Alert Sign Dear reader, online ads enable us to deliver the journalism you value. Please support us by taking a moment to turn off Adblock on Dawn.com.

Alert Sign Dear reader, please upgrade to the latest version of IE to have a better reading experience

.

The state of mental health

October 08, 2011

Email

THE average Pakistani has been nothing more than an innocent bystander in the great power politics of an international system gone awry.

For our country, already underdeveloped, struggling to form a national identity and manage a flagging economy, the events of 9/11 meant the start of a long and arduous journey, with our borders being transformed into war zones and our cities into hotbeds of socio-political instability.

We’ve experienced terror firsthand. And those reserves that were left over from combating terrorism were quickly dissipated in attempting to deal with natural calamities such as the 2005 earthquake, nationwide flooding, and more recently the dengue epidemic. The equation has left us with badly damaged infrastructure, a dearth of leadership and a collapsed economy.

More than a sizeable portion of 180 million Pakistanis hail from ordinary everyday backgrounds — 180 million versions of the ‘common man’. These common people are characterised by a fortitude that goes way beyond the strength of the average individual. Their resilience in the face of epidemic violence and social injustice is nothing short of inspirational.

But violence and social injustice is a two-way street and it’s time we gave the writing on the wall more than a cursory glance.

The mental health of a community is directly linked to its social development. There are five core adaptive systems that explain the effects of social adversity on mental health outcomes (Silove model). These are ‘safety’, ‘attachment’, ‘justice’, ‘identity-role’, and ‘existential-meaning’.

As a developing country with a history of long-term intrastate conflicts, we are twice as susceptible to chronic poverty.

Another related concern for psychiatrists and political analysts alike is that of ‘stress proliferation’, which is the notion that adversity tends to accumulate and severely affects those who are exposed to repeated stress. Therefore, for those Pakistanis who have been a fundamental part of the front lines of the war on terror, the tendency to be adversely affected by stress and related disorders is much greater.

The socio-political situation of the last decade has also witnessed massive social mobilisation, perhaps the biggest of its kind since the Soviet invasion of Afghanistan. These migrations have all had different fulcrums: the movement of civilian families from the tribal belt to safety zones, immigration from urban centres abroad, the rise of entire settlements in the form of IDPs, the constant threat of target killings in the country’s major metropolises and mass population being dislocated by floods.

These displacements have seriously undermined ‘attachment’ which helps form relationships and emotional bonds with people and our environment and serves to fulfil our basic need of comfort and recognition. The resulting ‘security’ dilemma is one where we live in a country in which we are afraid to step outside our homes.

We are subjected to everyday reports of suicide blasts, kidnappings and killings. The transformation of cantonments and the federal capital into fortified prisons only serves to heighten our sense of insecurity. And what of the millions of Pakistanis who aren’t privileged enough to live behind these fortified walls? Are they not deserving of the same protection as the elites?The media talks about Great Power ambitions to balkanise Pakistan. Yet we fail to see that we have balkanised the nation ourselves; the social divide has never been greater and we have several hundred LoCs running through our towns, cities, districts and provinces. Insecurity is thus but a natural consequence of the social fabric of post-9/11 Pakistan.

Continuing with the Silove model, experiences of atrocities can detrimentally serve to undermine an individual’s sense of identity and trust in other human beings. To add insult to injury, Pakistan’s national image has taken blow after blow to the point where Wikipedia uses ‘Pakistanis are terrorists’ as an example for stereotyping national behaviour.

The resulting lack of self-respect and control over one’s own image portrayal leads to a spiralling crescendo of feelings not least of which are dejection, helplessness and misery. Compounded by gross human rights violations, the denial of basic human rights as citizens of a sovereign nation-state has served to tear our society down the middle.

But perhaps the worst example of repeated trauma and human rights violations is damage to one’s faith in a meaning in life and humankind (existential meaning). This happens when a former source of identification becomes a source of internal conflict, for instance how identifying oneself as Muslim can become a mode for social exclusion and/or discrimination.

This year, World Mental Health Day, that will be observed tomorrow, is dedicated to ‘the great push: investing in mental health’. It is a global call for setting mental health high on the agenda and a campaign for developing better mental healthcare for the people. The people of Pakistan are standing on the precipice of a nervous breakdown, and they need to be saved from falling over the edge.

An oft-remembered quote from Julius Caesar is “There is a tide in the affairs of men….” It is time we addressed this tide, not only for the sake of our fellow countrymen, but also for the sake of our future generations. We need to invest in our sovereignty, our identity, our faith and our rights to ensure our survival. Let this be the last schizophrenic decade for Pakistan.

Asma Humayun is an associate professor of psychiatry at Rawalpindi Medical College.

econtactasma@gmail.com

Fahd Humayun is a graduate in International Relations from London School of Economics.

fahdhumayun89@gmail.com