Sunday, April 18, 2010

Might be off topic but is a great example

I watched this Hindi movie back in 2007 called Taare Zameen Par.

Ishaan Awasthi is an eight-year-old whose world is filled with wonders that no one else seems to appreciate; colors, fish, dogs and kites are just not important in the world of adults, who are much more interested in things like homework and grades. And Ishaan just cannot seem to get anything right in class.

When he gets into far more trouble than his parents can handle, he is packed off to a boarding school to ‘be disciplined’. Things are no different at his new school, and Ishaan has to contend with the added trauma of separation from his family.

One day a new art teacher bursts onto the scene, Ram Shankar Nikumbh, who infects the students with joy and optimism. He breaks all the rules of ‘how things are done’ by asking them to think, dream and imagine, and all the children respond with enthusiasm, all except Ishaan. Nikumbh soon realizes that Ishaan is very unhappy, and he sets out to discover why. With time, patience and care, he ultimately discovers that Ishaan is dyslexic.

I highly recommend you all see this movie to understand the perspective on mental health in India and Pakistan.

Taare Zameen Par Movie Link

Monday, April 12, 2010

Important Study

A large study at Jinnah Post Graduate Medical Center, Karachi back in early 1990s (4) showed that twice as many women as men sought psychiatric care and that most of these women were between 20s and mid 40s.
Another 5-year survey (1992-1996) at the University Psychiatry Department in Karachi (Agha Khan University/Hospital) (5) showed that out of 212 patients receiving psychotherapy, 65% were women, 72% being married. The consultation stimuli were conflict with spouse and in-laws. Interestingly, 50% of these women had no psychiatric diagnosis and were labeled as 'distressed women'. 28% of women suffered from depression or anxiety, 5-7% had personality or adjustment disorders and 17% had other disorders.
The 'distressed women' were aged between 20 to 45. Most of them had a bachelor's degree and had arranged marriage relationships for 4-25 years with 2-3 kids, and the majority worked outside home (running small business, teaching or unpaid charitable community work or involved in voluntary work). Their symptoms were palpitations, headaches, choking feelings, sinking heart, hearing weakness and numb feet.
A study on stress and psychological disorders in Hindukush mountains of North West Frontier Province of Pakistan (6) showed a prevalence of depression and anxiety of 46% in women compared to 15% in men.
A study on suicidal patients (7) showed that the majority of the patients were married women. The major source of suffer was conflict with husband (80%) and conflict with in-laws (43%).
A study of parasuicide in Pakistan (8) shows that most of the subjects were young adults (mean age 27-29 years). The sample showed predominance of females (185) compared to males (129), and the proportion of married women (33%) was higher than males (18%). Housewives (55%) and students (32%) represented the two largest groups among females. Most female subjects (80%) admitted problems with spouse.
A four-year survey of psychiatric outpatients at a private clinic in Karachi (9) found that two thirds of the patients were females and 60% of these females had a mood disorder. 70% of them were victims of violence (domestic violence, assault, sexual harassment and rape) and 80% had marital or family conflicts.


Women's mental health in Pakistan

In this entry, I am going to be talking about cultural practices playing a vital role in women's mental health. The religious and ethnic conflicts, dehumanizing attitudes towards women, joint family system (involving in-laws) represent major issues in the daily lives of women. In Pakistan, such practices has has an adverse psychological impact. Violence against women has become one the acceptable means whereby men exercise their culturally constructed right to control women. Statistics show that Pakistan women are relatively better off than their counterparts.

It has only been in the past few years that honor-killings and rape has received attention in Pakistan. The women's movement in Pakistan in the last 50 years shed light on forced marriages, violence, and tribal laws/disinheritance. There are still a vast majority of women who are unaware of these debates in the rural and slum areas in Pakistan.

The mobility of women:
Restricted mobility affects their education and job opportunities. Societal issues such as sexual harassment and violence has reached its peak and lack of awareness or denial confine women to the sanctity of their homes. This type of restricted mobility further lowers women's empowerment in society.

Honoring boys more than girls:
Birth of a baby boy is rejoiced and celebrated, while a baby girl is mourned and is a source of guilt and despair. Boys are given priority by giving better food, education, and overall care. This is where we get into child brides, exchange marriages, and dowries or "bride price." Females are shunned when they divorce and marriages often lead to wife-battering, conflict with spouse, conflict with in-laws, homicide/suicide, and stove burns.

In Pakistan, there are cultural institutions, beliefs and practices that undermine women's autonomy. Marriage practices can disadvantage women. Dowry can often times escalate to harassment, physical violence and mental abuse. This makes the female confined to an abusive relationship because of the social and cultural pressures. Divorce or separation is not encouraged by parents for fear of being stigmatized.

A United Nations research study found that 50% of women in Pakistan are physically battered and 90% are mentally and verbally abused by their men. A study by Women's Division on "Battered Housewives in Pakistan" showed that 80% of households has domestic violent acts. Human Rights Commission reports that 400 cases of domestic violence occur each year and half of the victims die.

