Abstract
Introduction: The burden of mental illness is increasing in Pakistan as political instability, violence and terrorism beset the country. Mental health in Pakistan can be examined from three perspectives—services, research and policy. Services are provided in major public sector hospitals and some private institutions. Trained health professionals including psychiatrists and clinical psychologists are limited, and people often access faith healers for mental illnesses. Research on mental health is also being conducted, the focus being on the clinical aspects of mental health. Public health initiatives in Pakistan are yet to develop disease prevention and health promotion programmes. Intervention studies on the social context of women’s mental health are scarce. There is a mental health policy and a mental health Ordinance, Pakistan’s National health policy documents do not integrate mental health as a priority area. Women’s mental health, in contrast, is well recognized as an issue, but no national or provincial programme is to be found.
Main Body: This chapter has two reviews—one, the mental health services in Pakistan, and two, the nature of research on mental health in Pakistan. It also includes what urban and rural women at community level have said about mental health. Women’s voices have been taken from two community-based research initiatives in three sites in Sindh and Baluchistan. What women say about mental health is juxtaposed with the services offered and research priorities in Pakistan. The three areas of services, research and women’s account of their needs are examined, and way forward is proposed.
Discussion: The analysis of policies, mental health services and research helps identify the possible consonance between what women want and what is available. Gaps between what women want and what they get are highlighted and further analysed for identifying policy entry points, need for human resource development and research agenda for mental health. Based on this analysis a framework for advancing mental health of women is developed and recommendations prepared for improvement in women’s mental health in Pakistan.
Implications: The importance of listening to women’s understanding of their mental health needs serious consideration by researchers and health providers. Researchers could pay more attention to searching for research methods that allow for expansion of women’s voices to deal with the stressors they carry.
Response: Two Urdu poets have written poems after reading the chapter.
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Notes
- 1.
Strategic interests refer to women’s decision-making—decision about when to marry, whom to marry, when to have a child, how many children to be in a family; to pursue their interests; to pursue employment. In short, what is the extent of women’s control over their lives.
- 2.
The distinction between women’s practical needs and strategic interests is well established in the feminist literature. This distinction is also to be found in many gender training manuals. See references to Molyneux and Moser in Wieringa (1994).
- 3.
Laissez-faire (French: “allow to do”), policy of minimum governmental interference in the economic affairs of individuals and society. The origin of the term is uncertain, but folklore suggests that it is derived from the answer Jean-Baptiste Colbert, controller general of finance under King Louis XIV of France, received when he asked industrialists what the government could do to help business: “Leave us alone.” (http://www.britannica.com/EBchecked/topic/328028/laissez-faire)
- 4.
Pakistan has two major surveys that take place on a regular basis: (1) Pakistan Demographic and health Survey, 2013, provides no information on mental health and (2) Pakistan Social and Living Standards Measurement Survey. Both do not provide any data that could help monitor the mental health of women.
References
Ali, N. S., Ali, B. S., Azam, I. S., Khuwaja, A. K., et al. (2010). Effectiveness of counseling for anxiety and depression in mothers of children ages 0-30 months by community workers in Karachi, Pakistan: A quasi experimental study. BMC Psychiatry, 10(1), 57.
Ali, N. S., Azam, I. S., Ali, B. S., Tabbusum, G., Moin, S. S., et al. (2012). Frequency and associated factors for anxiety and depression in pregnant women: A hospital-based cross-sectional study. The Scientific World Journal, 2012.
Ali, F. A., Israr, S. M., Ali, B. S., Janjua, N. Z., et al. (2009). Association of various reproductive rights, domestic violence and marital rape with depression among Pakistani women. BMC Psychiatry, 9(1), 77.
Ali, T. S., Krantz, G., Gul, R., Asad, N., Johansson, E., Mogren, I., et al. (2011). Gender roles and their influence on life prospects for women in urban Karachi, Pakistan: A qualitative study. Global Health Action, 4, 7448.
Ali, T. S., Mogren, I., & Krantz, G. (2013). Intimate partner violence and mental health effects: A population-based study among married women in Karachi, Pakistan. International Journal of Behavioral Medicine, 20(1), 131–139.
Ali, F. A., & Zuberi, R. W. (2012). Association of sociodemographic factors with depression in women of reproductive age. Asia-Pacific Journal of Public Health, 24(1), 161–172.
