From Stigma to Inaccessibility: The Plight of Mental Health in Pakistan - by Zainab Waseem

We’ve got to admit it; mental health isn’t Pakistan's strongest forte. Something we didn't know though, is how bad we’re at it. Out of the 200 million people who inhabit our country, there are less than 500 psychiatrists present to deal with them (according to The Lancet Psychiatry). This leaves about 90% of Pakistan’s population with common mental disorders left untreated. Unfortunately, this means there’s a good chance you and I might be falling in that majority too. But we’re not going to sit around and feel sorry for these tragic statistics; we’re going to figure out why so many of us fall into that majority.


I believe there are two fundamental reasons for our predicament in the domain of mental health: the stigma around mental health disorders and the stigma around going into the field of psychology.


Stigma Around Mental Health Disorders

We’ve all talked so much about raising knowledge on mental health and the stigma surrounding it, yet many of us still suffer from it. Is the stigma so deeply rooted that even after recognizing it, we ourselves are yet to overcome it?


We come from a very rich culture of our long line of ancestors. But culture isn't the only thing we've inherited; we’re very fond of their societal values and way of living, good or bad, as well. Unfortunately, this designed our society in a way that alienates anything new that requires our people to change their ways- the identification and treatment of mental health being the perfect example. So what are the different factors that stand in the way of getting help?


1. Lack of self-identification. Many Pakistani individuals don’t get treated for their mental disorders because they don’t believe they have one. If they have a problematic or unnatural behavior in their personality, they don’t consider it as anything but normal because that’s just how they've always been. They’ve grown up seeing their parents who grew up seeing their parents, unconsciously adopting the same patterns of concerning behavior without realising, let alone accepting that there could be something wrong with it.


2. It’s not taken seriously. Here’s a little dialogue to explain this one:

A- Where are you going?

B- To the doctor.

Why? Are you hurt?

Not physically.

Then why would you go to a doctor if not physically hurt?

I’m not feeling myself. I’ve been depressed and anxious.

*sigh* Go back inside and pray five times a day. And get off that damn phone. Dramay.


3. Pehle tou aaj tak khandan may kisi ko nai hua. We’ve been carrying the toxic traits and traumas generation after generation from our ancestors that it has become a part of their customs. If someone’s grandfather had serious anger management issues that passed on, it is excused and sometimes even glorified when the next child shows up with the same issue. Why treat it now when it’s a family thing? If someone recognizes traits of a bipolar disorder in them, the first thing they might get to hear is “Aaj tak khandan may kisi ko nai hua. Tum anokhi cheez paida hoye ho?”


4. Log kia kahain ge. “Mental disorder is a delusory disease that’ll only bring shame upon the family if God forbid we ever go to a doctor for it”. “Yes, okay I understand you’re feeling depressed but you don’t need to go to a therapist for it. They are for those who go completely crazy. We can resolve this at home.” “Don’t tell other people that you have a mental disorder. I don’t want people to think I have an abnormal child.”

Does anything sound familiar? Even when we do recognize the problem and realize we need to do something about it, the fear of social rejection is so deeply engraved in our heads that we refuse professional help over it.


5. Why would I let someone else into my home affairs? Some people, just for the sake of not letting a third person into their house affairs, don’t get professional help. A mother, for instance, wouldn’t want her son telling stuff about their home dynamic to a third party and then receiving advice from them.


6. Getting help means admitting you’re weak. Sometimes it’s yourself you have to convince to get better. Granted, it does feel like admitting to yourself that you weren’t strong enough to come out of it by yourself, but sometimes getting help is the strongest thing you can do for yourself. It’s the bravest choice to help yourself get better.


Stigma Around Going into the Profession

By far, psychology is one of the most neglected fields of Pakistan. For ages, medicine has always been considered the mainstream field, so psychology automatically ended up falling behind it. But what’s worse is that in many households, children are discouraged from choosing this field on the basis of ‘having no scope in Pakistan.’ When in reality, with the increasing mental health awareness, it has the highest scope now more than ever. People are reluctant to send their children, with the misconception of confusing psychology with psychiatry, that they’d have to treat crazy and schizophrenic patients.


Psychology includes treating mental disorders, performing therapy, and dealing with the depressed nation that we are. We need to understand that without the uplifting of this profession, we still wouldn’t be able to get good, peaceful minds regardless of an infinite amount of mental health education.


Steps towards a solution

The solution isn’t as superficial and far-fetching as it seems; it starts with you and me. If we all try little by little, just tiny steps towards removing the stigma around mental health and this field will be a good start.


I interviewed a psychology student, Maahin Salman, studying at Foundation University, and had an insightful discussion with her about the stigma around mental health.

“The challenges faced the most by psychologists in Pakistan is that people consider everything related to mental health a taboo. They don’t think of it as a mental health issue; to them, it’s a supernatural phenomenon; possession by a jinn. So, instead of coming to us, they’ll go to spiritual healers or pirs,” she stated. “Moreover, another issue is how people connect mental health to religion. Although I do believe religion plays a part in mental peace, people believe that the only reason someone’s mental health was disturbed was because of their distance from the religion.”


When I asked her about how we can help to overcome this taboo, she said,


“What I do is first tell people that it’s okay to not be okay. Secondly, I make them understand that just like they’d visit a doctor when they physically get hurt, they should visit a doctor when they're mentally hurt too. That depression and anxiety have become a common everyday disease that can actually be cured.”


Our government can also play a key role in the uplifting of the mental health stigma.


“There are a few things the government should take care of. There’s a government helpline for domestic abuse, but it never actually responds when dialed. So the first thing our government can help with is providing active mental health helplines,” Maahin said, discussing the role of government. “Secondly, the government can increase the budget for mental health services. There’ve been hardly any surveys done on this matter in Pakistan. Lastly, the government needs to improve the education standard of psychology schools. I wouldn’t say there’s a lack of psychologists in Pakistan, but I would say there is a lack of good psychologists; education just isn’t up to the mark as it should be. Some of the graduates even open private clinics without a proper license and then proceed to give treatments as well. The government needs to check on those too.”


Various NGOs and organizations have been working for the awareness of Mental Health. Fortunately, the issue has been raised enough that people find it easy now to talk about it. We need to keep working on it like this and raise our voices till our government hears what has to be done. There is a silver lining and a hope that our country is slowly progressing towards the fight against mental illness. Various helplines are now becoming available for suicide prevention and many seminars are being arranged in schools, colleges, and universities for mental health awareness. Not only students but parents are being educated as well. Hope is there that one day, we’ll be able to defeat it all or at least fight head-on against the stigma of mental illness and will be able to achieve a peaceful population.

















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