Set your house in order, set your mind at ease

“I saw my father being verbally abusive throughout my childhood and my mother simply just wants to micromanage my life,” recalls S*. Now 30, he feels that his parents played a major role in the onset of his mental illness.

Similar to him, 42-year-old N*, believes that the right upbringing and guidance during her teenage years could have spared he from the ordeal of being in treatment for mental health almost all of her adult life. “My mother constantly told me what to do and what not to do, and I was just afraid saying ‘no’. If I had been allowed the chance to make mistakes and learn through them, I believe I would have been much more confident and independent than I am today,” she said.

Countless individuals with mental health concerns feel their families, especially their parents, have contributed to their present state of mind. Traditionally, however, we are conditioned to brush away such concerns for sake of propriety. Is it time we re-examine the matter rather seriously?

Pakistan culture and society privileges familial ties above most aspects of life. Collectivist activities are preferred to an individualistic lifestyle as more often than not, families are the only social support most Pakistanis have. Contrary to our commonly held beliefs, however, family life for many Pakistanis is far less effective in offering the support needed for sound mental health, experts say.

This aspect, like many other hitherto hidden facets of modern life, has been exposed more than ever due to the novel coronavirus pandemic and the associated social changes it has brought. The fact that a surge in mental health issues was witnessed within a few days of the first lockdown being announced suggest there is a dire need for proper guidance on how to maintain our own mental health and that of those around us.

Midra Ikram, a psychiatric rehabilitation practitioner at The Recovery House, agrees.  In her clinical experience, every second client she comes across is faced with an environment at home that exacerbates their mental health concerns. More often it is related to a family member’s excessive criticism, over protective behavior or plain denial of the client’s mental health issues.

Similar views were shared by Taha Sabri, co-founder and Director of Taskeen, an initiative to provide easy access to mental health care and remove stigma associated with it.

“One of the most common ways in which caregivers react is denial. First they refuse to believe that the symptoms are of a mental illness. They treat it as a tantrum and respond to it aggressively. Then in an attempt to externalise the problem they assume supernatural factors to be the cause. Later on, when they finally take the person to a doctor, they treat it as a biological problem and over-medicate the patient.”

Being a mental illness survivor himself, Sabri believes that it is very rare for a family to accept that an unhealthy home environment might be one of the major contributors to mental illness.

Several studies conducted internationally as well as locally indicate a strong link between parental rearing practices and mental health problems.  One such research conducted in Lahore in 2015 suggests that parental rejection and anxious rearing have a direct association with emergence of mental health problems in adolescence.

Other studies conducted in Nawabshah and K-P also indicate that children of households where both parents are working and where parents fight frequently are at greater risk of developing psychological problems such as low-self esteem, anxiety, depression and behavioral issues.

Dr Uzma Ambareen, a psychiatrist with more than two decades of experience in the mental healthcare field also acknowledges that family turmoil and trauma is “very often” one of the main sources of a person’s mental health decline.

Moreover, she believes that if family has “difficulties resolving their problems and assigning roles, they might be in need of and should seek professional help themselves.”

So how effective is professional help? Z*, mother of a 24-year-old diagnosed with Schizoaffective Disorder, feels much at ease now that she knows about her son’s mental health concerns and the “triggers” that might aggravate his symptoms.

“There used to be lot of negativity in our responses in past when he acted impulsively or shared suicidal thoughts. We used to dismiss his talk as mere threats. After attending psycho-education sessions at The Recovery House, now we understand the nature of his illness and how to help him manage it.”

Watching her son return back to completing his studies, Z has an amplified willingness to bring changes in her parental practices and to support her son through his challenges.

After receiving counseling sessions with her daughter, B*, mother of a 24-year-old diagnosed with Bipolar Disorder, also expressed profound acceptance of the possibility that familial trauma might have played a role in bringing about her child’s illness.

“We should not over pressurise our children, no matter what the situation at home is. We should keep a look out. If we as elders will not accept our failings, it will only harm our own children.”

*Names have been changed to respect the confidentiality of those offering personal testimony