How To Begin Talking Mental Health In Pakistan

How To Begin Talking Mental Health In Pakistan
Life in Pakistan has become a scenario somewhat similar to that out of a dystopian novel – basic human rights are threatened, the disparity between the elite and the poor has never been so palpable, the detrimental effects of the digital era have started to sink in, widespread violence is the new normal, and human life is easily discardable. I did wonder whether writing about mental health within such a fragile time was the right move forward but after much reflection, it seemed necessary. The reason being that while we have started to acknowledge the pros and cons of the several facets of our day to day lives (legal, political, economic, financial, social etc.), the emphasis on our health can often take the backseat within a wider general framework. Within that, my area of expertise lies specifically within mental health and what it constitutes in Pakistan.

The possibility of utilising this space that allows me to talk about mental health seems easier in theory than in practicality; not because my enthusiasm for it has somehow fizzled out but rather it seems too vast to contain within a thousand words. This is a subject that needs to be talked more in the widespread community rather than just on colourfully created social media posts, a subject that needs to move beyond positive psychology and mindfulness breathing, a subject that shouldn’t just be curated for the rich to discuss in their self-funded therapy sessions, and a subject that should belong to all and not just some. Currently on a legislative level, mental health in Pakistan is guided by psychiatry (which is known to be an “old man’s club” and comes with its fair share of criticism) yet objectively it is directed by many other disciplines as well, including but not limited to psychology, sociology, philosophy, social anthropology, pharmacology etc.

The influences and linkages of mental health aside, I do wonder where to start and where to end. How do I talk about the delicacies of the mind when our very bodies are being threatened due to the political climate of Pakistan? Should I even write about mental health when health as a whole is fragile and vulnerable in ways that it shouldn’t be? Do I relate it to what is happening and how the shackles that bind our bodies burn our minds too? Do I distract from it entirely? Do I start with history, travel back centuries, explain how it isn’t now and here that the mind has demanded attention alongside the body? Or do I sit on the fence, drone on about the much-talked pioneers of positive mental health? Or do I go down the rabbit hole I work within – the darkness, the spirality, and the madness? Do I offer hope or do I offer despair? Do I offer solutions or do I offer problems?
While there is no doubt that we can use and benefit from Western frameworks of mental health to guide our own research, theory and education, it cannot be seamlessly applied onto cultures such as Pakistan’s

Answering all those questions warrants quite a lot of self-reflection and while knowing what to do is hard, knowing what NOT to do is easier at this time. And what I do not want is for this column to be an information-focused space that offers origins, influences, and histories of mental health. Topics that focus on theories, principles, and models can be found easily accessible on several online platforms that are tactfully decorated with neon and pastel backgrounds with bold headlines that attempt to give you a checklist for determining whether you are clinically depressed or perhaps it has just been the gloomy weather. In short, this column would be an opinion piece that utilises the aforementioned information to talk about mental health within Pakistan.

Lately, one of the debates within the discipline revolves around whether a Western view of mental health could fit seamlessly onto Eastern cultures. To be more specific: it is about whether models, therapies, and other interventions founded within and for individualistic frameworks can be applied onto collectivist cultures. The leading argument so far has been that it cannot.

While there is no doubt that we can use and benefit from Western frameworks of mental health to guide our own research, theory and education, it cannot be seamlessly applied onto cultures such as Pakistan’s. They need to be adapted, tailored and made to measure a culture so vastly different than the one it was created within. Even then, it needs to be acknowledged that we do not possess even the most basic infrastructure to implement them as of now. There are profound systemic changes required and we haven’t even begun to scratch the first layer. And perhaps when the time arrives, respecting the differences we have from those in the West might help us navigate that implementation better and avoid health hazards.

Some of the ways I feel I can contribute towards this implementation is by asking questions that pertain to mental health in Pakistan and attempt to answer them along the way. Grasping onto a wider systemic view would be the buttress of these queries but they might also alert us to the surface-level problems that lead to those wider issues.

For instance, does mental health have space in Pakistan as of now or is it still too early for us? Why are mental health hospitals excessively underfunded and reliant on charitable donations? Are wide-spread talking therapies (e.g., Cognitive Behavioural Therapy, Interpersonal Therapy, Dialectical Behavioural Therapy etc) applicable onto highly enmeshed cultures like Pakistan? Is there space for a dualistic model of therapy (the idea that the mind and body are two distinct and separate entities independent of each other) within religiously and spiritually informed cultures? Should there be protocols followed for delivering therapy considering Pakistan does not possess a proper and reliable mental health act? Should therapists take caution when practicing considering we do not have an accredited, governing body that could monitor this level of power and status quo?

Similar questions can also be asked on a population and individual level: why are traits of narcissism so prevalent within the Pakistani male population? Why are distribution rates of anti-depressants within Pakistani females so high? Why is a lot of the population addicted to sedating anti-anxiety medication at night-time? Why is “bipolar” the leading disorder offered to people with behavioural and emotional difficulties? How do therapists attend to individual concerns that are considered unlawful within our country yet accepted in others (LGBTQ+, cannabis use etc)? Why is “just read the Quran and it’ll be alright” not the right answer for someone who has clinical depression or hears voices in their head?

There are infinite questions to ask and infinite answers to be had and I only wish to ask a few numbered ones that might help us understand the precariousness of mental health within Pakistan. Alongside, I aim to find some answers that might help guide our view about the lives of those we love yet often cannot understand. To quote Lewis Carroll’s words delivered through the Cheshire Cat, “we are all mad here.”

In this column, I hope to unravel some of that madness, which yes, might be madness in itself.

Rijah Sheikh is a writer based in Lahore who has completed a BSc Honours in Psychology from the University of Edinburgh, Scotland. Subsequently, she has achieved a certificate in Counselling Skills and has since worked within a range of organisations that aid wellbeing and positive mental health within individuals. If you have any queries, comments or suggestions about this column, please email her directly at