Mental health - myths and realities

By Ahmad Rehan Khan

Health has two main subdivisions - physical and mental health. Physical health problems (PHM) commonly include high blood pressure (hypertension), high blood sugar levels (diabetes), heart diseases, strokes and appendicitis. Mental health or psychiatric disorders mainly comprise depression, anxiety, panic attacks, schizophrenia, obsessive-compulsive disorder, etc. Psychiatrists and psychologists treat them.

Psychiatrists are the medical doctors who do post-graduate training, either FCPS, MCPS or MD. As they are medical doctors, they are authorised to prescribe appropriate medicines. Psychologists, on the other hand, are not medical doctors who do talk therapy (psychotherapy) or counselling. Their usual qualifications are BS honours followed by a Master's or PhD, and they can’t prescribe medications.

Most psychiatric disorders are treated by a combination of medications and psychotherapy. People find it comforting to consult a doctor for PHM. Unfortunately, this comfort turns to fear regarding mental health problems (MHP) which are stigmatised in all segments of society, and it is considered a smirch and a blot, and consulting a psychiatrist is deemed verboten.

Folks who seek psychiatric care are often referred to as "pagal” (mad) and their friends and relatives start to distance themselves. PCPs, including internists (General Medicine) and general practitioners (GPs), are first-line soldiers rescuing patients from diseases. It is cataclysmic that most have little to no training in diagnosing and treating MHPs. Psychiatry rotation is not a mandatory part of general medicine training in Pakistan. Can you consider the misery of a sick patient who musters up the courage to seek help for mental health problems, only to be mismanaged by PCPs; it is horrendous and spine-chilling.

Another significant issue is the unwillingness of non-psychiatric doctors to refer patients to psychiatrists due to territorial issues, monetary benefits and a lack of a formal referral system. It's not uncommon for a cardiologist in Pakistan to treat depression, anxiety, OCD, insomnia, etc.

Misrepresentation of psychiatric issues on social media and television channels, especially morning shows, adds insult to injury. Celebrities who lack basic medical and psychiatric knowledge often recommend treatment of depression and anxiety solely by a balanced diet and exercise.

Social media influencers and unqualified life coaches provide unsolicited advice regarding mental health issues, which often lacks accuracy. Psychiatry departments in most of the hospitals in Pakistan are understaffed and underfunded. They lack modern treatment modalities like Electroconvulsive Therapy and Transcranial Magnetic Stimulation machines.

Mental health awareness has exponentially increased throughout the world. Psychiatrists are among the highest-paid physicians in western countries, which isn’t the case in Pakistan. Still, on the bright side, there has been considerable improvement in mental health awareness in Pakistan in the past five years.

The Pakistan Psychiatric Society (PPS) has been at the forefront of battling the stigma of mental health disorders. The structure and quality of psychiatry training have improved, attracting more young doctors to enroll. The solution to these problems requires a multidisciplinary approach. We need to educate the public about the common signs and symptoms of psychiatric diseases through print and television media. We should hold seminars to train PCPs in treating MHPs and referring patients to psychiatrists.

The federal and provincial governments should consider starting a media campaign to increase mental health awareness, like they do for polio, Covid-19, dengue, etc.

Punchline: Psychiatric disorders are caused by an imbalance between neurotransmitters in your brain and not due to weakness of faith or character.

The writer is Consultant Psychiatrist in the USA and can be reached at doctorpsychiatrist@hotmail.com