When spreading awareness on mental health or even trying to understand such issues in depths it is important to develop a proper understanding of the perspectives of different kinds of people on these issue since they are highly decisive.
Living with a psychological illness may at times make them feel hopeless and alone. Often, they don’t comprehend what’s going on or they may even feel like they’ve done something wrong. Even if they do comprehend what’s going on, they may think that it’s difficult to discuss what they’re going through with their friends and family. The disgrace related with having a psychological illness frequently makes it difficult to speak straightforwardly about their emotions and experiences. This, added to the fact that people fail to understand what they’re going through and look down upon them, makes it almost impossible for them to at first, admit that they have the illness, and then receive proper treatment.
Depressed people for example, go through a range of emotions, which many of us all fail to understand. Many Pakistanis have a misconception about depression. They refer to depression as sadness.
According to one individual, who suffered from depression, it is way more than that. Sadness is just on the surface. This feeling of emptiness and hopelessness is what eats away at them from the inside. For them, they exist without a purpose.
“Depression, is an endless journey, without any destination.”
And it keeps them from doing anything, because everything is pointless.
The fact, that many people, especially in Pakistan, do not take depression seriously, and fail to address it as an actual mental illness, is the cause for this misconception.
“They just simply tell you to ‘get over it’ or tell you that ‘you’re being ungrateful’, and some even, instead of giving support, tell you to ‘get out of this phase!’
The individual in question, continued to explain how the people reacted towards his illness.
“Since people don’t know about mental illnesses, when someone is ill, they tell you to go and offer prayer. Some even start to cast doubt on your Iman (faith) and call you weak.”
Some people shrug it off by referring to illnesses as a means of seeking attention.
And this is the worst response to a mentally ill person. It adds to his/her hopelessness. It makes one feel so alone; it makes them feel as if there is no point in living if no one understands you. Sometimes, even one’s family fails to understand what they are going through. And in this extreme state, one starts to think about ending his/her life.
The same goes with anxiety.
A person suffering from anxiety. They worry excessively, feel agitated and restless. They face frustration, panic attacks, and irrational fears.
Most people tend to ignore them because they think it’s normal. When the person gets angry, they start to avoid him/her, which further irritates the person. Society condemns such people, not shedding light on the fact that they have a disease and require assistance. (1.1)
As mentioned above, these people too, then pull back from interactions with society. When they realize, that people do not understand them or don’t care about them, the loneliness makes them go further into seclusion.
After talking to teenagers with ADHD, we realize that people with ADHD too suffer from the stigma. At first, people fail to categorize their illness as a mental issue, and refer to them as energetic. Many people remain undiagnosed because of this.
When it is diagnosed, the situation doesn’t necessary improve. To improve their condition, the parents restrict the movement of their children. This makes the child agitated, as restlessness is a part of his illness.
For ADHD, people, especially parents, shouldn’t necessarily limit their activities, but rather organize their routine in a way that the child gets his physical activity as well as is able to somewhat control his illness himself.
By now, most of you have realized the importance of removing the stigma around mental health issues.
And now, you are probably looking for a solution.
There is no single solution to the problem. It can be solved in multiple ways.
Visiting a psychiatrist helps. However, what should we do if we come across a person who is mentally ill? It can be anyone; a family member, a relative, or even a friend.
“People say ‘the only person who can get you back on your two feet is you’, but I don’t think that works for me,” says the interviewee.
One thing that you shouldn’t do, is ignore the person. The person needs to know that there is someone in this world who cares, who understands that he/she isn’t trying to seek attention. The individual is going through something and he/she requires understanding, to say the least.
“I think talking to someone who understands helps. Someone who empathizes with you, doesn’t pity you, someone who listens, and doesn’t treat it like it is nothing,” says the interviewee.
For a second, imagine. If someone has cancer, will you blame him/her for their condition?
No, you wouldn’t. Supposing, it was negligence on their part that resulted in their condition. Would you call them out on that?
Most of us wouldn’t. We don’t want the sick person to feel worse because of what we say. Similarly, telling a mentally ill person that his/her faith is not strong or that they are weak isn’t the way to go.
So, listen to them, not just for the sake of listening, but understanding. Put yourself in their shoes, and see what you would do, if you were going through all that. Empathy, is a strong emotion. When you start understanding what they are going through, you become more caring towards them.
And they will appreciate it too.
Muhammad Shaheer Saleh
Most professionals in the field of mental health, psychologists, therapists etc agree that mental health care needs to be incorporated as a core service in primary care and supported by specialist services. There is a strong need to provide adequate training for general practitioners and postgraduate training for mental health professionals to meet the current demands (2.1). A collaborative network between stakeholders in the public and private sector, as well as non-governmental organisations are required that promotes mental health care and advocates for changes in mental health policy.
