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Faizan / Male / 38 / Lahore

This is not a typical story of me as person. These are just some random thoughts. This is the story of the events happening with me. This is not the justification but this is me trying to justify the events that happened to, and with me. People think I am a bad person because I made many mistakes in my life. I admit that I made these mistakes – as a person I am not good or maybe I am good but my mistakes overshadowed the goodness inside me. I don’t know when I was trapped inside my mind or one can say I don’t know when my mind trapped me. 

The mind is very complex thing, it thinks and it analyzes and it tells the body to act on the very same thoughts and analysis- but what if the mind startsto think and analyze incorrectly and you started to act without knowing. This is what happened with me, and doctors told me this is schizophrenia. To become the patient of schizophrenia was not my fault. I never want to be the patient of schizophrenia. I want to be the so called “sane” person. 

This is common practice here in Pakistan and in our society that if any person is diagnosed with any kind of mental disorder or any kind of mental illness, our society starts to think that this person is insane, mad and only place for that person is a mental asylum. But before reaching to the stage of mental asylum a person diagnosed with any kind of mental illness need to go through from many stages, similar to a video game.

In my case, in 2007 I started to meet and talk to people and then I wouldn’t be able to meet or talk to them again. I thought maybe there is something supernatural going on with me. Maybe some jinns or some magic bothering me. I don’t know what, but I was not comfortable at all. 

I used to tell my family that I have too much of a migraine and I have too many rashes on my body. But the only answer from my family was that I was running away from my problems and that I am just being dramatic. They told me I am very sinful and this is Karma, and so on. That this is the curse of Allah so I need to ask forgiveness. At that time I had no problems. Maybe I did but I didn’t realize those problems. 

Now that I know what the schizophrenia is and how it affects a person, I came to know that all this was the beginning of the mental disorder. It’s not like I didn’t come to the family. I came to the family I discussed what is happening with me. I told them all. Later on I had financial losses due to those thoughts and people. I told my family that I meet unknown people I am not able to meet them again.

I told my family that something wrong is going on which I am not able to understand. I told my family where ever I put money or my valuables somewhere safe at home, I lost the money and I lost the things. The only answer I was getting from all was you lost the money somewhere else and are just creating stories. You are doing drama. You are lying.

In fact those things were happening with me.They continued to happen for long time. Maybe when I write these things now, I will get the whole new version of these things from all the people around me. But whatever they tell me or they told me in the past I don’t remember. Many things even if I try to recall, I cannot. All the people around me present many things in front of me again and again to tell me I was wrong and all other people were right. If i don’t remember many of these things, how I can tell or convince myself that I was right or I was wrong. 

From many years, I just made a habit that whenever someone tells me something, that I did this or I did that and I was wrong, I just say yes as I can not recall.

One of the worst things that happened during that time was that I lost my words. It was very difficult for me to talk, specially face to face. I was not able to recall words and I was saying the same thing over and over. What I wanted to say was always in my mind, but I did not know how to put those thoughts in words.

Now, I admit that I was wrong and every other person was right. But at least all the right people can make me remember as those things are like clean slate in my mind but instead all the people only remind me of one thing – that you lied and you were doing drama.

According to definition, Schizophrenia is a psychosis, a type of mental illness in which a person cannot tell what is real and what is imagined. A sudden change in personality and behavior, which occurs when schizophrenia sufferers lose touch with reality, is called a psychotic episode.

So when I already lost a touch with reality and after sometime coming out of that that psychotic episode, how can I tell others what exactly happened with me? I was only telling them what I remember and only thing I remember is that I met people. I don’t know who I met but I was not able to meet those people again in life. Those people were asking me to do certain things. At the time of those episodes the people I meet or talk always found them most friendly and most helping.

Problem only arises when I was not able to find those people again or not able to find those deals which I use to do and telling everyone very happily that I did that deal or I have that success in that field of business. After sometime when nothing was happening, I was always clueless why – where those people went, why I am not able to meet them , what is happening. Then the words surrounded me was you are a liar. You are creating stories. I always had no justification only words I was able to say ” I don’t know”. In my mind I was doing right things were very clear in front of me. Maybe in actuality, nothing was happening which I was not able to figure. Even if I tried to give some justifications, I was not able to find the right words.

I am not blaming anyone, I am just telling my part of the story. Every story has always two sides. This is my side of the story . 

