When Wajid Ikhlaq, 40, began suffering severe panic attacks and depression, like many others he could not understand or explain his condition to his wife and family. His wife thought his restlessness was because he was not offering his prayers regularly.

“When I was laid low by depression, my wife used to tell me every time that I was being lazy and ungrateful to God,” Mr Ikhlaq told Dawn.

“I was surrounded by huge walls of various kinds of fears, and I couldn’t break them despite struggling. I was afraid of meeting people, about my children’s future, my job security and much more.”

It was one of Mr Ikhlaq’s friends who suggested he go see a psychiatrist. He resisted the idea for some time, but eventually agreed. His psychiatrist diagnosed him with panic attacks and depression. Now on medication and in therapy, Mr Ikhlaq said his condition is improving.

He told Dawn that when he was a child, his mother used to lock him in a bathroom as punishment, which his doctor had suggested was a reason for his mental illness.

“I haven’t told my wife about my illness and treatment because she will not understand my condition and won’t respect me anymore,” he said.

Sakina Bibi, who is in her 50, was diagnosed with depression after she went to a hospital in F-8 complaining of pain in her abdomen. The gastroenterologist prescribed her medication, as well as antidepressants, and explained to her family that she was going through severe depression that resulted in inflammation of her large intestine.

“I spent my entire life in a tense atmosphere. Financial issues were the main source of stress between my parents and after I got married, there was no understanding between us. Life went on, but the sudden death of my younger son left me completely shattered,” she said.

Ms Sakina said she was not aware of conditions like depression and anxiety.

“I don’t know what the doctor said about the disease, but I am feeling better since taking the medicine,” she added.

A person with a mental illness growing up in developing countries like Pakistan live in a world where people are mostly uneducated when it comes to mental illness, and have a longstanding history of explaining mental illness as an example of spiritual or personal weakness, psychologist Dr Asima Khan told Dawn.

She said in fact, people with mental illnesses need support and care from the people around them. but because of the many stigmas attached to such conditions, people carry their pain, shame and suffering inside them; this is why, she said, mental illness is most often an “invisible” illness, that is not known or detected by others.

“Mental Health Pakistan says that the occurrence and prevalence of psychological issues in Pakistan is greater than ever. The growing psychiatric population can be due to the persistent wave of terrorism in the past, poverty, economic crisis, unemployment, stressful working situations, gender discrimination and unhealthy lifestyles,” she said.

“A range of psychiatric disorders have been observed, such as depression, anxiety disorder, drug abuse, schizophrenia, bipolar disorder and post-traumatic stress disorder,” she added.

The number of patients with mental illness are increasing, the head of the Pakistan Institute of Medical Sciences’ (Pims) psychiatry department, Dr Rizwan Taj, said.

“We receive around four to five thousand patients a month, when earlier this number was three to four thousand. We have increased the number of doctors to cater to the load; we now have four doctors in our department when we used to have two,” he said.

He said that most patients in Pakistan, rather than going to see a doctor, turn to traditional faith and religious healers believing mental illness to be caused by supernatural forces or a religious test.

“Due to the stigma, the patient doesn’t accept himself or herself that they have any kind of mental illness. If they accept the illness and see a doctor, they hide it from their loved ones because of the lack of awareness,” he said, while discussing social pressures associated with mental illness.

Mental illness can cause other health problems, he added. Chronic stress is associated with a risk of heart attacks, stroke, obesity and premature death, while untreated depression increases the chance of risky behaviour such as drug addiction. He said unidentified and untreated psychological problems can even result in suicide.

Both doctors emphasised the need for support from friends and family, saying this is a key part in helping someone cope with mental illness.

This kind of support provides a network of practical and emotional help and can be made up of parents, children, siblings, spouses or partners, extended family, close friends, neighbours, co-workers, coaches and teachers.

According to the International Journal of Emergency Mental Health and Human Resilience, mental health is one of the most neglected fields in Pakistan, where between 10 to 16pc of the population – more than 14 million people, mostly women – suffer from mild to moderate psychiatric illness.

It said Pakistan has just one psychiatrist for every 10,000 people suffering from any mental disorder, and one child psychiatrist for every 4m children. There are only four major psychiatric hospitals to cater to a population of 180m, which is one of the major factors behind the increase in patients, it added.

Published in Dawn, August 18th, 2019