How Sofia, Ahmed and Aliya are silently suffering in Pakistan

She hoped Sofia would eventually get married and live a normal life, maybe marriage was the answer.

Dr Saniya Sabzwari July 15, 2015
Sofia, a young college student, has been missing since she drove off in the morning. Her parents desperately tried to stop her from driving off. She had not been herself lately; behaving erratically and driving rashly the last few weeks. She had been getting into fights with her friends, staying up all night, not eating, and was extremely irritable at home. This behaviour was not new; her family had endured these episodes quite a few times before. They dealt with her anger and moods by confining the entire family at home till things improved.

In the past, clandestinely using sleeping pills had worked out, but now she was refusing every effort to be helped out and had become suspicious of her parents attempts, thinking they were poisoning her with those sleeping pills.

The distraught parents dare not contact family or friends, wanting to keep everything under wraps, but just as the father succumbed to desperation, dialling the missing person’s extension, a loud screech was heard outside the gate and their daughter returned home unharmed yet completely unhinged.

The mother broke down; shedding tears of relief on seeing her daughter and at the same time was dreading the verbal aggressive rambling they would be subjected to by the disturbed mind of their once happy and bright daughter.

Sana, her 15-year-old sister, quietly watches the horrible day come to an end, proceeding to sleep in the living room, since Sofia’s angry outbursts had made her move out of the bedroom they once shared. Sana often had to stay home too when Sofia either ‘lost it’ or at times spent days in depression as her mom required help handling Sofia when their dad left for work.

Sofia scared her at times, but Sana kept quiet, since she wanted to stay strong for her mother, who was mostly crying. She had now stopped inviting her friends as Sofia’s unpredictable and outrageous behaviour embarrassed her. To make matters worse, Sana also had to help with the housework due to Sofia getting suspicious of the maids which usually ended up in them getting fired.

The mother sits in her room past midnight, after an exhausted Sofia thankfully consumes a sleeping pill dissolved in a glass of milk without any fuss. Her eldest child’s behaviour was increasingly becoming intolerable and abnormal. She racked her brain as to what mistakes she had made raising Sofia and when this anguish would end. She was trying so hard, praying day and night, getting all sorts of amulets and visiting shrine after shrine in hope for respite, but this was of no avail.

She hoped Sofia would eventually get married and live a normal life, maybe marriage was the answer. A good man could keep her behaviour in check. With these thoughts flitting through her mind, she finally succumbed to an uneasy sleep at the break of dawn, dreading the onset of another day.

The father, however, continues to toss and turn, this ‘episode’ had been the worst ever. Never had Sofia run away like this. What if something bad had happened to her? He plans to hide the car keys and take a few days off work to help his wife handle his eldest born, whom he had raised with such pride, joy, and hope. She had always been his favourite, spirited and intelligent, maybe he had spoiled her too much.

His wife’s sleepy mumbling brings him back to the present and he remembers he has to call in to work. His boss won’t be happy, as he just took time off from work a few months ago as well. This time I will just have to use my wife’s illness as an excuse, as I really can’t disclose the chaos at home as the real reason, he thought to himself. Wondering how he would manage to get a medical report for his wife, he dozes off as his tired mind surrenders to a much needed slumber.

Many such families exist in Pakistan and around the world as well. Struggling with the rigors of a mental illness, common yet hard to diagnose and even harder to accept, manic depressive disorder or Bipolar illness, a combination of mood swings ranging from severe depression to an abnormally elevated or irritable mood that often results in irrational thought and behaviour.

The importance of early intervention in cases like Sofia’s would not only help get her life back on track but also assist the entire family lead normal lives with hope of happiness and normalcy.

Thirty two-year-old Ahmed feels his throat tightening and heart sinking while driving to work. His mind freezes and his vision starts getting hazy, but he manages to pull over just before his heart starts the dreaded race. Now finding it hard to breathe, he feels he is about to pass out, but the fearful episode slowly ebbs away. Drenched in sweat and feeling slightly nauseated, he turns back to drive home, unable to face a long day at work.

These attacks started when Ahmed was a student. The first time it happened was when he was sitting for his exam, leaving an incomplete exam paper to go to the hospital. Since then, he has visited different emergency rooms where all test results would be normal.

Over a period of time, however, his symptoms had worsened. His attacks became even more unpredictable and fierce. The once happy and outgoing Ahmed had now limited his social life, not going out much out of the fear of having another episode, especially at a party or a dinner. He had also developed new fears about driving and being out late at night (this was triggered by a cell phone snatching incident). He felt fearful all the time and was always foreboding another attack.

He had limited himself at work by making excuses for not travelling to conferences and workshops, preferring to stay on home ground just in case.

