Psychiatrists: Mental Health from their Prism!

From children to elderly people, everyone requires sound mental health for proper and adequate functioning.
Representational Pic
Representational Pic

Zoya Mir

Prof. (Dr.) Arshad Hussain quoted on World Mental Health Day, “Accessing Mental Health is a basic right of all citizens; let us work towards making mental health services available, accessible and acceptable and foremost let us make it equitable”

Mental Health Day, every year this day is celebrated with a different theme based on what we witness throughout the year, what is felt as need of the hour. And this year- The theme is ‘Mental Health in an unequal world’. Well in past few years nothing has remained the same, from financials to health statuses everything has been compromised. The world right now is becoming increasingly polarized. When we talk about the mental health services, they remain highly unequal. The gap between ‘haves’ and ‘have nots’ and ‘aware’ and ‘not aware’ is growing wider. Mental health due to lack of awareness and stigma has always been pushed down and with the increasing polarization its not listing the chart of priorities.

After a hurricane, we do try to live again, build up new houses, start up our lives, we do move on but we definitely miss what we lost without even acknowledging it because somewhere we just balance it out by saying it happened with everyone but does that justify the suffering?

From children to elderly people, everyone requires sound mental health for proper and adequate functioning. What are we asking here? A good mental health which is not just about the absence of mental health problems but is more of how to help one self to stay protected against developing such problems and also about learning to understand and deal with such problems.

But now the reality is ‘Mental health issues are on rise’ and its better to be well equipped and well informed instead of being in denial. Nothing is same, nothing is equal- the disparity has widened. Is this the new normal?

Prof. (Dr.) Yasir Hassan Rather shared his opinion on this inequality and mental health, “Life has many facets, so has mental health. Just like we have different phases of life, we have different phases of mental health. Whether stigmatized or put under the carpet, we always knew this part deep down. We shove away a bad mood with a good coffee and felt powerful about it. But since past few years a well assumed stable life has become unpredictable and unstable. An unequal world has been created. There are families who have witnessed disenfranchised grief as they lost their family members to covid and were not even able to mourn as per religious and cultural rituals and then there are people who have not been directly affected by covid. The mental health status is different for both the groups. Those who lost their loved ones are highly vulnerable to mental health issues or those who were infected with covid-19 and recovered, still are struggling with the fear, anxiety and disturbances caused. We are aware of online classes that is the new normal way of schooling but an inequality was created there also, everyone couldn’t attend these classes, there was a sect of low socio-economic status who couldn’t afford mobiles and internet facilities. Some children faced difficulties in online classes but there are many who haven’t had classes since past two years, there have been many dropouts as parents couldn’t afford continuing education of their children. A disparity in financial status has also increased, people have witnessed huge losses. These all disturbances have made people more vulnerable, which has pushed many towards severe mental health issues including suicide. To sum it up, we are in a state of accepted vulnerability.”

Covid-19 wasn’t just about the illness, it encompassed many other facets as well. One of the major associated factors was fear and uncertainty that developed during covid times. From being infected to the fear of the situation, somewhere our mental health was badly hit.

Dr. Rayees Wani tried to explain the connection between emotions and covid-19, “Humans are bound to witness emotions- fear, worry and stress are normal responses to perceived or real threats and at times when we are faced with uncertainty or the unknown. Covid-19 pandemic has made fear a common experience for everyone. Meanwhile, Covid-19 itself can lead to neurological and mental complications such as delirium, agitation and stroke, people with pre-existing mental, neurological or substance use disorders are more vulnerable to covid-infection increases the fear. Fear, anxiety and uneasiness is the new normal.”

In amidst of pandemic, we would hear everyone praying for good health, for protection from covid-19 in masjids and sermons and definitely it became a norm after every prayer. This belief that God will help us, acted as a coping mechanism for many. When people were quarantined, they were alone, isolated and they were only close to God at that time rather those who prayed more and tried to use religion and spirituality as a coping mechanism had felt more positive emotions and felt stronger.

Prof. (Dr.) Mohammad Maqbool has always believed in a deep-rooted connection with spirituality and stated that, “Kashmir known as the land of Sufis has always been connected more to spirituality and religion. Our belief system is highly influenced by spirituality so is our mental health. The first line of treatment which a common Kashmiri looks out for mental health issues is religion, God and spirituality. These all three factors are connected to mental health but are not first line treatment. Various religious and spiritual practices can be coping mechanisms for many going through mental health issues. In the current scenario when everything seems unpredictable, our belief system can create hope, acceptance, achieving meaning and purpose.”

Dr. Altaf Ahmed tries to always find a midway between psychiatry and spirituality and is of the opinion that, “Spirituality is a science which deals with interaction of one’s spirit/soul and God. It is a very sacred realm of human experience. Spirituality inculcates in a person the feelings of connectedness to one’s own self as well as to whole universe. It thus produces divine adjectives of love, humility, compassion, patience, hope and faith. It helps in achieving high frustration tolerance, acceptance of uncertainty, serenity to accept the things which one cannot change and a general sense of optimism. All these attributes help a person cope up well with mental illnesses and also reinforce resilience. Globally lot of research is undergoing on the use of spiritual processes and practices (transcending religions and religious pedagogies) in curing MH ailments. One such practice which is catching attention is ‘spiritually augmented cognitive behavioural therapy ‘which incorporates different spiritual values in CBT. I am of the opinion that different spiritual processes could be used in different therapies which can target different psychiatric issue. Need of the hour is to shift our attention towards this rather forgotten panacea for different psychiatric problem.”

