‘Mental health has always been a neglected issue’

Dr Mehtab Khanam is Honorary Professor, Department of Psychology, Dhaka University, and a renowned psychotherapist. In an interview with Eresh Omar Jamal of The Daily Star, Dr Khanam talks about the state of mental health awareness in Bangladesh and how much it affects general well-being.

What is the state of mental health awareness in Bangladesh and our attitude towards people who are having mental health issues?

There is very little awareness. We should have built more understanding and had a lot more discussions about this subject. Unfortunately, we have frequently sidestepped it because mental health is still a stigmatised issue in Bangladesh. Any time you say the word "mental", people get put off, even the educated ones. Just recently a woman told me that when she asked her husband if he would like to go see a counsellor, he said, "are you trying to take me to a doctor for crazy people?" A lot of people don't even know the difference between a psychiatrist and a psychotherapist.

When someone loses contact with reality, that is, when they are suffering from a mental illness, they need medication because their brain chemicals or neurotransmitters are imbalanced. This can happen from living a stressful life for a long time or because of substance abuse. Some people could also have a genetic predisposition to it, similar to physical ailments such as diabetes. People are willing to accept the latter positively, however, when people suffer from some sort of mental illness for genetic reasons, they are stigmatised, along with their family.

When people are physically sick, you don't see the family getting blamed for it, or family members fighting over it, blaming each other, but you see that happening when someone has a mental illness. That just tells you how it is seen through a negative lens. Instead of realising that the person who is suffering needs attention, we end up fighting amongst ourselves over whose fault it is.

There are many types of mental illness—some are neurotic and some are psychotic. When someone gets disconnected from reality that is psychotic. And when someone suffers from anxiety, depression, irritability, those are traits that are associated with neuroticism. The latter are people who are functioning, even though they are suffering from many problems. These people mainly need psychotherapy. But unfortunately, we have very few psychiatrists and psychotherapists in the country, which makes it difficult for people to get the type of counselling or psychotherapy they need. And when neurotic patients don't get the treatment they need, there is a possibility of psychotic development. That is another reason why we must try and provide early treatment to neurotic patients.

There is also a gender aspect present here. In Bangladesh, women tend to be more conscious about mental health issues. Men have a tendency to not talk about it or address it. They try and supress their emotions and just stay strong because that is what society tells them they should do—the message that society gives them is that men shouldn't cry, they should be bold and courageous and not be scared. As a result, they suffer more physical health issues that arise from mental health problems. Taking up too much stress and not addressing the mental health issues that comes from that eventually take their toll on men when they get older.

Some researchers have warned that a long-term serious mental health epidemic may break out because of the Covid-19 pandemic. What is your take on that and how can we address it?

Our society already has so many problems, mental health is not even on our list. I don't think we are at all worried about it, even though we should be. But still, there is an attempt to train up school teachers, which should have been done a long time ago. But I'm not sure how effective it's going to be simply because of the sheer size of our population and the huge number of schools in our country.

I think we need a comprehensive effort here, and parenting has to be key. Due to the pandemic, the whole world is now talking about mental health. The World Health Organization said that improving your mental health will boost your immune system and keep you safer during the pandemic. That is why some people are now bothering with mental health. But towards the beginning of the pandemic, a research paper came out which said that teenagers will be its worst sufferers, because it's at that age when people tend to go out the most and meet up with their friends. It is something that teenagers need to do, as part of forming their own identities.

People go through many hormonal changes during their teenage years. Boys slowly turn into men and girls slowly turn into women—and this transition period can be quite confusing. At this time, they need the support of their peer groups, which they have largely been denied due to the pandemic. The fact that we still have some semblance of familial bonding is good and helpful. But the pandemic is taking its toll and as a psychotherapist I can see that. Anxiety and depression among people have increased and so has suicides. The first step to addressing this is to increase consciousness among people, which is seriously lacking at the moment. Secondly, we need to have dedicated hospitals that treat mental health patients, which we are also badly missing. We do have two specialised hospitals, but they are not enough given the size of our population.

What advice would you give to young people in particular, who have been struggling with anxieties due to the uncertainty about their future because of pandemic-related issues?

What advice can I give them? These are real problems. Those who have had their salaries halved, yet have four children to feed, can I tell them don't get depressed? Many people are in deep distress. If we are going to provide them with psychotherapy, then we cannot give such advice.

In developed countries, there are ways for people who are struggling with these issues to first get out of them. There are shelter homes for domestic abuse victims—they can easily seek help from the police. Over here we don't have adequate shelter homes or sufficient emergency helplines. Women and children in particular remain extremely vulnerable.

Children are literally at the mercy of their parents. If they are being abused by their parents, there is no one who would come and help them. That is why children should be given the right to call the police. But our children don't have any rights. We have to give children their due rights and protections and the nation state has to uphold them. The same goes for elderly people. Why should someone have to depend on their children when they get old? Shouldn't the state provide them with enough financial security?

One thing we can do is tell people not to lose hope. As long as they hold onto that there is a chance that they might be able to overcome their current crisis. But the state has to do a lot more to provide relief to people and to help them deal with their struggles.

How can someone who is struggling with mental health issues help themselves get better? For those who want to seek professional help, but are struggling financially, what facilities are currently available in Bangladesh?

They can turn to their loved ones for some sympathy. But often we see people who suffer from depression being told that they are pretending and they should just get over it. People are told there is nothing called depression. So this is something that needs to be discussed more and family support is something that should be ensured. Our first reaction to someone who is suffering has to be more empathetic and supportive. Then we can try and motivate them.

For those who want professional help, the unfortunate reality is that we have very little professional help available in our country. We do have some psychiatric posts at district and sub-district levels, but they are nowhere near enough. Hospitals need to hire many more psychiatrists and therapists. A therapist has to give a lot of time to their patients, which means the ratio of therapists-patients has to improve. And we also need a lot more helplines with properly trained individuals.

Students in the country are now returning to their educational institutions after 1.5 years of school closure. What institutional steps should be taken by the government to help them adjust back into their respective institutions without facing mental health problems?

Well, teachers could have done a lot to address this, had we been conscious from before. They should have been trained to look after the mental health of children. We are talking about all these because of the pandemic. But have we done anything for children's mental health before the pandemic? So what can we do now to all of a sudden change it? Teachers themselves are now struggling with mental health issues because of the pandemic. How can they heal their children when they themselves are so stressed out?

But mental health has always been a neglected issue, which is why we are in an even more difficult situation right now. So, there are no quick fixes. We have to start from scratch if we want to create a system that considers children's mental health to be important. Only then can we do anything about it.