Stigma is synonymous to shame, dishonor and disgrace. The same narrative is what those battling mental illnesses are taught to feel – to be ashamed, to believe that their ‘personality flaws’ are disgraceful, and to their ‘inability to cope’ brings dishonor upon those associated with them. The social pressure to be ‘normal’ stems from ‘log kya kahenge’: the singular precept that miraculously manages to unite Pakistanis across all social divisions.
The associations with mental health go beyond just stigma – it manifests itself in stereotypes, prejudice and discrimination. Stereotyping individuals as ‘dangerous’ or ‘crazy’ is a convenient way to dismiss them and exclude them from families, friend groups, or social settings. It is also an easy justification for discrimination, given our society is infamous for forming opinions without being fully informed of the facts, and this is precisely where prejudice stems from. Those battling eating disorders or addictions are frequently seen as being a product of their own faults, without acknowledging that (like physical health problems), these issues too can stem from complex and multiple contributing factors.
In our society, if families are aware (and at times even supportive) of their children’s choice to seek treatment for mental health, it is not uncommon for them to claim that their daughter is out for house errands, or their son is out for training at his sports club, instead of revealing that they are actually at an appointment with a therapist. Mental health is barely understood, let alone valued as a legitimate health problem.
For those battling with mental health, taking that first step to confide in those around them is awfully difficult, not only because they feel the need to overcome the stigmas associated with their illness to speak out to begin with, but also because there is a possibility of it being used against them in the future by the very same confidants. In times of arguments, turmoil and abuse, the stigmas associated with mental illness are routinely used either to discredit the individual or as a scapegoat mechanism:
‘You can’t trust what she says, she is mentally unstable’
‘He doesn’t remember what actually happened because he was depressed’
‘I accepted you even though you had psychotic problems, no one else would have’
‘She is incapable of making her own decisions because of her mental issues’
Such statements can cause individuals battling mental health to take on self-stigma; to start internalizing negative associations with their condition and ultimately resulting in feelings of hopelessness, low self-esteem and distress. In worse cases, they start doubting their own perceptions of reality. In Pakistan, the interplay of religion, tradition, culture and patriarchy intensifies mental health stigma ten-fold. It causes those struggling with mental health illnesses to battle them in silence, to hide their symptoms, to isolate themselves and to be reluctant to speak out and seek help.
It’s essential to do everything we can at an individual level to remove the stigma, only then would it catalyze social change. Let’s start here: it is untrue that people with mental health conditions do not recover. It is also untrue that their illness is the result of a character or personality flaw. Depression is not equivalent to over-sensitivity or playing the victim, and acts of self-harm are not testament to attention-seeking. It is incorrect to assume that mental health conditions are the result of religious anecdotes and can be fixed with a simple visit to a faith-healer. Bipolar personality disorder is not indicative of diabolical spiritual possession. And most importantly, it is false to believe that those with mental health are unable to effectively and successfully partake as active members of society.
Why do we only speak about mental health after it has made headlines, at the expense of a human life? Talk openly about mental health; whether it be your own struggles, the struggles of those around you, or by simply engaging in general conversation about the misconceptions and myths that surround mental health narratives. Educate yourself and others about the parallels between physical and mental health. Be cautious of how you use language and refrain from using mental health conditions as adjectives: ‘she is honestly so bipolar,’ ‘he was a complete psychopath.’ When we do this, we are effectively trivializing the actual conditions and validating the stigmas already associated with the illness. Why is it acceptable to bring the names and symptoms of mental health conditions into casual conversations, but frowned upon when the actual illness is being discussed?
We cannot continue to dismiss mental health when it affects 25 per cent of our population. We cannot continue to silence ourselves about the sheer prevalence of mental health illnesses because society dictates that we should. We cannot continue to lose lives because our ignorance makes us unwilling to accept our own realities.
Published in the Daily Times on September 15, 2018