Ansari, M. A., Rahman, R. U., Siddiqui, A. A., Jabeen, R., Qureshi, N. R., Sheikh, A. A., et al. (2008). Socio demographic correlates of stigma attached to mental illness. Journal of the Liaquat University of Medical and Health Sciences, 7, 199–203.
Ayub, M., Irfan, M., Nasr, T., Lutufullah, M., Kingdon, D., Naeem, F., et al. (2009). Psychiatric morbidity and domestic violence: A survey of married women in Lahore. Social Psychiatry and Psychiatric Epidemiology, 44(11), 953–960.
Aziz, A., Shams, M., & Khan, K. S. (2011). Participatory action research as the approach for women’s empowerment. Action Research, 9(3), 303–323. Retrieved from http://arj.sagepub.com/content/9/3/303.full.pdf+html.
Bari, F., & Pal, M. S. (2000). Women in Pakistan: Country briefing paper. Asian Development Bank.
Bonbright, D., & Azfar, A. (2000). Philanthropy in Pakistan: A report of the initiative on indigenous philanthropy. Karachi, Pakistan: Aga Khan Development Network.
CSDH. (2008). Closing the gap in a generation: Health equity through action on the social determinants of health. Final Report of the Commission on Social Determinants of Health. Geneva, Switzerland: World Health Organization.
Gadit, A. A. M. (2007a). Psychiatry in Pakistan: 1947–2006: A new balance sheet. Journal of Pakistan Medical Association, 57(9).
Gadit, A. A. M. (2007b). Opinion and debate—Is there a visible mental health policy in Pakistan? Journal of Pakistan Medical Association, 57(4), 212.
Guba, E. G. (1994). Competing paradigms in qualitative research. In N. K. Denzin & Y. S. Lincoln (Eds.), Handbook of qualitative research (pp. 105–118). Thousand Oaks, CA: Sage.
Gulamani, S. S., Shaikh, K., & Chagani, J. (2013). Postpartum depression in Pakistan. Nursing for Women’s Health, 17(2), 147–152.
Heikkinen, H. (n.d.). Whatever is narrative research? Retrieved October 21, 2014, from https://www.jyu.fi/hum/aineistot/tutkijakoulu/Narrative.pdf
HRCP. (2012). State of human rights in 2012. Lahore, Pakistan: Human Rights Commission of Pakistan. Retrieved from http://hrcp-web.org/hrcpweb/wp-content/pdf/AR2012.pdf.
Husain, N., Parveen, A., Husain, M., Saeed, Q., Jafri, F., Rahman, R., et al. (2011). Prevalence and psychosocial correlates of perinatal depression: A cohort study from urban Pakistan. Archives of Women’s Mental Health, 14(5), 395–403.
Irfan, M. (2010). The concept of mental health policy and its journey from development to implementation in Pakistan. KUST Medical Journal, 2(2).
Karmaliani, R., Asad, N., Bann, C. M., Moss, N., McClure, E. M., Pasha, O., et al. (2009). Prevalence of anxiety, depression and associated factors among pregnant women of Hyderabad, Pakistan. International Journal of Social Psychiatry, 55(5), 414–424.
Karmaliani, R., Shehzad, S., Hirani, S. S., Asad, N., Akbar Ali Hirani, S., McFarlane, J., et al. (2011). Meeting the 2015 millennium development goals with new interventions for abused women. Nursing Clinics of North America, 46(4), 485–493.
Khalily, M.T. (2011). Mental health problems in Pakistani society as consequence of violence and trauma: A case for better integration of care. International Journal Integration Care, 11(7), 1–7. Retrieved April 23, 2015, from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3225239/pdf/ijic2011-2011128.pdf.
Khan, H. M. (2012). Coping styles in patients with anxiety and depression. ISRN Psychiatry, 2012, 128672.
Khan, M. M., Ahmed, A., & Khan, S. R. (2009). Female suicide rates in Ghizer, Pakistan. Suicide and Life-Threatening Behavior, 39(2), 227–230.
Khan, M. M., & Ali Hyder, A. (2006). Suicides in the developing world: Case study from Pakistan. Suicide and Life-Threatening Behavior, 36(1), 76–81.
