Being bipolar in Pakistan

First published in Dawn blog.

I suffer from a disability called bipolar disorder, something that 2.4 per cent of the global population suffers from. For most of us, it is a genetic disease, but there are others who don’t have a family history of it. It manifests itself by making an individual feel extreme highs and lows in cycles. It is also varied in intensity and has two classifications: bipolar I and bipolar II.

Being bipolar in Pakistan is not easy. Mental health disorders in this country are taboos that lead to discrimination which we face increasingly by the day. And because our disability cannot be seen, it is often dismissed as a lie or an excuse not to work. The very same people who imply that it’s possible for us to “snap out of it” would never dream of telling someone in a wheelchair to stop whining and walk.

Day by day, we hide our pain, the obsessive thoughts in our head and make excuses that are lies just so that we are not judged. Some of us don’t disclose this to our employers until we’ve been hired because we know that if we do, we may not be hired at all. More often than not, we never disclose. We pretend to be what we are not and over the years, it takes a huge toll on our well-being.

Can you imagine being in our shoes? Can you imagine a day when you’re so depressed that you’re unable to move, let alone get out of bed to brush your teeth or eat? Can you imagine being able to convince yourself that killing yourself would be the best thing you could do for your own family so that they don’t have to put up with your wretched existence? Can you imagine being so elated that you actually believe jumping off a roof will not harm you at all? Can you imagine being so manic that your totally irrational and incomprehensible thoughts actually make sense to you – Can you possibly imagine it at all unless you’ve been through it? We live in hell, which is why we mostly don’t fear death, perhaps this is why we have the highest suicide rate.

While I cannot speak on behalf of all females who have bipolar disorder, I do believe that we face similar discrimination and challenges. Bipolar patients necessarily need support from their family and friends, but in our culture, most families are not willing to accept that we have a problem. There is a lot of denial because of the huge stigma associated with mental health disorders. Many times, it is important for families to convince a bipolar person to seek help for the one who is suffering is not willing to acknowledge that he/she has a problem.

Because we live in a very superstitious culture where religion is given greater value than medical interventions, too many bipolar people are only diagnosed much later than they should be. People who are mentally unwell are usually taken to shrines. Since there is no visible “illness”, it is also considered a “curse” due to black magic. If someone is suffering from a mental health illness, it is assumed that they are possessed by a jinn.

Psychiatrist Dr Nusrat Rana, who runs the Punjab Institute of Mental Health, has had patients whose arms have been cut off by pirs who were trying to exorcise jinns out of them. She treated a woman whose face was scared by a faith healer with hot tongs when she was hysterical. By going through so much trauma, both physical and emotional, most develop Post Traumatic Stress Disorder which further exacerbates their ordeal.

Others marry off their daughters thinking that marriage will “cure” her, only to see that her bipolar disorder has been exacerbated by childbirth and postpartum depression or mania. If her condition results in a divorce, which is mostly the case, she is further shunned and mistreated. This “shaadi kaara doh” advice is also given by doctors, linking it to conversion disorder, which according to Dr Nusrat Rana, is a new version of hysteria, the archaic “wandering womb” syndrome.

As a teenager, I used to hallucinate and see black giants. Even though my mother belongs to a family that manufactures and sells pharmaceuticals, she was convinced I was seeing jinns. She really thought prayer and rituals would solve my problem but they never did. I know I was hallucinating because all the giants went away once I started taking medications that stabilised my brain chemistry. I no longer see things that are not there, nor do I hear voices like I used to. It’s not my mother’s fault that she believed religion could solve my problem and I do not judge her for it. She is, after all, a product of the society she comes from and has been incredibly supportive over the past few years.

This misconceptions regarding bipolar disorder and horrific stereotypes perpetuated by the media, as well as, people in general make having an unseen disability worse than it should have to be. Nor should it necessarily be seen as a “curse” for it can be a gift. Some of the most creative geniuses had bipolar disorder such as Virginia Woolf.

Stephen Fry openly talks about it and has even made a documentary about what it is like to be bipolar. Studies show connections between bipolar disorder and creativity and many lists of famous bipolar artists, writers etc have been compiled which shows just how much those of us with this “disease” have contributed to the world.

Had it not been for bipolar people, the world would have been a duller place and I keep thinking, perhaps just to console myself, that it surely must have evolved for a good reason.


