THIS is with reference to the article ‘Decolonising mental health’ (Feb 9), which highlighted the conditions that produce distress. One fundamental question — ‘are we addressing the roots of distress or merely managing its symptoms?’ — begs serious attention. There are two treatment models operative in Pakistan; psychiatry and psychotherapy. The first is primarily based on medication, while the second is based on healing the repressed wounds through personal change and growth. The rivalry between these two models tends to deny the patients the collaborative professional advice for rapid healing.

The deeper root causes of mental health challenges in our cultural context include inequalities that cause distress. The incidence of drug addiction is endemic in the dispossessed population, but it is also prevalent in the upper echelon of society.

In the middle and upper-middle classes, however, the broken interpersonal relationships are the major cause for mental health issues. For instance, in the primary parental caring system, a father — domineering, disciplinarian and an authoritarian in attitude — can lead to repressed mental conditions. If untreated, such conditions can retard organic growth of a chile. I have also witnessed a large number of cases where an overbearing mother ends up suppressing the genuine desire of the daughter for freedom to act independently and to avoid dependence.

The primary reason for this is the insecurity of the mother which compels her to protect the daughter from social vulnerabilities. Overall, in my experience the root cause of a large majority of the mental health cases is the consequence of shattered or unhealthy interpersonal relationships.

This is a serious challenge for integrated human development and a planned policy intervention is required from the govern-ment. Meanwhile, I feel a collaborative model of mental health, rather than an adversarial professional model, is needed in Pakistan.

Neither the psychiatry model of medicine nor the psychotherapy model can meet the challenge alone. In my professional view, the field of psychotherapeutic models needs government patronage to facilitate the needy ones in growing up as integrated personalities rather than fragmented ones.

Dr Zafar Iqbal Qureshi
Lahore

Published in Dawn, March 6th, 2026