Dr. Asim Hussain, chairman of Ziauddin Group of Hospitals in Karachi, and former Advisor of Prime Minister for Ministry of Oil and Natural Resources in Pakistan revealed that Bilawal Bhutto Zardari, son of the late Benazir Bhutto has been diagnosed with bipolar disorder. Benazir was and still is one of the most iconic Pakistani female leaders of all time and with her political responsibility came a lot of pressure for her and her family. Son of Benazir has been dealing with her mental health condition for years undiagnosed but recently had it publically known by Dr Hussain that he has now been diagnosed with bipolar disorder.
The stigma against mental health is so prevalent in Pakistan, the place where spiritual cures is popular culture. In Pakistan the culture dictates mental health as evil spirits (jinn), in which only spiritual cures can dissolve but the lack of understanding mental health causes, treatments and symptoms can increase the stigma attached to the sensitive subject.
The Pakistani government plays a large role in the continued stigmatization of mental illness. Before the 2001 Mental Health Ordinance (MHO), which has marginally improved the treatment and management of the mentally ill and their affairs, the law presiding over patients in need of psychiatric attention was the Lunacy Act (1912). If the name of the colonial-era law is already unfortunate, its contents had even more glaring problems. The text had no concept of informed consent for the patient — it was not necessary for doctors to inform patients or their guardians about the nature, effects, risks and costs of prescribed treatments or offer alternatives before carrying them out. It also called patients “idiots” and spoke of “criminal lunatics” — an oxymoron, given that a “lunatic” should be provided care and treatment, as opposed to punishment.
While the new ordinance is drastically better than its 1912 predecessor, it remains poorly implemented. Another important factor to this legislation is how it deals with the criminal fallout of untreated mental illness. In order to meet international standards set by the World Health Organization, the MHO will have to make be amended to ensure that authorities will investigate the mental health of those under trial as well as those who have been convicted. To this end, the MHO should mandate mental health law workshops to educate members of the judiciary and the police.
It will be difficult to make much progress, given Pakistan’s current budget guidelines. Only 2.4 percent of Pakistan’s annual expenditure goes toward health, and out of that,a mere 2 per cent is set aside for mental health. Pakistan has one of the lowest mental illness patient-to-doctor ratios in the world. In a seminar held earlier this year in Karachi, Dr Aneel Kumar during his presentation at a seminar organised by the Pakistan Association for Mental Health revealed that Pakistan has only 380 trained psychiatrists — meaning that there is roughly one psychiatrist available per half-million people. The result is that even when patients fighting something as common as depression or anxiety recognize their symptoms, overcome the stigma, gain the support of their families and start looking for medical help, there simply isn’t much help to be had.
One can only hope that Pakistan will begin to pay attention to the problems that lie beneath. The attitude towards mental health is in serious need of re-education for better mental health.
Culture is only changed by society alone and without willingness or a role model reaching out to the people it would be hard to do.