Our mental health

According to the Centers for Disease Control and Prevention (CDC) in the US, whose motto is: ‘Saving Lives, Protecting People’, the term mental health is usually used with reference to mental illness. Enormous progress has been made in this field over the last few decades to differentiate between the two and experts have now established that they represent totally different psychological states of mind. The following is taken from their website.

“Mental health is a state of well-being in which the individual realises his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her community.

“Mental illness is defined as collectively all diagnosable mental disorders or health conditions that are characterised by alterations in thinking, mood, or behaviour (or some combination thereof) associated with distress and/or impaired functioning. Depression is the most common type of mental illness.

“Evidence has shown that mental disorders, especially depressive disorders, are strongly related to the occurrence, successful treatment, and course of many chronic diseases including diabetes, cancer, cardiovascular disease, asthma, and obesity and many risk behaviours for chronic disease such as physical inactivity, smoking, excessive drinking and insufficient sleep.”

The International Day of Mental Health was held recently, but very few articles were published in our national press, showing both a lack of interest in, and awareness of, this most important public health problem in Pakistan. My interest in the subject was aroused about 15 years ago when the eminent psychiatrist, Prof Dr Malik Mubashar, was reported to have jokingly remarked that in Pakistan every second person was a “nut”.

When a colleague showed me this remark published in a newspaper, I joked with him saying: “Well, since I am definitely not, you must be one”.

As a Karachiite, I was aware of the hectic life and tension there. Prof Dr Haroon Ahmed, a well-known psychiatrist and a friend, discussed the need for an institute for providing expert consultation/treatment to the masses. I, in turn, discussed the matter with two of my very dear friends, unfortunately now both deceased, Mian S M Farooq and Saeed A Kustiwala. I then embarked on a fund raising campaign and within a few months had managed to collect about Rs70 million.

Thanks to the quick decision and action taken by Gen Moinuddin Haider, then governor of Sindh, we were allotted a plot of land next to what is now Dow University of Health Sciences near Suparco Chowk. The designing was done by friends from Messrs Naqvi and Siddiqui, Qamar Alavi and Khizar Hayat, and the facility was built within two years.

Prof Dr Haroon Ahmed was appointed Executive Director of the Institute of Behavioral Sciences (IBS), the name of the institution. Medicines (often very costly) were donated by kind-hearted owners of pharmaceutical companies, most notably Sardar Yasin Malik of Hilton Pharma. The institute is now closely associated with Dow University of Health Sciences and its Vice Chancellor, Prof Dr Masood Hamad Khan, an eminent physician, and his colleagues are helping.

My dear friend, Senator Abdul Haseeb Khan and his friends, notably Mehtabuddin Chowla, are now actively upgrading the facilities and have established a drug rehabilitation centre. IBS now treats thousands of patients every month and provides free medicines as well.

It is estimated that more than half a billion people around the world suffer from some sort of neuro-psychiatric disorder. Only a very small number of these people are treated by psychiatrists. All those patients suffer from anxiety while an estimated 350 million also suffer from mood disorders and 250 million from personality disorders.

Unfortunately, the majority of these patients are in developing countries. Clearly, psychiatric problems are much more common than diseases such as hypertension, diabetes, etc and create in enormous burden on society through both direct and indirect costs.

Mental disorders have been known and dreaded since antiquity. Unfortunately, in our society primitive superstitions and prejudices still exist. Because family members consider the illness to be possession by the devil or unfriendly ‘jins’, the help of ‘pirs’ is often sought rather than proper medical care.

Ignorance breeds fear and fear breeds superstition. Even in western countries the scientific study of human behaviour is quite recent. Not very long ago, Sir Karl Popper, one of the world’s greatest philosopher-scientists, described psychology and psychiatry as “non-scientific, soothsaying arts that defy verifiability”. Over the last 30 years attitudes have changed dramatically. Now mental illness, like any other disease, is being treated by finding biological causes and through counselling.

Mental illnesses like schizophrenia and manic depression may be due to the dysfunction of genes that have recently been linked to these disorders, but there are also other important contributory factors. Alcohol abuse and drug addiction are global problems. Drugs alone claim millions of hardcore addicts, mostly from among the younger generation.

In Pakistan there are no proper institutions to help guide the young or to care for the elderly. Awareness needs to be created in this regard and we must re-assume our responsibility in truly educating our children so that we inculcate the intrinsic comprehension of the meaning of integrity, responsibility, discipline and freedom – words that have lost their real meaning in modern society. Our children are too often exposed to norms from other societies and they forget our own values. Unless we accept the responsibilities of guiding our children, they are going to be lost in a confusion of alien values.

An integrated framework to address mental disorder and related issues is required. The level of mental health in any nation depends, in part, on the successful implementation of public health efforts and deserves utmost attention. Like Sir Karl Popper, I am neither a biologist nor a medical practitioner. In science there is no longer a well-defined line between scientific subject and the wider interests of the people.

I too, have a desire to improve the quality of the lives of the poor. I am just as enthusiastic about medical or behavioural research as I was in the planning and establishment of the GIK Institute of Engineering Science and Technology. IBS was established in this spirit.

The good news is that the long awaited refurbished ‘Sindh Mental Health Ordinance 2013’ has finally been signed by the governor and includes all the amendments suggested by the Pakistan Association of Mental Health. Sindh is the now the only province in the country that has a law that governs issues of mental health (this is courtesy www.pamh.org.pk).

Email: dr.a.quadeer.khan@gmail.com