Accepting the realities of mental illness

On February 15, headlines in the The Daily Star highlighted the four main causes of deaths in Bangladesh in the past year. Compiled by the Bangladesh Health Injury Survey 2016, the findings reported 23, 868 suicides occurring in one year. This has drawn attention to domestic abuse, financial strains, and several other causes that have been known to incite suicide, initiating laudable corrective measures such as the amended Dowry Prohibition Act 2017. However, these figures also hint at another issue that is largely repressed and glossed over in our country. It is imperative that we start addressing the reality of mental illnesses in Bangladesh, and their contributions to many of the key concerns that we are trying to solve.

In 2015, The Guardian ran a vivid photo story by photojournalist Allison Joyce portraying mental health patients in Bangladesh. In the pictures, a bald-headed woman squats in a starkly barren room, eating directly from a board holding scattered remnants of her food. A man lies down on a bed merely covered by a crinkled sheet of paper, surrounded by flaky walls that have turned yellow and blue from damp, and a floor covered in pools of white and brown congealing waste. Other pictures show tied up and shackled patients who would be harming themselves otherwise, and a dead girl lying half submerged in muddy rainwater. Captured in the Pabna Mental Hospital, Bangladesh's only state-run mental care institution with only 500 beds, these graphic images mention the 14.5 million adults who were reported as mental patients in a National Institute of Mental Health survey. The story also mentions a doctor working at the hospital who referred to his profession with regret, calling it something that he had 'ended up' in after failing to succeed as a surgeon.

This photo story symbolises the neglect with which mental health issues are treated in Bangladesh. The social stigma surrounding the subject bars people from even considering that they might be facing psychological troubles, let alone consulting professionals until the matter reaches extremes. Examples can be found in an article that the Star Weekend magazine ran in March last year. The story, titled 'Out in the Open', features two Bangladeshi women who suffered from mental health issues from a young age. One of the women who lives in the UK realised that her troubles with attention span were a cause for concern and not simply the signs of an active mind; she sought help in London and was diagnosed with ADHD – Attention Deficit Hyperactivity Disorder. The woman living in Bangladesh suffered from insomnia, weight gain, severe mood swings, anxiety attacks, and even bouts of dizziness; she was advised by parents that marriage would be the cure to her "loneliness". It was when her condition worsened to the point of incoherent speech and thought that she was diagnosed with Disorganised Schizophrenia.

Distrust in mental health treatment takes the shape of embarrassment for those living in cities, who worry about what their social circles will say once the news gets out. It isn't altogether unfounded given the furore with which such stories are spread around through gossip, besmirching the names of patients and families in need of support and respect at such a difficult time. Others, perhaps in fear of facing such scandals, completely deny the reality of issues such as depression and more serious mental illnesses.

The stories in rural areas take on darker tones. If a woman from a village or an underprivileged background were suffering from psychological troubles, the most urgent concern would be about how she would get married. Alternately, a man with mental illnesses would be encouraged to find a wife who would take care of him and free others from having to do so. In neither instances would the patients receive diagnosis and medical help. Worse still, mental illnesses in villages are most often thought of as possessions by evil spirits. Patients who are sometimes even young children are subjected to 'exorcism' practices that involve beating them up with brooms and other violent rituals. Most of them are left with the fate of being chained or tied up at home, living under the title of the village 'pagol'.

The lack of awareness regarding mental health issues, and more importantly a lack of qualified medical help in these areas, has been contributing to the miserable lives led by these patients.

There is no unified human rights review body in charge of monitoring mental health issues in Bangladesh; neither are there any mental health provisions in social insurance schemes. Meanwhile, the 2007 Report on Mental Health System in Bangladesh, the last large-scale study of mental health issues carried out by the WHO and the Ministry of Health and Family Welfare, sheds light on how less than 0.5 percent of the national budget was allocated for health care expenditures in 2005. While we hope that the situation has significantly improved in the past decade, no such noteworthy studies have been carried out ever since, leaving us with no reliable source of information about the state of mental health care in the country.

When combating the spread of violence in our midst, we need to notice the psychological causes and implications of the incidents occurring around us. We need to realise that mental illnesses are very real, and very prevalent. The frequency of sexual and physical assault cases point towards a large number of people in dire need of psychological help. The ever-increasing victims of various crimes signal an even greater need for post-traumatic psychological support across different levels of society. In fact, people suffering from mental illnesses are most vulnerable to abuse and mistreatment because of their inability to speak out for themselves, and the tags they would assume as unreliable witnesses in a crime.

Depression can lead to 67 percent higher chances of death from heart disease and 50 percent higher chances of death from cancer; schizophrenia can double and triple the chances of death from heart and respiratory diseases, according to the Mental Health Foundation, UK. The pain suffered by parents, spouses, and most of all, the children of these patients, transcends units of measurement. The more we gloss over these issues, the greater the damage that we cast around us.

The government and institutions across the country need to provide more expansive mental health support, through affordable medical services at the community level, and more importantly through a rigorous spread of awareness. The stigma, and the sheer denial surrounding mental illnesses need to be pushed aside. The responsibility to make these ideas heard falls upon the media – ranging from print, digital, and social media to the books, movies, and TV shows that have more direct access to viewers' minds. It is also up to society at large to extend help and support, so that people suffering from mental illnesses can feel confident to address their problems, and decide to seek help.

We have been striving to evolve as a progressive society – one that frowns upon discrimination and stands up for victims of injustice, regardless of their gender or background. In truly embracing such ideologies, we must learn to perceive mental issues as illnesses – no more shameful than an ailing lung or liver – and combat them with the correct treatment and, above all, sensitivity.

The writer is a student of North South University, and a member of the editorial team at The Daily Star.