In the current era, the younger generation is grappling with mental health issues at an unprecedented rate, in stark contrast to the past. The taboo surrounding discussions on mental health and therapy has begun to lift, shedding light on the pervasive impact of nervous disorders. This article explores the evolving landscape of mental health, focusing on two prevalent conditions: bipolar disorder and schizophrenia.
Bipolar Disorder
Bipolar disorder, also known as manic-depressive illness, is a complex mental health condition characterized by extreme mood swings that encompass episodes of mania and depression. Individuals with bipolar disorder undergo phases marked by intense emotions, shifts in sleep patterns, and alterations in daily activity levels[1].
They may partake in behaviors inconsistent with their typical actions, often unaware of their conduct’s potential harm or undesirability. These identifiable periods are called mood episodes, which bluntly contrast with a person’s normal behavior. Throughout these episodes, symptoms persist daily for a substantial portion of the day and can extend over extended periods spanning several days or weeks.
Bipolar episodes are like chapters in a book of emotions, where intensity redefines the narrative, and individuals navigate through the unpredictable terrain of their own minds.
Root causes of bipolar disorders
The origins of bipolar disorder are complex and involve a combination of genetic, biological, and environmental factors. Genetic predisposition is a significant contributor, with individuals with a family history of bipolar disorder being at a higher risk. Studies suggest that abnormalities in brain structure and function, neurotransmitter imbalances, and hormonal factors contribute to the development of this disorder. In addition, stressful life events, trauma, or major life changes can trigger the onset of bipolar episodes in susceptible individuals[2].
Bipolar disorder can affect individuals of various age groups but most commonly occurs in late adolescence or early adulthood. The typical age of onset is between 15 and 30 years, with cases being diagnosed during this period. In younger individuals, symptoms may present differently, making the diagnosis challenging.
Childhood-onset bipolar disorder, characterized by severe mood swings, can be particularly challenging to identify and is often misdiagnosed as other conditions[3]. In contrast, bipolar disorder in older adults may be complicated by coexisting medical conditions and medication interactions.
Complex Interaction of the Factor
Although bipolar disorder does not spread like infectious diseases, there is a clear familial pattern, indicating a genetic predisposition. If a close family member has bipolar disorder, an individual may have a higher likelihood of developing the condition. Environmental factors also play a crucial role, with exposure to stressful events, substance abuse, or disruptions in circadian rhythms contributing to the expression of bipolar symptoms in genetically susceptible individuals.
Schizophrenia
Schizophrenia is a prevalent, long-term mental health condition characterized by disruptions in cognition, emotions, and behavior. The common manifestations of this condition include hallucinations, delusions, disorganized thinking, and impaired social functioning. Although the precise etiology remains unclear, a combination of genetic, environmental, and neurobiological variables is believed to contribute to its development.
Schizophrenia, a chronic and severe mental health disorder, affects approximately 21 million people worldwide and presents a significant challenge in Pakistan, where an estimated 1-2% of the population grapples with this condition[4]. This complex brain disorder is characterized by a range of symptoms, including delusions, hallucinations, cognitive impairments, and a notable lack of motivation. These symptoms can profoundly impact individuals’ thinking, behavior, and overall functioning.
The prevalence of schizophrenia in Pakistan remains uncertain, which hinders effective strategies to combat this illness[5]. In addition to the lack of precise data, this challenge is exacerbated by prevailing misconceptions and inadequate awareness, particularly in rural areas characterized by low literacy rates. In these regions, there is a tendency to associate schizophrenia with spiritual possession, leading affected individuals to seek guidance from faith-based healers rather than from medical professionals[6].
This misguided approach not only perpetuates harmful practices, such as physical abuse, under the belief that it targets evil spirits but also contributes to the silent suffering of individuals with first-episode psychosis, as they often go without proper evaluation and treatment. While non-governmental organizations such as the Fountain House Network are working towards providing essential services, comprehensive government intervention is necessary.
Addressing schizophrenia in Pakistan requires a multipronged approach encompassing awareness campaigns, improved healthcare accessibility, and destigmatization efforts[7]. This not only involves accurate diagnosis, care, and treatment but also focuses on social inclusion and understanding to enhance the overall well-being of those affected by schizophrenia in the country.
Deja Vu: A Neurological and Psychological Perspective
Déjà vu (DV) is a psychological phenomenon characterized by a temporary and erroneous perception of new circumstances, objects, or people as already known. This phenomenon, coined by French psychologist Emile Boirac, is part of derealization disorders. DV is widely experienced in the general population, with estimates suggesting that up to 97% of individuals may experience it spontaneously or in association with sleep disorders and anxiety [8].
