Cannibalism in Bhakkar: Not as crazy as we could be

The Bhakkar cannibal incident has led many to highlight the poor state of mental health in Pakistan.

The unusual episode of cannibalism in Bhakkar has been followed by the usual outrage. Predictably, it has led many to highlight the poor state of mental health in Pakistan. However, to really address this issue, we must be as creative as the very perpetrators of the act, people we would like to see institutionalised.

There are several positives that can be taken out of this episode, which I shall tastefully call “Breakfast in Bhakkar”. It is heartening to note that Chaudhry Nisar and the rest of the opposition have not spun this around into yet another attack on the incumbents.

He has shown great restrain in not declaring that the cause of this episode is the direct result of rising meat prices in Punjab. This episode is also unique in that it is possibly the only recent national event not directly perpetrated by Raymond Davis (although this might be open to interpretation).

Finally, these two YouTube sensations have given the people of Bhakkar something that years of Mughal, British or Pakistani rule have not — an identity.

However, to really understand Breakfast in Bhakkar, let us go back to the beginning and start with the definition of “normal”. According to the current Western model of thought, normal is a statistical aggregate, a series of behaviors and traits that tend to occur most commonly amongst a large group of people. “People” are defined as Western folk, who are the basis of all psychiatric classification and understanding, since practically all psychiatric research has been conducted on them.

The synthesis of modern clinical psychiatry is the “Diagnostic and Statistical Manual of Mental Disorders” (DSM), a collection of diagnostic criteria, which when fulfilled, allow for a physician to diagnose a person.

However, in its fourth edition now, the DSM has been constantly evolving, and has been open to criticism on several levels. Several “conditions” that started out as being labeled diseases (homosexuality, for example) are now considered healthy variants of normal behavior while others such as post-traumatic stress disorder (PTSD) were introduced only after certain powerful lobbying groups pressed for them to be labeled as a diseased condition.

Therefore, we should be careful when criticising the Breakfasteers of Bhakkar lest a human-flesh devouring political action committee (Tehreek-e-Nifaz-e-Adamkhori?) have their behavior categorised as normal, and all of us outraged civilians come across as fascist bigots in historical retrospect.

Another weakness with the DSM, and consequentially, with the entire model of psychiatry, is that it is almost entirely derived from, and based on, Western populations.

This is not something that we in the Orient can criticise the Western world for, since it only highlights our own failings in furthering our understanding of the mind. However, lazy sloths that we are, instead of actually understanding psychiatric disease in our indigenous cultural context, what with centuries of events molding our minds to think a certain way, we apply diagnoses made for the likes of Charlie Sheen on our Ghafoors and Shakoors.

Consider this: a study published in a Pakistani journal stated that PTSD was present in 75 per cent of people presenting to a psychiatric clinic in Peshawar. At first, unwittingly, I took the research for what it stated — that just about every one in Pakistan is diseased. And yet, when I looked back at my own experience through medical school, and well, life, I could not think of a single person who suffered from anything remotely akin to PTSD. Having my own relatives taken hostage, my friends caught in terrorist crossfire, and living through a constant stream of violent events, I could think of no one who had elicited such a response.

And that is because such a study, and I would reckon, every research paper published from Pakistan and every psychiatrist practicing in Pakistan, has done nothing at all to advance our understanding of our psyche. In fact, by rehashing convenient half-truths, they have taken us several steps back.

To move forward, we need to stop indulging in the age-old Pakistani practice of taking shortcuts and think of these issues in our context and come up with long term solutions.

One research study that I found particularly compelling, published in the Lancet, described a project that used lady health workers to alleviate depression that occurs in women after pregnancy. The success of this intervention revealed a solution that is uniquely ours and that can be scaled up to a national level. We can wail and cry about the lack of psychiatrists in Pakistan, but that situation is not changing, and it is debatable whether more psychiatrists would make us more sane or less.

But take a step back from this man-eat-athon and you might conclude, as I have, that Pakistan is really a very sane country. What with the earthquakes, the bombings, the floods, the economy, the hopelessness and the constant yearning for human flesh arising in the eager belly, you would expect, as some of my foreign colleagues do, that there would be psychotic people running around naked on every Pakistani street corner. And while I do realize that many crazies might be hiding behind bushes and beards, certainly the mental resilience of the Pakistani people needs to be commended. This statement, however, should not allow you to rest easy — far from it, because I fear sane people a lot more than the crazies.

Every society will have people like Mumtaz Qadri — but few will have lawyers garlanding him en route to court, evangelists feting him on national television, newscasters finding means to justify his actions and educated people setting up Facebook pages in his honor. While the diseased certainly deserve our sympathy, the sane do our derision. Something about these people makes me think they would taste really good with some adrak and laal mirch.

Haider Warraich, a fellow in Harvard Medical School, is a graduate of the Aga Khan University, and author of the novel, Auras of the Jinn.

Published in The Express Tribune, Sunday Magazine, April 24^th, 2011.