The Psychiatric Cost of Turmoil in Pakistan
How does one cope in a country where the equivalent of 9/11 happens almost every day?
This question is posed in the article ‘The PTSD Pandemic in Pakistan,’ which sheds light on the neglected mental health concerns of a violence-afflicted society. Psychiatrists in Pakistan believe that large numbers of Pakistanis are suffering from Post-Traumatic Stress Disorder (PTSD) and have limited resources at their disposal to seek treatment. They also raise the unsettling argument that PTSD can only be diagnosed after a traumatic incident has ended but in a country like Pakistan, which is chronically in crisis mode there is no ‘post’ and only ‘ever present’ stress making diagnosis and treatment both very difficult. An article in The Lancet also notes that ongoing violence and recent natural disasters have taken their toll on mental health in Pakistan. More specifically, data from population-based studies indicates that a third of Pakistan’s population have anxiety and depression.
Intrigued by this pertinent but overlooked issue, I observed the reactions of many Pakistanis (mostly under 30) in the social media space in response to the terrorist attacks on a naval base in Karachi two weeks ago, and informally mapped the range of emotions that were expressed. The most frequent emotions that came up were: anger, helplessness, anxiety, disgust, suffocation, outrage, mistrust, hatred (towards government). Then there were statements such as “the world’s 9/11 is our 24/7” or “it couldn’t get worse does not apply in Pakistan.” These are not isolated occurrences, the frequency with which such emotions are being expressed is increasing and reveals a much deeper issue – the unfolding events in Pakistan are having an indelible impact on the psyche of Pakistani youth including those who are not even directly impacted by the violence (in the form of losing a friend or family member).
Little attention is drawn to how a population that is constantly exposed to news of suicide bombings, honour killings and targeted shootings is coping with the cumulative psychological aftermath of these events. In developed nations, trained medical professionals handle traumatic situations promptly and professionally and there are a range of psychosocial services available. In Pakistan where death and fear have become a part of daily life, psychological help is a luxury not a necessity. A luxury that even those who can afford do not avail due to cultural stigmas attached to seeking psychiatric treatment (especially for men who see it as a sign of weakness). Let alone the rest of society, even health professionals hold biases towards mental illness. A study carried out to assess stigma amongst medical students and doctors, from 3 medical colleges in Lahore found that over half of the respondents held negative attitudes towards people with schizophrenia, depression and drug and alcohol disorders.
The mental health sector in Pakistan is ailing and the figures are staggering. The WHO estimates there to be just 320 psychiatrists in Pakistan to deal with 176 million patients and a large number of these doctors are not appropriately trained to provide psychiatric care. There is only one psychiatrist for every 10,000 people, one child psychiatrist for 4 million children estimated to be suffering mental-health issues and only four major psychiatric hospitals and 20 such units attached to teaching hospitals. Even beyond these figures, one doesn’t have to be a rocket scientist to be able to predict that an entire generation is growing up in a culture where violence is experienced, repeated and observed everyday and where living in fear has become second nature. Yet, there are no resources available for people to be able to address and get treated for the resulting emotional trauma or ailments such as PTSD.
Another issue is the fact that in Pakistan perpetrators of violent acts or terrorism are never brought to justice. To date, even culprits responsible for high profile political assassinations have not been punished, let alone those who have claimed the lives of journalists and other civilians. How do families of victims cope with loss when there is no hope of any justice or retribution? This is exemplified in the suicide act of the young widow of one of the men shot down in broad daylight by Raymond Davis. The reasoning she gave doctors before breathing her last? “I do not expect any justice from this government.”
Mental disorders are not only prevalent in the aftermath of violence and conflict but also in post-disaster settings. A study conducted 18 months after the 2005 earthquake on a select sample of 1200 men and women found that 55% women and 33% men suffered from PTSD. I’m not aware of any recent studies that examine the effects of last year’s devastating floods but I would make an educated guess that flood-affected populations were also significantly exposed to trauma and are not getting the help they need.
Simply put, Pakistan is not equipped to deal with the mental health concerns of its rising population and increasing psychiatric resources or improving access to them does not feature highly on the public health agenda. Investment in the unacceptably underfunded mental health sector is absolutely critical in a country that is fast becoming a ‘psychological pressure cooker.’ This needs to be accompanied by a shift in attitudes towards seeking psychiatric help and culturally de-stigmatizing the notion of visiting psychologists. Even these efforts seem to be a tall order since I wonder if a state that seemingly has little interest in protecting the physical well-being of its citizens actually cares about the mental and emotional trauma that those who are surviving are undergoing on a regular basis.
Statments in Italics are directly taken from the article The PTSD Pandemic in Pakistan