"I wish I could tell you how lonely I am. How cold and harsh it is here. Everywhere there is conflict and unkindness. I think God has forsaken this place."

Elizabeth Gaskell "North and South"

A video clip currently doing the rounds on WhatsApp, Facebook and local tv channels caught my attention. Ordinarily, I would refrain from further publicising a tragic incident but since the clip has already gone viral, and has been aired on multiple tv channels, it appeared necessary to comment on it.

The clip shows a heavyset woman, perhaps in her mid-30s. She is reportedly a staff member at the Gujranwala Medical College, a government institution. She appears irritable and agitated. A tv microphone is being thrust into her face as several people try to calm her down. One of those surrounding her is a psychiatrist, also on staff at the college, trying to calm her down and fend off the media. As we watch, the woman gets more and more agitated and finally explodes. She starts yelling that she is Hussain, grandson of the Prophet (pbuh). She starts abusing Chief Minister Shahbaz Sharif in the choicest language, and as those surrounding her try to restrain her, she gets more and more agitated until she is yelling incoherently, completely out of control. The tv microphones continue to be thrust into her face, and the entire sordid episode is captured on camera. It is promptly aired and distributed on the social media.

Of the coverage that I have seen of this incident, nowhere is the possibility mentioned that the woman is suffering from a serious mental illness. Some people seem to find the episode funny, others advise that all she needs are ‘a couple of hard slaps’.

This is the level of ignorance in our society regarding mental illness.

Reports say that the woman just had a baby about two months ago and while it is never advisable to venture an opinion about someone’s mental health on the basis of a two-minute video clip, it seems obvious that she is in the grip of an acute illness. Her agitation and the nature of her ranting would suggest that she is ‘manic’. This is a state of extreme agitation brought on by any number of factors including recent childbirth.

A person suffering from mania can become sleepless and irritable. If untreated, they may begin to hallucinate (i.e. see or hear things that are not there), and to develop delusions: false fixed beliefs totally at odds with reality such as the belief that they are a religious personality. A person in a manic state can indulge in reckless, dangerous behaviour that may endanger their lives or the lives of others. Immediate hospitalisation is required along with emergency medication treatment to normalise sleep and calm the person down.

With appropriate medication, the episode usually passes in a few days, and the person returns to normal. Medications usually need to continue for a few weeks, sometimes a few months. Continued psychiatric supervision and treatment is essential, especially in the case of a new mother to ensure the safety of both the mother and the baby.

Regardless of the nature of the actual illness, it is safe to say that recording a person in the throes of an acute illness, and then uploading the video on the internet is a gross violation of a person’s confidentiality and privacy. In addition, circulating a video like this can, in today’s Pakistan, seriously endanger a person’s life. There are already murmurings of ‘blasphemy’ against her. We have already seen an example of the abysmal state of affairs in Pakistan where a severely mentally ill man sentenced to death had his appeal rejected by the Supreme Court.

The honourable justices of the Supreme Court then totally exceeded their mandate and declared that not only was the patient fit to be executed, but that schizophrenia, one of the most severe mental illnesses out there, was not even an actual illness! (http:// www.dawn.com/ news/1291384)

This decision by the Supreme Court was widely derided all over the world with Pakistan’s judiciary becoming a laughing stock over their ignorance. It was only after a concerted effort in the press, social media and personal appeals to the president that the execution order was stayed, and the case referred back to a panel of experts for review.

And now we have this.

Despite the widespread use of information technology and the consequent spread of information about all kinds of topics, mental illness remains a taboo subject in Pakistan. In neighbouring India, awareness about mental illness received a huge boost when popular Bollywood actor Deepika Padukone and powerhouse director Karan Johar both went public about their battles with depression. It is hard to overestimate the impact these kinds of declarations have on the public consciousness.

All the public awareness campaigns in the world cannot match one ‘celebrity endorsement’. Once someone famous goes public with their illness (such as Wasim Akram about his long struggle with diabetes), attention and increased funding usually follow giving a huge boost to those fighting to prevent and treat these illnesses.

Sadly, in Pakistan, the stigma associated with mental illness remains strong and consequently, those in the public eye shy away from admitting that they, too, have struggled with these very common illnesses.

A notable exception is the renowned actor Roohi Bano who has suffered from schizophrenia for a number of years, and has helped in raising awareness about this terrible illness. Noted Pakistani film actor Waheed Murad as well as famed singer Amanat Ali Khan are both known to have struggled with alcohol addiction and died young, probably as a result of it. Short story writer Saadat Hasan Manto was an alcoholic and also struggled with mental illness. His acclaimed short story ‘Toba Tek Singh’ was inspired by his stay in the Lahore Mental Hospital.

In the current era though, our artists, writers, sportsmen, singers and other celebrities remain tight-lipped about this topic. From personal experience, I can vouch that this does not imply that mental illness does not exist amongst the rich and famous in Pakistan. Quite the contrary. The list of people who come to consult me regularly would make up quite a who’s who of the celebrity circuit in Pakistan but sadly, their first request is complete anonymity.

As a medical professional, I must, of course, respect their confidentiality but I do wonder at times, if one or more of them went public with their struggles, it would inspire so many ordinary people to seek out the help they need. Perhaps in that case we would see less of what we saw in that outrageous video clip which was circulated all over the internet: a young mother in the throes of a severe illness being made a mockery of and instead of receiving the treatment she needs and deserves, being ridiculed and threatened for being ill. Tomorrow, one of our loved ones can be in the same position. Before laughing at her, think about that.