Maybe I was wrong, maybe I am right, maybe I was always a liar, maybe I am always creating a story. I think now this is the time to tell everyone what actually was in my mind. What actually was happening to me. Maybe after that I will be able to justify myself. Maybe after that people will able to forgive me. Maybe after that I will able to see my kids. Maybe after that I will able to see my wife.

Mental Health and Animals

By Amal Naeem

Around the world, more and more people are experiencing mental health problems every year. The World Health Organization reports that more than 300 million people of all ages suffer from depression globally. Despite there being evidenced effective treatments for depression, fewer than half of those affected in the world (in many countries, fewer than 10 per cent) receive such treatments.[1] There are efforts being made to identify and mobilize resources to support people living with mental illnesses, however this space leaves much to be desired in Pakistan. Here, majority of affected populations do not have access to quality mental health services, which is made worse due to the rampant stigma associated with mental illnesses. The more traditional approaches to dealing with mental illnesses include self-management of long-term conditions, which focus on psychological mechanisms of behavioral change. While these approaches can be effective, they fail to consider extraneous variables, such as the domestic and local environments which form the latent and constituent part of systems of lay and community support for individuals.[2]

The Pakistan Association of Mental Health (PAMH) cites that the country is increasingly getting ‘depressed’, with the actual number of people living with depression and other mental disorders believed to be much higher than the recorded 37 per cent.[3] The President of PAMH said that levels of stress are worsening, with every fourth household having someone who suffers from a mental illness requiring specialized treatment. Negative personal stressors of life, including work and education-related stresses, financial problems, death, health, unemployment, sleep problems, commuting and legal problems, amongst others, are taking their toll on people.

In addition to more traditional methods of treating mental illnesses and dealing with personal stressors, people are also turning towards newer methods, such as animal-assisted pet therapy to address mental health problems. Animal-assisted therapy can be used to help improve patients’ mental, social, emotional, and physical functions. This kind of therapy can take place in various settings, including specialized treatment centers and hospitals. It involves different activities such as walking, nurturing and grooming the therapy animal. Globally, studies have shown that support animals can provide a comforting presence to owners that suffer from mental health illnesses, especially patients dealing with PTSD, anxiety, agoraphobia, depression and generalized anxiety disorder.

The first research on pets and mental health was published 30 years ago by psychologist Alan Beck of Purdue University and psychiatrist Aaron Katcher of the University of Pennsylvania. For the experiment, they measured what happens in our bodies when interacting with a friendly dog, and recorded physical changes which included the lowering of blood pressure, slower heart rates, breathing becoming more regular and relaxed muscle tension; all signs of lessened stress.

Although the use of animals to assist individuals with psychiatric issues is a more recent trend,[4] it has quickly caught on in the West. More recently, according to the Journal of Evidence-Informed Social Work, there has been an 82 per cent reduction in the symptoms of PTSD (and other trauma-related issues) after just one week of having an emotional support animal. One case noted that interacting with the dog for as little as one week, enabled a patient to decrease their dose of anxiety and sleep medications by half.[5]

A study by Centers for Disease Control and Prevention (CDC) reported that a pet dog may protect children from anxiety, building a case for encouraging families with young children to adopt animals as pets.  A total of 643 children participated in the study by the CDC. A little over half of them had pet dogs in the home, while all participants were controlled for similar BMIs, screen time and physical activity. However, their anxiety levels were different, with only 12 per cent of children who had pet dogs testing positive for anxiety, compared with 21 per cent who did not own pet dogs. As a result, children who grow up with pets may have a better chance of becoming happy and healthy teens.

A 2016 study at the University of Manchester noted that the participants said that pets helped them manage their everyday lives and illness. The study involved participants who had been diagnosed with mental disorders, ranging from depression, schizophrenia, bipolar disorder or PTSD. 60 per cent of the participants placed pets in their most important circle of supportive connections and reported that pets gave them a sense of identity, higher self-esteem, self-worth and distracted them from their symptoms, which for some, included hearing voices, suicidal thoughts or negative cogitation.[6]

Furthermore, caring for a living being other than ourselves makes us feel needed, and can have specifically positive effects on the elderly. A study at the Kyungpook National University School of Medicine, Korea in 2016 gave elderly people five crickets in a cage. Researchers then monitored their moods over eight weeks and compared the results with a control group which was not caring for any pets. The participants that were caring for crickets became less depressed and reported lower levels of loneliness after eight weeks when compared with the control group.

