FOR a country with over a third of its population suffering from some form of mental illness, Pakistan has done little to help these unfortunate people.
Take, for instance, the barbaric Lunacy Act of 1858 (modified in 1912). This law allowed husbands to have their wives committed to institutions — called lunatic asylums in less enlightened days — so they could grab their property or remarry. Even when this archaic law was replaced by the Pakistan Mental Health Ordinance, 2001, not much was done to improve matters.
The Sir Cowasji Jehangir Institute of Psychiatry, Hyderabad, was built in 1865 with a Rs50, 000 grant from Bombay philanthropist, Cowasji Jehangir Readymoney. This facility, popularly known as ‘Giddu Bandar’, was among the first to specialise in mental health in the territory that is now Pakistan. Sadly, it still lacks facilities as well as psychiatrists and trained nurses. Much of the land attached to the hospital has been encroached, a fate shared with other mental health institutions.
Unsurprisingly, Pakistan has a higher proportion of patients than most other countries. For example, a survey of medical students in Karachi indicated that 70 per cent suffered from anxiety and depression, compared with 13-25pc in Canada and the US.
There’s a need to change public attitudes towards mental illness.
This is understandable in the context of the violence and other urban pressures people in Karachi have faced for decades. According to a paper (Mental Health in Pakistan: Yesterday, Today and Tomorrow) by Safdar Sohail, Akhtar Syed and Atif Rehman, 34pc of the people of Sindh suffer from mental health problems; Punjab has only 8pc; Balochistan 40pc; and KP 5pc.
Clearly, Balochistan with its simmering insurgency and its hundreds of ‘missing’ men has taken a heavy toll on mental health, as has Karachi’s decades-long dominance by MQM militants. Punjab, by contrast, has remained largely peaceful. KP’s relatively low numbers are a puzzle given US drone attacks, and repeated acts of jihadi terrorism.
According to the blog JPMS (Journal of Pioneering Medical Science), there is less than one hospital bed for the mentally ill. Women, no doubt due to the awful social conditions they have to endure, make up 69pc of the population in all mental health facilities. Children, another highly vulnerable group, make up 46pc of patients in outpatient clinics.
To fill part of the vacuum caused by pathetically low government investment, private outpatient facilities have stepped in. However, the quality of the treatment these clinics provide is variable.
Far worse is the quackery widely prevalent in this nebulous area. Fifty-three per cent of Pakistanis attribute mental disease to possession of the patient by jinns and evil spirits. Cashing in on this gullible mindset, charlatans and ‘holy men’ inflict the most horrendous treatment on the ‘possessed’, subjecting them to violence, locking them up, and starving them to drive the jinns out.
Then there is the widespread belief that spirits can harm us if we interact with mentally ill people. This attitude, combined with the general stigmatisation of patients, means that families tend to keep them out of sight. Parents fear that such an illness could harm the chances of a ‘good’ marriage for the other siblings.
An insensitive media and film industry further reinforce stereotypes, showing the mentally ill as stupid butts of humour. Their presence is regarded as a misfortune the immediate family has to suffer; few have much love to spare for them.
One reason there is little progress in the treatment of mental issues is the tension between the traditional religious, approach and modern methods. Many Muslim scholars believe such problems to be the product of a patient deviating from the teachings of the faith.
Faith healers thus prescribe the repetition of certain religious verses. Poor, uneducated people have few options but to turn to them, or to quacks for ‘treatment’ that makes things worse.
Few doctors specialise in psychiatry after taking their MBBS degrees. Hence the shortage of trained psychiatrists as well as specialist nurses. Perhaps government incentives could improve matters.
More important is the need to change public attitudes towards mental illness. As long as over half the population believes the problem to be the result of demonic possession, they will take patients to quacks and faith healers rather than to psychiatrists.
Media persons should be made aware of the damage they cause by their endless stereotyping of the mentally ill. Perhaps NGOs could organise short sensitivity courses for TV and print journalists.
Patients suffering from physical illnesses have a range of options available to them and can make informed choices. This luxury is denied to those with mental problems: they have to endure whatever their carers have organised. Usually, none of the options are good.
As long as mental disease is a subject of shame and embarrassment, little will change.
Published in Dawn, March 9th, 2019