Gendered debate

September 24, 2018


EARLIER this month, on World Suicide Prevention Day, Hajra Khan, the captain of our women’s football team, took to Twitter to discuss mental health. In a series of passionate, eloquent tweets, she described her own battle with depression and anxiety, explained the pressures that make athletes vulnerable to mental health issues, and highlighted the lack of adequate support and care. She also called out the continued stigmatisation of those with mental health conditions.

Khan is not one to shy away from battles. She has fought against anachronistic gender stereotypes that may prevent Pakistani girls from dreaming about being football champions. She has pushed back against the conservatism that judges her occupation. She has demanded redressal of the lack of gender parity in terms of athletes’ pay, facilities, training and promotion. She has struggled to put Pakistani women’s football on the world map. But of all her battles, her campaign to raise mental health awareness is arguably the most difficult, and the most important.

This is not the first time Khan has spoken out on these issues. Earlier this year, she gave a TED talk on mental health challenges among athletes. She repeatedly raises the issue in media interviews. Her admirable persistence just might start a national conversation Pakistan needs to have.

Pakistani women are more prone to mental health issues than men.

It is, after all, shocking how immature public discourse on mental health remains in Pakistan, despite the fact that decades of conflict, terrorism, growing inequality, entren­ched patriarchy, persecution and displacem­ent have left our nation traumatised. In 2010, Dr Murad Moosa Khan, then head of AKUH’s psychiatry department, estimated that 34 per cent of Pakistanis suffer from depression and anxiety (let alone other disorders).

That approximate likely does not fully reflect the toll on the nation’s psyche of brutal and frequent terrorist attacks, recent political upheavals, deepening sectarian divides, urbanisation, missing persons, and increasingly stifling censorship.

Given her background and experience, Khan is right to focus on athletes’ mental health challenges. But the hope is that her confident messaging sparks a wider debate, one much needed in a country that, according to WHO, has only one psychiatrist for every 100,000 people in the country. (Interestingly, and terrifyingly, Dr Murad has argued that number is closer to one psychiatrist for every 500,000 to a million people.) And one aspect of that debate must be that mental health issues in Pakistan are deeply gendered.

Study after research study has shown that Pakistani women are more prone to mental health issues than men. A 2017 study at Washington University showed that twice as many Pakistani women lose disability-adjus­ted life years to depression than men. A 1990 JPMC study showed that twice as many wom­en sought psychiatric care. A 1994 study of suicidal patients by Unaiza Niaz showed that the majority were married women. A 2012 stu­­­­dy published by Pims revealed that wom­en worry more about terrorism than men.

This should come as no surprise to those who know how deep patriarchy runs in Pakistan. The reasons identified for a higher incidence of mental health challenges among women are: forced and arranged marriages, domestic and sexual violence, extended family dynamics, social restrictions on movement and occupation, etc.

So what’s to be done? Champions like Khan can do much to relieve the stigma associated with mental health issues. Surely this young woman can inspire others — including celebrities, politicians, professionals and religious leaders — to share their struggles with mental health conditions.

But growing awa­reness must be complemented by government initiatives to redress the scale of the problem. We need more mental health professionals, training and facilities. We also need creative, localised approaches that link religious and spiritual leaders and hakims — who are often the first port of call for those suffering from mental health problems — to qualified mental healthcare practitioners.

Recognising the gendered aspect of the mental health challenge in Pakistan, our government should also do more to further women’s safety, rights and opportunities.

If our new government needs a compelling pitch to take up the endemic mental health challenge, it should consider a 2016 WHO report that established a clear link between mental health and economic productivity, finding that depression and anxiety disorders cost the world $1 trillion annually. Naya Pakistan cannot prosper if one-third of its citizens have poor mental health.

Our new human rights minister should also catch up on the growing movement to link mental health prevalence and treatment with human rights, including rights to life, dignity, free speech, freedom of religion, and safety.

In her tweets, Khan astutely acknowledged that “mental health has a stigma that is tied into weakness”. Perhaps by taking her example and bringing this issue to the fore, Pakistan can start to make itself a bit stronger.

The writer is a freelance journalist.

Twitter: @humayusuf

Published in Dawn, September 24th, 2018