The stigmatisation of mental illnesses

Why is our society afraid of addressing mental health issues?

I’ve heard it so often—“people in Pakistan don’t face the same issues as people in the West. Nearly everybody in the United States has a shrink or a psychiatrist because they don’t have anybody else to help them resolve their problems.” However, given the facts, it is a little hard to believe that a country with a sizable population of 180 million, 60.3 percent of which lives on or under $2 a day (HDI) and is routinely destabilised by the rising violence, terrorism, gender discrimination, political instability, energy crises and poorly handled natural disasters such as the 2010 floods, faces a considerably lower risk of mental health issues than the developed world.

Given the dearth of empirical data on mental illnesses in Pakistan, it is difficult to provide an accurate estimate of the percentage of our population living with psychiatric problems. Karawan-e-Hayat Institute, a Karachi based NGO, estimates that around 15 million people suffer from mental illnesses in Pakistan while other studies show the numbers being closer to 30 million. A very limited number of hospitals have psychiatric wards and according to the WHO’s Mental Health Atlas (2011) there are only 419 certified psychiatrists and 480 psychologists in Pakistan. Despite the startlingly slim number of medical practitioners in this field, an acquaintance observes that on a recent trip to her psychologist, she found her clinic “empty, very unlike a doctor’s office and it was hidden away in the basement such that nobody could see you going in”.

It is not that individuals in Pakistan do not suffer from all kinds of mental illnesses; it is rather that we have chosen silence as the governing voice in our discourse on mental health issues. Mental health patients are stigmatised as social outcasts in a very different manner from people facing other illnesses, they are often perceived as deviants and their condition is treated as a shameful secret by their families. In a number of cases, family members are offended by the suggestion of seeking outside help, as talking about personal and intimate problems is a cultural taboo.

The need to protect one’s izzat, or honour, constructs another barrier for individuals. The burden of izzat is often disproportionately placed on women who might fear that seeking professional mental health services might ruin their family’s reputation. When no clear signs of “abnormality” such as uncontrollable rage, fits, etc are visible, the individual’s problems are frequently ignored, repressed or completely disregarded. Given this shame inducing culture of suppression, it seems likely that the most common mental disorders such as depression and anxiety, remain undetected and by extension, untreated.

On the other hand, certain conditions such as eating disorders, which do not pose a threat to social norms and fail to characterise the individual as a deviant, are often dismissed as ‘real problems’ altogether. On more than one occasion, I have heard people telling individuals suffering from anorexia nervosa that they are “so lucky to be so thin” and “if only we had eating habits like yours”. The media and the fashion industry also downplay the harmful potential of eating disorders, demanding models and actresses to maintain a certain weight or get rejected altogether. For an anorexic, especially one who is not receiving treatment, supermodel Kate Moss’ famous one-liner “nothing tastes as good as skinny feels” is a positive reinforcement of her/his daily mantra and normalises her/his condition.

It is commonly noted that the first step towards recovery is recognising that you have a problem. However, in a society where stereotypes involving mental health issues are almost exclusively negative, how can individuals talk about their conditions without the threat of social alienation? In a study conducted by Tehreem Rahman at Columbia University, she notes that “a major barrier that prevents South Asian women from seeking professional help is the fact that their somatisation of psychological distress hinders their primary physician’s recognition of any mental illness that they might be suffering from. For instance, South Asians who claimed that they were suffering from a “sinking heart” were in fact exhibiting some of the main symptoms that are associated with the Western concept of “depression”.”

It becomes impossible for people to convey their conditions when our language systematically excludes and subverts the correct definitions and classifications of mental disorders. Obsessive Compulsive Disorder is a real psychological illness that people struggle to live with, as ‘real’ as arthritis or lymphoma, and not just part of the English lexicon used in a caricatured manner to describe someone who is excessively meticulous. Similarly, using words such as bi-polar to describe volatile behaviour or vice versa, undermines the reality of psychological disorders and generates a sense of fear. Deprived of a safe space for addressing their issues, individuals living with mental illnesses seek to internalise their trauma and may indulge in self harm.

Moreover, in a culture enshrouded by superstitious beliefs and rituals, some people seek help from unconventional sources such as spiritual healers, religion, etc. While these mediums might help in providing reassurance to the family and/or individual, receiving help from other avenues besides professional healthcare services reinforces the idea that mental illnesses are not deemed to be equal to physical ailments. For example, if you had a relative diagnosed with diabetes, hopefully you’d feel no shame or stigma around discussing their condition and getting them the best medical treatment available. And yet, when the problem is mental illness – affecting the brain and not the pancreas, like diabetes, – we often don’t know how to respond.

There is a huge roadblock between people and the treatment they need: the stigma and shame that pervade our culture regarding mental illness. We need to recognise that people living with mental illnesses need as much care, medical treatment, sensitivity and support, if not more so, as any other kind of patient and instilling them with the fear that they will become social pariahs is not helping them in any way.

The writer is a staff member and holds a degree from Mount Holyoke College.