KARACHI: Dr Sajida Hussain*, 54, a general physician, does not know what it is like to be happy. “My son got engaged and my daughter’s nikah was performed recently; I did everything from organising the two dinners to shopping for both my daughter-in-law and daughter. Everything went perfectly but if you ask me honestly, even these big milestones in my life failed to excite me.”

She pines for that zing of pleasant emotion most people take for granted, but which eludes her. “I have everything — doting children, money, a successful career — what I don’t have is inner peace and happiness,” she says in a deadpan voice.

Hussain has been on anti-depressants for a very long time, almost 20 years, since the time she first tried to commit suicide, when her second child was just three. But no one knows, neither her husband nor even her grown-up children. But her battle with depression began much earlier. She pins it to her marriage.

Depression never makes it to the discussion table. When it is spoken about, it is always in reference to others and in uncomfortable and hushed tones. People hardly admit they are suffering from it.

“My brother has been on anti-depressants and sleeping pills and has not come out of his room in 20 years”, says 53-year old Amena Saeed*, working in a government office in Karachi. “The doctor has prescribed him sleeping pills to vanquish the demons that haunt him after his best friend died in a car accident in which he was driving,” she said adding: “He has attempted suicide several times.”

Since last year, the doctor has prescribed her with anti-depressants as well as sleeping pills after she told him her work was getting affected. But she is not making it public. “I will be sacked,” she said.

Even Hussain, a practicing doctor, refuses to make her illness known. “There is still a lot of stigma attached to mental illnesses and if people find out I am on ‘paglon wali dawai’ [medicines for the mentally challenged], it will not only destroy my career but my social standing.”

Social stigma

Stigma is not just peculiar to Pakistan but is a global phenomenon. According to WHO “lack of support for people with mental disorders, coupled with a fear of stigma, prevent many from accessing the treatment they need to live healthy, productive lives”.

While both Hussain’s brother and her son had also been diagnosed and treated for depression, she is emphatic her condition has nothing to do with the genetic factor, and blames her circumstances. “I was mistreated by my mother-in-law and my husband would just look on. I felt lonely and unloved and even wanted to abort my first child,” she recalls.

But now when so much has changed, she continues to carry the baggage of her past. “My husband and my mother-in-law dote on me now, but it’s too late. I cannot forgive or forget how I was treated,” she says with a tremor in her voice.

The silence of many of those living with depression does not really surprise Dr Murad Moosa Khan, professor of psychiatry at the Aga Khan University, “because when you combine lack of awareness with lack of health systems then people will suffer silently.”

He finds it worrisome, nevertheless “because when people suffer they are not productive. This affects the person, his/her family and ultimately the whole community.”

Grim figures

A 2005-2006 AKU study comes up with grim statistics for Pakistan, putting the figure for prevalence of anxiety and depressive disorders in Pakistan at 34 per cent. It put schizophrenia and bipolar disorders at between 1-2pc of the population. And 15pc of Pakistani kids suffered some form of mental health problems.

Another disturbing statistic shared by Dr Khan is the psychiatrist-population ratio (not psychiatrist-patient ratio as we don’t know how many patients there are) which is one psychiatrist to 0.5-1 million people. The Royal College of Psychiatrists, in the UK, recommends one psychiatrist to 25,000 people. It is the same with psychologists.

Most people, he said, sought help when it starts to affect their day-to-day activities. “Even when one family member suffers from depression, the entire family gets affected.”

However, over the years, to some extent he says the stigma around depression has decreased as awareness has increased.

Today people acknowledge that depression is the result of a multitude of factors including genetic, environment, personality, upbringing, social etc that come together to make a person vulnerable to it.

In addition, disproportionately high poverty, unemployment, illiteracy, lack of health and education facilities, poor housing, poor living conditions, pollution, no regulation of food, medicines, hospitals, poor justice system just aggravate the situation further.

And if depression is not treated, it can lead to suicide. In fact, it is the second leading cause of death among 15-29 year-olds after fatal road accidents. In Pakistan, too, the incidence of suicide has gone up. Citing WHO, Dr Khan said every year between 13,000-14,000 Pakistanis commit suicide, in addition to the 130,000-300,000 attempted suicides.

Attempting suicide is considered a criminal offence under Section 325 of the Pakistan Penal Code and punishable by imprisonment or a fine, or both. Dr Khan, who is president elect of the International Association for Suicide Prevention (IASP) emphasised that given the high numbers of attempted suicide, it should act as a wake-up call for the government to rethink and decriminalise it so that people who have psychological problems can seek help without fear.

In the last couple of years, Indian actors Deepika Padukone and film producer Karan Johar etc have disclosed their battles with depression. In Pakistan too there are a couple of well-known people who suffered from mental illness like writer Saadat Hasan Manto and actor Roohi Bano, but by and large the subject remains a taboo with few willing to speak on the record.

Dr Khan was of the opinion that public-awareness campaigns should be carried out thoughtfully and sensitively — with factual information and mention of resources about where and how to seek affordable help.

*Names have been changed to protect identity.

Published in Dawn, April 7th, 2017