18 thoughts on “Being bipolar in Pakistan

  1. I don’t quite agree with the part where you constantly refer to yourself as ‘disabled’. For me, it has a sort of a negative ring to it, I don’t know. I mean, if anything, knowing one’s weakness and trying to live with it or deal with it or find a way around it, is probably the biggest strength anyone could possess. #justsaying

    • I think you’re assuming that I see disabilities as negatives & weaknesses. I don’t. I DO have a disability but I don’t see it as a negative. Thought my positive conclusion would make that clear to my reader.

  2. Hello Nabiha

    You make some very eloquent and cogent points about what it’s like being a female bi-polar sufferer in a society like Pakistan. Unfotunately, a lot of Pakistanis take that attitude towards mental illness wherever they travel around the world. I have a sister with bi-polar and she has suffered many years of ill-health and unhappiness due to this misunderstanding. It is only now, in her thirties, that she has been able to find some help.

    It saddens me that as a people we are so inclined to hide from problems or put a veil over them. This always leads to problems festering, no solutions being found and the unnecessary continuation of suffering. It seems to me that unless more people talk about the so-lablled taboo issues, Pakistan, and Pakistanis, will never progress beyond the first steps of self-actualisation as a nation.

    Keep up the good work.

    • Thank you. I do think things are improving and if more people start to speak up and not hide, we CAN change things.

      It’s hard though. I was diagnosed 6.5 years ago and I’ve only now written about it. I wouldn’t have unless I had a supportive family & friends.

  3. How brave of you to ‘come out’ with this disorder, Nabiha! You once asked me if I knew any articles about bipolar disorder, but I don’t think I ever replied. You sent it when I was travelling and when I came back I was swamped with mail to sort… Never guessed you asked for yourself. I have a friend who is diagnosed with Bipolar II and am interested in it myself. I have some articles about it, do you want them? Can send in your e-mail as pdf.

    There is an organisation here in Finland for psychologists interested in international development work:

    They currently have projects in Libanon, Namibia and Palestine running projects with local NGOs. For a while now I’ve been thinking about joining the crew. If you have some ideas how Finnish expertise/money could be used to improve the knowledge of the population about mental health issues, please be in touch. There is also a similar organisation for doctors, so some psychiatrists could be involved as well. In Finland patient/relative organisations have done a great job, but even here, there is some stigma. I guess mental health issues are something people are naturally a bit scared of, especially if they/their friends or family haven’t had any.

    P.S. Tho those of you who don’t know me, I’m a friend of Nabiha’s from high school and a PhD student of cognitive neuroscience (with a M.A. in psychology).

    • Thank you Soila! This organization looks amazing. I’m going to go through the website and check them out properly next week.

      In Pakistan, the stigma is so great that the silent suffering makes it worse. I remember when I was too scared to disclose it to people and I would have to listen to rants about mental illnesses, afraid to say anything or defend myself. Being told, over and over again, that you deserve to feel horrible because you’re not religious or because you’re not conforming to your culture used to make me angry and would add to the despair. I’m trying to think of ways we can break this stigma.

      I can understand why someone would naturally be scared of mental health issues if they’ve never met anyone who has a mental illness. I’ll thank the media for that one.

  4. “Studies show connections between bipolar disorder and creativity and many lists of famous bipolar artists, writers etc have been compiled which shows just how much those of us with this “disease” have contributed to the world.”
    – thats right, its the writers who have really plumbed the depths of despair who have an almost supernatural ability to illuminate the human condition. look at F. Scott Fitzgerald, Ernest Hemmingway, Albert Camus, Virginia Wolf, the list is endless.

    keep on trailblazing Nabiha 🙂

  5. One of the worst things about being bipolar is, some days you think you’re not bipolar at all–there is nothing wrong with you, you are fine, you are awesome. And then other days your sanity comes crashing down on you like a house of cards and you’re caught in the confusion. You never know quite what to believe about yourself, you never even know IF you should believe Yourself.

  6. From the school of humanism, everyone is free to do and has unique characteristics that cannot be measured on the behalf of others’ traits. SO if someone is crazy, don’t you think he or she has different personality traits? Simply, Someone does anything for because of his or her desire which does not violate laws, social norms etc. Humanistic approach, if you know, says we cannot call anyone mental or abnormal.My point is, you are born free and you may have different traits, qualities that vary in a way that other primates have different thinking, different traits and different past experiences. So, how can we name anyone abnormal? For instance level of happiness is different for me and might be different for you as well for others. Same as it applies to craziness.
    One thing i want to add more is about that as i have felt people are now becoming more aware about their daily life problems as these were considered in past as just merely band omens. Well I like these following lines:
    “Because we live in a very superstitious culture where religion is given greater value than medical interventions, too many bipolar people are only diagnosed much later than they should be. People who are mentally unwell are usually taken to shrines. Since there is no visible “illness”, it is also considered a “curse” due to black magic. If someone is suffering from a mental health illness, it is assumed that they are possessed by a jinn.”

