Peshawar: When Shandana, 34, goes to see a psychologist at a local hospital, she doesn’t tell her family. She has been struggling with psychological issues since she lost her son five years ago.

“My family and husband do not allow me to visit a psychologist because fear that the people of the village would make fun of them, saying I am mentally ill,” says Shandana, who is from Musa Zai, a neighbourhood in Peshawar.

At the hospital where Shandana gets treatment, a mother of a psychiatric patient told News Lens about her young daughter whose condition the family tried to keep a secret but couldn’t for long. She said when the condition of her daughter, a student of tenth grade, deteriorated, the family took her to the shrine of Kaka Sahib, a saint buried in Nowshehra – a town near Peshawar –and other saints but there was no improvement.

“Now everyone knows about her mental illness and that is a big embarrassment for us,” said the mother. “People whisper there is something wrong with her “character”, which is why she has been cursed by God. Such gossip is very much painful for us.”

Hifsa Khan – a clinical psychologist and psycho-therapist working with the Khyber Pakhtunkhwa government’s Psycho- Social Support Programme, said that the province has a large number of patients living with depression, stress and anxiety. She said years of conflict and social violence, sexual harassment, injustice and lack of awareness about psychological problems have contributed to a spike in mental health issues.

“In most cases, people take their patients to saints and shrines because of the stigma associated with mental illness,” said Khan. “People from marginalized communities are often illiterate and due to insufficient knowledge about psychological problems, they are unable to cope with it.”

Moreover, said Khan, social taboos related to psychological problems make the situation even worse for women. “People don’t seek psychological support from the psychologists as society label them as ‘mad.’ To avoid this people do not seek medical attention to cure their disorders.”

Dr Syed Muhammad Sultan, Chairman of the Department of Psychiatry at the Khyber Teaching Hospital in Peshawar, said gender inequalities in the society makes women more vulnerable to psychiatry problems. He said women were bound to live their lives under socially-sanctioned strict norms, while facing discriminatory behavior from family members. “They cannot access basic rights like education and health, remaining ignorant about health conditions and medical help. Women have the X chromosome which makes them vulnerable to stress and other psychological disorders due to hormonal changes.”

Another woman with depression and drug- addiction who didn’t want to be named told News Lens that she got addicted to drugs when she started to use Nalbin, an opioid used to relieve moderate to severe pain. She has been using it for the last six years to cope with her sleeplessness and depression. Even though a nurse by profession, she did not seek psycho-social support fearing it may jeopardize her professional and social standing. “I have been using Nalbin for the last six years but realized after two years that my life is totally dependent on the drug. I tried to rehabilitate myself and go back to my life. But due to social taboos, I was unable to consult a psychologist. Later on my body was covered with wound patches due to continuous injections. At that stage one of my friends insisted me I seek help from a psychological rehabilitation center so I did because I was desperate for help.”

The Government of Khyber Pakhtunkhwa has introduced the Mental Health Act 2017, paving the way for establishing a dedicated commission for handling issues related to mental health in KP. The Pakhtunkhwa Radio, the broadcast channel managed by the information department in KP, produces a weekly radio program around mental health awareness.

Nizam Uddin, the producer of Studio Clinic Programme told News Lens: “We have received enormous response from the rural communities seeking guidance around mental health issues. A large number of these audiences include women and girls. According to the feedback we have received so far, majority of the girls in the rural setup are facing anger, anxiety, depression and tension issues.”

He said the programme focused on engaging women on mental care. “Although a very good number of women discuss mental issues keeping their identity secret, many more women-related issues are discussed by men on air. It helps to get their issues resolved and stay anonymous.”

Dr Sultan said 42 percent of women in KP suffered from psychiatric problems like phobia, post-traumatic stress disorder, stress disorder and depression. As militancy affected people directly and indirectly, said Dr Sultan, the situation is quite alarming for the people of this region.

He said a majority of women patients he treated were in a bad way as people first take them to saints and shamans due to their superstitious beliefs. “The saints burn their mouths and beat them badly to exorcise demons. In some severe cases, they sear the scalp or other parts of the body with a burning rod. All this takes place due to lack of awareness and social taboos and because people don’t go to psychiatrists due to the stigma associated with mental illness.”

Dr Sultan shared a case study of a doctor suffering from epilepsy: “He was engaged to get married but suffered a seizure at his in-laws house. His epilepsy condition was under control but the stigma attached to mental health lead to annulment of his engagement.”

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