The Express Tribune Magazine - March 4

MARCH 4-10 2012

A rare glimpse into the lives of those grappling with unquiet minds

MARCH 4-10 2012

Cover Story 18 Bipolar Roller Living with the massive highs and miserable lows of bipolar disorder 24 Mind Games Going from being a patient to becoming a psychiatrist, the writer chronicles her battle with her own mind

24

28 From the Other Side What does it do to a family when one of their own suffers from mental illness?

38

32 Everything in its Right Place When rituals become obsessions, and habits put you in a headlock

Interview 38 The Healing Touch A new approach to treating mental illness makes inroads in Pakistan

Regulars 6 People & Parties: Out and about with Pakistan’s beautiful people 41 Reviews: What’s new in films 42 Ten Things I Hate About: Shopping

41

4

Magazine Editor: Zarrar Khuhro, Senior Sub-Editor: Batool Zehra, Sub-Editors: Ameer Hamza and Dilaira Mondegarian.

Creative Team: Amna Iqbal, Jamal Khurshid, Essa Malik, Maha Haider, Faizan Dawood, Sanober Ahmed and S Asif Ali. Publisher: Bilal A Lakhani. Executive Editor: Muhammad Ziauddin. Editor: Kamal Siddiqi.

For feedback and submissions: magazine@tribune.com.pk

PEOPLE & PARTIES

Nadia Hussain launches her signature lawn prints in Karachi

Monica

PHOTOS COURTESY TAKEII

Mahin Hussain and Muneera

Nomi Ansari and Nadia Hussain

Munaf and Sabeen

Hira Lari and Tehmina

Mahin Hussain and Muneera

Mahin Hussain and Muneera

Shameneh

6 MARCH 4-10 2012

Zainab Sajid with Zaheer Abbas

Adnan Pardesy and Warda Saleem

MARCH 4-10 2012

PEOPLE & PARTIES

Fashion Central Media Group launches MusicBox360 in Lahore

Masoma, Amara and Amina

Mr and Mrs Hashim PHOTOS COURTESY BILAL MUKHTAR EVENTS AND PR

Khalid Sulman and Fia

Madiha and Neelma

Tayyaba and Mishal

Farhad and Lubna

Noman and Fariha

Humera and Saleha

8 MARCH 4-10 2012

Aamir Mazhar and Bilal Mukhtar

Tahir and Maria B

MARCH 4-10 2012

PEOPLE & PARTIES

Rubab, Fatima and Mariam

Frieha and Uzma Jamil Baig Aamir and Sara

Faria Khadija and Fatima Khadija and Fatima Farah and Madiha

Amna

10 MARCH 4-10 2012

Aliha

Afreen and Ayesha

Alizay

PHOTOS COURTESY VOILA PR AND EVENTS

Ellemint Pret holds a multi-designer exhibition, Welcome 2012, in Lahore

MARCH 4-10 2012

PEOPLE & PARTIES

Sara, Nooray and Mahira

Ali and Natasha

The Moor, a hotel apartment, part of the Heritage Luxury Suites, opens up in Lahore

Sameen, Sheryar and Saira

Saim

Mariam and Zohair

Sheryar, Mustafa, Abrahim, Rafay and Mohammad

12 MARCH 4-10 2012

Dr Arif and Hamda

Amina and Asif

PHOTOS COURTESY SAVVY PR AND EVENTS

Mariam and Gulnar

MARCH 4-10 2012

MARCH 4-10 2012

MARCH 4-10 2012

MARCH 4-10 2012

MARCH 4-10 2012

COVER STORY

bipolraorl er Bipolar disorder is the rollercoaster that takes you to the most dizzying height before plunging you into the deepest abyss. This writer tells us how she manages to hold on, despite not knowing if the track is about to come to a sudden end

BY BM

18 MARCH 4-10 2012

There has been a bit of a storm in this insular little teacup recently. Someone wrote a ‘funny’ piece mocking celebrities that featured descriptions of the symptoms of actual mental illnesses. That made some other people justifiably angry. Their anger led to some outraged mudslinging. The mudslinging led to a gut-wrenching piece by the daughter of a woman with bipolar disorder. The gut-wrenching piece led to heartfelt messages of support from other people who have lived with, treated or lost someone with bipolar disorder.

