Let me begin with the article heading, "The Unbearable Burden of Being Mentally Ill." This tells me two things. One, mental illness is unbearable and a burden so, if I am depressed or bipolar and have reached for the morning paper in an effort to stay connected to the world, I should screw that and go ahead and drown myself in my coffee. Two, the writer (Mahnoor Sherazee) or sub-editor has read Milan Kundera’s The Unbearable Lightness of Being. Or it’s title. Or possibly had it thrown at them.
"KARACHI: Why me? This emerged as the dominant theme among parents of children with special needs when asked about their role as primary caregivers."
The sub-heading tells me this is going to be an article about the challenges faced by parents of children with special needs. Since I do, for some reason, believe that the symptoms of ‘mental illness’ generally manifest themselves clearly around adolescence and after, when I think of children with ‘special needs’, I think of autism, Down’s syndrome, physical disabilities.
"Parenting on its own can be a tough job and parenting a child with limited cognitive development is significantly more challenging. Of course there are some parents who are quick to move past the denial and forward with the responsibilities of providing for their children but in such situations acceptance can extend beyond just one person’s understanding."
According to this paragraph, parenting is tough, parenting a kid with limited cognitive development is even more challenging, and the inevitable response to said challenge is denial. In other words, nowhere on God’s earth is a parent who has held their newborn in their arms (for some reason I am still thinking Down’s Syndrome or something akin to it), listened as the circumstances of its birth and life are explained to them and thought ‘it doesn’t matter, this too is creation, and this too is love.’ And then there is the line ‘in such situations acceptance can extend beyond just one person’s understanding.’ If you’ll excuse me for a minute, I’m going to think about this line very hard.
I have been thinking about this line very hard for some time now and have come to the conclusion that I don’t understand it. This can mean one of two things. One, that it doesn’t make any sense. Two, that my cognitive development is limited.
I blame my parents denial.
“While some mothers come out of denial very quickly then they face resistance from not just their family members but also in some cases their husband,” says Sadaf Shahid, a speech therapist, adding that, “In fact, often the child is not given the same privileges as their siblings.”
Speech therapist? When did speech therapists become the first port of call for expert opinions on mental illness? Do they also know for whom the bell tolls? Or where I put that sock? But on to what the quote implies: Some mothers do have ‘em. And love ‘em. But to date there have been no recorded instances of human fathers.
"According to psychiatrists, traditionally the “burden of care” for a mentally ill child or person falls on the single female(s) of the family or the daughter-in-law. The reason for this is there are no real institutions to help provide care or train individuals who are caring for people with such illnesses thus creating a dangerous lack of professional understanding of the psychological issues at stake. This also adds a financial burden on the person. And when society at large provides no support and even less understanding, the stress can be immense on a caregiver."
Fair enough. The burden of care generally does fall on women. And it is indeed tremendously difficult to cope with a person with complicated psychological issues. In fact, caregivers sometimes end up developing psychological issues themselves. Not that that’s worth mentioning. Because that would detract from the focus of the piece, which is…
"Dr Murad Moosa Khan is a consultant psychiatrist and chair at the Department of Psychiatry at the Aga Khan University (AKU). Speaking at a seminar organized by AKU he said, “Between 40 to 50 per cent of the nation is affected by some minor or major mental illness (MI).” Minor or common illnesses constitute up to 30 per cent and include depression and anxiety whereas major or psychosomatic disorders include illnesses such as schizophrenia, brain damage and resistant depression."
Enter the big quote gun to finally name, several paragraphs in, some of the things people think of when they see the term ‘mentally ill’; schizophrenia, depression, anxiety, psychosomatic disorders, resistant depression. That point about the stress of dealing with complicated issues earlier was really an excellent one. I’ve only been exposed to Ms. Sherazee’s muddy thinking for about five minutes and I’m already thinking why me? And also, Crouching Psychiatrist, Hidden Speech Therapist.