Khan, M. M., & Reza, H. (1998). Gender differences in nonfatal suicidal behavior in Pakistan: Significance of sociocultural factors. Suicide and Life-Threatening Behavior, 28(1), 62–68.
Marmot, M., Friel, S., Bell, R., Houweling, T. A. J., & Taylor, S. (2008). Closing the gap in a generation: Health equity through action on the social determinants of health. The Lancet, 372(9650), 1661–1669.
Mirza, I., & Jenkins, R. (2004). Risk factors, prevalence, and treatment of anxiety and depressive disorders in Pakistan: Systematic review. British Medical Journal, 328(7443), 794.
Mumford, D. B., Minhas, F. A., Akhtar, I., Akhter, S., Mubbashar, M. H., et al. (2000). Stress and psychiatric disorder in urban Rawalpindi community survey. The British Journal of Psychiatry, 177(6), 557–562. Accessed 21 October 2014.
Munogee, N. (2007). Medical history of British India—Mental health collection. Retrieved October 21, 2014, from http://digital.nls.uk/indiapapers/mental-health.html
Naeem, F., Irfan, M., Zaidi, Q. A., Kingdon, D., Ayub, M., et al. (2008). Angry wives, abusive husbands: Relationship between domestic violence and psychosocial variables. Women’s Health Issues, 18(6), 453–462.
Niaz, U. (2004). Women’s mental health in Pakistan. World Psychiatry, 3(1), 60.
Perveen, R. (2013). Beyond denial: Violence against women in Pakistan—A qualitative review of reported incidents. Islamabad, Pakistan: Aurat Foundation.
Qadir, F., Khan, M. M., Medhin, G., & Prince, M. (2011). Male gender preference, female gender disadvantage as risk factors for psychological morbidity in Pakistani women of childbearing age-a life course perspective. BMC Public Health, 11(1), 745.
Rafique, Z. (2010). An exploration of the presence and content of metacognitive beliefs about depressive rumination in Pakistani women. British Journal of Clinical Psychology, 49(3), 387–411.
Rahman, A., & Creed, F. (2007). Outcome of prenatal depression and risk factors associated with persistence in the first postnatal year: Prospective study from Rawalpindi, Pakistan. Journal of Affective Disorders, 100(1), 115–121.
Rahman, A., Sikander, S., Malik, A., Ahmed, I., Tomenson, B., Creed, F., et al. (2012). Effective treatment of perinatal depression for women in debt and lacking financial empowerment in a low-income country. The British Journal of Psychiatry, 201(6), 451–457.
Saeed, K., Gater, R., Hussain, A., & Mubbashar, M. (2000). The prevalence, classification and treatment of mental disorders among attenders of native faith healers in rural Pakistan. Social Psychiatry and Psychiatric Epidemiology, 35(10), 480–485.
Saxena, S., Sharan, P., Garrido, M., & Saraceno, B. (2006). World Health Organization’s Mental Health Atlas 2005: Implications for policy development. World Psychiatry, 5(3), 179–184.
WEMC. (2008). Women empowering themselves: A framework that interrogates and transforms. Research Programme Consortium on Women’s Empowerment in Muslim Contexts: gender, poverty and democratisation from the inside out.
WHO. (1948). Constitution of the World Health Organization—Basic documents. Geneva, Switzerland: World Health Organization.
WHO. (2005). Mental health policy, plans and programmes. Geneva, Switzerland: World Health Organization. Retrieved October 21, 2014, from http://www.who.int/mental_health/policy/en/policy_plans_revision.pdf.
WHO. (2009). WHO-AIMS report on mental health system in Pakistan. Geneva, Switzerland: World Health Organization.
Wieringa, S. (1994). Women’s interests and empowerment: Gender planning reconsidered. Development and Change, 25, 829–848. doi:10.1111/j.1467-7660.1994.tb00537.x.
Zahidie, A., & Jamali, T. (2013). An overview of the predictors of depression among adult Pakistani women. Journal of the College of Physicians and Surgeons–Pakistan, 23(8), 574–580.
Zahidie, A., Kazi, A., Fatmi, Z., Bhatti, M. T., & Dureshahwar, S. (2011). Social environment and depression among pregnant women in rural areas of Sind, Pakistan. Journal of the Pakistan Medical Association, 61(12), 1183.