As a woman with bipolar disorder who has felt the contours of her own life as daughter, wife,

mother etc be irrevocably molded by it, I am not surprised to see that the other illnesses the piece referenced have been completely eclipsed by it. Thanks to the pervasiveness of pop culture, and the

mythologising of the illnesses’ association with creative giants like Plath, Woolf, Byron etc, in the

(westernised) public’s imagination bipolar disorder is the rock star of mental illnesses. It is the one that always has an entourage, groupies and a nifty skull and crossbones tattoo on its ass.

Am I mocking the disease? I am. Having lived with it for about 17 years, time enough for the ill-

ness and the self to come to a respectful if uneasy impasse, I am now what I call post-victimhood. I

don’t feel compelled to share the litany of my woes with you because they are not relevant. I don’t need to tell you the frequency or outlines of my ‘cries for help’. There is no ‘I am more bipolar than you!’ contest with sequined chicken wings as a prize.

If we fall into the trap of making it so, stridently, we imbue it with precisely the kind of romanti-

cism we need to discard if we are to lead full, meaningful lives. Like the people in wheelchairs who

will not let their disabilities keep them from tasting life’s pleasures, we who live with ‘an unquiet mind’ must also learn to expect nothing from anyone but our selves.

Because I don’t believe the narrative that says all those with this illness will never be able to keep

a job, have a (relatively) happy family or cross a road without looking both right and left, I’d like to share with my fellow bipolar rollers how — despite several full-blown episodes at both ends of the

spectrum — I have managed to be largely functional without constant medication and with only the occasional trip to a headshrinker. This is in no way meant to be a substitute for professional

help. In fact, these are conclusions I have come to despite, not because of, aforementioned professional help.

19 MARCH 4-10 2012

COVER STORY

1.

Wait till you have been diagnosed with bipolar disorder before deciding that you have bipolar disorder. Bipolar disorder is not a fashion accessory you can pick off

the rack in a supermarket for neurosis. According to an expert, “Manic-depres-

sion distorts moods and thoughts, incites dreadful behaviors, destroys the basis of rational thought, and too often erodes the desire and will to live. It is an illness

that is biological in its origins, yet one that feels psychological in the experience of it, an illness that is unique in conferring advantage and pleasure, yet one that

brings in its wake almost unendurable suffering and, not infrequently, suicide.”

If you think you need help, ask for it. If someone in your life thinks you need

help, consider seriously the possibility that they might be right. Go to a clinic, a hospital, a psychologist, a therapist or an online directory that can point you

in the direction of any of them. Once you have a diagnosis — there are different types of BD — learn all you can about it. If your doctor happens to be one of those

2.

3.

‘voice of God’ doctors, get another doctor.

Don’t buy the hype. Having bipolar disorder does not always mean you are smarter or more creative than anyone else. If 1 in every 10,000 people with bipolar disorder is more than a little out of the ordinary, there are 9,999 people who are not.

Stay with the herd. Don’t let the delusions of grandeur pick you off. They’re fun

to catch up with once in a while, but up close they have teeth that aren’t meant for brushing.

Unless you are a phenomenon like Kay Redfield Jamison, forget about educating other people. First, because chances are you will never be completely objective.

Second, because in this day and age, for those who are placed to surf articles like this, there are opportunities and resources available for those who really want to

know you to do what they need to do to know you. Those who don’t are really just not that into you. Have compassion for both. In moments of levity you might feel

that you are special, that you are worth it. But there are no Bipolar Olympics. Not everybody has the stomach for the emotional evisceration a roller in full swing can unleash on those around them. Don’t judge them, afterwards. Most of them

4.

5.

fight every second of every day to not judge you.

Educate yourself. The net is everybody’s friend. Stay abreast of the latest treatments being favoured in more developed countries (Carrie Fisher currently says

there’s nothing like Electroconvulsive Therapy, by the way). This is very important considering the next point…

Don’t let woefully unethical medical professionals use you as a guinea pig. Psy-

chiatrists can be a slippery lot. To some of them, you are a petri dish with legs.

The local breed in particular tends to chuck pills at you the minute you walk through their door. They don’t know how to do anything else. Have some respect for the miracle that is your brain chemistry. Don’t let anyone who has dem-

onstrated little but a morbid curiosity about it mess with yours unless you have testimonials about their exceptional effectiveness or it is an exceptional time.

If indeed it is an exceptional time, any support system you might have should research their remedies before approving it for you. Sometimes they might find

that the anti-psychotic, anti-depressant or mood stabiliser they want you to take is banned in seven countries.