Two types of déjà vu are recognized: “pathological-epileptic” déjà vu in epilepsy patients resembling a seizure, and “nonpathological-nonepileptic” déjà vu, a normal psychological occurrence in healthy individuals. The occurrence of DV is noteworthy in both healthy individuals and those with psychoneurological conditions, such as Charles Bonnet syndrome, temporal lobe epilepsy (TLE), depression, or schizophrenia. Furthermore, they can indicate early brain lesions[9].
Cultural Beliefs and Alternative Treatment
Cultural beliefs significantly shape the interpretation of the symptoms of nervous disorders in Pakistan. Some communities attribute these conditions to supernatural forces, leading individuals to seek alternative treatments such as religious rituals or traditional healing practices. Bridging the gap between cultural perspectives and evidence-based mental healthcare is paramount for effective treatment and stigma reduction[10].
In Pakistan, the influence of traditions on the seeking of mental health treatment is profound. Cultural beliefs often dictate how nervous disorders are perceived, shaping the path individuals choose when confronted with mental health challenges. Unfortunately, these cultural nuances can also contribute to the development of taboos surrounding mental health.
In some regions, especially in South Asia, the “Peer Baba” concept is often associated with individuals believed to possess spiritual or supernatural powers. In certain communities, there is a tendency to consult Peer Babas for mental health issues, including schizophrenia[11]. However, relying solely on spiritual or faith-based approaches without professional medical intervention can be harmful.
Similarly, the stigma associated with nervous disorders is deeply ingrained, often stemming from misconceptions and historical beliefs. Mental health challenges may be perceived as a reflection of personal weakness or, as mentioned earlier, attributed to supernatural forces. The interplay between cultural beliefs and the associated stigma can create a double-edged sword.
On one hand, seeking alternative treatments, like religious rituals or traditional healing practices, might be perceived as more culturally acceptable. On the other hand, the fear of judgment or societal ostracization might prevent individuals from accessing evidence-based mental healthcare[12].
This cultural impact on treatment-seeking behavior further intensifies the existing taboo around mental health in Pakistan. It contributes to a climate where individuals, especially those suffering from nervous disorders, may opt for secrecy, fearing societal judgment. This, in turn, hampers the early diagnosis and intervention crucial for effective mental health management.
Breaking cultural barriers and challenging the associated taboos is a complicated process that involves not only sensitizing communities about mental health but also creating an environment where seeking professional help is viewed as a courageous and culturally acceptable act.
Impact of social media on mental health perception
The rise in social media in Pakistan has both positive and negative implications for mental health. While online platforms can foster awareness and support, they may contribute to misinformation and amplify societal pressure.[13]
The extent to which social media affects mental health is considerable and encompasses various dimensions of our well-being. On the positive side, these platforms create a space for social connection, community support, and the dissemination of mental health awareness. However, the negative impact is significant as well, influencing self-esteem, fostering feelings of inadequacy, and contributing to issues like jealousy and the Fear of Missing Out (FOMO). The Fear of Missing Out (FOMO) is a psychological phenomenon exacerbated by social media[14].
The continuous stream of exciting and fulfilling experiences shared by others can make individuals feel like they are missing the joys of life. This fear can lead to dissatisfaction with one’s life, impacting overall mental well-being.[14]The comparison complex can also intensify feelings of inadequacy, as users may feel they don’t measure up to their online peers’ perceived successes and happiness.
Moreover, the relentless pursuit of an idealized life portrayed on social media can contribute to jealousy, creating an emotional landscape where individuals may feel envious of other achievements, possessions, or experiences. Recognizing the impact of social media on mental health perceptions is crucial to addressing the unique challenges posed by nervous disorders in the modern age.[15]
Diagnosis and Treatment
The diagnosis and treatment of mental health disorders involve a detailed and multifaceted approach according to individual well-being. Mental health professionals employ a comprehensive assessment process involving clinical interviews, observations, and standardized assessments to gain a deep understanding of the psychological state of an individual.
This examination comprehends various truths of their life, including thoughts, emotions, behaviors, and potential contributing factors. With an accurate diagnosis, personalized treatment plans are made to address specific needs. These plans often incorporate a mix of treatments, including medications such as antidepressants, mood stabilizers, or antipsychotics to alleviate symptoms associated with the diagnosed disorder.
An integral aspect of treatment is psychotherapy, offering a supportive and confidential space for individuals to delve into their thoughts, emotions, and behaviors. This therapeutic approach aids in gaining insight into mental health challenges, developing coping mechanisms, and fostering positive behavioral changes. Beyond medical and therapeutic strategies, lifestyle adjustments are vital in holistic mental health [16].
Importantly, support is fundamental for sustained mental health management. This support network includes healthcare providers, families, and community resources, ensuring individuals receive consistent care, understanding, and access to resources that enhance overall mental health and quality of life.
