20-26 January 2017 #842

Stigma and silence

Economic hardships, political chaos and natural disasters have lead to an increase in the incidence of mental disorders in Nepal
Ketan Dulal

Source: The Lancet

I had just returned to Nepal from Germany after experiencing my first psychotic episode, and like most patients with mental disorders in those days my parents took me to a shaman.

Behind the curtain, the female faith healer shook violently showing that she was under the spell of spirits that would tame my demons. She emerged from her trance to give us a small pouch of rice. I was to bathe before dawn and chew on one grain of rice every day.

My mother would dutifully wake me up at four every morning, force me to bathe and then hand me the single grain of rice. Things have moved on a bit in the diagnosis and treatment of mentally ill people in Nepal, but visits to the shaman are still common. Most people, it seems, have more faith in faith healers than in modern psychiatry.

Indeed, society had conditioned me to regard psychiatrists as people who dealt with ‘crazy’ people, those who were ill because of their own fault. Psychiatric disorders brought shame to the family, and I had seen patients stigmatised and ostracised. Persistent ignorance of mental disorder has meant that society labels people afflicted with everything from epilepsy to schizophrenia as being ‘mad’.

Then I was diagnosed with schizophrenia myself, a disease that had greater stigma than any other mental illness. For decades I kept it hidden because of the indignity attached to the condition in Nepali society. I could not talk about it openly with friends and relatives, and although I acted normal the disease was killing me and my family. I was lucky that my affliction was not severe enough to induce hallucinations and delusions, and I did not succumb to substance abuse.

But what my mother and grandmother did to me was also a form of abuse, the kind of treatment that people with mental illness endure from their families across Nepal every day. A recent study conducted by the World Health Organization (WHO) shows that the situation of the mental health system in Nepal remains dismal.

The study shows that the ratios of psychiatrists and psychologists in Nepal (0.22 and 0.06 per 100,000 population) are one of the lowest in the world. A quarter of Nepal’s psychiatrists work outside the country. This leaves most mental patients alone to fend for themselves and battle both the disease as well as the social stigma on their own.

The conflict, political instability, migration, economic woes and the earthquake have combined to take a serious toll on the mental health of Nepalis which has gone largely unnoticed because of society’s reluctance to talk about it. A recent study in The Lancet outlines the increase in the prevalence of mental health problems in Nepal (see left) and argues that mental health should no longer be regarded as just a health issue but a socio-economic burden on the country.

Help can be provided to patients only if they seek it in the first place. The stigma attached to mental illness is so strong in Nepal that most people would not seek help when they need to. Even some of my own family members used to believe that if I do not have the motivation to work then it is my own fault. If I wake up with hallucinations they believe that an evil spirit has possessed me. It has taken years for them to understand that mental conditions are treatable and there are medicines that can reduce the symptoms of the disease.

If we just remain silent about the epidemic of mental disease in Nepal tens of thousands of patients will continue to suffer in silence. Nobody will understand mental disease unless the people who suffer from it first speak out. Society will only listen if we make ourselves heard.

Ketan Dulal is a PhD candidate at the University of Prince Edward Island in Canada.

Read Also:

The republic of insomnia, Editorial

The silent scream, Anjana Rajbhandary

All in the mind, Jagannath Lamichhane

Mental cost of migration, Shreejana Shrestha

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