20 MARCH 4-10 2012

6.

7.

8.

Exercise. Exercise. Exercise. I can’t stress this enough. Exercising, even some-

thing as simple as a brisk walk in fresh air, releases enough feel good chemicals to tide you over small swings. If you catch a swing as it begins, you can conceivably play a part in deciding how high or low it will go.

Make sure you have no vitamin or mineral deficiencies. Take steps to remedy those if you do.

Express yourself. If you do not write, sketch, sing, dance or speak the language

of the body in sport, talk about your feelings. They don’t have to be your feelings about being bipolar. They can be your feelings about the spiritual ramifications of kitchen sinks. In most places, psychotherapy is part of frontline treatment

after any kind of episode. Make a friend if you can’t afford a therapist (not sur-

prising, considering how expensive therapy is here). If you can’t make a friend, get a dog. Or a pigeon. And when you do express yourself, don’t inhabit victim-

hood. Inhabit experience. Your illness is not a crutch for you to beat the rest of

9.

10.

the world into submission with. Any support group you decide to participate in should subtly reinforce rather than dilute that perspective.

Don’t cry wolf. You know why.

Self-interrogate. Pitilessly and ceaselessly. Whenever you can. You might find, like I did, that if you work towards developing a strong sense of self, identity

markers like flash cards, there will come a time, even during those highest highs and lowest lows, when the part of you that is the core of you is audible. Listen

to it. Focus on it. Even if you find yourself unable to listen to that disembodied

voice, fight to keep a link with it alive at all times so that, once you have finished doing that really stupid thing it was telling you not to do — jumping off a roof,

say, or thinking you and those six stray dogs are a pack, or inappropriate physical contact with someone you really should not have physical contact with — you and that disembodied voice can have a conversation about what a really stupid

thing that was to do. You might not enjoy the conversation, there will hopefully

be a bit of egg face and shuffling around on your part, and you might find you

have lost a spouse, broken a limb or gained a debt the size of Lichtenstein’s GDP,

11.

but in that conversation lies your strength.

Tell the people who choose to be around you that you love them. Tell them often.

Tell them loudly. Say it with words. Say it with flowers. Say it with food. Say it

with limbs. There is a reason bipolar disorder is considered a home wrecker. If there is anything else that carries within it the seeds of such catastrophic interpersonal destructiveness, I don’t want to know about it. Make sure that the

children you raise, the mates you love and the parents who struggle to under-

stand you know how much they mean to you because, when the dust settles on the apocalyptic emotional wasteland your last episode will leave behind it, that

feeling is the only bridge they might trust enough to make their way back to you.

Or the idea of you.

21 MARCH 4-10 2012

COVER STORY

date : 27th feb 2012 time : 3 am

name : AE

mind games 24 MARCH 4-10 2012 JULY 4-10 2010

What is it like to spend your life struggling with your own mind as your enemy?

Being unable to trust your own thoughts and feelings? This writer tell us how she went from being a victim, to actually helping other people who suffer from mental illness.

Life in school was lonely. I was simple, polite and shy, wanting to excel in studies but never attaining more than average grades. As a result, I was constantly stressed, depressed and fearful, and wasn’t able to hold on to friends.

As a family, we were not very social, never going to any social gatherings. My father stuck to his

family like glue which was really irritating and left very little time for us. Like my father, my mother also worked long hours and we were left to the mercy of male servants.

Having suffered sexual abuse as a child, I was very protective of my younger sister. I had been mo-

lested first by a male servant, then by my maulvi. I had told my mother about it and my father had

gone to the mosque and humiliated the maulvi for what he had done. But that didn’t stop me from

crying myself to sleep every night. At one point, I blamed God for not having prevented the abuse. At another point, I was convinced that my mother hated me.

School at the Convent of Jesus and Mary was a safe haven. But although I loved it, I couldn’t seem to

make friends. I really wanted to become a prefect but wasn’t able to. St Joseph’s College, on the other hand, was simply a blur.

Then came Aga Khan University. I was proud to be in the most prestigious medical college of the

country and loved my classes. But soon everything fell apart. One boy gave me red roses and I was convinced that every man liked me and that every woman was jealous of me. I couldn’t handle the pressure of studies and living in the hostel made it worse. I had come to AKU to become a doctor, not to find a match but could not stop thinking that if I could find the right guy, everything would be all right. Then in the 3rd Year it came to a head. The anxiety, depression and paranoia from the abuse made me break down.