The situation, however, had now changed. He had gotten married recently on his mother’s insistence. His wife was a kind and patient woman, adapting her life to his limitations, but now with a new born baby, he felt even more anxious as he faced the added responsibility of a father.

He knew his wife often wished to go out but he would find one excuse after another, very rarely complying, as his fears overpowered his desire to lead a normal life. She often looks at Ahmed and wonders whether they would ever lead a happy life. She sees her husband’s anguish but feels her life has changed drastically and limitations have increased as well, but she silently continues on living, hoping and praying for the chains to break.

Ahmed finally feels the need to get help. The intermittent use of sedatives helped, but only temporarily. Doctors had prescribed medicines for palpitations and his breathing issues, however, none of them had been effective as such and over time had proved to be useless. He felt his problem was more psychological than physical, but he did not know where to seek help.

This is a story of a man, crippled by anxiety and panic attacks that arise from underlying stress, closely mimicking physical symptoms of breathing and heart problems. While it is imperative to rule out heart and respiratory illnesses, the underlying treatment has to target the psychological problem in order to free patients suffering from this often debilitating and incapacitating disorder, which limits life as the anxiety grows and takes over.

Aliya is a 43-year-old housewife who finds it had hard to get up in the morning. For the past few years, waking up and getting out of bed has been a struggle as the day holds no joy or pleasure, rather life feels burdensome and every small household chore a huge burden.

She wonders when all this started, as nothing in her life has changed. She got married to a banker at the age of 24 and fortunately, he was a considerate man. She had suffered two miscarriages early on in her married life, after which God blessed her with two children, who were doing well in school.

Despite everything in life going well, she still feels life is not worth living. She does not like meeting people anymore. Her daily routine after the children left for school was to call and chat with her friends after which she would exercise, plan the menu, and then work in the kitchen.

Now she has stopped calling and barely talks to any of her friends. All the conversations seem so meaningless. Her favourite pastime used to be searching for new recipes, cooking for her family which brought so much pleasure to her, but now her husband’s encouraging remarks seem false and fake.

Aliya does not want to get up to see her husband and children off, they all grab their own breakfast and leave, not wanting to disturb her. She feels guilty about being a bad mother and wife, but despite trying extremely hard, she cannot do the things she used to enjoy doing.

Usually an early riser, she now wakes up at noon and still does not feel like changing her clothes or doing anything. Whatever the maid concocts is now eaten in the house.

Aliya’s husband often orders takeaway. He keeps wondering what is wrong with her. Aliya was such a vivacious and happy person, but lately she has become quiet, withdrawn, and always complains of being tired. She does not go out anymore and at times does not even shower. She mostly lies in bed and rests or sleeps. He also noticed that she cries silently thinking he won’t notice.

He has taken her to a couple of doctors who ran her tests, but found no valid cause of her fatigue. The medicine the doctor prescribed for her fatigue actually made her sleepier, so she stopped taking them. Even the children are worried about their mother, wondering why she stays in her bedroom all day long and has stopped talking to them. Aliya has recently started wondering when this misery will end, and at times she wonders how long she can continue to live like this.

Aliya is one of the many women suffering from one of the most common mental health problem, depression.

Indicators of depression usually begin with physical symptoms of tiredness, low energy, loss of appetite, and sleep disturbances. The key feature, however, is the low mood accompanied by a loss of interest in routine activities to the point of affecting daily activities.

Fortunately, it is treatable but requires timely intervention in order to allow early recovery and prevent worsening of symptoms and functionality.

In Pakistan, the stigma of medical and mental illness is enormous and unfortunately the burden of mental illness is extremely high. Many such families have suffered silently, leading restricted lives where one person’s illness dominates everything.

Poor mental health awareness and acceptance often leads to delayed diagnosis and suboptimal treatment rendering individuals and families virtually paralysed and dysfunctional. Moreover, cultural beliefs on black magic and faith healers often interfere with appropriate and timely treatment.
Dr Saniya Sabzwari

The author is a Fellow of the American Board of Family Medicine and an Associate Professor in the Department of Family Medicine at the Aga Khan University Hospital Karachi, Pakistan. She has a special interest in community mental health, health education and geriatrics.

The views expressed by the writer and the reader comments do not necassarily reflect the views and policies of the Express Tribune.


ارشد حسین | 8 years ago | Reply Our major issues are not issues in the views of most authors these days. And the minor issues are discussed like that problem solved will change the whole world.
ارشد حسین | 8 years ago | Reply Our major issues are not issues in the views of most authors these days. And the minor issues are discussed like that problem solved will change the whole world.
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