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.

The ‘brainwash’ conspiracy

Insanity in individuals is something rare — but in groups, parties, nations and epochs, it is the rule.— Friedrich Nietzsche

THE word ‘brainwashing’ has been used loosely in our media for quite some time now.

It has been employed to describe how the West is trying to westernise us, to point to an Indian conspiracy to promote ‘Bollywoodisation’ and, more recently, to voice concern about the Talibanisation of our youth.

It is believed that the term was originally coined in 1950 and was later used indiscriminately in the western media to describe how communist regimes coercively persuaded their citizens or systematically instilled certain beliefs and attitudes in the masses. There were also reports during the Korean War of the 1950s of captors brainwashing American prisoners of wars. Apparently 21 such POWs refused to go back to the US after release.

There were also movies like The Manchurian Candidate (artificial thought control) and Conspiracy Theory (mind-control drugs) which depicted the use of such practices by the American secret services. But what exactly is brainwashing? Unfortunately, so much fiction abounds that it is hard to differentiate myth from reality.

Some psychologists refer to the phenomenon as ‘thought reform’ or‘re-education’. The three main principles of re-education are repetition, activity pedagogics, and criticism and self-criticism. To elaborate, this would involve repeating things until they have been stamped on the memory; not giving subjects any time to think on their own by keeping them engaged in various activities at all times; and making the person who is being re-educated feel that he or she is under constant threat of being disliked.

This is a contentious concept and even those who believe brainwashing is possible think it occurs in a less severe form than the media portrays it to be. There is no particular drug which can be used to control or brainwash people. However, there have been reports of some security agencies using certain drugs to get the truth out of captured subjects. Known as truth serums, they could include substances like ethanol, temazepam and various barbiturates but the most common drug alleged to be used is sodium thiopental, an anaesthetic induction agent. These are mainly sedatives that impair the individual’s judgment and higher cognitive functions. There is still a lack of true research evidence of whether such intrusive attempts are successful in obtaining the correct information.

Whereas the outright transformation of a person still remains fictional in nature, the possibility of drastic attitude change is something that is more common in our society. Attitude modification can be explained by certain psychological theories. A behaviour heightens or lessens depending on whether it is rewarded or punished, i.e. reinforced positively or negatively. We, and children in particular, also imitate observed behaviour, especially that of people held in high esteem such as pop stars, actors, parents, religious scholars, etc.

Society plays a very important role in shaping our personalities and behaviour towards others. We fear that some religious fanatic might brainwash our children into an extremist, but we forget that social influences are at play every minute of every day. When we try to justify atrocities such as the Wah or Marriott bombings or when we shout out in joy at dreadful events such as 9/11 or 7/7 in front of our children, we are as responsible for creating future suicide bombers as anyone else.

The role of the media in shaping our society cannot be ignored any longer in Pakistan. There are too many talk shows with loose-tongued presenters who should be held responsible for giving reckless statements. There is a particular talk show whose anchor usually tries to present lies as facts. The media also needs to be more responsible when reporting sensitive news or flashing images of terrorist attacks. By repeatedly exposing our children to such gruesome images we are desensitising them and increasing their threshold for tolerating violence and normalising such actions. Parents too should take more responsibility for decreasing their children’s exposure to violent and aggressive movies, TV shows and video games. It is through this combination of ways that we change other people’s attitudes, beliefs and behaviours, or in other words brainwash them.

Our nation also seems to be suffering from a syndrome called the ‘victim mentality’ where individuals believe that no matter what happens they are the victims. This seems to have reached epidemic proportions and is developing into a mass hysteria. We continue to blame others as a reflex, without introspection and an examination of our own fault lines. This has created a nihilist national psyche which is leading us down the road of self-destruction. Instead of blaming any one person, group or country for this mess, we need to stand up and take collective responsibility.

We as a nation can still make it through these turbulent times but we will need to put our house in order first. We need to understand that two wrongs do not make a right. If someone has mistreated us somewhere, retaliating in similar fashion is not the solution. If the American bombings are wrong then the Taliban bombings are wrong. Nothing and absolutely nothing justifies the killing of innocent civilians. We need to fight this fanatical mindset which is creeping slowly and gradually into our society and leaving it plagued. If we don’t teach our children what true justice is now, then there is no stopping them from acting unjustly when they grow up.

During a recent discussion on an internet forum, a friend mentioned 1984, the George Orwell novel about a totalitarian state. It seems that apart from the many similarities between that fictional state and the Taliban mindset, there was one particular thing which was most similar, the three slogans of Big Brother’s regime: “War is Peace, Freedom is Slavery, Ignorance is Strength”.

The writer is a psychiatrist based in the UK.


Originally published in Dawn Newspaper in Pakistan on 07/10/2008

PEACEFUL- مسالمت آمیز

Peaceful
is the one
who's not concerned
with having more or less.
Unbound by name and fame
he is free from sorrow
from the world and mostly from
themselves.......
By: Jalāl ad-Dīn Muḥammad Balkhī (RUMI)