My parents took me to a psychiatrist who only prescribed some injections and drugs. The Pakistani

doctors I was taken to were largely indifferent and always in a rush, hardly ever bothering to listen to

anything I had to say. On my father’s side of the family, there are instances of mental illness, mainly

schizophrenia. But because my parents are open-minded, I had a distinct advantage in battling my

condition. We emigrated to the UK and I found that doctors there were compassionate, tolerant and kind. What helped more than anything else was the fact that they listened to what I had to say. If I

didn’t want a certain kind of medication, they would give me an alternative. I also underwent cogni-

tive behavioural therapy which was a great help. The doctors really believed in me and were openminded about treatment.

I took up studies again, clearing, on my second attempt, the Professional and Linguistic Assess-

ments Board (PLAB) and the driving test, and started working at a hospital. But then I suffered a relapse. I hated being in the spotlight and having to handle the expectations and demands. Again I became fixated on finding a guy to marry. I was convinced it was essential to my happiness.

When the episode passed I started studying psychiatry, mainly to develop an insight into my ill-

ness. I felt the pain of my patients and believed deep down that they were victims of their circumstances.

Mental illness carries a stigma unlike any other illness. In Pakistan in particular, people feel that

those with mental disease deserve what they get. But it is possible to overcome psychiatric illness and live a normal life. For me, it was the support of my family and friends and a deep faith in God that got me from being a victim to being able to help others who are going through the same ordeal as I did.

25 JULY 4-10 2010 MARCH 4-10 2012

COVER STORY

from the other side

When you suffer from mental illness, you don’t suffer alone. The nature of the condition takes a huge toll on family members as well. Here, one lady talks about how she and her parents dealt with the discovery that her brother is bipolar

By Saamia Minhas

28 MARCH 4-10 2012 JULY 4-10 2010

It was on my birthday, at exactly 6:00pm on the 18th of November, 1990 when the phone rang. I picked it up eagerly as I was waiting for my brother Saam to call from his college in the US and wish me. Instead it was the dean of the college on the line wanting to speak with my father. I was confused and scared. I didn’t know what the dean said but all I saw was my father holding his head and looking down as tears rolled down his face.

in Pakistan, but once again, the only solution they offered was

It was an image and a day that I will never forget. It was the

cancer. He had fought his own disease with great courage and

day all our lives changed forever. Only now, over 20 years later,

have I found the courage to write and tell you what my brother and family went through all these years.

medication. Despite his own illness, my father made sure Saam completed his studies and got a degree so that he would be able to make something of his life.

Those years were a rollercoaster ride. Saam was in and out

of hospitals. He was made a guinea pig with different medica-

tions being tried on him by different doctors. It was tough, but he fought on against all odds.

Then, on 18th September, 2004, my father lost his battle with

a positive attitude but in the end it got the better of him. May Allah rest his soul in peace, Ameen.

When it came to Saam’s own condition however, I feel my fa-

My father told us Saam had been diagnosed with bipolar

ther never really accepted it. It was left to my mother to hold us

by his side. We had never heard of anything like this before

lives. Sadly, she suffered a stroke three years ago, and then we

disorder and quickly arranged for a ticket and flew off to be and couldn’t understand what was going on. The two days my mother and I spent waiting for our father to call were probably

all together and it was she who was the pillar of strength in our were truly left on our own.

This is when my Khala pointed us towards a local rehabilita-

the worst of our lives. When the phone finally rang, we learned

tion center. It was the best thing that had happened to us ever

hospital. Much later he told me he would never forget the way

years ago.

that Saam had been admitted in the psychiatric ward of a local my brother looked that day.

Saam had been in the US for only three months before this

episode took place. The doctors said it could have been culture

since the day we got the phone call from Saam’s Dean, all those Finally, we were told that the cause was a chemical imbalance

in the brain, that it was a condition that had to be managed.

More importantly, we learned that managing this condition

shock, an emotional trigger, or a genetic predisposition that led

is not just about medication but requires extensive therapy,

asked us to let Saam undergo treatment in the US, my father just

were told that Churchill, Einstein and Ted Turner, despite hav-

to his condition. Or it could have been all three. While the dean wanted him to come back home and get treatment in Karachi.

My Khaloo took us to the airport the day they arrived. My

mother and I waited eagerly at the arrival lounge and finally Saam came out. We hugged and cried as we didn’t know what

to expect but at the same time were so relieved that he was back home with us.

