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1 - Shrugging it off: Mental Health and Pakistan

Shrugging it off: Mental Health and Pakistan

It’s Mental Health Awareness Month everyone.


There were hushed whispers, amidst blank and unfocused stares, that would silence and trail off the closer you got to the conversation. There seemed to be a secret floating around, and much like any grapevine-infused secret, you can be certain of two things: one – everyone knows about it, and two – while everyone wants to talk about it, no one will mention it, perhaps except within their immediate circles.


Back in March 2015, any observer could claim that my life was perfect, I had ‘achieved’ everything I had worked towards, I was well-known and I seemingly had no reason to be anything but content and happy. It was true: I was President of one of the largest student-run societies in Pakistan; I was studying at one of Pakistan’s most prestigious universities, with more ‘friends’ than I could count; and I was committed to a stable and, what seemed a given at the time, a long-term relationship. There seemed no conceivable ‘reason’ for me to be depressed.


Yet, one fine day in March, everything changed.



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I was not a stranger to depression. As a child, I had seen it consume my mother. I had seen what it could do to a human being as strong as her. it could almost turn you into a completely different, unrecognizable version of yourself. And it did so by surgically removing the pith of your existence from within your bones and by shattering your self-image into a million tiny shards.

And so, when on that fateful day in March 2015 I found myself unable to move off the couch, unable to focus on anything, unable to ‘do’ much except stare at the ceiling, I knew that the demon was now mine to bear as well.


I could argue it had been a long time coming. Looking back, I could recognize signs as early as my O Level years (where, again, I had no ‘apparent reason’ to be depressed) – I wanted to ‘merge with the shadows’ and ‘be anonymous’; I wanted to just disappear. Somehow, I fought through it. No. That’s not true. I mustered everything I had to push it aside, and to never think about it. Denial became a close friend. And that denial carried me for the next seven years.


But that’s the thing with pushing things under the rug. At some point, you’ve pushed so many things under that the heap literally transforms into the elephant in the room.


Everything becomes more serious when you attach a label to it. And now I had a medical label. I had ‘depression and anxiety’. It suddenly became very real.



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And so I began to try and figure out what this ‘illness’ was all about. And I have yet to find a better way to describe it than Andrew Solomon in the opening lines of his book, ‘The Noonday Demon: an Atlas of Depression’:


“Depression is the flaw in love. To be creatures who love, we must be creatures who can despair at what we lose, and depression is the mechanism of that despair. When it comes, it degrades one’s self and ultimately eclipses the capacity to give or receive affection. It is the aloneness within us made manifest, and it destroys not only connection to others but also the ability to be peacefully alone with oneself … In depression, the meaninglessness of every enterprise and every emotion, the meaninglessness of life itself, becomes self-evident. The only feeling left in this loveless state is insignificance.”


Of course, when you tell someone you’re depressed, they automatically think you’re sad. Perhaps you’re just a little bit upset. “It’s okay,” they try and comfort you, “it’ll pass.” Of course, there is the ever-abundant, “Cheer up!” But you see, as Solomon posits in his TED Talk:


“There are three things people tend to confuse: depression, grief and sadness. Grief is explicitly reactive. If you have a loss and you feel incredibly unhappy, and then, six months later, you are still deeply sad, but you’re functioning a little better, it’s probably grief, and it will probably ultimately resolve itself in some measure. If you experience a catastrophic loss, and you feel terrible, and six months later you can barely function at all, then it’s probably a depression that was triggered by the catastrophic circumstances. The trajectory tells us a great deal. People think of depression as being just sadness. It’s much, much too much sadness, much too much grief at far too slight a cause.”


But it still made no sense to me. I had everything. I should be grateful. I shouldn’t be depressed. I was not stuck in a war-torn country, starving, or running to find shelter from bombs being dropped from invisible flying objects in the sky. I was safe. I had a home, a loving family, friends, success stories – I didn’t really fit the ‘profile’ of a depressed person. But that’s how depression is: an equal-opportunity illness that  does not discriminate. And suddenly I found myself relating to Kevin Breel, and the double-life he lived: being happy, jolly, and ‘perfect’ on the face of it, whilst being miserable, lonely, and depressed inside.




This, to date, makes no sense to me. If back in March I had been diagnosed with diabetes, and had been prescribed insulin, no one would bat an eye. That is completely normal for everyone. But the moment you tell someone you have a mental illness, and you go to a psychiatrist, and you take medication, they (almost instinctively) flinch.


“But are you sure you need medication?”

“You shouldn’t take that stuff.”

“You’ll get hooked on to it.”

“You don’t need it.”

“You’re fine!”

“It’s all in your head”


So on and so forth– drivel that you don’t expect to hear from educated members of the community, but alas (the phrase ‘parhay likhay jaahil’ (the educated illiterates) comes to mind.


