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Mental health disorders in Khyber Pakhtunkhwa: women suffer more than men


In Khyber Pakhtunkhwa province of Pakistan, societal attitudes and norms, as well as cultural practices such as gender discrimination, exchange marriages, bride price, lack of power and conservative patriarchal system, etc. play a vital role in women’s mental health. The religious and ethnic conflicts, along with the degrading attitudes towards women, the extended family system, conservative patriarchal system, role of in-laws in daily lives of women, are the major issues and stressors. Such practices in traditional Pashtun culture have created the tendency of downgrading of women in multiple spheres of life, which has had an adverse psychological impact on them. Violence against women is one of the acceptable means of ensuring obedience, and is even encouraged in many families, as men exercise their culturally constructed right to control women by being ‘traditional’ brothers, fathers, husbands and even brother and father in laws.

There is an alarming increase in the incidence of mental illness in Khyber Pakhtunkhwa due to a persistent wave of violence, natural disasters, militancy and frequent changes in the social fabric. It is due to these reasons that a large number of women have and continue to suffer. As a result of this, a range of psychiatric disorders have been reported, such as depression, anxiety, stress, drugs and alcohol misuse, schizophrenia, bipolar disorder, and post-traumatic stress disorder. More female suicides are committed every year, as all these socio-economic issues lead down-trodden women towards hopelessness. As a result they are more prone to commit suicide.

Sajida Bibi, an attractive young woman in her thirties, thought that life had taken a turn for the betterment of her family when her unemployed husband got a job in Saudi Arabia and went there. She was left behind with her children. She had numerous rewards like their own home, TV, better lifestyle, and expensive new clothes, at first, a fair exchange for the temporary loss of her husband.

But gradually, the stress of coping on her own with the children, inlaws and the day-to-day problems her husband used to attend to previously, were difficult to deal with. Feeling depressed and suffering from severe headaches, she turned to tranquilisers in an attempt to forget her loneliness and take some mental relaxation.

She finally ended up in a psychiatric clinic where the doctor diagnosed that the problem with her and others in situations similar to hers was “stress caused by an absence of standards to guide their lives. Faced with new possibilities of progression, these people were unable to put limits to their desires, and suffered the consequences of a weakening of their value system”. A big number of women are living with the same issues in rural areas of Khyber Pakhtunkhwa. Where a considerable number of men have to go abroad, especially to the Gulf countries for the means of livelihood while leave their women for sufferings as they are the ones who have to live with their in-laws.

In Khyber Pakhtunkhwa, there are cultural institutions, beliefs and practices that undermine women’s autonomy and contribute to gender-based violence. Marriage practices can disadvantage women, especially when customs such as dowry and bride’s price, Watta Satta and getting married to the enemies to settle disputes (Swara), and getting married to someone who pays off for his wife (bride price), exist.

Violence against women is very common in our society. The violation of women’s rights, the discrimination and injustice are very much common and obvious in Pashtun culture. A United Nations research study (Tinker GA. Improving women’s health in Pakistan. Karachi: the World Bank; 1999) found that 50% of the women in Pakistan are physically beaten and 90% are mentally and verbally abused by their men. A study by the Women’s Division on “Battered Housewives in Pakistan” (National Commission on the Status of Women. Report of the status of women in Pakistan. Islamabad: 1997) reveals that domestic violence takes place in approximately 80% of the households. More recently the Human Rights Commission report (Rehman IA. The legal rights of women in Pakistan: theory and practice. Karachi: Human Rights Commission of Pakistan; 1998) states that 400 cases of domestic violence are reported each year and half of the victims of such abuse do not survive.

The Government of Khyber Pakhtunkhwa has introduced the Mental Health Act of 2017, which paved the way for establishing a dedicated commission for handling issues related to mental health in KP. Under this Act, it is expedient to establish the Khyber Pakhtunkhwa Mental Health Authority in the province of Khyber Pakhtunkhwa for the treatment, care, management of properties and affairs of the mentally disordered persons, their families and for the matters connected therewith and ancillary there to.

The Pakhtunkhwa Radio, the broadcast channel managed by the Information Department in Khyber Pakhtunkhwa, produces a weekly radio program about mental health awareness, issues and the facilities being provided by the government. There are free facilities and treatment options in government hospitals as well as a UNICEF sponsored psycho-social support programme desks in the hospitals, where free treatments are provided to the people suffering from mental health issues. However people have very limited knowledge about these facilities so the radio programme is bridging that gap and providing awareness to the people.

Nizam Uddin, the producer of Studio Clinic Radio Programme stated: “We have received massive response from the rural communities of Khyber Pakhtunkhwa seeking guidance about mental health issues they are suffering from. A large number of these listeners include women and girls. According to the feedback we have received till date, majority of the girls in the rural setup are facing anger, stress, anxiety, depression and tension issues.

He said the programme focused on engaging women on mental care. “Although a very good number of women discuss mental health issues keeping their identity secret due to the stigma, many more women-related issues are discussed by women on air. It helps to get their issues resolved and stay unidentified.” He further added that women are restricted to abusive relationships and they are unable to escape their captors due to the strict conservative culture. Parents never encourage their married daughters to return to their father’s home for fear of being stigmatized, as a divorcee, as it is considered to be a source of shame for the whole family. Even many people uphold the mentality that says that a brave Pashtun lady would die before leaving the house of her husband, that once married, the only reason for departing her marital home should be her funeral. Moreover, if a woman leaves her husband, she would lose all her respect in society as she would not be considered a chaste woman as she was unable to become a good wife. Cultural attitudes towards male honor serve to justify violence against women in traditional Pashtun culture.

Professor Dr. Sultan, Head of Psychiatric Department at the Khyber Teaching Hospital, Peshawar, stated that 42 percent of women in KP suffered from psychiatric problems like phobia, epilepsy, post-traumatic stress disorder, stress disorder and depression. As Khyber Pakhtunkhwa is been affected from natural disasters and militancy, said Dr Sultan, the situation is quite alarming for the people of this region.

He said a majority of women patients he treated were brought in critical conditions as people first take them to saints, shrines and shamans due to their superstitious beliefs that are an important part of our culture. “The saints burn their mouths and beat them badly to eliminate demons. In some severe cases, they burn the scalp or other parts of the body with a burning hot iron rod. All these situations take place due to lack of awareness and social taboos and because people don’t go to psychiatrists due to the stigma associated with mental illness.” Due to the stigma women remain quiet and their mental health issues reach extremely critical stages. The need for focus on mental health and well-being in women is urgent in our part of the world, as qualified by the many factors mentioned above and the steps like welfare treatment and awareness campaigns are very welcome and much needed here.


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