Saam went to several doctors until we finally settled on treat-

ment by one of the most reputed doctors in the field. Unfortunately, the treatment was based almost solely on medication and sim-

ply wasn’t effective. Saam didn’t get better and would find it hard

in which exercise and walking are very important factors. We ing bipolar disorder went on to achieve great heights and become icons for the world at large.

At first it was very hard to convince Saam to go there but now

he thanks his stars that he did. He has now managed to get some of his old life back, and to live as normally as possible.

He still has bad days, but is now able to manage his condition

on his own without relying on medication. He has now been

working for Adamjee Insurance for the last 10 years…a firm that has given him 100% support through his illness.

What the rehab has taught us is that Saam’s condition is noth-

to control his reactions, and would swing from being highly excit-

ing to be ashamed of or to hide from the rest of the world. We

tives to control these swings. And we suffered along with him;

help others who might be going through the same problem.

ed to being severely depressed. More and more, he was given sedanot a single day passed when my father would not fight with him

learned that what we need to do is to create awareness and thus

I take my hat off to Saam for surviving all he has been

at the dinner table, trying to stop him from overeating. I started to

through. I have heard of many people who have lost their lives

Then came another blow: my father was diagnosed with can-

with bipolar disorder is easier said than done, it’s tough on his

prefer staying hungry than sitting at the table with them.

cer. So now we not only had Saam to deal with but my father as well. Then began the extensive rounds of chemotherapy and radiotherapy, and we were forced to constantly remind Saam that he wasn’t the only one suffering, that our father was fighting for his life.

Saam began treatment at one of the most reputed hospitals

without family support or correct treatment. Helping someone family and his loved ones, but that’s nothing compared to what the person himself goes through.

As Astrid Alauda said: “There’s no other love like the love for

a brother. There’s no other love like the love from a brother.”

Saam, I am proud to be your sister and may Allah always give

you the very best of health and happiness always. Ameen.

MARCH JULY4-10 4-102012 2010

29

COVER COVER STORY STORY

four

Everything in its right place

An unwanted thought, pervasive doubt, dislocated dread — OCD appears laughably simple, sometimes even to those who suffer from it

BY VN

32 JULY 4-10 2010

MARCH 4-10 2012

One two three four. One two three four. One two three four. One two three four. One two three “now I can just trust in God and pick up my book”. Quickly pick up book: check.

Have no ‘unwanted’ thoughts during this time: check. And if this whole process doesn’t feel JUST right, you do it again. Sometimes up to a hundred times, but mostly about ten or twenty.

All this happens because 19 (4 fours and a three) is a good number. So are 21, 29, 7 and 43 (but not 143); on the other

hand, 12, 13, 6, 78 and 182 are not. There is no reason as to why they are what they are, at least not anymore. What started out as a semi-rational avoidance of certain numbers is now a militaristic regimen which, at times, controls my life.

I have obsessive-compulsive disorder or OCD. Unlike many other people who suffer from psychiatric diseases,

diagnosis was of little relief to me. In fact, it was a bit of an anticlimax, because I already knew what was wrong

when I went to a well-known doctor. He wouldn’t give me the time of the day. It took seven years, and a significant worsening of the symptoms, for me to go see a doctor again. And while this second doctor was a lot more helpful, he

simply wasn’t qualified enough to treat a somewhat unforthcoming patient. I eventually lied that I was completely better to get rid of the increasingly frustrating therapy sessions. OCD is different from other mental illnesses be-

one

cause you know you have OCD. You know you’re in control, and these thoughts and resulting compulsions are irrational. And yet you do them anyway. So you have unwanted thoughts (obsessions) that make you uncomfortable,

and you perform rituals (compulsions) to try and alleviate this discomfort. Except this relief is only temporary, so then it’s more obsessions and more compulsions. This feeling of going around in circles is deadening.

The ‘disease’ (disorder, therapist no. 2 always reminded me; it’s a disorder) has mutated so much over the years

that it’s hard to recognise. It started with a persistent unwanted thought when I was 18: I kept thinking of the words “I hope my mother dies”. The more I tried to get rid of this thought, the more entrenched it became. So I made

the first of many homemade antidotes: “I hope my mother doesn’t die”. Saying this again and again, sometimes silently, other times under my breath, and aloud when alone, I thought I could get rid of this unwanted thought.