    It’s genuinely 80 percents of Pakistan are superstitions including high profile educated people living in Pakistan or abroad. Well, religion does not fellow the society norms.

    • I don’t like defining things like “normality” or “madness” because they are nothing but slurs, words used to oppress and demean those of us who don’t fit the ideal.

      This relates to the concept of happiness in many ways. After being diagnosed, I had to make many major life changes and give up a lot of things that were, I thought, making me happy. But they weren’t. I was doing things because they made most people happy so I assumed they would make me happy and fulfill me, which they didn’t. And in many cases, what makes people happy makes me downright miserable like weddings (I rant about them A LOT for a reason. I truly hate them). I was dragged to weddings, forced to attend events that were making me incredibly miserable and I was constantly crashing. No one understood why and really judged me for it. My doctors had to order my mother to never emotionally blackmail me or try and force me to go to a wedding. So, yes, I see your point. Happiness means different things to different people. My elitists relatives actually enjoy living in an ostentatious bubble and partying for months on end, drunk all night. But it makes me incredibly miserable for many reasons. I don’t get how they can be happy like that, they don’t get why I’m miserable but we can all respect each other.

      • So you’re suffering from Wedding Phobia….! Well, I do agree. Attending weddings and all other events that we don’t want to go there, why does someone force us to join them? Although, there are many things except one’s experience as your is different for me and as well same for others. Some of my friends enjoy participating wedding ceremonies and they often talk about wedding events. It may reflect social learning and social relations that are useful for them not for me because according to my view becoming more societal, will hurdle many ways in particularly achieving a goal in a society. Being bipolar disordered or being any kind of disordered is not easy to spend life in Pakistani society especially for females whose duty has been forced to bear only child rearing and home diagnostic management. I think there are many ways to bring a social change about our awareness of mental health and their consequences on daily life. But can you elaborate what would be the consequences if a female is mentally disordered and her life is stuck in manic and depressive disorder (Bipolar disorder) ?

      • Not sure what you mean by “can you elaborate what would be the consequences if a female is mentally disordered and her life is stuck in manic and depressive disorder (Bipolar disorder) ?” Bipolar disorder is for life. We can live full, healthy lives but episodes WILL happen and even if we do our best to avoid all triggers, the state this country is in can depress anyone.

        The reason why I feel females are affected more is not just because of society but also because of biology. I must add here that I am not a gender essentialist but certain things like pregnancy and childbirth can be VERY difficult for bipolar women. They need to be closely monitored and because women end
        up taking care of children, it can be quite trying to be caring for someone when in need of care oneself.

        btw even if someone doesn’t take meds, their episode will eventually go away so no one can be stuck in one episode. Sometimes it may feel like it’s been forever, but because of the nature of the disorder, we are always up and down. And of course, life events like the death of a loved one can wreck us more so than others.

        Think of it this way: I have a lot more dopamine than you do. I necessarily feel more than you do. Something that will make you smile may make me laugh out loud. Something that may just make you sad may lead to me weeping. But if I take a mood stabilizer, my dopamine can be controlled and I can be less intense.

  7. Nature has granted some innate functions that have to do by specific sex but not in worst situations . Being student of psychology, I understand what types of circumstances people face when they are suffering from mental problems and being human I feel more for those who are physically disables.

    It sounds much better when i hear people are concerned for treatment of their daily life problems even psychiatric disorders like schizophrenia must be treated so that affected people must enjoy life as normal human beings do.

    I like your blog and like to see more posts concerning to spread awareness about genuine life problems not artificial ones.

  8. I agree with every word you have written but in Pakistan it’s not easy living with a mental disorder more specifically when the person doesn’t even know much about it, mental health clinics, psychiatrists, psychologists etc don’t come cheap. As I hail from the middle class, I have witnessed a lot of families just keeping it under the rug because they think they cannot afford any kind of therapy, counselling. I myself have been undergone some traumatic experiences, which my co-workers, friends and even family are not capable to understand the magnitude of

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