In 2016, the Supreme Court of Pakistan ruled that “schizophrenia” did not qualify as a mental illness under the country’s laws regarding the matter. Imdad Ali, who was diagnosed with schizophrenia, was on trial for having committed murder. The judge ruled that his illness was variable and related to stress, and was not seen as having interfered with his crime. Such a ruling regarding the defendant was spoken out against by both the UN and Amnesty International amongst other organisations. Ali’s case is just one example of the confusing way in which mental illnesses and subsequent treatment is dealt with in our society.
It is estimated that around 50 million people in Pakistan suffer from some sort of mental disorder. Another estimate puts 36% of Pakistanis as having suffered or suffering from anxiety and depression. The majority of this 36% is often caused by strained relationships with loved ones, failure to meet societal expectations and pressure of social norms. While most mental illnesses are treatable, or at least manageable under the right guidance, it is getting that expert attention that often becomes a struggle.
Mishal Ladhubhai, a recent psychology graduate and founder of mental health awareness blog @dimaaghi_sehat spoke to us about the struggles of providing psychotherapy and treatment for mental illnesses in Pakistan, and what can be done in order to change the narrative.
After completing her degree in the UK, Mishal has worked at multiple institutes in Pakistan including addiction therapy centres. Many of the organisations Mishal had worked with or has come in contact with offer free services as well. Of course there’s always the other side of the coin as well. Those who do charge for therapy or counselling services often charge exorbitant amounts, which leads to questions on how these prices can be seen as capitalising on the desperate situations patients may find themselves in. In a society that looks down on not just treatment for mental illnesses but often their very existence, accessibility of these services is just as important as that of physical health services.
Accessibility is not limited to the price of services either. Mishal noted that even in cases where counselling services were provided for free, many people had gotten in touch with her to talk about relatives or friends that suffered from mental illnesses but refused to get professional help. Accessibility also includes familial pressure, social stigmas and lack of access to such services.
Social stigma around therapy not only forces people to avoid therapy, but often pressures them into lying about it even when they do avail it. At an addiction therapy center Mishal worked at, many patients in their in-house program would lie to the people they knew about about being abroad rather than being in a rehabilitation program. Battling addiction can be overwhelming enough already without having to deal with the added pressures that come with hiding such treatment.
The best way to rid ourselves of this stigma is by education and awareness, which is exactly what Mishal does with her blog. However, not everyone has access to social media pages and a more widespread way of spreading awareness is through the school system. Children should be educated about their mental health with the same importance that is given to their physical health. Everyone’s mental health is important and we shouldn’t have to get to breaking point to access mental health services. Counselling can be for everyone and for people who may not find support systems that they need elsewhere it should be actively encouraged.
It is important to be aware of the kind of help that is available. Educating ourselves and sharing that information is the first step in removing barriers to accessibility. Commonly available counselling services rely mainly on two kinds of therapy practice.
CBT (Cognitive Behavioural Therapy) is a practice that takes both behaviours and thoughts into consideration. It works on the idea that by changing thoughts through a series of exercises, you can also change behaviours. Most people find it helpful for these exercises to be guided but many self guided CBT programs can also be found online or in app form.
Person Centered Therapy is a form of therapy that branches out from a Humanistic Approach. In such therapy, the focus is given towards the client instead of the problem. The main focus of this therapeutic technique is to make the client independent to deal with their present and future problems
We see more and more people willing to have this conversation and it is heartening to note that change is coming. It is a movement that shouldn’t and won’t be stopped. It's important to break out of circles that do hold such beliefs and find ways to bring this information to those who still face stigma around mental health. Only then will the narrative move forward.