Since past few years, there has been a surge in cases of people having substance use disorders. From cannabis to medicinal opioids and now to Heroin, the trend of substance use pattern has changed in past 20 years. Heroin is an illicit drug which is easily available in our valley and is being used by all age groups, people of all socio-economic backgrounds and people from different array of professions. This drug has crossed all bars of notions we have had about drug abuse. The picture of Heroin in Kashmir is very serious but it's visible to us just as the tip of the iceberg, we don’t know the depths of it.

On the scenario of Drug abuse, Dr. Fazl-e-Roub stated that, “Kashmir – a resilient nation that has battled multiple man-made and natural disaster is currently facing an exponential increase in demand for illicit substances especially heroin. This new challenge has a barrier for treatment seeking because of the discrimination, social and institutional stigma related to persons with drug use. But a comprehensive strategy involving schools and community leaders to raising awareness, encouraging people to seek professional help, treating substance users with dignity and respect, strengthening the health infrastructure and the government crackdown on big mafia to cut down the supply chain will help our society to keep drugs under control. To me, recovery in drug use disorders is a reality, is achievable but for which every element of society needs to play a pivotal role.”

The most talked about population is youth, indeed they are our future, but what about people in old age. Why do we neglect their mental health? Why do we take it as its okay if they are going through some emotional problems? Is it because we believe that they have lived their lives, or somewhere fulfilled the purpose of life which was growing up, earning, raising kids and that’s it? Mental health of elderly people is often ignored and attributed to as normal aging.

Dr. Junaid Nabi shared his opinion in regard of this age group, “Geriatric age group is the most neglected age group in terms of mental health. Whether be it due to lack of awareness or stigmatization, a lot of dementia cases are thrown under the carpet. In recent years, there has been a huge rise in cases of dementia and other mental health conditions in elderly population. This age group often goes through empty nest syndrome- as their children are staying in different parts of the world because of their jobs and education. And when they really look for support, they have no one around. And as due to advancement in science longevity has increased, that can be possibly one of the reasons for increase in cases of dementia. Elderly people are also witnessing various forms of abuse which are considered as a normal part of growing old- be it physical, emotional or financial.”

Women are at a greater risk of mental health issues due to many social and economic factors. If we talk about women in Kashmir, they are often taught to adjust, accept their fate, be more submissive, don’t take your decisions on your own. They are given wings but are taught to fly in cage. What happens when a bird tries to fly and fly in the cage, its wings get bruised so does the mental health of women.

Dr. Sadaqat Rahman stated that, “Gender is a critical determinant of mental health and mental illness. Women’s mental health is multifactorial which is determined by both biological and social factors. The patterns of psychological distress and psychiatric disorder among women are different from those seen among men. Women tend to ignore their mental health; their center of attention is always family and significant others but they need to be more aware of their own needs and emotions.”

Mental health issues are definitely on rise, people are somewhere fighting the ambivalence of treatment seeking versus letting the problem be. Hospitals are witnessing a surge in mental health issues encompassing all age groups with all sorts mental health disorders. While dealing with these issues, mental health professionals can also witness burnout and breakdowns.

Dr. Sabreena Qadri stated, “Over the past decade, need for mental health care and hence mental health professionals has increased manifold. Kashmir has been facing the brunt of psychological trauma, most of which passes through our mental health professionals during treatment and makes a significant impact on their own psyche. It is therefore important to highlight the significance of mental hygiene in these professionals to prevent burn out and increase their work efficiency; lest warriors become victims.”

Seeing the unpredictable happening every day, seeing your plans falling apart, witnessing uncertainty every day, we have developed a sense of hopelessness. We are reaching to a point of numbness, where we are always lost in our thoughts or get into fights on petty issues, where we get into road rage or don’t feel anything at all. It looks like we aren’t comfortable with the state we are in, we aren’t comfortable with what we have gone through, we aren’t comfortable in thinking about what can happen- it looks like we aren’t comfortable in our own skin.

Nothing that’s not in our control can be changed but what can we do to bring in peace is Acceptance.

Dr. Masood Maqbool shared his narrative of being mindful, “Past is reality but can we change it, then why to ruminate it as it has already happened. Future is not known then why to worry about it. Emotions overwhelm all of us because of past or future so stay in present, attention in the outer world rather than in mind, even if present is painful, it is reality, stay in present reality”

To conclude with, on World Mental Health Day just want to sow a seed, “Let mental health be as important as physical health, let your emotions flow, let yourself talk, let yourself feel, there’s already a lot of burden we carry, don’t let emotional burden rule the chart- LETS NOURISH OUR MENTAL HEALTH”

Zoya Mir is M.Phil. Clinical Psychology Scholar in IMHANS-K, trained in Cognitive Behavioral Therapy from Beck’s Institute, USA and Motivational Interviewing for Addiction from MI Institute.

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