In retrospect, I gave that thought too much importance. If I’d ignored it then, it might have gone away. I left it to

two three

fester, and it became a sore. More unwanted thoughts popped up, with more ‘solutions’. People were going to die, go to hell, I was going to fail my exams; any rational fear could be converted into an irrational, incoherent dread.

OCD is often called a disease of pathological doubt (by Wikipedia, not me), which sounds exactly right. I spent hours obsessing over whether I’d had a ‘wrong’ thought, and then trying to pacify myself by either clarifying that

I’d actually thought something else, or explaining away the thought. It took up more and more of my time, until it was what I was doing, actively or passively, for the better part of the day.

Other than picking up books, I have had discomfort (ranging from mild to incapacitating) starting to eat, turning

on a computer, praying, washing my hands; anything that could be doubted (and some that couldn’t, but I doubted

them anyway). About three years ago, at its absolute worst, a change of clothes and trying (and failing repeatedly) to make a phone call could take up three hours. That is what eventually drove me back to therapy.

OCD is also a very embarrassing disorder, because you hold on to doorknobs too long, mumble things which

people overhear and which you then have to deny. You also disappear from restaurants when food is served so you can go be alone and start ‘right’. The definition of right is, of course, subjective. The self-awareness, however, is

amusing by now, because I’ve had the time to look at and laugh at the silliness of what I do. I’ve read stories about people suffering from other variations on this theme — their OCD is based on a fear of germs, or of being responsible for accidents — and their concerns seem downright hilarious to me.

I’m also always on the lookout for reassurance. Did I have that thought? Will God forgive me for it? Will said un-

wanted thing happen because I said it? I know the answers to all these questions. They’re easy. But somehow I can’t

shake the feeling that it might happen anyway. So I go and ask people I think would know. My cousin. My doctor.

My friends. It’s taken a while, but now I’m comfortable enough telling my closest friends about it. And their reassurances help, for a while. Then it’s back to square zero and more reassurances and more relapses and so on.

I don’t think this disorder will go away completely, and by now I’m more or less comfortable with this thought.

People with OCD can live more or less normal lives if treated (yourself, or by a therapist); untreated, it becomes im-

possible to manage. Maybe I’ll see another psychiatrist at some point. If that sounds underwhelming, it probably is.

33 MARCH 4-10 2012

JULY 4-10 2010

INTERVIEW

By Zarrar Khuhro Nestled at the end of a quiet lane off Karachi’s Gizri Boulevard is the Recovery House, a rehabilitation centre for people with psychological illnesses. With a tasteful, bricked exterior and a spacious sculpted lawn, it looks just like the other buildings in this residential neighbourhood. There

into perspective for me that the lives of mentally ill people are

the atmosphere is like that of any other home. And that’s just

munity centres, attended conferences to see how their system

sion was that ‘this is all the care these people deserve,’ and that was tragic.

So how did you go from that realisation to setting up this facility?

are no signboards to mark it as being any different, and inside,

SA: I joined mental health boards in the US, volunteered in com-

how Shaheen Ahmed, founder and president of the Caravan of

worked. Then I started to see which of these practices could be

Life Pakistan Trust, wants it. Pioneers in psychological rehabili-

tation, Shaheen and her co-workers are out to change the way mental health issues are treated in Pakistan. I met Ms Shaheen

and the Recovery House’s consultant psychiatrist Dr Uzma Ambareen to learn exactly what was different about their approach.

What made you get into the mental health field?

SA: Growing up in Pakistan in the sixties, I had siblings who suffered from severe mental illnesses, and at that time we didn’t know if it was an illness or simply a behaviour pattern.

applied in Pakistan and made contacts with mental health professionals in the US, trying to convince them to help train Pakistani mental health professionals. The medical model of treat-

ment existed in Pakistan already, but the next step in treatment in the US was psychiatric rehabilitation, so that was the knowledge I wanted to bring back. We’ve been actively working in Pakistan for 8-10 years, but I think this is still just the beginning. Our

goal here is to teach the tools needed for psychiatric rehabilitation (PR).

While they may have the best practices in place in the US, there

We only learned what was wrong when we took my sister to

are also barriers to treatment that don’t exist here. I openly told

a decade had passed, and I felt that if we had learned earlier,

and do a better job of rehab here in Pakistan. You could say that I

the UK, where she was finally diagnosed. By this time, nearly

then perhaps we could have done something about it in time.