Real world examples can be found in universities and colleges in the United States that have been facilitating physically handicapped students who require guide dogs and other types of service animals to provide ease for decades. However, within the past few years, it is becoming gradually more common for mentally disabled students and students suffering from mental illnesses to bring emotional support animals to campus to assist in managing their stress, loneliness, depression and anxiety. Furthermore, animal assisted therapy can be a more viable option for people who may find it difficult to open up and share with another human, or those who may be hesitant to approach the more traditional treatments for mental illnesses.  

The Human Animal Bond Research Institute (HABRI) is working towards increasing the knowledge of health benefits of pets and has funded approximately $2 million in research projects which explore the health benefits of human-animal interactions, while continuing to raise awareness of the health benefits of pet ownership and animal-assisted interventions. Unfortunately, any such research body is lacking in Pakistan. Coupled with the Islamic tradition that dictates dogs are impure and warns against contact with them, there are miles to cover and many gaps to fill before pet therapy can become mainstream in Pakistan as an effective treatment for mental health disorders, despite its demonstrated benefits and positive results.  

Research and personal experience of a lifetime of animal companionship and unconditional love corroborate that simply petting a dog lowers the stress hormone in humans, cortisol, while interactions with dogs increases the levels of the feel-good hormone, oxytocin,[7] something all pet owners can testify to. This kind of unconditional love is good for mental health, as Dr. Levinson, the pioneer of animal assisted therapy said, “a pet is an island of sanity in what appears to be an insane world.”

[1] World Health Organization

[2] Helen Louise Brooks, Kelly Rushton, Karina Lovell, Penny Bee, Lauren Walker, Laura Grant and Anne Rogers

[3] Dr. S Haroon Ahmad, PAMH

[4] Huss, 2012

[5] Debra Mims & Rhondda Waddell (2016) Animal Assisted Therapy and Trauma Survivors, Journal of Evidence-Informed Social Work

[6] Brooks H, Rushton 2, Walker 3, Lovell 2, Rogers A.

[7] Johns Hopkins Medicine

Izza Malik / 19 / Karachi

Books got me out of my depression

I lived with depression for a few years. Those years changed me in a lot of ways. I turned inwards, my self-esteem waned and the word ‘pessimistic’ followed me like a shadow. Every person I met openly told me that I was very ‘pessimistic’ and I should change. Their words were unfriendly and hurtful, but they were true.

As time passed, I felt sad and lonely. A cold realization dawned suddenly—my circle of friends was shrinking. Apparently, I had become too negative to even be friends with. 

I tried to keep all my friendships from tearing down, but after a while, I gave up. It was difficult trying to make people like me or talk to me or be friends with me. The constant struggle of holding everything together made me weary.

In the midst of everything, I was introduced to a novel called Kane and Abel by Jeffrey Archer. I decided to read the book. This was a serious decision after a really long stint of avoiding books.

I read through the pages—they were full of words carefully glided across the pale yellow sheets. And they weren’t empty words. They had stories woven into them. They gave life to Kane and Abel and made them real. Kane and Abel were people now, not merely characters.

As I lived through the lives of Kane and Abel, I realized how much I missed reading. Each time I held the book in my hand and turned its pages, I felt contented and all empty space in my life slowly reduced. Each time I read the book, I had the chance to break free from my own world and drift into another.

I read another book after Kane and Abel, and then another, and then another—I was lost in the world of books. Each time I read a book, I became the characters I was reading about, and wandered in their lives. I was no longer myself when I was reading.

I still remember reading Dan Brown books before going to school each morning and then thinking about what was going to happen next as I sat through the long and boring classes. I was always excited to come back home and start reading from where I left off.

I read The Forty Rules of Love by Elif Shafak and learned from all the rules that she had so beautifully put into words. I remember some of them even today. They helped me heal. They helped me understand myself and those around me. I read Tuesdays with Morrie and When Breath Becomes Air and lived the lives of two dying men. I learned from their experience of life. They taught me how small things matter in life. They taught me how to look at things differently.

I started looking at life itself differently. I read books about women— TraffickedThe War on Women, and books by Jean Sasson are only a few of them. The women whose stories these books narrate come from different parts of the world but have struggled in much the same way. Their dire circumstances also resonate with the lives of Pakistani women. I read a lot of fantasy fiction books. They nurtured my imagination. It was fascinating living in the era of dragons, vampires, fairies and magic.

