Mad Not Stupid: Living, Loving and Thriving with Bipolar Disorder
By Meezan Zahra Khwaja
Sang-e-Meel Publications
ISBN: 978-969-35-3704-8
186pp.

It is not every day that people with some sort of mental disorder declare the state of their mental health openly. What we see around us is that people with mental disorders and their families do not accept that there is a problem and, if they do so, they try to hide it from others, which often results in aggravating the problem.

However, there are brave people like Meezan Zahra Khwaja, who not only accepted her bipolar state but also did not hesitate in telling the world about it. In her book, Mad Not Stupid: Living, Loving and Thriving with Bipolar Disorder, which is part autobiography and part a discourse on the state of mental health in Pakistan, Khwaja discusses how the disorder affects her and how she deals with her problem.

Khwaja reveals that she had her first episode of mania — a state of bipolar type 1 — when she was 17 years old, when all of a sudden the world seemed to be a dangerous place to her, and there was a complete break from reality in her thoughts. She recalls that she was the subject of — often malicious — gossip as there was no awareness about bipolar patients, and there was a great deal of stigma surrounding mental illness.

She explains that bipolar disorder is of two types: bipolar type I and bipolar type II; then moves on to explain the various stages of bipolar type I (which she suffers from) — mania (highs), followed by depression (lows) and euthymias (normal periods). She writes, “As a bipolar patient, and possibly as a human being, life is a constant struggle, up and down, high and low.” She further says, “It is up to you how you control your manic phase and depression.”

She considers it an achievement that, despite being bipolar, she was able to acquire her Master’s degree from abroad. She worked in the development sector and even founded and ran her own NGO — the Ali Faateh Foundation — and opened and managed the AFF Barkat Jan Primary Girls’ School in Lahore, which provided free education to girls from underprivileged backgrounds for a decade.

A woman dealing with bipolar disorder pens a book that is part autobiography and part a discourse on the state of mental health in Pakistan

Khwaja considers herself lucky to have a supportive family and true friends who not just understood her but supported her and stood by her throughout her life. She thinks that the solid bond with the family and support of her friends enabled her to achieve all that she has.

The book explores the problems faced by the mental health sector in our country. In older days, the mentally ill were considered dysfunctional and not a part of society, but now “there is medicine and cognitive therapy, and if you have supportive family and friends, then that makes for a wonderful combination for a bipolar patient to return to functionality. It is functionality that every bipolar must aim for.”

In Pakistan, there is a massive lack of awareness about mental disorders and their treatment; most people do not know how to deal with mental health issues. There is also a stigma attached to mental illness. “It is all around us, yet mentioned nowhere. If it is mentioned, it is done in low tones and hushed whispers.” To add to the stigma, there are myths surrounding mental health. People believe in ‘dum darood’ and think that mental problems can be cured by exorcising evil spirits or applying herbal remedies. This is because of the lack of education in the country.

As there is not much awareness of mental health issues, there is little concept of cognitive therapy. People want instant results; they visit psychiatrists for medication and non-medication treatments, ie therapy, are often not thought about. They also feel that, if they are not getting any medicine, their money is being wasted. Since doctors are over-worked in the public sector hospitals, they cannot pay individual attention to each patient, which also causes dissatisfaction among patients.

Khwaja talks about the cultural issues related to therapy and is also conscious that there is a financial cost involved in seeking therapy. “Only people of a certain class can afford CBT [cognitive-based therapy] in Pakistan at present — which is problematic in itself.” Another issue she mentions is that mental health patients keep changing their doctors and therapists. “I would advise against this,” she writes.

Discussing her own experience, Khwaja recommends a combination of cognitive therapy and anti-psychotic medication and mood stabilisers. However, “therapy is another difficult domain. … Therapy is difficult the world over, because it is expensive and there is generally a long queue to get to a psychiatrist.”

To ascertain the state of mental health in the country, Khwaja held extensive conversations with several psychiatrists and therapists. She was told that, because of the heavy workload of doctors and nurses — both in the public and private sector — and the severe lack of financial resources for most people, patients often do not get the deserved care and attention.

The patients doctors mostly see at the public sector hospitals are the ones who cannot afford private fees or medication. These patients are often not happy with their experience, as there are long queues in the public sector hospitals because the ratio of psychiatrists to patients is one of the lowest in the world. Those who can afford it, visit private psychiatrists and therapists and often get “better” care. But awareness is lacking everywhere, even in cities, where information is more readily available.

Khwaja details various self-improvement techniques that she used and benefitted from, such as journalling, prayer, yoga, meditation and using apps like Headscape or Calm; she also advises patients to recognise and avoid triggers such as certain types of music or unpleasant company, pointing out that triggers are different for each person. She introduces the readers to online community interaction platforms for bipolar patients, such as PatientsLikeMe, which can be joined to help overcome the intensity of the disorder.

While she openly discusses her feelings and problems, Khwaja does not portray her life as a sob story. In a very simple narrative, she tells the readers what a bipolar patient’s life is like and how difficult it is for such an individual to cope with life. She emphasises the importance of removing the stigma associated with mental illness in Pakistan.

It is important to change the way society views mental health. While it may not be possible to change the mindset of the older generation, efforts can be made to create awareness so that the younger generation does not follow the old mindset and looks down upon the mentally ill and, instead, accepts them as one of them.

What the mentally ill need is kindness and empathy, not dissociation. Rather than being shut behind doors, they must be treated with kindness and included in everyday life. Khwaja wants a more harmonious and compassionate culture in our country, as mental health patients are very much members of our society. She firmly believes that the mental health situation in Pakistan can be improved if resources, time and attention are allotted to it by the government as well as the public and corporate sector.

The reviewer is a freelance journalist.X: @naqviriz

Published in Dawn, Books & Authors, October 26th, 2025