Cultural Stigma and Societal Challenges
Mental health stigma is deeply rooted in Pakistani society, creating significant barriers to acknowledging and addressing neurological disorders. Misconceptions and societal attitudes foster a reluctance to openly discuss mental health issues, leading to delayed diagnosis and treatment. Socioeconomic factors, including economic disparities and limited accessibility to mental health services, exacerbate these challenges[17].
In Pakistan, talking about mental health is not an easy conversation. It is like navigating through a maze of cultural stigmas and societal challenges. People facing these issues are hesitant to seek support because of the prevailing belief that admitting mental health struggles is a sign of weakness[18]. This societal stigma often forces individuals into silence, resulting in delayed diagnosis and treatment.
The hushed whispers around mental health not only foster widespread misunderstandings but also extend the suffering of those desperately in need. The impact is further intensified by economic disparities, where access to mental health services becomes a privilege rather than a basic right. To break this cycle, envision community initiatives dismissing myths and providing accurate information.
Organizing workshops fosters empathy and understanding, creating a society where neurological disorders are met with compassion rather than judgment. Advocacy for increased mental health resources becomes a collective effort, ensuring that everyone can readily access the support they require regardless of their economic background.
References
- Carvalho, A.F., J. Firth, and E. Vieta, Bipolar Disorder. N Engl J Med, 2020. 383(1): p. 58-66.
- Arnold, I., et al., Old Age Bipolar Disorder-Epidemiology, Aetiology and Treatment. Medicine (Kaunas), 2021. 57(6).
- Carlson, G.A., Differential diagnosis of bipolar disorder in children and adolescents. World Psychiatry, 2012. 11(3): p. 146-52.
- Habiba, U., et al., Differential Treatment Responses in Pakistani Schizophrenia Samples: Correlation with Sociodemographic Parameters, Drug Addiction, Attitude to the Treatment and Antipsychotic Agents. Brain Sci, 2023. 13(3).
- Nawaz, R., et al., Overview of schizophrenia research and treatment in Pakistan. Heliyon, 2020. 6(11): p. e05545.
- Hasan, S. and M. Adil, Schizophrenia: a neglected problem in Pakistan. The Lancet, 2019. 394(10193): p. 115-116.
- Ansari, I.J.I.J.E.M.H., Mental health Pakistan: optimizing brains. 2015. 17: p. 288.
- Chervyakov, A.V., et al., EEG characteristics of déjà vu phenomenon. 2013. 21(1): p. 27-35.
- Aitken, C.B. and A.R. O’Connor, Converging on understanding the déjà vu experience, in Memory Quirks. 2020, Routledge. p. 288-305.
- Ahmad, S.S., and S.W. Koncsol, Cultural Factors Influencing Mental Health Stigma: Perceptions of Mental Illness (POMI) in Pakistani Emerging Adults. 2022. 13(5): p. 401.
- Duckworth, K. and L. Halpern, Peer support and peer-led family support for persons living with schizophrenia. 2014. 27(3): p. 216-221.
- Lippi, G., Schizophrenia is a member of the family: Burden, expressed emotion and addressing the needs of the whole family. S Afr J Psychiatr, 2016. 22(1): p. 922.
- Pantic, I., Online social networking and mental health. Cyberpsychol Behav Soc Netw, 2014. 17(10): p. 652-7.
- Gupta, M. and A. Sharma, Fear of missing out: A brief overview of the origin, theoretical underpinnings and relationship with mental health. World J Clin Cases, 2021. 9(19): p. 4881-4889.
- Fauzia, J., et al., Social media-induced fear of missing out (FoMO) and social media fatigue: The role of narcissism, comparison and disclosure. Journal of Business Research, 2023. 159: p. 113693.
- Podolan, M. and O.C.G. Gelo, The Functions of Safety in Psychotherapy: An Integrative Theoretical Perspective Across Therapeutic Schools. Clin Neuropsychiatry, 2023. 20(3): p. 193-204.
- Husain, M.O., et al., Stigma toward mental and physical illness: attitudes of healthcare professionals, healthcare students and the general public in Pakistan. BJPsych Open, 2020. 6(5): p. e81.
- Waqas, A., et al., Public stigma associated with mental illnesses in Pakistani university students: a cross-sectional survey. PeerJ, 2014. 2: p. e698.
“THIS ARTICLE IS DEDICATED TO MY KINDEST TEACHER, DR HAROON SHEIKH, MAY HE REST IN PEACE, WHO WORKED DEVOTEDLY IN GENETICS INVOLVED IN NEURO-DISORDERS AND PSYCHIATRY”
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Sadaf Sarfraz, currently a lecturer, holds an MPhil in Molecular Pathology and Genomics, complemented by a BSc in Medical Laboratory Technology. Contributing as a healthcare writer at Scientia-Pakistan, she passionately engages in calligraphy and art.