Reasons for women to stay in abusive relationships: fear of retribution, lack of other means of economic support, concern for children, emotional dependence, lack of family support, and hope of husband changing one day. (70% of abused women have never told anyone about the abuse).

Psychological consequences of abuse are more severe than physical: Erodes self-esteem, increases chance for disorders like depression, post-traumatic stress disorder, suicide, alcohol, and drug abuse.

Saturday, March 27, 2010

what do we know: circumstances affecting Muslim Girls and Women

This part of my blog will talk about the issues Muslim Girls and Women face in many Islamic Cultures. I will list bullet points defining each.

*Child Brides: Minors married off to older men.

*Forced Marriages: This can be sometimes called "arranged marriage." It is sometimes difficult to see the difference between these two. It usually depends on how much pressure was put on the girl to get married. Resistance to this sort of marriage very often lead to severe beatings and the punishment can go as fas as to lead to an "honor" killing.

*Concept of Guardianship: This is the idea that a woman must always have a male guardian from whom she needs permission for all her activities to leave the house to seeking permission to sign contracts, accept jobs, etc.

*House Arrest: Girls and women who are seen to be too liberal or westernized are forbidden to go out of the house without a male escort: resistance to this often leads to punishment and, in the worst cases, to an "honor" killing.

*Female Genital Mutilation: This practice is often inflicted upon girls between the ages of 4 and 14. This practices is not in anyway related to Islamic scripture or law. It is ensure virginity until the girl's wedding day. Such circumcision became illegal in the United States in 1996.

*Honor Beatings: Beating of a girl or woman for refusing to comply with family code of honor and engaging behavior deemed by family to be shameful.

*Honor Killings: Beating ending in murder. Honor are often carried out with knowledge and help of family members and relatives.

Level of mental health literacy in Pakistan - A study done in 2005

A survey was done in three cities of Punjab among a population sample of 1750 people from all different types of living conditions. Participants were requested to provide diagnosis, causes, prognosis, and possible treatments for their disorders. The majority of the population in Pakistan neither acknowledge nor accept mental health problems and a lot of the stigma is attached to being recognized as being mentally sick. When a mental health case does occur, individuals are most likely to consult in primary medical care and many of the staff are not trained to understand or deal with these problems. Faith healers and religious leaders are often the people who most mentally ill patients first approach (Mubbashar & Saeed, 2001). In a recent analysis of mental health profile in Pakistan, Karim, Saeed, Rana, Mubbashar and Jenkins (2004) point out that mental illness is stigmatized and widely perceived to have supernatural causes, and that the traditional healers along with psychiatric services are the main mental health service providers.An analysis of mental healthcare system in Pakistan reveals that things improved after the implementation of a new mental health law, which replaced the lunacy act of 1912 on 20 February 2001, and which embodies the modern concept of mental illnesses, treatment, rehabilitation, and civil and human rights. However, mental health services including policies, programmes and resources are still not in proportion to the total burden of illness in Pakistan.

The sample for this survey was obtained from three main cities of the province Punjab, i.e.,Lahore (the provincial capital),Multan and Faisalabad. To give some representation to rural populations, three villages near to these cities were also included. All three cities contain a rich mix of people ranging from very poor to very affluent as well as illiterate to highly educated. In villages, with a few exceptions, the people are usually poor and less educated or illiterate. In cities an attempt was made to give a suitable representation to different areas ranging from those with better socio-economic status (e.g., Defense, Gulberg in Lahore) to
inner city congested ones (e.g., Bhatti, Rang Mehal in Lahore). A special effort was made to obtain a good mix of sub-groups pertaining to gender, social class, education and age. A total of 1750 made the sample for this study.

The findings showed that depression was four times more likely to be diagnosed than psychosis (18.75% vs. 4.94%). A logistic regression analysis with forward selection for the predictors showed that the type of disorder, education status and area of residence contributed significantly to one’s ability to diagnose. More people believed that GPs (23.76%), psychologists (23.92%) and psychiatrists(20.73%) were the right people to consult for these problems. There were also some who considered hakims and homeopaths (4.22%), magical (13.11%) and religious healers (13.54%) as the appropriate people to contact. Those recognizing mental disorders were more likely to identify the underlying causes, prognosis and appropriate treatment of the problems.

Journal of Mental Health; Apr2005, Vol. 14 Issue 2, p167-181, 15p

Monday, February 15, 2010

Mental Health of Females in Pakistan


I created this blog for my Mental Health Policy in Public Health class. The reason I chose this topic is because I feel mental health is not talked about in many cultures of pakistan. The perception of mental illness in Pakistan is that of medieval times. People draw connections from God, demons, or of past misbehavior to mental illness. Social attitudes (towards women) and cultural practices contribute to mental illness in many ways. Aside from religious conflicts-- arranged marriages, dowry, family values, and education are also major contributors. All of these factors play a big part in the daily lives of women in Pakistan. The marginalization of females on many levels of life has impacted the mental health on many levels. The culturally constructed norm of men being violent to women to exercise control has done significant damage. Current human rights issues to consider are honor killings, rape, forced marriages, and violence. As this blog progresses, I will be touching on each of these topics with relation to mental health of Pakistani women.