Mental health is the most neglected field in Pakistan where 10- 16% of the population, more than 14 million, suffers from mild to moderate psychiatric illness, majority of which are women. Pakistan has only one psychiatrist for every 10,000 persons suffering from any of the mental disorders, while one child psychiatrist for four million children, who are estimated to be suffering from mental health issues. Only four major psychiatric hospitals exist for the population of 180 million and it is one the major factors behind increase in number of patients with mental disorders. In Pakistan, majority of the psychiatric patients go to traditional faith healers and religious healers who believe that mental illness is caused by supernatural forces such as spirit possession or testing by God. All this is due to acute shortage of mental health professionals and relatively low levels of awareness about mental disorders. There is also no political will and no proper mental health policy in Pakistan. All this adversely affects the integration of care delivered by government health care professionals for patients with mental illness (2.2).
All this is cause for extreme concern among the professionals in mental health community in Pakistan and they along with government officials are trying to alleviate this situation.
Mental health awareness has always been a constant struggle in a country like Pakistan where psychiatric services and resources are so limited. Faced with stress inducers like erratic gas, electricity and water supplies, rising inflation, unemployment, the breakdown of law and order, political uncertainty, terrorism, and the disruption of the social fabric, Pakistanis are finding themselves unable to cope. As a result, mental disorders are on the increase, especially depression. Religion has been touted as a panacea to all their problems, but given the rising number of suicides in the city, mental illness is a time bomb that will take many innocent victims with it when it explodes.
According to WHO, depression will be the prevalent disease in the world by 2030, outranking blood pressure, cardiac disease, and cancer. With more women suffering depression than men, studies have shown that children raised by mothers suffering from depression have increased cognitive defects. Most alarmingly, Pakistan’s rate of depression is four times higher than rates in the rest of the world.
Yet even when faced with this plethora of facts arguments all striving to convince us of the major mental health epidemic that is occurring and spreading in Pakistan many of us choose to turn a blind eye, to ignore these professionals, these government and UN officials, doctors, psychologists and therapists. Many of us ridicule and deride them. If you don’t then surely you know friends or family members who have adopted this mindset. We ignore their warnings and simply call them ‘crazy’ since they work with ‘crazy’ people it is only logical that they be ‘crazy’ themselves is it? Yet this sad and pathetic mindset is all too prevalent in our society especially among the uneducated or lesser educated people. Many professionals run into this problem when trying to combat ignorance about mental health yet they run head first into this strong wall. Some of us even regard unstable mental conditions as a sign of weakness and therefore embarrassment, something to be hidden away from the eyes of society and therefore we lash out on the very people who seek to tear this ideology apart and in doing so we hinder and harm the very people who are trying their utmost best to help us.
So trust in professionals and listen to them rather than spite them and turn a deaf ear and convince others to do so as well.
Yet, there is still another major problem these professionals face in Pakistan is how to deal with the mental health problems of the poor masses. The poverty stricken are most vulnerable to mental illnesses, they do not have the money to help themselves when facing these illnesses and most importantly they are the most ignorant on this matter. Their hard lifestyle can lead to mental illnesses like depression, anxiety and in more extreme yet rapidly growing cases; personality disorder, schizophrenia and bipolar disorder. Yet these illnesses are just an everyday part of life for them. Since they do not believe in their existence nor have the money and knowledge to get help they either get on with their miserable lives and reach a point where they simply cannot control themselves any longer, such cases are most often violent and seen on the news, or they turn to other methods to ease their suffering. Methods readily available to them, chiefly the use of illegal and poorly made drugs such as moonshine. There are countless such cases in Pakistan where mental illness leads to addiction and therefore creates a whole new set of problems for the family and friends of the affected and person as well as society as a whole.
So, we should give not our trust to these professionals but our complete support as well because they need it in order to combat such dire problems.
Syed Taha Taimur
Definitions of poverty vary with social, cultural, and political systems. Attempts to understand poverty from poor people’s perspectives reveal that poverty is a multidimensional social phenomenon. From an epidemiological perspective, poverty can mean low socio-economic status (measured by social or income class), unemployment, and/or low levels of education.Poverty is one of the most significant social determinants of health and mental health, intersecting with all other determinants, including education, local social and community conditions, race/ethnicity, gender, immigration status, health and access to health care, neighborhood factors, and the built environment (eg, homes, buildings, streets, parks infrastructure). The mental health effects of poverty are wide ranging and reach across the lifespan.