Zakar, R., Zakar, M. Z., Hornberg, C., & Kraemer, A. (2012). Coping strategies adopted by pregnant women in Pakistan to resist spousal violence. International Journal of Gynecology & Obstetrics, 116(1), 77–78.
Zakar, R., Zakar, M. Z., & Kramer, A. (2012). Voices of strength and struggle: Women’s coping strategies against spousal violence in Pakistan. Journal of Interpersonal Violence, 27(16), 3268–3298.
Acknowledgement
We would like to thank Ms. Sanober Mubeen and Dr. Yusra Sajid for their support in literature search and review of the document.
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Appendices
Response #1
Trapped in my being
Life!
O life of mine!
I have no grievance against you
None, whatsoever
There’s nothing that hasn’t changed
Nothing that I’ve not acquired.
Why is it then that I don’t feel happy
A feeling of distress haunts me
A briery, prickly notion makes me restless
I feel something is amiss in my life
A smoldering fire, I apprehend
Will flare up into a conflagration
My home and hearth
My peaceful existence
Would come to an end.
I am a bulwark of defense
around my near and dear ones
I’m at ease with my environ
Satisfied with my children, my husband, my family
Content with their going and coming time schedule
Their presence on breakfast table or evening tea
I’ve no gripe against in-laws
No grouse against kith and kin
Nothing, indeed, that might create tension
Cause distress.
My home is a paradise incarnate
A refuge and a shelter
Peacefulness, placidity is my own creation …
I always thought my life was a sheltered haven
Harmony and restful quietude is the norm
In my day to day life … but
For some days
I have been feeling a thorn prick my heart
A burning itch, as it were, getting sharp
An itch that perhaps
might, for a moment, be bearable for me.
Was it an insufferable dream or an illusion?
I felt I have wings—self-grown,
I am flying somewhere, far away, above and high, embraced by the space,
Leaving this daily life behind …
I am happy, God knows why I am feeling so.
Then it was
That all of a sudden
A beckoning call, a cry from below
Made me wake up, pull me down …
Down into a chasm, a gorge of dejection
I fell down and down
I got entangled—finally losing myself.
No longer am I a distinct ‘self’ now.
No longer do I have any relationship with any one
No affinity at all.
In a house I am, but
The house is not my own.
I have nothing … indeed, nothing at all.
Why and wherefore did it happen?
Indeed, I don’t know.
I don’t know at all.
**********
Response #2
(Translated by Kausar S. Khan, Ghazala Rafique, Sohail Bawani)
Listen to my needs
When ill, I cannot go to a doctor
either there is no money, or husband has no time.
When a cow is stricken, treatment is rapid
Is cow more valuable than me?
Yes. It is, for it provides milk;
but I also give milk to children
I bear the weight all household work.
I also need attention
I am not noisy, so nobody listens.
If I speak,
I am called impatient, petulant, and short of reason
My tired body needs rest
My mind needs peace
My heart has desires.
Why this restriction on my mobility and movements?
Why this violence on me?
Violence destroys homes,
destroys mental tranquility
Would somebody ask me what I wish?
Without health there is nothing,
no happiness without respect
I carry the weight of body and heart
They say my home is heaven
Yes. It is heaven, but for my husband and children
I made it so with hard work and sacrifices.
I want to be part of this heaven
How is this to be?
It is possible only if I’m accepted as equal
And my pain and suffering are addressed
I need few words of respect and love;
Acknowledgement of my importance
I need also to feel
that I am an equal being;
part of decisions made.
I am not a servant, nor a soul-less body
My mind thinks, and my heart has a rhythm
I need recreation too
I want to share what my heart says, with those who are mine
See what it is to understand me as an equal being
This home would really be heaven
For you and also me.
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Khan, K.S., Rafique, G., Bawani, S.A.A., Hasan, F., Haroon, A. (2015). Social and Societal Context of Women’s Mental Health, What Women Want, What They Get: Gap Analysis in Pakistan of Mental Health Services, Polices and Research. In: Khanlou, N., Pilkington, F. (eds) Women's Mental Health. Advances in Mental Health and Addiction. Springer, Cham. https://doi.org/10.1007/978-3-319-17326-9_3
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