"With such eye-opening statistics it is sad to see that mental illness remains a “stigma or mark of shame”. This is also one of the reasons behind the neglect of these individuals even though according to a 2007 study published in the Lancet medical journal, mental illness makes up about 14 per cent of global disease, more than cancer or heart disease."
What is the Lancet medical journal? Why is it being quoted at me now? Why would I care what some scholarly tome says when I already know what the (say it with me) speech therapist thinks?
"“The US versus THEM attitude of social exclusion adds to the myths and issues that are present surrounding mental illness,” explains Dr Haider Ali Naqvi, a consultant psychiatrist. “Society has common names for people with illnesses – loony, nutcase, charia, pagal and psycho. This is then added by their general behaviour and attitude towards those are different,” he added.
Interestingly Dr Naqvi added that people, even those who are well educated, seem to know more about physical illnesses than psychological ones. In fact when they do witness someone with a mental disorder they resort to black magic and prefer to go to quacks than trained professionals for help."
Yes Ms. Sherazee the Us vs. THEM approach to people with mental illness is a bad, sad thing. It alienates, marginalizes and makes it more difficult to address an issue that, as you pointed out earlier, affects a large number of people across the world. You know what else doesn’t help? Your ignorance, lack of focus, and constant harping on extreme cases that cement the very mythology you presumably want to combat. It is not interesting that Dr. Naqvi pointed out that people tend to know more about physical illnesses than psychological ones. What is interesting is the line ‘when they do witness someone with a mental disorder they resort to black magic.’ Because, you know, everyone who has a mental illness is visibly deficient and apt to chew on the furniture.
"Not all mental illnesses are biological or genetic, some stem from environmental or lifestyle choices e.g. financial woes or drug and alcohol abuse causing – severe – depression, respectively. Doctors attribute a very high risk of mental illness where drug and alcohol abuse is involved. Drug Free Pakistan 2008 statistics show at least five million people in the country are drug users. However, a bigger problem now is the easy access and availability of alcohol in the country. Excessive use affects not only the drinker biologically with liver damage but the family emotionally as it may have to suffer violent behaviour. “I cancelled my wedding with only a month left,” said Sara (not her real name). “My fiancée used to drink a lot. At first I didn’t pay much attention to his aggressive demeanor but then one day he pushed me during an argument and I fell down the stairs and got hurt pretty badly.” That was the day Sara decided she could not deal with her fiancée’s illness any more. “He wasn’t a bad person, it was just when he drank, he lost control of himself.” Dealing with an alcoholic is a full-time job, especially when the person is “totally dependent on the alcohol and in absolute denial.”"
Right towards the end, the writer decides to muse aloud on the root causes of mental illness. Apparently, not all are biological or genetic. So some are? Should you perhaps have mentioned that when you were talking about the denial some parents feel when they have a special child?
"Some stem from environmental or lifestyle choices." For example not enough space to exercise or commune with something other than concrete? High concentrations of lead in the water? Ceaseless exposure to blood and gore on TV? The stress of a joint family system? Both parents at work all day? Nope. "Financial woes or drug or alcohol abuse."
If you, like me, think this is the bit where solutions and options for the rather drastically disenfranchised people featured above should make a dramatic, if belated, entrance, don’t hold your breath. We are left, instead, with the thought that substance abuse is always a cause rather than a symptom, and that people with mental illnesses exist on the peripheries of society rather than being a faceless, misunderstood part of it. We do not know who they are but we will know them when we see them, from their speech impediments and their uncontrollable rages. They will be the ones who are shunned by their parents. They will be the ones who are dragged to quacks by ignorant relatives. They will be the alcoholic men looming over their sobbing fiancés at the bottom of the stairs. They will never be the special child who hears music when others don’t, the CEO who harnesses his obsessive-compulsive attention to detail into material success, the alcoholic poet who marries lyricism and mysticism, or the artist who pins his heightened sensitivity and capacity for wonder onto canvas before taking his own life.
"Experts say the most important thing is self-awareness and communication, both of which do not come easy and that is when a strong, supportive family or friend is needed the most."
Physician, heal thyself. Editor, wake up.