WHENEVER I visit a pharmacy in Karachi, I notice that the two most popular medications being sold are high blood pressure pills and tranquillisers. I’m not sure why I should be surprised: Karachi has always been a notoriously stressful city to live in. This month, eminent psychiatrist Dr. S. Haroon Ahmed is raising the alarm about mental health: Karachi’s citizens are in extreme psychological distress because they have been pushed beyond their limits.

Mental health awareness has always been a constant struggle in a country like Pakistan where psychiatric services and resources are so limited. Faced with stressors like erratic gas, electricity and water supplies, rising inflation, unemployment, the breakdown of law and order, political uncertainty, terrorism, and the disruption of the social fabric, Karachiites are finding themselves unable to cope. As a result, mental disorders are on the increase, especially depression. Religion has been touted as a panacea to all their problems, but given the rising number of suicides in the city, mental illness is a time bomb that will take many innocent victims with it when it explodes.

The Pakistan Association for Mental Health, under Dr. Haroon’s direction, has declared January 2019 as a month to raise awareness about mental health and erase the long-standing societal stigma against mental illness. PAMH has planned a series of seminars in Karachi on stress and anger management, mental illness, parenting and emotional regulation, child mental health and child abuse. These seminars are free and are being conducted by well-known Karachi psychiatrists and psychologists, including Dr Uzma Ambareen, Dr Saima Qureshi, and Professor Badar Abbasi.

Karachi’s citizens are in extreme psychological distress.

PAMH has also produced short ads for radio and television in Urdu and Sindhi (the focus of the campaign is Karachi for now) to spread the message that mental illness is treatable and that patients do not have to suffer in vain. These ads tell people that depression is not a weakness in character, but a physical illness, just like diabetes or blood pressure. It intends to hold an annual national conference and a biannual international conference on mental health in Pakistan.

According to Dr Haroon, Karachi’s stress-ridden environment is having deadly impact on individuals and the community at large, resulting in behavioural changes such as violence, sickness behaviour and people withdrawing into themselves. “Targeted killings, street crimes, sex-related offences, including the barbaric act of kidnapping, rape and murder of young children, are playing havoc with the mental health of our people.”

While he stresses that 60 per cent of depression is biological — meaning that brain chemistry is involved in causing this extremely common mental illness to strike — there are many avoidable stressors for which the state must take responsibility. Providing the basic amenities such as clean water, unadulterated food, genuine medicine, transport, hygienic environment, curbing crime and ensuring security would lift huge burdens off the shoulders of private citizens, and this would result in a mentally healthier city.

Dr Haroon notes that there are two types of treatment for depression: medication, including various types of anti-depressants; and psychological therapy, which involves talking to a psychologist or counsellor, who might employ cognitive-behavioural or other types of therapies, or simply a safe space for patients to receive support. A combination of both therapies has been found to be most successful, while the introduction of exercise, a healthy diet, and regular sleep helps patients not just recover from mental illness, but makes them more resilient to stress.

Another eminent psychiatrist, Prof Raza ur Rahman of Dow University, drew a grim picture about the adverse effects that mental illness can have on societies and nations at large. According to WHO, depression will be the prevalent disease in the world by 2030, outranking blood pressure, cardiac disease, and cancer. With more women suffering depression than men, studies have shown that children raised by mothers suffering from depression have increased cognitive defects. Most alarmingly, Pakistan’s rate of depression is four times higher than rates in the rest of the world.

In Pakistan we are still ignorant about mental illness. We blame jinns and jealousy — or the victims, telling them that they are being lazy or ungrateful when they are laid low by depression. We cannot afford this ignorance any longer. PAMH is blowing the whistle on these “impending disastrous consequences that will tear apart the very fabric of our society, stealing away the productive potential and innovative capacity of our workforce.” But our government must alleviate the stressors that make life a living hell for Pakistanis, and we must not blame this on a lack of morality, if Karachi is to regain its sanity.

The writer is the author of Before She Sleeps.
Twitter: @binashah

Published in Dawn, January 6th, 2019