The evidence is strong for a causal relationship between poverty and mental health. However, findings suggest that poverty leads to mental health and developmental problems that in turn prevent individuals and families from leaving poverty, creating a vicious, inter generational cycle of poverty and poor health.
The link between increased rates of physical and mental illness and poverty has been well established. And yet, many psychiatrists receive little training in assessing and intervening in poverty.
Psychiatrists may be hesitant to screen for poverty if they do not have ready access to interventions or referrals. Screening should not occur in isolation, especially because most of the remedies for poverty and other social determinants of health or social determinants of mental health lie beyond the health sector. To address the complex effects of poverty on mental health, a 3-level approach to socially accountable care can be used. Psychiatrists can assist patients living in poverty at the micro- (individual, clinical) level, at the meso- (local community) level, and at the macro- (policy and population) level.
Poverty increases the risk of mental health problems and can be both a causal factor and a consequence of mental ill health. Mental health is shaped by the wide-ranging characteristics (including inequalities) of the social, economic and physical environments in which people live.
To break the complex links between economic inequality, poverty, and poor mental health, providers need to take a multi-level, prevention-oriented approach that addresses upstream causes. Through careful screening, clinical care, referral to social services and psycho social programs, and community- and population-level advocacy, mental health professionals can work collaboratively with clients, in a strengths-based manner, to improve health for all.
During my research and interviews I found out that most of the middle class people have the basic knowledge about mental health. They accept it as a major issue and believe that steps should be taken to aid for people facing it. But the problem is that they themselves do not want to do anything regarding this matter. They consider it to be handled by professionals because they are either not interested or think that they might not be able to manipulate the case. They fear they might misdeal with the issue which would than lead to more concerns. They also have the stigma. They fear that if they try to deal with the issue other people will regard them as crazy, ill, etc. Lack of resources can also restrict one. Hence they have the basic cognizance and lack the awareness ahead.
Hence steps are to be taken in order to convince people to take action and not to just sit back and wait for others to do something regarding the matter. The best way is to try to convince them by raising awareness. Try to convince people by reasoning and telling them their advantage in doing something about the issue. Their advantage is that the standard of the community they live in will increase as their will a greater understanding of the global issues by the communal people. Another way is to develop middle class people’s interest in mental health. You can tell them that unknowingly they are themselves indulged in a mental illness, e.g. depression and anxiety. This will automatically encourage them to take steps in order to help with the issues. Another approach can be to warn them of the incoming danger. Notify them that if they themselves are faced with an issue, nobody will be out there to help them. So if they want relief for themselves they have to do something from now on, for better future. Another technique is to give them reference of the western world. Tell them that if they want their country to succeed just like the developed countries they need to comprehend the issue completely and contribute in solving it.
These efforts can help spread awareness. As a large proportion of people will be convinced to find a solution to the problem. In this way professionals will be able to carry out their work more efficiently, hence contributing even more in finding a solution to the issue.
Mental illnesses(such as anxiety, depression, bipolar disorder, etc) were commonly associated with old age. However, in this day and age, another group is becoming a victim of these illnesses: teenagers.
Depression is the one of the major causes of illness and disability in adolescents worldwide. Half of all mental health issues start by the age of 14, but either go unnoticed or are not treated. (5.1)
A survey was conducted, and all the questioned teenagers agreed that mental illnesses don’t always start in old age. They all also believe that mental health is indeed an issue that needs to be given importance.
But what exactly causes mental illnesses in teenagers? This question was also put to a group of teenagers, and about 70% of them believe that peer pressure and overburdening school/college workload are the main causes of these illnesses. Although, a fair portion of the questioned teens gave bullying and family problems as their answer, too.
Factors such as low self-esteem, negative thinking, and social pressure seem to be common causes of depression in teenagers. Failing to fit in with one’s peers or not finding acceptance can lead to a teenager becoming depressed. Peers also tell a depressed teen to “snap out of it”or “be happier”, which only makes things worse. Most depressed teenagers are also bullied, for depression is seen to be a “weakness”. This is a major reason why most teens won’t open up about their depression; they fear people won’t understand or will judge them.
And worse cases of teen depression often ends in suicide.
Having a person to talk to about one’s feelings is essential for one’s mental well-being, for keeping emotions buried inside is not good for one’s mental health. We must be more caring towards such people, and show them that we are there to help them, no matter what.
And ending the stigma on mental health will ensure that these teenagers will be able to open up and accept help.
Play your part. End the stigma on mental health.
1.1 Anxiety Awareness, OK2Talk, https://ok2talk.org/post/188107808840/anxiety-awareness, Website
5.1 Adolescent mental heath, https://www.who.int/news-room/fact-sheets/detail/adolescent-mental-health, Website