When we returned to Pakistan in 1967, I started to explore the facilities here. We travelled across Pakistan, visiting facilities

and meeting mental health professionals. Nothing came out of it. The only solutions they offered were medication and Electroconvulsive Therapy (ECT), which is a horrific procedure. At this point I had moved to the US, and when I used to visit Pakistan,

I approached these professionals to say: “What can I do for you

in terms of helping arrange training and knowledge exchange from the US? How can we make this work?” Unfortunately, we

failed at every attempt. It was very discouraging and heartbreaking, but it seemed everyone in Pakistan thought the services

38

viewed as being of lesser value than healthy people. The impres-

they were offering were sufficient. That’s when it really came MARCH 4-10 2012 JULY 4-10 2010

medical professionals in the US that we could take their practices was just trying to pique their interest, but I actually believe this.

We have a very strong social and family support system here that

they lack. The US legal system and the culture of individuality

can actually hamper treatment. For example, an adult can simply refuse treatment, saying s/he doesn’t need it. Ironically,

refusing to acknowledge the problem is also a symptom of the illness. Also, in the US I’ve found that employers are unwilling

to hire people with mental illness, because they are afraid of legal liability. Here, we’ve found that many employers, when approached, will do it ‘Allah wastay’, as an act to earn sawab. That’s

important, because there’s no point bringing a patient down the road to recovery if they can’t later be gainfully employed. That’s a very important part of leading a whole, normal life.

Tell me about psychiatric rehabilitation, how does this differ from more traditional forms of treatment?

Dr Uzma: The difference is that the usual methods focus on symptom

reduction and simply bringing the illness under control, but not on taking the patient forward to having as normal a life as possible.

That includes developing their social skills, and reintegrating them into family and community life. This is where psychiatric rehabili-

tation comes in. It’s the next step after the medication ends. Unfortunately, that usually doesn’t happen here, or if it does, then it’s in a very disjointed way.

SA: We are giving birth to the concept of PR in Pakistan, by training

and teaching people. For example, we made a five year commitment to Karwan-e-Hayat to train their people in PR while paying the fees

ourselves. We have online classes and held by experts from the US who also visit a few times a year. Thus far, 22 people have been certi-

fied in the field and others have done non-certificate courses. It’s a slow process, but eventually we hope to move from training to a consultative role.

Most mental health patients complain that the only solution doctors offer is medication. I’ve rarely heard anyone focus on rehabilitation. Why is that?

Dr Uzma: It’s because of lack of time and expertise. PR requires a

trained team. We have psychiatrists and psychologists in Pakistan, but we don’t have psychiatric nurses or social workers, occupational

In the US I’ve found that employers are unwilling to hire people with mental illness, because they are afraid of legal liability. Here, we’ve found that many employers, when approached, will do it ‘Allah wastay’, as an act to earn sawab

therapists or case managers. These jobs require specialised training, which simply isn’t available — those who go abroad for training don’t usually return. We provide that training, but unfortunately I

don’t think that most professionals in Pakistan even know that yet, or see the need for it.

Medicine is not necessarily the first step in a lot of cases. Most of

the time people will delay seeking treatment and had they not done that they could have been treated with therapy. In cases of bipolar

disorder, for example, since it’s an actual illness, some medication is inevitable. But with other syndromes, like depression, counsel-

ing and lifestyle management can solve the issue. Even Obsessive compulsive disorder (OCD) is now considered to be a chemical disorder. A certain part of the brain is overactive in OCD and when we medicate the activity level decreases, showing a clear response.

What role does this facility, the Recovery House, play in all this? What happens here?

SA: This is a direct service facility. It’s a 10-bed facility, with a day treatment programme as well. That’s a comprehensive, integrated

programme with one on one counselling sessions, yoga, art therapy, computer classes, games and skill building. All of these are proven, evidence-based practices. At the moment, we have 12 day clients

and four residential clients who have been successfully discharged.

39 MARCH JULY4-10 4-102012 2010

INTERVIEW

One patient came to us with acute mental illness, and went all the way from stable to rehabilitated. We even helped him get a job by contacting an employer whom we briefed on his condition. He still comes in once a week

for counseling and, if there is an episode, our case manager goes and speaks to the employer to smooth things over. But our end goal is to have him stand on his own feet without our active help.

What’s the biggest misconception re: mental health in Pakistan and the biggest barriers to treatment?

