Mental Health in Pakistan: The Mind Matters Conversation

Attia Altaf01:14

Okay. Mental health illness can be looked at from many different angles. But basically, the way I understand it is this: it's your basic motivation to live a meaningful life. And within that, your emotions, your feelings and your motivation are aligned with some goal that you want to achieve in life. And it doesn't necessarily have to be aligned with a goal — even taking it one day at a time can be one of your goals. But the most important factor in it is this: what is your motivation level? Are you comfortable with your emotions, or not comfortable. How do you regulate your emotions? A great many emotions come into this, and in our society some emotions are seen as very negative. For instance, anxiety falls into that category. Aggression falls into it, anger falls into it. If these very things are regulated in a healthy way, they can actually be beneficial for you.

Attia Altaf02:30

is the difference? Basically, the whole thing begins with stress. Stress is when anything in your everyday life puts some kind of pressure on you, whether that's physical or mental. You feel stressed about it. You get upset. You can't focus. And when that stress keeps building and building, and you can't deal with it on a day-to-day level, then it turns into anxiety. What is anxiety? Anxiety is fear. Anxiety is that you are kind of worried about everything. A fear settles inside you, and you can't work out whether you can deal with it or not. And when that anxiety keeps running — when it reaches a point where you can't control it, and it's happening to you on an everyday basis — then it goes on to become depression.

Attia Altaf03:44

Depression becomes what you'd have to call a deep-rooted illness — one that, here in our society, isn't actually identified. If a child slips into depression, the parents will say he's throwing a tantrum, that he has mood swings, that he doesn't eat properly, or that he's on his mobile too much. So different labels start getting attached to him. Basically, the symptoms that begin — at one level he can be a super ambitious person, and at another level he can be a super lazy person. In both cases your depression is functional. The biggest thing you notice is this: you don't have the motivation to get up. You have no motivation. You have no goal. You feel sadness without any reason. There's weight gain, there's weight loss. On top of that you're fatigued. There's insomnia — you're not sleeping properly. You start moving towards self-harm. You start having suicidal thoughts. This entire list falls on the depression side.

Attia Altaf05:22

communication between parents and their children? — Communication, of course, is absolutely essential. Beyond that, what I see is that parents keep themselves trapped in their parental role the whole time. They believe they know everything, and that their job is to give orders to the child, to tell him, "I know better." And then what happens is they compare the child with their own era: "We went through the same thing. We did it this way too." But obviously, the scenario then and the scenario now are different. Now the most important thing — what matters for the child — is that the child is neither heard nor seen. Never been heard and seen by the parents. To the parents he's just another person in your house, walking about, moving around. You're meeting his physical needs, but you're not meeting his emotional needs. You're not seeing that child's emotions. From the very start you've taught that child to dissociate from his emotions. When a child gets hurt, instead of letting the child sit with that injury, with that feeling, with that pain, the parents immediately say, "No, beta, no, you're so brave. Get up, you're not in any pain at all." That child is in pain. Please, let him sit with his feelings. Tell him he doesn't have to suppress his emotions. The more a child learns to suppress his emotions, the more he turns into a people pleaser. He comes to believe that if I validate my actual emotions, if I express them, people won't accept me. From childhood he learns that he has to suppress his emotions. And when a child starts suppressing his emotions, they begin to turn into trauma. After that, the child carries that trauma forward. When he grows up, he realises that his emotions are never validated. He was never seen and never heard. And that's where his mental illness begins. And the biggest point I'd like to make is that mental illness is not only mental illness. When your body is telling you that you don't want to do this, that you don't want to play this role — but despite the fact, despite the feelings, you say yes to it — then your immune system is very badly affected by it.

Attia Altaf07:54

Basically, these factors come later. If a person is mentally healthy — someone who is sound in mind — then all of these things you've mentioned, all those factors, they know how to navigate through them in a healthy way. They'll be distressed, but perhaps for an hour, or for two hours. They'll find their way out of it. But when it comes to mental illness, then you become overwhelmed. You can't work out how to accept your emotions, how to navigate through them, how to come out of them. So the simple truth of it is that in Pakistani society, neither parents nor children are taught how to regulate their emotions.

Attia Altaf09:05

Yes, overthinking is a phenomenon. That is a part of anxiety, what I can say, because when you're anxious, you would be either thinking, thinking about your past or your future.

Attia Altaf09:21

Yes, societal pressure is certainly there, because there are so many pressures on you. From your parents. From society. There's a certain role you've been handed to play, and you don't want to play that role. So overthinking definitely comes into it. But here's the thing about overthinking: these days we've made avoiding it into a technique, and that technique is being involved with media 24 hours a day. There's a phone in our hand. We're scrolling it. We're in meaningless conversations. We're in meaningless relationships. All the time, our escape point has become either media or our mobile phone. And once we're relating to that, we feel that when we come back to reality, that reality isn't acceptable. Because on media, what you're shown is the highlights — people's Oscar-winning moments — you're not shown the behind-the-scenes struggle. On social media, whether we're talking about ourselves or people in general, you'll see far more of the positive moments. You'll very rarely see the negative stories.

