World Mental Health Day: Without dignity, there can be no recovery

Despite no apparent symptoms, patients suffering from mental health disorders are often misunderstood

KARACHI: Last week, 55-year-old Salma* tried to commit suicide by ingesting a poisonous substance. The mother of eight is suffering a psychiatric disorder, known as bipolar disorder, and is on medication for the last many years.

“Each evening, she asks her sons to take her out,” her brother-in-law, Ishaq*, told The Express Tribune. “She feels uneasy and irritable and wants to go out and sit somewhere where she can get a sense of peace. But they simply ignore her requests and walk away.”

Can you imagine ignoring the needs of someone with a broken leg or a physical ailment? No. Salma’s predicament is that though she is unwell, she cannot prove it to her peers and family. The disorder does not present any physical symptoms and it is not easy to diagnose, for example through a blood test.

Lack of apparent proof leads to misperception, misunderstandings and ignorance. The mind searches for meaning and when it does not find a satisfactory explanation, it formulates its own reasoning; for instance, most people believe the patients are themselves responsible for the symptoms, behaviour or sufferings. Not long ago, people had a similar attitude towards epilepsy, said associate professor and head of the psychiatry department at the Sindh Institute of Urology and Transplantation, Dr Naim Siddiqi.

Dr Siddiqi explained that the state or quality of being worthy of honour or respect is called dignity. How we value a person in terms of their attributes and character is a complex issue. Ignorance and lack of knowledge leads to our attitude of disrespect, he explained. “Do you ever call a person pneumonic?” he questioned before answering it himself. “No, you always say Mr X suffers from pneumonia. You can easily separate person from illness and the person does not lose respect.” The illness is different from the person’s attributes, qualities and potentials.

The doctor wished to explain the difference between a ‘schizophrenic’ and a person suffering from schizophrenia. “A person could lose some of his abilities, both as a result of stroke and schizophrenia, but is it justified that all patients suffering from stroke or schizophrenia should be judged to have some level of disabilities and be assigned or deprived of their rights, privileges and responsibilities?” asked Dr Siddiqi.

The World Mental Health Day is observed on October 10 across the world and this year’s theme is ‘Dignity in Mental Health’.

Ishaq revealed that Salma had psychiatric problems before his brother tied the knot with her. The family did not know about her illness and it was his brother who had suffered mentally as much as his wife. “After she attempted to commit suicide, her sons and daughters did not pay much heed, brushing it off as just depression,” he shared.

“The lurking monster behind mental illnesses is stigma. Depressed people are termed ‘pagal’ and depicted as unpredictable. Their ‘humanness’ may be, in some ways, stripped away,” says the head of the psychiatry department at the Aga Khan University Hospital, Dr Ayesha Mian.

She added that most people with mild to moderate mental illnesses are productive members of society. With proper treatment, they can work and lead normal lives. “Unfortunately, they are often stereotyped, sometimes even in the media, as people with poor grooming, disheveled state, talking gibberish or shouting,” she lamented.

A common narrative that exists in most minds is that people with anxiety and depression are weak, said Dr Mian. We often hear depressed people being told to have happy thoughts, ‘shake’ themselves out of the low mood, and be strong. Why don’t we address people with mental illnesses the way we deal with those with diabetes or another chronic diseases, she questioned. We don’t ask patients with hypertension to think good and snap out of it, she said.

“It is a hard illness to bear, to feel ‘trapped within your brain’. Their suffering is deep and these patients need the most patience, empathy and understanding. The reasons for psychiatric illnesses are multifactorial, it is not ‘their fault’,” said Dr Mian.

There is a dire need to understand that recovery is a journey and it thrives in an environment of dignity and respect, said Dr Siddiqi.

*Names changed to protect privacy

A neglected field: ‘Govt must give mental health due importance’ 

There are only two major hospitals with psychiatric wards in Sindh, which proves that mental health is the most shamefully neglected field, said Karachi health services director Dr Zafar Ejaz.

“There is a dire need to declare psychiatry a separate and recognised field. We do have data for other diseases such as TB, polio and patients with other severe health issues but we don’t exactly know how many people are suffering from mental health illnesses,” he said.

The future of healthcare commission bill, which was passed in the National Assembly in 2012, is still hanging in the balance, said Dr Ejaz. According to the Bill, all private hospitals will be registered and their performance will be monitored. It’s a pity that the health department does not even have data of private hospitals that have psychiatric facilities, he said.

On the heavy fees at private hospitals, he said that the bill will allow the government to keep checks on the qualifications of the psychiatrists and fees they charge for the services. “The onus is on the health department to speed up the implementation of the bill to deal with the rapidly growing threat of mental illnesses,” said Dr Ejaz.

Published in The Express Tribune, October 10^th, 2015.