April 17, 2003

Naheed Akhtar took the bold step of breaking the silence about her encounter with quacks and faith healers in treating her mental illness. She has now taken it upon herself to spread awareness and help fight mental illness, writes Robin Fernandez

Ordinary women are discovering a potent way of supporting their gender by sharing their experiences of sacrifice and difficulty. A young woman who survived dangerous therapies of quacks and faith-healers is now running a campaign in her neighbourhood against her former tormentors. For days on end, 18-year-old Orangi resident Naheed Akhtar was beaten, bound to her bed and kept in an unlit room, because self-styled faith-healers claimed she was possessed by djinns.

“I remember I used to fall down and cut my tongue so many times,” Naheed told participants at a seminar on women’s mental health. Quivering slightly, Naheed blurted out her story in full public view, with her father silently looking on. “My parents were advised [by relatives and well-wishers] to go to fake pirs and faith healers for some miraculous cure,” the burqa-clad girl said.

Her epileptic-like seizures worsened as did the offending therapies. Confined for hours to a small, dark room, Naheed’s mind and body suffered more indignities. Her body had already been enduring mystery drug concoctions prepared exclusively for her. When these spurious methods failed to give Naheed even a semblance of robust health, her dejected parents sought help from the medical charity Karwan-e-Hayat.

After several months of treatment and care there, Naheed has seen a remarkable turnaround in her health. Throughout this period, Naheed has come to understand the connection between undiagnosed mental disorders and her own prolonged bout of illness. This has inspired her to go out in her Orangi Town neighbourhood and convince women to abandon their trust in pirs and others masquerading as faith-healers.

According to Karwan-e-Hayat founder Dr Zafar Qureshi, “Naheed has emerged as a great crusader for mental health among women. Her arguments against quackery are persuasive because she has lived through an ordeal herself,” says Dr Qureshi, whose charity group’s psychiatric services are widely recognized.

For the past 20 years Karwan-e-Hayat has been providing free treatment to mentally ill patients, though all the medicines dispensed by the charity come from private benefactors. With her father trailing behind her, Naheed visits the homes of ailing women and encourages them to pay serious attention to their mental health. “I tell them to stop visiting quacks and not to attribute their illnesses to demon possessions,” says the young campaigner. Ten women who heeded her counsel are now cured of their illnesses, thanks to Karwan-e-Hayat’s workers.

Former victims of quacks aren’t the only ones thrown into turmoil. Care-givers and family members of those sufferers are just as much scarred but too embarrassed to speak out. One female care-giver Samina Khwaja, however, chose to break her silence and share the pain of her family. Samina’s voice was choked with emotion as she observed, “Our society ostracises those with mental illness. They are cast out of the mainstream of life.” Samina believes the public ought to show greater empathy towards these individuals.

Unlike most members of society, Samina says, she was never ashamed to be seen out with her mentally ill sister. “My sister is schizophrenic. She lives in another world. Of course people can see that but they are nevertheless disparaging,” she says with a sigh.

From her education and family background, it is hard to tell that Samina’s sister had a mental disorder. She topped a prestigious teacher-training course and was selected for a key post in a Lahore college. Her father was a liberal man who encouraged both his daughters to pursue higher studies. When the job offer came her father was supportive of her moving out of the city and living in Lahore. But at that point the gifted girl became obstinate, having resolved earlier to turn down the job. She soon turned into a hermit, locking herself indoors and shunning company. “She told us not to meet some of our relatives and fed us false stories about them. She discouraged us from visiting other relatives and gradually we became isolated,” she recalls.

Samina says her sister also poisoned the minds of her brothers by telling them not to eat food prepared by their mother. “The result was that they rarely ate anything except fruit at home. Soon they developed strong feelings of resentment against their mother and those feelings threatened to torpedo their relationship with her,” she says, without explaining the reason for her sister’s influence over the family.

Prospects of Samina’s own marriage began to shrink. “Since our interaction with relatives and friends was extremely limited, my angst-ridden mother put my marriage prospects at zero,” she adds. Another cause for family heartache was the widening gulf between her mother and her brothers. “My brothers no longer talked to her and that added to the air of tension in the home,” Samina explains. She is sure that had her father not been a bedrock of support for all of them their future would have been doomed. Their parents still withstood the storm and bequeathed their five sons and two daughters with some hope of a better home environment and life.