Attia Altaf10:41

Right now, if you ask me, this is destroying 80% of your mental health, absolutely. Because that instant gratification you get through reels, and that knowledge you're receiving — I don't know what kind of knowledge it is; some of it is helpful too. But this Instagram psychology, and these philosophers who have appeared, who come without any research and tell you that these are your issues. And you feel like, yes, I have that problem too. I have that problem too. On top of that, when you're watching other people's happy moments, you feel worthless. You start believing there's nothing in your life at all. Look at the kind of life this person is living. Look at that one. For example, I find these captions really intimidating — the ones written underneath, If there's a picture of any couple, underneath it will say "couple goals" with a heart next to it. That is — these happy moments, the behind-the-scenes story of that couple, nobody is going to tell you that. Right? So you set an unrealistic goal for a relationship, or for any other relationship, and then when you step away from the media and have to face the real thing, that's where you get damaged — because you had imagined something else, and real life is something else entirely.

Attia Altaf12:17

Exactly, and the issue with it, as it seems to me, is that we go into these distractions to avoid our present moment. Our present moment has become so — maybe for a lot of people — so horrifying that they don't want to face themselves. They don't want to face their surroundings. So then they look for diversions. They look for an escape. And in that escape, your reaction sometimes goes to a real extreme. You turn to drugs. You turn to alcohol. You turn to shopping. You develop extreme — what should we call them — eating habits, where an eating disorder sets in. You go down that road. Exactly — sometimes you start eating far too much, and sometimes far too little. Now, when all of that is happening, it turns into a kind of addiction, because for a little while it takes you away from your present moment — it carries you away from it. So in reality, addiction is a normal response to abnormal circumstances. Right? So when abnormal circumstances are going on around you and you look for an escape, that escape is definitely not helpful in that way. It only damages you. The basic thing is: how far can you face yourself? How comfortable are you with your emotions? How much acceptance is there within you? If you say, "No, my anger isn't mine, my jealousy isn't mine," then that same jealousy and that same anger will keep coming back at you, and you'll project it onto other people.

Attia Altaf14:14

Identifying it isn't that easy, because if a person had that acceptance — that this is my emotion and I can deal with it — then there'd be no problem at all. What happens is, when other people point it out to you — you get so angry, you throw tantrums, you've developed these kinds of habits — then that isn't acceptable to us. In fact, we start getting even angrier at them. So if a person is mentally stable, they will sit with their emotions. They won't find it that difficult to identify, because they can easily identify their healthy expressions and their unhealthy expressions — the ones they convey to other people, or to themselves, in the form of their emotions. So in a healthy way — suppose you've become angry — your anger is a kind of indication for you that something has happened which triggered you ...is. Your parents have said something, or a friend of yours has said something. That triggering point has arrived. You've identified it. Now you need to sit with it for a moment and not react to it. You have to tell yourself: right now I am feeling angry. How am I going to express this in a healthy way? If I direct it negatively at other people — if I shout, if I scream — that will create problems. Sit with yourself. Ask yourself how you want to say it. And you can tell people in a very calm and cool manner — if you just give yourself a little time. If you give an instant reaction, then things go very badly.

Attia Altaf16:42

normalise the idea that a mental health issue really is an issue, and a big one? — That's a very important point you've made, and we need to go a lot further with it. We need to do a great deal of work. Here, mental illness is turned into a stigma. And the person who is affected suffers in silence and is left alone. There is no one around them who is identifying these things. And all the time — morning, noon and night — if they're with their family, at home, and they don't have the strength within them, or they are so mentally distressed that they can't even get out of bed, then they have to listen to all kinds of things.

Attia Altaf17:40

Absolutely — that's exactly what I'm saying. Our society still has a long way to go. We need proper education on this, because your mental health is related to your physical health. And on this, there's a very big name — Dr Gabor Maté, a Canadian physician. He has done a great deal of work on it, and he has shown that illnesses, diseases — like the different cancers we see these days — do not appear randomly, as though they picked me, or picked someone else, to develop that disease. Basically, it is connected to your past traumas. The more damage you have taken psychologically, physically, socially, the more your body keeps the score of it. It keeps storing it up. And after that, all those emotions of yours that went unexpressed arrive in your body in the form of a disease or an illness. The concept of holistic medicine that is emerging now is precisely this that when a patient comes to you, the first thing you must not ask them is "Why drugs?" You must ask, "Why the pain?" What was the pain that you went to drugs in order to avoid? Or this disease you've developed — what were the background circumstances behind it? Here, simple and They'll simply take hold of them, run a couple of tests, hand them a long list of medicines, and that's all.

