Unmasking mental health stigma in Bangladesh

Illustration: TBS

Bangladesh has a population of more than 170 million and it is estimated that 15–35% of the population has mental health issues. However, we have an acute shortage of psychiatrists and psychologists and a limited number of reliable and skilled mental health professionals.

Moreover, there is limited awareness and exposure to information on where to go for mental health support, prognosis, referral, and professional help. On top of that, mental health issues are often identified as an outcome of supernatural influences and that has been a breeding ground for stigma and bias. 

This creates and enhances confusion, misinterpretations, and an eagerness to try alternative solutions to resolve mental health issues. Unfortunately, some alternative healing practices cause further psychological harm and make prognosis and care more complex.

Mental health issues can develop from socially constructed norms and expectations, abusive relationships, and substance abuse. Social and family pressure to fulfil high expectations in school, higher education, career, family, and in all spheres of life can create tremendous emotional and psychological stress. 

Domestic violence causes psychological distress and can lead to mental health issues for the victims and perpetrators. Drug abuse causes mental health problems and its use is higher among young adults in the age group of 15 to 30 years. Access to and use of drugs have increased alarmingly and their use can lead to the development of psychosocial symptoms and psychosomatic disorders.

Although mental health issues may arise from personal situations and practices, there are also external factors that impact mental health. For example, the refugee crisis that Bangladesh has been bearing since 2017 is not only taking a toll on the mental health of the Myanmar refugees but also the Bangladeshi people. 

Research shows that climate change and climate-impacted people suffer emotionally and physically. Bangladesh is an extremely climate-vulnerable country and prone to natural disasters. Due to this, we fall into health hazards and witness unexpected climate-induced calamities in the country, which have a mental health impact on the affected population. 

Recently, a school-going child died from a heat stroke during school hours and her classmates witnessed it. This event scarred the students and put them in a mentally shaken state. Their mental wounds were visible to the psychologists who provided primary first aid at that school after the incident.

Mental health issues are increasing but treatment is limited and the practice of preventive and early care is negligible. The stigma attached to mental health issues further limits people's willingness to find and reach out for support. Stigma and myths are intertwined in our thought process. 

Myths around mental health include the belief in evil spirits, misconstrued religious interpretations, and cultural practices. We see the influence of stigma in identifying the causes of mental health issues. There is a skewed perspective that depression is a self-created problem that can be overcome by just ignoring it. Others claim that depression arises from not being busy enough with meaningful work or activity. 

Some more serious mental health issues, like bipolar and schizophrenia, are believed to be caused by supernatural power and evil spirits, and treatment is expected to come from religious, spiritual, or traditional healers. Sometimes these healers may lead to some positive changes but they can also be detrimental and lead to more severe cases of trauma and disorder. 

The stigma and superstitions in this case are so ingrained that the possibility of psychological or biological factors causing this illness isn't considered. We also see that suicides are classified as accidents rather than manifestations of mental health conditions. Yet suicide ideation and suicide attempts occur in our society and it is believed that the real statistics for ideation and attempts are 10–20 times more than what is reported. 

So, we can clearly see that suicide isn't an accident but rather an ultimate step in mental health breakdown. It is essential to change the dependency on myths and stigma in interpreting mental health conditions and create awareness, understanding, and acceptance of professional help for all forms of mental health care.

There is a rise in mental health awareness among the younger generations and it is important to endorse this, strengthen their understanding, and show them the path to accessing care. A government college student from Sylhet very articulately said, "We pretend to be doing better than we actually are." 

This is an example of their actual understanding of how they feel internally and how they portray themselves to the external world. They are able to identify feelings of depression or anxiety and want to reach out to skilled psychosocial support providers for sessions. 

However, they do not know where to go or how to find mental health experts for early care. As a result, they continue spending months and years with a growing weight of unexplained feelings and thoughts. We live in a culture where early care is rarely practised and this is much less visible when it comes to psychological and emotional wellbeing and mental health. 

This leads to neglect and overlooking of preliminary mental health issues, which eventually may take on a more serious form of mental health disorder that requires long-term treatment or even lifelong medication management of symptoms.

Good mental health is crucial for well-being and sound health. Mental health is a human right and having a mental health condition should never be a reason to be deprived of or ostracised in the community or workplace. Bangladesh has passed the Mental Health Act and the National Mental Health Strategic Plan. These steps are undoubtedly steady moves forward but they aren't nearly enough. 

The stigma around mental health has existed in our society for a long time but with the development of science, the spread of education, and a better healthcare system, these stigmas were expected to decline. On the contrary, we see the continuation of stigmatised reactions to mental health conditions. It is extremely important to condemn this, raise awareness, change the bias, and lead to a decline in stigma around mental health.

There is a visible increase in the inclusion of mental health lenses into discussions in multiple sectors. This is commendable and needs to continue. We need to proactively take actions focused on mental health care to bring about impactful change. More importantly, it is imperative to bring about change in our behaviour and approaches towards people with mental health issues and this has to start with the homes we live in and the people we interact with daily.

Sound mental health is a human right and we can start to ensure this for our citizens when we are able to move away from the cultural stigmas and myths that smog the field of mental health care.

Tabassum Amina, PhD is an Assistant Professor at Brac University and the Team Lead of the Mental Health and Psychosocial Team at the Brac Institute of Educational Development (Brac IED)

Disclaimer: The views and opinions expressed in this article are those of the author and do not necessarily reflect the opinions and views of The Business Standard.