects for psychological inquiry. Psychologists also explore questions which overlap with fields such as anthropology, biology, and neurology.
It is also important that we know the difference between a psychiatrist and a psychologist. A psychiatrist is also a medical doctor and can, therefore, prescribe medication. This may be a reason why people avoid visiting them as the general consensus about psych-somatic treatment with medication is that these medicines give you little relief other than lulling you to sleep or giving you a temporary high. The fear of being hooked on to these drugs, especially anti-depressants, is also present. This may be the reason why psychologists, also known as therapists or counsellors (or “shrinks” in slang), are a more popular option. Coming back to why people in our society avoid professional help, Anjum Basheer, a clinical psychologist, feels it is probably because of:
(a) The perception that it is a sign of weakness; an inability to cope with life’s stressors “like everyone else”
(b) The stigma that professional help is for “mad” people
(c) The belief that it is disrespectful to discuss family matters outside the home
(d) Difficulty finding a trained counsellor
Rummaging through a cross-section of people, we came cross varied points of view as to why people thought this trend is catching on. Nadia Wasi, a 27-year-old doctor, is doing her residency in the US. She feels that the need for going to therapists or psychiatrists in any society is because a lot of times the common most problem of depression is intrinsic. There can be a hormonal imbalance in your body leading to it exacerbated by your surroundings. Talking of Pakistan, Nadia says, “Schizophrenia and manic depressive disorder are more common than people think. Domestic violence (even in the affluent class) is very common. So is addiction. If someone goes to see a psychologist because he/she wants to talk to them is because they want to talk to someone who will not judge them.”
Quratulain Ahmed is a graphic designer by profession. Her work-related research has led her to believe that going to psychologists is not a hip American trend. According to recent surveys around 20 per cent of our population suffers from GAD: Generalized Anxiety Disorder. It means one is stressed out most of the time, one is cranky, one is anxious, one is always irritable for no apparent reason.
How are these mental illnesses like depression or delusional disorder manifested in people? Therapists feel that in Pakistan physical manifestations of a mental illness are more common. According to Anjum, “Psychosomatic complaints have been quite common during my clinical experience, particularly with clients coming from a background where the level of education (and consequently exposure and awareness) is low. Manifestations of stress, anxiety and depression are reported as ghabraahat, baychainee, dil dharakna, jism tootna and the all time classic gas demagh par charhna (seriously, many people believe this to be true). In such cases it often becomes a challenge convincing clients that a person who does not prescribe medicines and “just talks” can actually help. In the upper socio-economic stratum parents often encourage their teenage children to go for counselling when they find it difficult to understand and deal with the changes in attitude and behaviour.”
After futile attempts at solving a problem oneself, many people realize the need to ask for help. When they feel there is no one around them who can help them in a balanced, objective way, they often feel the need for a professional and start a search for one, or in some cases having heard of a therapist (on TV, in a magazine, from a friend or during a lecture of some sort), go directly. The frustration of being unable to cope seems to be the final push.
A major reason why people want to confide in a therapist is the confidentiality issue. They feel these counsellors will keep their secret. As Nadia Wasi feels, “The patient/doctor confidentiality prohibits the physician from talking about the conversation while even when you talk to your best friend you have the slightest bit of doubt who will find out about your problems. I mean if your husband abuses you, I would not even want my mother to know. So who do I talk to?”
But do the therapists really take the confidentiality issue seriously? One fear that many people have is that they worry about their therapist’s talking to other people. They are really scared of ‘gossip’. In Pakistan, it is especially difficult to sue doctors for breach of confidentiality.
Difference of opinion is very natural when you discuss any topic with various people. We found an interesting array of responses when people were confronted with questions about the need for psychological help in our society. Having studied sociology, Samira Dadabhoy, who is a teacher and a mother of four, says, “My theory is that the popularity of shrinks is probably parallel with the other social trends in society. For one, the trend towards nuclear families deprives one of social support which would be easily available in a joint family system.” Samira feels that women need to talk about feelings more than men. For her, a good listener in the family can do the trick.
Though Anjum agrees that a large part of a psychologist’s work is to be a good listener, she disagrees with the notion that the joint family set-up guaranteed that family members were necessarily close to each other and could share everything, hence the need for therapists was less than now. “I feel in a joint family the quantity of relationships was more than the quality. As of today, a man needs more than a home-maker as a wife; he needs a companion too, and vice versa. They want to share what went on during their day.” Doesn’t that say that relationships are more communicative now?
Atif Amin, a marketing executive, feels, “It’s true that to some extent visiting therapists is an ameeron ka nakhra. People with loads of money feel that by going to shrinks they are doing something which is ‘in’ and they are ‘with it’. However, such people constitute a very small number of the total number of patients seeking psychiatric help. The rest of the cases are genuine.” He feels that especially genuine are the cases where people were abused as children either physically or sexually or both and as adults they are traumatized by their childhood experiences. Another thing that may stop us from confiding in family members is the fear that they might hurt their family. They would choose to talk about it to a total stranger who is bound by ethics not to divulge or be judgmental.
Seeking professional help to treat a psychological illness is no more unusual 
