The Impacts of Disregarding Schizophrenia as an Illness: The Plight of an Unhealthy Nation

It is not just an insult, but an affront to people who are constantly fighting the uphill battle against Pakistan’s deteriorating mental health, to exclude schizophrenia as a disease.

These people include but aren’t limited to, psychiatrists, psychologists, counselors, teachers, researchers, students, and those who have experienced or even emerged from the plague of mental illnesses.

In 2016, the Supreme Court of Pakistan decided to rule against schizophrenia being recognized as a mental illness, considering it to be a recoverable disease, the SC allowed for the execution of Ali Imdad, who murdered a religious scholar. Reports affirm that while Ali had been referred to therapy for the mental illness a year before the murder, his mental health was not even mentioned in the court ruling that convicted, and then sentenced him to death.

Despite the fact that both his doctor and his wife provided testimony to the fact that Ali suffers from paranoia, delusions of grandeur, voices in his head that give him commands, and eight years of treatment while in captivity ascertain that he suffers from schizophrenia, and barely has control over himself, the supreme court refuses to not just change their ruling on recognizing schizophrenia as a mental illness, but do not take back Ali’s death sentence.

This not only reflects Pakistan’s legal and social perception of mental health illnesses, but also our blatant disregard for international law, humanitarianism, the stigma that is attached to psychology, lack of efforts to combat the ever decreasing state of the people’s mental health, and the notorious and internationally criticized death penalty.

The state of Pakistan’s mental health facilities is disturbing. According to a 2009 report by the World Health Organization,

0.4% of health care expenditures by the government health department are devoted to mental health. Of all the expenditures spent on mental health, 11% are devoted to mental hospitals.

The rate of spending on mental hospitals is lower than other low and middle-income countries (LAMICs) as Pakistan did not inherit large mental hospitals, except the one at Lahore that is being downsized, and more facilities are being set up at the district hospital level (secondary level). 5% of the population has free access (at 80% least covered) to essential psychotropic medicines. For those that pay out of pocket, the cost of antipsychotic medication is 3% and antidepressant medication is 7% of the one-day minimum daily wage in the local currency. None of the mental disorder is covered by social insurance schemes.” We’re not sure what has been done to develop the deplorable conditions of mental health facilities so far, but it can’t be much given the echoing silence of our national treasury.

We must also acknowledge the taboo that is mental illness in the country. First and foremost, we have trouble being self-aware, or conscious of health issues, even physical, let alone mental, due to lack of awareness, and concern regarding an individual’s state of mind. The stigma that is associated with mental health causes people to not seek professional help in the first place, hence the increasing number of issues they face. Moreover, people refuse to be open, or go public about their disorders in fear of other members of society looking down upon them, considering them inferior, and most abominably, “pagal,” or crazy, especially if they take prescribed medication.

According to Dawn,

“A 2005-2006 Aga Khan University study comes up with grimmer statistics for Pakistan putting the figure for prevalence of anxiety and depressive disorders in Pakistan at 34pc. It put schizophrenia and bipolar disorders at between 1-2pc of the population. And 15 of Pakistani kids suffered some form of mental health problems.”

Another disturbing statistic shared by Dr. Khan is the psychiatrist population ratio (not psychiatrist-patient ration as we don’t know how many patients there are) which is,

One psychiatrist to 0.5-1 million people. The Royal College of Psychiatrists, in the UK, recommends one psychiatrist to 25,000 population. It is the same with psychologists.”

In a state where students are not encouraged to pursue the profession or study of psychology or psychiatry, the SC’s actions only seek to worsen the already grim situation.

Most people suffer their entire lives, either without the knowledge that their suffering is caused by the imbalance of neurotransmitters, or due to some other issues, such as PTSD, early childhood trauma, repression, abuse, or simply the inability to cope with loss or grief. All of the mentioned and more – which we disregard – can be helped with therapy. An increasing number of people deal with existential dread, and suicidal ideation, which can be relieved through the proper channels, but unfortunately, either the means are unavailable to them, or they fear societal discrimination.

Not only do people have to struggle coming to terms with their psychic health issues, on a regular basis, they also have to struggle with how people will perceive them after they come out with being ill. In this author’s humble opinion, no one should be ashamed or guilty of their own afflictions, because it is not their fault, whatsoever.

People shouldn’t have to be scared of being in society due to their mental illnesses.

When Pakistan’s highest legal body refuses to admit that schizophrenia is a legitimate disease – just like any other physical affliction – of the brain, and that it has no cure to date it delegitimizes the struggle of the individuals who suffer, and cannot receive treatment, or even be diagnosed with it. How would you feel, if a chemotherapist refuses to allow chemotherapy, telling you the cancer isn’t legally recognized, hence the insurance company won’t pay for it, and you are to do your dying at home? Sounds ridiculous, doesn’t it?

So, how would it feel to a person suffering from schizophrenia, who can possibly achieve control over himself through prolonged treatment, medication, and support from friends when they are informed that the judiciary and legislature of the country don’t even recognize their disease? Besides, if someone like Ali Imdad, who cannot control his actions, due to the voices in his head, how can he be executed or held accountable when he is quite clearly sick?

We urge the Supreme Court of Pakistan to take back their verdict against Ali Imdad, and for Pakistan to dedicate resources and funds to increase awareness in not just urban, but rural areas as well as providing more government facilities with psychologists, psychiatrists, therapists, and counselors for all.