IN the next 40 seconds, there’s a chance someone will end their lives. The period that follows will be spent covering up what really happened. Whilst figures for Pakistan are sketchy, a consensus exists that suicide and suicide attempts are rising. What’s missing is the acknowledgement that a mental health emergency is aggravating the problem.
Less than one per cent of global aid is allocated to mental health, making every nation a ‘developing’ country. In Pakistan, approximately 50 million people suffer from mental health problems. According to WHO, Pakistan has 0.19 psychiatrists per 100,000 inhabitants.
What is triggering the decline in mental well-being? First, a plethora of daily stressors, including poverty, malnutrition, unemployment, job insecurity, lack of physical activity, looming debt, family size, gender-based violence, traffic, pollution, etc.
The frenetic nature of modern life is a lesser recognised cause. Technology, whilst enhancing access to information, requires one to be in ‘always-on’ mode, which is correlated with rising stress levels. Juggling childcare with job pressures creates a skewed work-life balance, elevating anxiety levels. Breadwinners compelled to pursue financially rewarding but otherwise unsatisfying careers, experience frustration.
Mental health problems are not imagined maladies.
Mental health struggle — depression, anxiety, eating disorders, addiction, schizophrenia, etc — is misunderstood in Pakistan. Anxiety gets dismissed as a ‘first-world problem’. Post-partum depression is an ‘indulgence’ unaffordable for new mothers. Celebrities on morning shows link mental health solely to dietary habits. The result: mental health problems appear to be imagined maladies. Afflictions are seen as the outcome of curses by djinn or a result of the evil eye; remedies are sought in spiritual healing.
Stigma compounds the suffering; if you seek support, derogatory labels such as ‘mad’ or ‘psycho’ are tossed around. The shame intensifies in a world where success is measured by professional and material accomplishments. Prolonged spells of sluggishness, reaching out to others and voicing despair, indicate failure — signs of a poor performer. You aren’t allowed time out to pause, reflect and reboot. The propensity to victim-blame and shame conflates serious mental conditions with moral failings.
Medication is often presented as a quick fix. Given the easy availability of tranquillisers and similar drugs in Pakistan, this is hardly a revelation. Certainly, prescriptions are helpful, often necessary at times, but so is conversation. People are complex, evolving, often broken creatures with individual trajectories; their histories and stories impact their mental condition and who they become over time. Hence, individuals aren’t simply seeking a prognosis on paper. They are desperate to express, offload, devise a process to manage their condition, learn to peacefully coexist with it and employ strategies to eventually conquer it.
Despite the increasing mental health wreckage, its complex causes and taboos act as deterrents against bold measures. Whilst top-down initiatives are useful starting points, we cannot wait for Mental Health Day to make a difference. Nor should solutions be reduced to rhetorical tag lines; hands-on action is imperative. In California, a collaborative offers tools to residents: a behavior tracking app, therapy and trauma-informed yoga. In Zimbabwe, grandmothers offer evidence-based counselling on benches. In South Wales, prisoners regain a sense of purpose by working in jail gardens. Technological innovations offer 24/7 interventions.
In Pakistan too, a multi-pronged approach is vital, with public-private initiatives and creative self-care. In addition to normalising the conversation, individuals can introduce lifestyle adjustments: meditation and mindfulness (through apps such as Headspace), yoga, clean eating and activities which generate personal happiness — for example, reading, travel etc. Walking, experiencing nature and the outdoors, refreshes the mind. Keeping a gratitude journal recognises positive forces in life. Pushing back on workplace politics and unreasonable demands by bosses are helpful. These are immediate practical changes.
Recently, I listened to my friend divulge her battle with depression; of how, despite its crippling effects, social pressures compelled her to act normal and look after her children. I was filled with exasperation at the decrepitude of Pakistan’s mental health infrastructure — a fledgling, under-committed enterprise, offering token outreach even to the privileged, let alone others.
Her story is one of millions; together, they reinforce the gravity of mental health neglect in Pakistan. Such a situation in a chaotic society as ours, signals a ticking time bomb. So, unless we stop downsizing the trauma and pigeon-holing this as a figment of people’s imaginations, this tinderbox — waiting to be ignited — will eventually explode.
The writer is a freelance contributor.
Published in Dawn, September 15th, 2019