Psychiatrists have unearthed some startling facts about mental disorders among Pakistani women. Women with secondary school education were found to be more prone to mental disorders than, say, those with primary-level education.

According to a consultant psychiatrist, Dr Shahin Hussain Haye, “this is probably due to the fact that such women are more aware of their rights but less sure how to secure those rights. Those who are less prone, however, are unaware of their rights and so they can’t be too pushed about setting things right,” Dr Shahin explains. In contrast, the women who hold post-graduate degrees are less vulnerable to depression because they know both what they want and how to get it as well.

In Dr Shahin’s expert opinion, Pakistani women suffer from depression for a host of reasons, including low-esteem, a sense of helplessness, poor literacy and marital problems arising out of being childless or having an excessive number of children. Besides interpersonal and cognitive behaviour therapies, she says, depression sufferers are encouraged to change their lifestyle; take up some form of physical exercise, renew their religious faith or attend marriage counselling sessions. With deep concern, Dr Shahin notes that psychiatric illnesses are increasing in the country, even though ways of treating those disorders are still slow.

Dr Seema Munaf, the director of the Institute of Clinical Psychology, has spotted some gender differences in psychological disorders. Quoting results from several studies, Dr. Seema pointed out that the panic disorder ratio among women is two to one compared to males, while the ratio for obsessive disorders followed much the same pattern.

Statistics show that less importance is given to women in almost all spheres of activity. Females have fewer opportunities for education and personal growth. Other factors that have an adverse effect on a woman’s mental health include the birth of a girl child, domestic violence, working or not working, marital status, sexual harassment, hormonal changes and environment stresses.

It is widely observed that though women are more susceptible to depression than men, appeals for their treatment are seldom entertained. “Our society favours the male-child because he has to grow up and take his place as a breadwinner. Girls have to play second fiddle to them,” notes Dr Seema.

The pain of prisoners

Spare a thought for the dozens of unfortunate women who are lodged in local correctional facilities. The pyschiatric community is increasingly worried about their condition. Some have even volunteered to provide them free treatment, while a few others are campaigning for their right to psychiatric care.

Najma Parveen, a former deputy superintendent of police and the first female superintendent of prisons here, believes that prison inmates as well as jail staff require more psychiatric care than any other isolated or fringe group in society. Without doubt, she says, a majority of the inmates are mentally ill and in need of some kind of treatment.

Her prognosis, of course, is based on years of interaction with inmates. Prisons are unlike any other place in a built-up environment. This extreme form of confinement triggers off depression and anxiety. “All correctional facilities need the services of psychiatrists,” observes Parveen, reflecting on the mental condition of the inmates she has enountered. “Confinement is a big problem.” Prisons also carry an indelible stigma for women. Female inmates usually hide from the cameras that are allowed into jails occasionally.

These inmates fear that if their pictures are taken and published somewhere their relatives and neighbours would recognize them and find out where they are. Such publicity would bring shame upon them and their children. Bear in mind that some of these women are incarcerated for crimes they haven’t committed. Often they are scapegoats for another person’s crime. Other women about whom the public is already scandalized prefer to stay in jail—even when their jail sentences are over. They know at least they can’t be further victimized there.

In recent months, psychiatrists like Dr Zafar Qureshi and other jail visitors have reported with satisfaction the improved conditions of juvenile jails but they know a lot more has to be done. Still, the level of medical facilities and the sanitary conditions there have been praised. Parveen’s comments on the subject are more subdued. “Our juvenile jails are not so bad,” she says, scoffing at the media’s projection of these facilities. She insists that the media has got it wrong when it claims that women are being abused and raped with impunity there. But she does acknowledge that matrons and other low-level support staff need to be trained on how to handle and treat prisoners.

Dr Qureshi, a frequent visitor at the juvenile prison, could not help but agree. He recollected how each time he arrived at the juvenile jail one elderly policeman signalled to female inmates to duck out of vision. This is illustrative of the general attitude at prisons. Apart from these few peculiarities, he says the juvenile prison is “well-administered and spotlessly clean”. Sheba Shar, Parveen’s successor, is also sensitized to the pain of female inmates. Shar has become adept at spotting the signs of depression, according to Dr Qureshi, and now she wants her support staff to learn the skill as well. Yet that is not going to be enough. Dr Qureshi explains that in order to make this effort purposeful the country’s mental health experts would themselves have to get involved in the jail population.

Please Visit our Sponsor (Ads open in separate window)