It is irrational to expect the status quo to improve significantly unless the cultural barriers giving rise to the stigmas attached with mental health issues are set aside....
COVER STORY
According to a reliable study, ‘Perceptions Pertaining to Clinical Depression in Karachi’, by Nisar M, Mohammad RM, Fatima S, Shaikh PR, Rehman M., more than 20 million Pakistanis (almost 10 percent of the country’s population) suffer from some form of mental illness. This figure, though actually alarming, is not surprising for a society where mental health issues are frequently associated with black magic, possession of evil spirits or punishment for a previously committed sin, and thus shied away from bringing the least of them out in public lest they should bring public disgrace. There exist numerous ways to alleviate the sufferings of the mentally ill; however, it is irrational to expect the status quo to improve significantly unless the cultural barriers giving rise to the stigmas attached with mental health issues are set aside.
A careful analysis of the mental health problems reveals that they are often linked to some sort of physical imperfection – a sub-category of stigma. The physical imperfection may be in the form of a permanent disability or a short-term ailment; it might even be pain associated with an acute injury. As a consequence, the affected individual cannot partake in activities in which his colleagues do, feeling as if he is the odd one out. This feeling of loneliness, in turn, takes a toll on the subject’s mental health. For instance, in a football game at school, a student with an injured foot is likely to watch his teammates play while he blames his ‘misfortune’, stopping him from being one of the players.
Moreover, the feeling of stigma associated with physical imperfection is further exacerbated when the differently-abled people avail the privileges associated with their condition. For instance, ‘priority seats for disabled persons’ in public transport, ‘reserved seats for disabled candidates’ for admission to medical colleges and ‘counter for people with disabilities’ in banks are some of the common examples of the aforementioned discrimination in our society, being a constant source of stigma for the beneficiaries.
The examples cited above clearly prove the bond between physical wellbeing and mental health is intimate.
Another aspect of stigma in our society involves emotions of a person; for example, the post-traumatic experience of an individual. Whereas the trauma – for instance a rape case – is itself a mark of disgrace for the victim, revealing the experience even for legal purpose is considered an even greater dishonour for the entire clan. So, not only the woman has to cope with mental distress due to the trauma, she also has to feel the embarrassment for ‘letting her family down’.
Furthermore, in a reserved society like we have in Pakistan, undergoing tests for medico-legal formalities to confirm rape is often considered a breach of privacy and a ‘sin’.
Consequently, the victims, mostly women, either keep their mental agony to themselves voluntarily or are forced to do so by their elders. At times; however, when they do approach authorities for legal support, the victims find the law enforcement agencies biased, in which case the woman also has to bear the pain of divulging the ‘confidential’ ordeal to no avail. This is just one example of how stigma leads to a long-lasting mental distress.
There is no country, society or culture where people with mental illness have the same societal value as people without a mental illness. However, much can be done to bring the discrimination between these two people to a negligible level.
The foremost is to talk openly about the problem, mental or physical. Speaking about an issue is the first step in actually solving it. If an atmosphere of mutual trust develops, at the family level to start with, where any member feels confident in speaking out his suffering while the others sympathise with him and endeavour to solve that person’s problem, it will result in the sufferer feeling unembarrassed; he will realise that telling others about his mental health issue will get him support and sympathies, not scornful comments.
Secondly, there is a need to encourage equality between physical and mental illness. Unfortunately, while the health-care system is almost entirely centred on curing physical illnesses, mental illnesses are, particularly in developing countries like Pakistan, not even considered conditions that require treatment. When the society is not inclined towards consulting trained psychiatrists for mental health problems, it is not surprising at all that in Pakistan, for a population of 220 million, only 400 trained psychiatrists exist! (Source: ‘Mental healthcare in Pakistan’ published in Taiwanese Journal of Psychiatry.) And, approaching them is a real hurdle, especially for people living in remote areas.
Thirdly, the general public, and celebrities having a huge fan base in particular, have to be more conscious of the language they use for those suffering from mental health problems. Instead of labelling a person as ‘schizophrenic’, referring to him as a person ‘suffering from schizophrenia’ is more reasonable. In the former case, one gives the impression that there is nothing more to the individual’s life other than schizophrenia; in the latter case, the notion given is that there is so much more in the life of the concerned, schizophrenia is just a drop in the ocean. By referring to those with physical maladies ‘differently abled’ instead of ‘disabled’, our society has marked a step forward concerning the appropriate choice of words. Same needs to be done for those with mental health problems.
Probably, the biggest role in shaping a person’s overall thinking is that of the media. Unfortunately, media coverage of mental illnesses has been consistently and overwhelmingly negative and imprecise. Dramas and films airing on the television repeatedly depict those suffering from mental illnesses as ‘unpredictable, unreliable and destructive’. The portraying of the lead role in the film ‘Joker’ as a mentally ill person with a brutal mind-set is a case in point. In this regard, a major step would be to shape the media in a way that a positive image of people with mental health issues is displayed to the public.
Even though the aforementioned ways to reduce mental health stigma may sound easily applicable, a long list of cultural and societal barriers intercept the implementation of these methodologies, and it is only after these barriers are crossed that the desired outcome can be achieved.
To start with, mental illnesses are very often considered the effects of black magic and evil eye, and instead of consulting psychiatrists, the masses turn to faith healers for remedy. Our society’s over-reliance on the peer (faith healer) to cure all types of illnesses by a taweez (amulet), and the beliefs in jinn (ghost), churail (witch) and nazar-e-bad (evil-eye) leaves very little room for actually thinking of an ailment as a health disorder requiring medical intervention.
Another aspect of the foregoing beliefs, deep-rooted in our society, concerns blaming parents for an affliction of their children, particularly one involving the mental health. While each physical and mental abnormality has sound scientific logic, stating that ‘the child’s condition is a punishment for the bad deeds his parents have committed in the past’ is what simply appears to a majority of the less-educated class of our society. Hence, the fear of being labelled as wrongdoers continues to haunt the parents. They also avoid consulting a psychiatrist for their child’s condition in an effort not to bring it out in public. So, while the child continues to suffer from the mental illness, parents suffer from the stigma of having a mentally ill child.
A second cultural barrier is the society’s hesitance in consulting doctors of the opposite gender. Recently, I came across a woman who chose to consult a freshly graduated and inexperienced dentist over a practicing and highly experienced dentist, only because the former was a female while the latter was a male. This reluctance is further enhanced when the disease is a mental one, not physical, because in that case the patient is required to open up all his/her emotional and psychological distress instead of just exposing the apparent sign of a sickness or injury.
The foregoing scenario accentuates the need to prevail upon the masses that narrating the patient’s physical, mental, emotional and psychological sufferings is an inevitable part of the overall check-up and that gender discrimination should not come into play while seeking medical help.
In conclusion, any stigma is a barrier to mental health, more so in conservative societies. While all kinds of physical and cultural conditions can be the cause of stigma, the aforementioned statement can be rectified in numerous ways concerning both, the attitude of the individual involved and role of the society. However, significant improvement in the existing situation can only take place once the cultural barriers imposed in the way of seeking mental health treatment are abolished.
