Mental health in Mirpur

On my last visit to Mirpur, I was interested to discover how mental illness is handled and was unsurprised to learn that there is practically no community level mental health service. I came away with several discrete insights about mental health in Mirpur.

Rarely is mental illness diagnosed when there is a sudden onset of psychotic symptoms. Instead the person is deemed to be possessed by a spirit, or jinn, and the spiritual route to cure is taken. This involves reference to pirs, who perform various rituals. Patients with psychotic symptoms behave and speak in an uncharacteristic way. However, this is often interpreted as the behaviour and speech of the jinn. Although there is no cure, the placebo effect often means the immediate acute symptoms are relieved by the intervention of the pir.

I also noted a fascinating resemblance between mental health in Mirpur and the history of mental health in Victorian Britain, particularly in relation to women. In both cases there is an underlying social hypocrisy that creates a tension between expectations and innermost desires, a tension which manifests itself in mental symptoms. Often there is profound guilt about illicit liaisons. Young women are most affected by the prevalent hypocrisy.

Medication is also often prescribed, particularly for depression. I was able to speak to a village doctor who, though not a specialist in mental health, said he frequently prescribed anti-depressants. Life is tough in the villages, particularly for middle aged women with large families and larger still responsibilities from dawn to way past sunset. It is not difficult in such circumstances to diagnose depression.