Books were suddenly my freedom. I was reading all the time—when my bookshelves filled up, I started filling my wardrobe with books.

My mom admonished me several times for reading novels even during exams, but I couldn’t stop reading because it made my life so much better. They made up for friends that I had lost, they inspired me, they taught me lessons, they made me a stronger person. But importantly, they were my reason to return to life. I made my place among those who delightedly told others that books were their best friends. 

Today, it’s another lonely day. But as I look at three new books neatly piled up on my writing table, waiting for their stories to be told, I don’t feel so lonely anymore. I’m thinking about the new lives that I’ll live. They are, after all, all that I need to get through the day, and maybe even, through life.

Mental Health and Air Pollution

Lahore, a city of 11 million people, was engulfed by smog for majority of the winter months. Many have taken to twitter and other social media platforms to complain of headaches, burning eyes, congestion and sore throats. On some days, the global air quality index recorded the highest level of air pollution in Lahore as five times the generally prescribed legal limit.

9 out of 10 people breathe polluted air every day. This year, the World Health Organization has declared air pollution to be one of the greatest environmental risks to health. Microscopic pollutants in the air can penetrate respiratory and circulatory systems, damaging the lungs, heart and brain, killing 7 million people prematurely every year from diseases such as cancer, stroke, heart and lung disease. Around 90 per cent of these deaths are in low- and middle-income countries, with high volumes of emissions from industry, transport and agriculture.

Physical health, cognitive performance, labour and productivity are considered to be more ‘tangible’, and therefore adverse effects if poor air quality on these outcomes are significant and well-established. However, the effects of toxic air impact not just physical health, but also mental health. We have seen a lot of campaigns to reduce the personal and societal costs of mental illness, which include the social environments of individuals, including their personal characteristics, family and romantic relationships as well as their work environment; but it is just as important for public health efforts to also look at facets of the physical environment; such as air pollution. The link between the mental health and toxic air is one which is regularly ignored, and any correlations found are typically dismissed as being simply coincidental and not based on causation.

In one of the first researches aimed to study this link, a study published in the Psychiatry Research journal combined information from a group of children in London with high-resolution data on air pollution levels. Of the 284 children studied, those who lived in the top 25 per cent of the most polluted areas at age 12 were found to be three to four times more likely to have depression at age 18; in comparison to those living in the 25 per cent least polluted areas. The study took into consideration other factors that could affect mental health, such as family history of mental illness, level of income and bullying; and ensured that the results were controlled for these factors. Well-known psychiatrists have also referred to this study repeatedly, explaining that pollutant particles are small enough to cross the blood-brain barrier, and can cause inflammation in the brain, potentially leading to the development of depressive symptoms.

To present a reasonable measure of comparison, data has shown that children who suffer physical abuse are one and a half times more likely to develop depressive disorders as adults. Finding toxic air and pollution to cater for a higher likelihood of mental health impact is therefore quite significant.

Social determinants of physical and mental well-being largely include where you live, and your access to resources and public spaces. Air pollution has therefore also been associated with behavioral changes, such as spending less time outdoors and chosen to adopt a more sedentary lifestyle. Some parents choose to not send their children to school on days that the smog outside is considered unbearable. Such changes, especially in the long-term, have the potential to lead to psychological distress and social isolation. A study at the University of Washington found that the risk of psychosocial distress increased in parallel to the amount of particulate matter in the air. The study surveyed the participants’ feelings of sadness, nervousness and hopelessness through a psychometric scale, to find that neighborhoods with higher levels of pollution scored higher in psychosocial distress. When corroborated, the findings indicated that an increase of 5 micrograms per cubic meter of pollution had the same effect as a 1.5-year loss in education.

More recently, a study in China used real-time data on the people’s mood through social media posts and reactions, and compared it to the amount of airborne particulate matter found in air pollution. Collecting data from over 200 million tweets in 144 Chinese cities, the study found a high association between low levels of happiness, and increased levels of toxic air pollution.

Despite being a newer area of study, the international community has started taking more interest in the links between mental health and air pollution. In October last year, WHO held its first ever Global Conference on Air Pollution and Health in Geneva. Over 70 countries and organizations in attendance made commitments to improve air quality.

It’s about time Pakistan starts taking similar steps – for not just the physical, but also the mental well-being of their citizens.