This lack of awareness and understanding leads to a great divide, between what mental illness actually is and what people have made it out to be. This creates a stigma, which stems, perhaps, from a fear of the unknown. And consequently, no one raises their voice because they don’t want to be the one to upset the status-quo. Plus, there is always the added impediment of “Log kya kahein gey? (What will people say?)”



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This perpetuation of silence is as great an issue as the mental illness itself. And Pakistan is no exception. In fact, with an overwhelmingly ‘conservative’ mind-set, it only gets worse (actually, I ought, perhaps, to use the word ‘regressive’ rather than conservative). Let’s take a quick look at the situation at hand.


Pakistan’s laws are outdated: Pakistan inherited the Lunacy Act of 1912, and later formed its own Mental Health Ordinance in 2001; there was nothing in between, and there has been nothing since, except for the devolution to provinces post the 18th amendment leading to them drafting their own versions of the legislation. Meanwhile, section 325 of Pakistan’s Penal Code still holds that (attempted) suicide is a punishable offense. And as recently as 2016, Pakistan’s Supreme Court ruled that schizophrenia is not a mental disorder. (Check out this article by Dr. Asma Humayun for a more holistic picture of the situation.)

Pakistan’s population has since only been rising. The number of mental health professionals? Not so much.


The need to rely solely on spirituality while disregarding modern medicine and therapeutic techniques is another common feature of Pakistan’s society. “Beta yeh humaaray zamaaney mein tau nahin hota tha. Ajeeb baatein kartay ho. Namaz parho. Sub kuch theek ho jaaye ga. (Son, this never used to happen in our time. You’re talking nonsense. You should pray. Everything will fix itself.)” I intend to take nothing away from the power of prayer or worship – the solace one can find in turning to a Higher Power is very real. And it does help. But that’s not what you would recommend to someone with a broken leg, or a someone having a heart attack.


Meanwhile, Pakistan also faces a dearth of adequate facilities to deal with the mental health crisis. A survey carried out in 2015 revealed that Pakistan only has 380 trained psychiatrists. Let that sink in. That’s 380 trained psychiatrists for a population of 189.4 million (in 2015). Assuming an equal spread, that equates to one trained psychiatrist for approximately 498,000 people.


Let’s change that up a bit. It is estimated that approximately 50 million people in Pakistan are facing one common mental disorder or the other. That still means one trained psychiatrist for approximately 132,000 people. For contrast, an Al-Jazeera article posits that “in the United States, any area where the ratio exceeds 30,000 people per psychiatrist is considered to have a shortage of mental health professionals.” Pakistan’s population has since only been rising. The number of mental health professionals? Not so much.



There are a number of other factors that lead to the worsening of the mental health situation, and until the stakeholders involved choose to act responsibly, very little to nothing can be done to help the community. The same community that also includes 60 million people living below the poverty line; that includes the IDPs who have had to leave their homes and resettle; that includes all the children who have been made victims of abuse.


The trauma from childhood abuse is one that I cannot begin to attempt to contain in words. But I shall let Junot Diaz’s words speak for themselves:


“Not enough pages in the world to describe what it did to me. The whole planet could be my inkstand and it still wouldn’t be enough. That shit cracked the planet of me in half, threw me completely out of orbit, into the lightless regions of space where life is not possible. I can say, truly, que casi me destruyó (living a double life nearly destroyed me). Not only the rapes but all the sequelae: the agony, the bitterness, the self-recrimination, the asco, the desperate need to keep it hidden and silent. It f*cked up my childhood. It f*cked up my adolescence. It f*cked up my whole life.”


Still think a mental health issue is ‘just in your head’?



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I can understand how all of this sounds absolutely dismal. I know how the facts make everything look bleak. I also know there are a number of other mental health disorders out there apart from depression (I talk primarily about depression because I know what it is).


But there is always something that we can do. And if all of this looks too bleak, then maybe we can come together and change that. And maybe we can start by speaking up. Ash Beckham puts it beautifully by comparing it to coming out of the closet:


“All a closet is, is a hard conversation, and although our topics may vary tremendously, the experience of being in and coming out of the closet is universal. It is scary, and we hate it, and it needs to be done. Sure I’ll give you a 100 reasons why coming out of my closet was harder than coming out of yours, but here’s the thing: hard is not relative. Hard is hard. We need to stop ranking our hard against everyone else’s hard to make us feel better or worse about our closets and just commiserate on the fact that we all have hard.”


Being there is lonely and isolating. Thinking, on a loop, that no one will ever understand you or be there for you or take you seriously. That your friends will no longer invite you over, or that they will give up on you if you don’t show up a certain number of times. But just try and believe in yourself, and try and take that leap. Maybe, in doing so, you can convert your friendships into something more meaningful. A recently concluded Harvard study (that spanned a duration of 75 years) tried to determine the source of happiness. The answer? Good, close relationships.


And in building these relationships, in forging these bonds, and in making your voice heard, perhaps we can make it a little easier for the next person to get help, to find the courage to speak up, and to find the solace to know there is no shame in going to war with a mental illness.