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Interview: Deciphering the brain

Acquisition of information and intellect has almost become a compulsive need for today’s aspiring individual. Be it a scholar, entrepreneur, engineer or a doctor, the yearning for information in a milieu of intense competition, does not seem to subside. Ironically, however, despite having perused narratives on the subject of mental health, only a handful of people are willing to acknowledge the importance of psychiatry and its implications; the rest invariably link psychiatry to insanity.

Furthermore, in the wake of persistent taboos and the soaring numbers of patients seeking redemption from depression and mental illnesses, the dearth of psychiatrists and psychologists nationwide has become an alarming concern. Being the sixth most populous nation in the world, Pakistan’s socio-economic and demographic characteristics indicate a high fertility rate with a large but young rural population, and a poor economy.

Mental illness is one of the foremost health problems of the country with 10pc of the population suffering from it, of which 35pc remain undiagnosed. Every fifth house has a potential patient who needs attention for anxiety, depressive disorders, psychosis, drug abuse and developmental disorders. Factors linked to these disorders are: lack of education, financial constraints and relationship difficulties.

Dr Syed Haroon Ahmed, founder-convener of the Pakistan Association for Mental Health and Pakistan Psychiatric Society, describes the state of psychiatric treatment in the early days by recalling, “As a part of the curriculum we used to visit Giddu Bandar, now the Sir Cowasji Jehangir Institute of Psychiatry Mental Hospital, Hyderabad, to observe the patients’ behaviour. It was like a zoo where we paid 25 paisas for watching the mentally deranged patients,” and adds, “There were signboards that read ‘Feeding the mad is prohibited’, which I considered quite disconcerting.”

Later, when Dr Haider Ali Qazi joined Giddu Bandar Mental Hospital after his return from abroad, he was appalled at the deplorable state of affairs. When asked for advice, Dr Haroon suggested that the ticket system should be abolished forthwith. “I advised him to grow something and generate revenue for meeting the expenses. So he started a vegetable farm which was quite successful,” he remembers.

Dr Haroon hailed from a family of land cultivators who lived near Allahbad, UP. With the acquisition of education, family members gradually departed for better prospects to the cities. His father also took up a job in the Great Indian Peninsula Railway, where for the first time he was introduced to politics since his father was an active member of the railway union and used to bring our newspapers such as Naya Zamana which he would also read.

The second wave of political influence was during 1941-42 when he spent a couple of years with his sister’s husband who was a warden at the district jail. This was the time of the Quit India Movement by Congress and jails were brimming with alleged renegades, particularly literates, intellectuals and teachers. As a student of class eight he would spend time with the inmates who would teach him academic subjects and narrate their political experiences. As the bonds with inmates got stronger, he also became a trusted courier for crucial communication. “Having seen the unwavering unity between Hindus and Muslims, it was quite incredible to see the sudden rise of differences between the two when the two-nation movement began,” he recollects.

After the post-partition migration, with a well-primed youth and brimming fervour to vector the nation towards progress, Dr Haroon took to politics during his studies at the Dow Medical College, Karachi. Having been impressed by a group of students who were pursuing liberation of the oppressed in a socialist demeanour, he became the core founder member of the Democratic Students Federation (DSF) in 1951. The numerous activities of the DSF nurtured his political acumen. Eventually, after graduation, he left the party for pursuing his professional career in medicine.

After his post-graduate degree from England in 1965, Dr Haroon came back and joined the Jinnah Postgraduate Medical College as a faculty member, where he worked until 1991. “Teaching and grooming young people is always rewarding because today when I see so many of my students on important assignments, it gives me satisfaction. Some students went abroad and succeeded in careers of professional practice and teaching,” he states with pride.

The existing vacuum in health services during the ’60s offered opportunities for innovation to him. Being a member of the Pakistan Medical Association (PMA), Dr Haroon and some colleagues prioritised the well-being of patients in the charter of the PMA which was previously almost non-existent. According to Dr Sahib, what PMA is today is because of the catalytic component of some progressive doctors like Dr Hashmi, Dr Sarwar and others.

“In the days of my early practice, akin to family planning and tuberculosis, there was a requirement for treatment of drug-dependence,” Dr Haroon says. Almost every hospital unit had drug-dependence cell, but the problem was that the patients, after detoxification, would go into frequent relapse. Hence to avoid wastage of resources, he drew out a strategy to engage the patient’s family during treatment as opposed to the Western method of treating a patient in isolation with limited visiting hours. With this amendment there was a visible improvement in the patient’s health. Later the same arrangement was made at home with the doctor on call, which showed further improvement.

For the reason that emotional illness is not fatal, there was little or no attention given to psychiatric treatment. “Instead of advertising the importance of psychiatry, we decided to create gradual awareness,” Dr Haroon says, “With about seven or eight psychiatrists onboard, I became the founder-convener of the Pakistan Psychiatric Society, which is thriving today.”

The other achievement was the establishment of the highly effective Pakistan Association for Mental Health in 1966 which in fact was a merger of two organisations; ‘Mental Hygiene’ which was started by Dr M. H. Shah and ‘Mental Health’ that was initiated by Dr Afzal Habib. Operating independently, these organisations were struggling to create a viable impact.

“Considering the inescapable effects of stress that causes psychosomatic changes leading to ailments ranging from heart attack to cancer, I tried to connect psychiatrists with family physicians,” he reveals solemnly. Dr Sahib opines that purging bottled-up emotions is perhaps the only cure for certain mental illnesses. Usually a good general practitioner or physician would gauge the patients’ mental state and appearance as he enters the clinic — which is half the diagnosis — and extend counselling before writing a prescription.

Dr Sahib emphasises the need to spread awareness and expand the discipline of psychiatry, improve the mental health of the people and impart mental health education. He says, “It is crucial to promote remedial and preventive measures and undertake treatment of psychiatric disorders because the national economy can be boosted if the huge segment of the population stricken with mental illness is salvaged to play a productive role.”

Dr Haroon believes in the dynamic devising of standards of education and training in psychiatry and establishing commensurate facilities. “There is an urgency to appreciate the importance of research in the area of psychiatry and mental health,” he highlights, “the cardinals of psychiatry and new developments should be disseminated regularly from a central authority.” To protect the interest of fellow psychiatrists and professionals and to encourage ethical practice of psychiatry across the country is also that he continues to pursue with unwavering resolve.

“After the 18th amendment in the constitution, there is no law for the mentally ill. The Lunacy Act of 1912 for British India was repealed by the Mental Health Ordinance in 2001, because of it was incompatible,” says Dr Haroon, who is also one of the main architects of this ordinance, “Incidentally, it is just today that I have been informed by a government official that the amended Mental Health Ordinance has been approved and would be notified soon.”

In the days of youth, Dr Haroon was interested in sports and athletics and was also secretary to a hockey team. He was a long-distance marathon runner and had participated in some major events. He is fond of Mushairas, English literature and personalities of artists. “It was Ali Imam who made me wiser about the painting scene of Karachi during the 1970s and encouraged me to help artists by acquiring their paintings,” he states. Some rare paintings of Bashir Mirza, Mansur Aye, Naheed Raza and others that adorn the walls of the drawing room, corroborate his passion for paintings and classify him as a discerning connoisseur and a devoted collector.