Published in the Daily Times on 7 February 2019.

Mental Health and Employment

By Zoya Imam

“How do I tell my manager that I need to leave early once a week to see my therapist? He may consider me to be less competent, or even unreliable.” Such fears are well-founded; society continues to stereotype those struggling with mental health as incapable or even dangerous in some cases. Given the prevalence of mental illnesses, it is not surprising that even within the work environment, at least 13.3 per cent of employees below the age of 25 have depression, 3.8 per cent of employees aged over 55 have depression, and at least 1 in 4 people experience some kind of mental health problem in any given year. For men specifically, 37 per cent may deal with anxiety or depression, yet their partners and relatives are unaware of it. Globally, 67 per cent of employees feel scared, embarrassed or unable to talk about mental health concerns with their employers. This number is likely to be much higher in Pakistan.

We need to remember that our health is important. It is a unanimous opinion that looking after employees’ health makes a business more successful. And hence, most organizations offer health insurance to ensure that they are protecting their staff’s physical health. Despite companies understanding, and taking necessary measures to protect physical well-being, there has been little effort to give mental health the same importance.

Our understanding of the malfunctioning mind lags far behind that of physical illnesses. In the genomic age, neuroscience remains almost medieval and mental health research is underfunded. Services for mental health are also stunted due to Pakistan’s budget allocations – only 2.4 per cent of the country’s annual expenditure goes towards health, of which only 2 per cent is put aside for mental health. We are seeing more and more life insurance claims resulting from suicides everywhere in the world. What we need to remember is that mental illnesses do not differentiate based on an individual’s status, wealth or age.

Almost a quarter of Americans suffer from a mental illness every year. This total adds up to over USD 105 billion a year in lost productivity (in the U.S. alone), according to the National Council of Behavioral Health, and stands at GBP 42 billion a year for UK employers, according to a report published by Deloitte in 2017. The World Health Organization estimates that by 2030, the world will lose 12 billion workdays to depression and anxiety alone if treatment does not improve.

Alison Pay, the managing director of Mental Health at Work says “it’s amazing what can be achieved with a change of attitude. A lot of bosses wouldn’t think twice about allowing someone to work from home if they have a broken leg. Making the same accommodation for someone struggling with anxiety goes a really long way towards helping them manage their symptoms.”

Organizations globally marked October’s World Mental Health Day by handing pamphlets and green ribbons, and arranging for relevant workshops and seminars, but the journey only begins here. Organizations have a long way to go from simply claiming to support mental health to actually doing so in practice. What employers need to keep in mind is that a strong mental health program also helps recruit top talent, as it demonstrates the organization’s priorities of putting their employees first. Helping staff members improve their mental health also works to foster goodwill towards the company. This goodwill, in turn, decreases the chances of employees being dissatisfied and looking for new opportunities. Research has frequently documented instances where if someone with depression, anxiety or stress feels trusted by their manager, they are often more productive in their jobs.

Organizations must start incorporating mental health and well-being into their priorities. A few steps they can take are as follows:

  • Understand the subject and the ensuing problem, and acknowledge that it exists.
  • Understand the company culture, and identify how programs can be shaped to ensure that employees respond to mental health initiatives.
  • Educate employees about mental health. Create an awareness program, host a speaker, and organize meetings. Many people, even those suffering from anxiety or depression, don’t quite understand what mental illness is, and how it can affect them on the job. Employee education helps to increase awareness of potential mental health issues affecting co-workers and even themselves. Education can also contribute to removing the stigma most people have around mental illness.
  • Help your managers to help your staff. Line managers are absolutely pivotal as they are usually the ones responsible for dealing with mental health in the workforce on a day-to-day basis. However, many lack the confidence or experience to manage this alone. What managers need to remember is that they are not expected to become experts in mental health, instead they are there to flag problems, communicate without judgment, offer support and signpost available resources.
  • Actively encourage employees to seek and receive treatment for any mental illness. Provide them with support. Support can be by altering their roles and responsibilities, changing their work environment (flexible hours being one example), or monitoring and managing workloads. It is important for managers to be respectful of these choices, if they choose to grant such flexibility.
  • Collect data such as absenteeism, job satisfaction and productivity through employee questionnaires and surveys. Having concrete, measurable data will assist the organization in strategically planning and implementing a needs-based approach to mental health. On the whole, an effective mental health and well-being strategy considers prevention, intervention and protection.