Attia Altaf19:46

what is the psychiatrist's role in it? What is the psychotherapist's role? What is the counsellor's role? We've mixed them all together, and a concept has formed in our minds that if we go to someone for counselling, they'll put us on antidepressants or on some kind of medication. The first thing you have to identify is what level your mental health issues have reached. Basically, what happens more often is that you integrate two different methods. If you see that a lot of disorders are coming up. You have a personality disorder. You have phobias. You have some other kind of depression that you can't control. In that case, it may well be that at the beginning, for a period, you have to go on medication — to regulate your body chemicals. But talk therapy, which we call psychotherapy there still isn't any awareness about it in Pakistan. So it isn't necessary that you go straight onto medication. You can take sessions. Talk therapy basically explores your soul. It explores your childhood traumas. It shows you that your past patterns are dominating you — and they're still running, which is why you have this stress. Let's suppose a child was a victim of abuse in childhood — sexual abuse, or some kind of financial abuse, or psychological, social, any kind of abuse. Now, at that time that child wasn't in a position to do anything, right? He was helpless. The anger inside him got stored. Now that anger his body registered it: this has been stored inside me. Now when he grows up, he's still carrying that same past pattern. He's carrying that anger and frustration, carrying the sense that an injustice was done to me. So even if later on it converts into much bigger issues, he still needs to talk. He needs to

Attia Altaf22:14

Yes, it depends according to the circumstances. Look, everyone has their own way of sitting with their pain. Mine will be one way, yours another. I might go out for a walk, or I might start reading a book. Some people start listening to music. So we all have different ways of dealing with it. Yes, what does happen is that when you're already under stress and you go into that kind of situation — you watch a film like that, you listen to a song — you definitely relate to it. You relate to that character you relate to it as well. That's why there were so many examples of this kind — where someone was suicidal, had gone towards self-harm, and hadn't yet decided how to harm himself, and then he heard some news that so-and-so had taken his own life, or he watched a drama or a film in which a man had killed himself and it was glorified — that man, the one who is already self-harming, will draw strength from it and say, "If he can do it, then I can do it too." So it depends on what your mental condition is at that moment and on what you are watching — but with that, you need help. The people around you need to identify what you have been through, but people have no compassion, no sympathy of any kind. They just hand you a label and push you aside.

Attia Altaf23:46

Look, it's been something like 18 years that I've been counselling students, and they come to me — they trust me. Apart from that, their counselling sessions — sometimes I do a proper session with them too. Otherwise, within the counselling hours, however many students come, I deal with them. From what I've seen so far, the biggest issue I've noticed is that parents don't have acceptance for their own child. That child has to make an effort to convince his parents that "I am your child" — and that becomes such a deep wound for him: "If I don't get 99% marks, then I'm not their child at all. They won't be proud of me. They won't take pride in me." The child is handed certain set goals — "Son, if you achieve this, then we will be proud of you, otherwise you're not our child." Their mental level is different. It's different. Now let me tell you the basic issues I have identified so far during the counselling sessions. First of all — I won't say that the joint family system is bad or anything like that. But within it, parents don't have the awareness that your children, with your relatives, with uncles and aunts, are not safe. Most of the abuse cases that have come to me so far — and I couldn't work out how to deal with them — it's within the family that a whole cycle of sexual abuse is running, and those children were the ones affected by it. Their parents will never believe it — that their grandfather could do such a thing to them. That their maternal grandfather could do this. That their uncle could do this. They negate the whole thing, even if the child tries to speak about it. And now the child has no outlet at all. He is so helpless. By the time they reach me, their wounds have already become so deep. A whole personality pattern has already formed. I don't know when we as people will learn how to keep our children safe.

Attia Altaf26:14

Exactly, absolutely they can. Someone who is already fighting this battle alone he simply can't work out where he stands. Where is he in society? What is his level? How is he supposed to deal with his emotions? He's in a struggling phase. Now if one more person comes and stands with him — even if they convey it silently. Of course they may not be able to put it into words, or give him professional help of that kind. I understand that. But someone simply being there and telling him, "I'm with you. Whatever you're going through, I understand it" — for him that will perhaps be worth more than the help he would get by going and seeking it professionally. If, even before that, he gets this little bit of support at the initial level, then that is more than enough. And the point is that it isn't necessarily that bad things are happening to you. The point is that good things aren't happening to you. So this can be a really valuable contribution — something you can do for your friends, for your cousins, for your younger brothers and sisters. And the most important thing is knowing how to go about it, because in our culture supporting someone tends to mean going up to them and saying, "You don't even pray. Your faith is so weak. That's why this is happening to you. Honestly, you've just got into the habit of making a drama out of everything." "You're an attention seeker." We start handing out labels like this. Then he starts questioning himself — where do I stand? And if I'm already going through this phase, do I now have to listen to all of this as well? So you mustn't compare him with anyone. Don't tell him his faith is weak. Simply sit with him and share a silence with someone in that kind of distress, someone who has already been through a very tough phase. That becomes an enormous thing.

Attia Altaf28:14

Look, the first thing is that we need to educate our parents. The background they come from — they had no awareness of any kind relating to mental health. They were never taught to regulate their emotions either. They were never taught acceptance either. They too had to fight very hard to win approval. Right? So when, from further back, there is what we call in simple words generational wounds — your parents are carrying those generational wounds too, and they're passing them on and transferring them into you. So the media can play this role: it can make programmes of this kind for parents and for children, and make them in a very light way. It shouldn't turn it into a bogeyman and present it as though this person is now about to go mad. In a much lighter way — through small programmes like this, through short public service messages, through reels — you can create awareness, and in a very sympathetic way. It must not be presented as a threat.