Since the first column of this series was published on December 22 I have been inundated with e-mail messages and telephone calls praising the virtues of our 'national icon, treasure, hero' and whatever else. Some have confirmed his shining reputation as an efficient garnerer of wealth, plots and properties, and of his penchant for the acquisition of real estate.

The good have come with the bad, but not even his most ardent supporter has voiced approval of his December 10 armed assault and take-over attempt on Karachi's Institute of Behavioural Sciences. No correspondent has expressed any concern about the plight of the patients. But, then, that is not strange, it is quite normal in this land of ours. The poor, the sick, the deprived count for nothing.

When the IBS was being organized in the latter half of the 1990s, we were told that it was not just another mental hospital or psychiatric institute, that the name was not to circumvent the adverse connotation of mad or mental but to incorporate a wider range of human behaviour in the process of coping. The basic premise was that when stress-conditioned behaviour is expressed as mental disorder, it calls for psychiatric attention. We learnt that a large section of the population - some 30 to 40 per cent - suffers from disorders of a psychosomatic nature and are abandoned as diagnostic orphans. The emotional and cultural stress of everyday life produces subliminal chronic distress, suffered sometimes silently, sometimes violently. Stress also affects work efficiency and eventually national productivity.

Mental health is no longer merely an individual problem - it is now an economic problem as well, affecting both profits and productivity.

The World Health Organization and the World Federation for Mental Health are seriously worried about this economic factor with the fast growing incidence of mental disorders around the globe. Both organizations are launching a programme, hand in hand with health leaders and international business leaders, to whom the subject is a major issue, to tackle the various mental illnesses, leading to physical disability, with which this world of the 21st century is afflicted.

It is mental health, they say, which, as things progress, is soon to become a weapon of productivity.

In North America, it is estimated that mental disorders cause businesses an approximate $80 billion in lost productivity, and of this a loss of $60 billion is due to depression and ischemic heart disease. Both lead to disability and premature death and it is projected that they will cause a greater loss of workdays than any other form of illness or injury.

The workplace traditionally was somewhere people went not merely to do a job but to join a group, develop relationships and find a sense of purpose in life. No longer. It has become a worrying uncertainty, and stress and depression are rife. Depression is brought on by stress and can lead to heart attacks and death.

Global corporations are, obviously, far more dependent on mind rather than muscle and are thus suffering as the global burden of disease has come to be dominated by an escalation in psychiatric disorders.

There are many causes of stress - for instance, unreasonably long working hours, an overload of work and equally an under load of work, an unhealthy work environment, fraught work relationships, lack of coherent communication, job insecurity, lack of trust, office politics and the fulfilment of assumed obligations.

In a developing country such as Pakistan, the WHO has estimated that roughly 10 per cent of the population is in need of psychiatric treatment or attention. If disorders such as epilepsy and psychosomatic illnesses are included, the figure would rise dramatically to over 35 per cent. Scattered around Pakistan, we have five mental hospitals which are run as asylums for custodial care and 16 badly equipped psychiatric clinics attached to medical colleges. The public sector provides around 3,000 beds for mentally ill patients.

As for the province of Sindh, no medical college or teaching hospital is staffed by recognized and competent psychiatrists.

To touch once again on the subject of Dr Abdul Qadeer Khan's behaviour and the suit he has filed in the Sindh High Court against those who established the IBS, a reading of how the good Dr Khan, the plaintiff, modestly and publicly describes himself, cannot, of course, 'shock' anyone (we are beyond that particular emotion), but it should distress even his most ardent admirers. To repeat: "The Plaintiff is a national hero. He is singularly responsible for facilitating the requisition of nuclear technology for Pakistan, developing the 'enrichment of uranium plant' at Kahuta, and an atomic bomb for the country. He has also been the recipient of many awards, including the national awards of 'Nishan-i-Imtiaz' and 'Hilal-i-Imtiaz'. Apart from being a renowned scientist of international repute, the Plaintiff is a philanthropist with many charitable projects to his credit.

"It is pertinent to point out that the Plaintiff derives great respect and trust in society, with the result that many on his solo call richly contribute to any charitable endeavour."

The arguments and hearings of Dr Khan's suit and of the counter-suit filed against him continue in the Sindh High Court. At the last hearing on January 14, Dr Khan's lawyer Farogh Naseem brought in his senior, the highly respected but unfortunately perpetually ailing Mr Mohammad Ali Sayeed who at the outset sought an adjournment on the ground of ill health. The adjournment was granted and the case will be taken up again on January 29 (we hope).

At the hearing the advocate of the IBS, Kazim Hassan, suggested that "it would be appropriate to have an interim arrangement in the form and style of an ad-hoc committee which would oversee the running of the institute." This suggestion was resisted by Dr Khan's lawyers.

However, Justice Zahid Qurban Ali Alvi observed: "Since it is the concern of this court that the patients should not suffer and an assurance is held out that the patients are being looked at, the Official Assignee is requested to look at the IBS as it stands today, check the number of patients treated daily and the number of patients that have been treated after this dispute has occurred. He should also ascertain the number of psychiatrists attending the patients. The psychiatrists would be in the category of specialists who would be attending to the patients."

Afterthought: The last time my learned friend Mohammad Ali Sayeed appeared against me was in the Supreme Court at Islamabad in 1999 when he was representing the real estate developers of the infamous 'Glass Towers' on the main Clifton Road. He opened up by coughing and spluttering and immediately sought an adjournment. Chief Justice Ajmal Mian who had given due notice and assembled a bench of five, would not hear of it. Mohammad Ali Sayeed then asked if his junior, Farogh Naseem, who was then not qualified to appear before the Supreme Court, could plead on his behalf. No objection was raised. Farogh pleaded and lost. The offending portion of 'Glass Towers' was ordered to be demolished. This petition was filed in August 1996 and it took us three years to get a decision from the Supreme Court (1999 SCMR 2089).


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