Far From the Stoning Crowd

There has been evidence of the treatment of mental illness from the Egyptian civilization. The skulls discovered belonging to that era had signs of trephination (a hole in the skull) signifying procedures which crudely resemble what we now call as lobotomy.

The perception of psychiatric illness has been changing over the ages. Their understanding has evolved from these patients being considered as devils and witches to realising the biological origins of these disorders.

The treatment of mental health problems has also been evolving over the years. During the 15^th century in an effort to exclude them from society they were sent on ships known literally as ‘ship of fools.’ In the 17^th and 18^th century they were more ‘pathologised’ and were systematically locked up in institutions called asylums. It was only after the 19^th century that there came a more biological understanding and after the introduction of neuroleptic medications in the 1950’s the management of such illnesses changed drastically.

There still exist a lot of misconceptions and misunderstandings about psychiatric disorders through out the world. Some people in the Caribbean attribute the occurrence of mental illness to voodoo magic, in Nigeria they label them as the work of Satan and a cause of all the ills, while in the west there are anti-psychiatry movements like Scientology (brought to more fame by the actor Tom Cruise).

When you visit Pakistan especially the inner cities, it is hard not to notice certain individuals roaming around in a dishevelled state. They appear to be talking to themselves, acting in a bizarre manner or are sitting reclusively in a corner with their incongruent possessions around them. These individuals are almost an implicit but ignored part of our society, roaming around aimlessly and surviving on the charity of a few philanthropists.

If assessed thoroughly it will bee seen that most of these individuals would probably be victims of mental illnesses and have reached this stage after years of neglect and abandonment by the society. There is a range of psychiatric disorders which can be the cause of such presentations. Severe and enduring mental problems like Schizophrenia and Bipolar affective disorder if left untreated can have devastating effects on the individuals and their surroundings. In fact there is an inverse relationship between the outcome of the treatment and the ‘duration of untreated psychosis.’

Some might have learning disabilities (mental retardation), others may suffer from a severe form of depression which can be quite debilitating, while others could have a burnt out personality disorder like Diogenes syndrome. People suffering from the latter are known to have a reclusive lifestyle, expressive of a hostile attitude and living in squalors.

These individuals should be looked after and cared for by the state. Instead not only are they ignored but are also harassed by the public. In some cases they are chased around by young children while in others they are pestered by being hit with stones. This image has been portrayed in a number of movies and TV dramas produced with in the subcontinent. Interestingly a famous song from the movie Layla & Majnun has the following lyrics “Koi Pathar Say na maray meray dewanay ko” (please do not hit my deranged lover with stones).

It is a mystery where the tradition of stoning the 'deranged' comes from and why we still do it. Some anecdotes show that certain archaic beliefs still prevails regarding the causes of mental illness. They think that such people have been possessed by the devil and as the devil is stoned during the Hajj then we should do the same. At times throwing of stones at such individuals can be a retaliatory action.

There is great stigma attached to being mentally ill, hence the populace thinks it is acceptable to act in this way. They are looked upon as gibbering lunatics and sometimes it is felt that these people are being punished for their illness as if they deserve this sort of treatment.

In order to eliminate the diseased and create the pure Aryan race the Nazi made efforts to get ‘rid’ of people with any disability. It has been estimated that over 200,000 individuals with mental disorders of all subtypes were put to death during their era.

If we do not live up to the expectation of safeguarding the rights of the most vulnerable members of our society then we are no better than such brutal regimes. There should be an immediate end to such inhumane and foolish behaviour. We need to wake up and recognise the needs of the people in need, especially the mentally ill. Whereas the lack of funds might be a genuine reason for the inability to treat them medically, but how can we explain our behaviour of throwing stones?

The role of psychiatry is becoming ever so important in this world. Mental illness ranked second only to ischemic heart disease in magnitude of disease burden from the Global Burden of Disease study. There is an increasing demand on this profession and this is even more important for a country like Pakistan, where the true magnitude of mental illness is unknown and very few people have access to mental health facilities, especially in the rural area.

There is a need for the initiation of massive awareness campaign in Pakistan, so that people are not only able to seek help at the earliest, but should also be responsible for treating the mentally ill with the long overdue respect, love and affection that they really deserve.