Dr Uzma: That it’s all in the mind, all in the patient’s control, that they are just doing ‘drama’. I can tell you that

even in my profession, there are people who believe this, so what can you expect from the non-medical public?

I have patients come to me saying their doctors told them they were fine and had no need for medication. Very few GPs have an awareness; the rest are dismissive.

I’ve been practicing 14 years, and yes there is a lot of stigma but that doesn’t mean families throw out or disown

the patient. Whether they will actually take the patient for treatment is something else. They will go to mullahs, pirs etc first. Then sometimes they will hide the treatment. They don’t usually exile them to mental wards. That only happens when there is no hope for treatment or money, or if there is no one who can take responsibility.

Shaheen: The biggest problem is also getting the client to admit they need help. Admitting that you have an illness is the first step on the road to recovery. There are people who will never gain that insight, but that doesn’t

mean they can’t be treated. A misconception is that people with mental illness cannot live life, and that’s not true. But at the same time, it’s not like a fever that will pass with the right medication. It’s more like diabetes:

an illness or a condition that will never fully go away. As with diabetes, you will have to observe certain proto-

cols throughout your life, but you don’t stop living. So patients have to be taught about their illness, the way it works, its symptoms and how to live with it. We tell them: “Don’t put your life on hold. You still need to live life, wake up in the morning and brush your teeth.” Will it work for everyone? No. Will it work for a great many people? Yes. Should the effort be made? Absolutely. The tragedy is how easily people give up. If they have a family

member diagnosed with terminal cancer, they will seek a second opinion and then a third. They will go abroad

and try everything they can. Hope never dies in those cases. But in the case of mentally ill people, many times

40

that hope never even starts. a MARCH 4-10 2012 JULY 4-10 2010

REVIEW

horror potter and the dark shadow

BY NOMAN ANSARI

In terms of quality, this horror film adaptation of the 1983 novel The Woman in Black is neither black, nor white, but shades of grey.

On the one hand, the film is easy to soak in visually because of the great cinematography and production values. On the other, thanks to run-of-the-mill scare tactics, which eschew fear for shock value, it seems unable to stand out of the crowd.

The film tells the tale of solicitor, Arthur Kipps (Daniel Radcliffe) whose beloved wife Stella (Sophie Stuckey) died during childbirth, leaving him to care for his four-year-old boy, Joseph (Misha Handley). On top of the pressure of being a single parent, Arthur is also under stress from his employers, who send him to a small town to handle a troubled estate. Upon arrival, Arthur is shocked to discover that the children of the town are mysteriously committing suicide, and is met with hostility from the locals, who blame his investigations into the estate which they believe to be haunted. While conducting his investigations, Kipps finds unlikely allies in landowner Sam Daily (Ciarán Hinds), and his spouse

better off dead

BY NOMAN ANSARI

Directed by Swedish directors Måns Mårlind and Björn Stein, Underworld: Awakening is a slick looking action/horror flick, which is heavy on the gore and fan service, but tells a tale too thick, and features characters too dull, to be interesting. Frankly, there is only so much you can tell about the war between vampires and werewolves, and Awakening is the fourth installment in the franchise, carrying a plot that is long-winded as they come.

Set after the events of Underworld: Evolution, the film reveals that humanity has decided to cleanse the world of vampires and werewolves, calling them ‘the infected’. Selene (Kate Beckinsale), the vampire hybrid who has been genetically modified to have extra abilities, escapes from cryogenic suspension in a human medical corporation called Antigen. She quickly learns that twelve years have passed since her capture, and that humans believe they have eradicated all werewolves, and are on the verge of finishing off the vampire race as well. She also starts getting visions, which she believes will lead her to her love interest from the previous films. But these visions instead lead her to befriend other vampire survivors, including a mysterious vampire named Eve (India Eisley), who was also one of the test subjects in the lab, and was the one

Elizabeth (Janet McTeer), a couple that are more deeply involved in the mysterious events, than they realise. Eventually, Arthur’s resolve meets the ultimate test, when his own son, Joseph, becomes entangled in the events.

Radcliffe delivers a fine performance, though one must question his attempts to break out of the Harry Potter persona and not be typecast since he stars in a film where he must battle an evil creature of supernatural origins.

One must also question Radcliffe’s decision to play a hero who is as dim-witted as they come in the horror genre: It takes Arthur Kipps the entire movie to discover what the spirit haunting the house desires, when it was fairly obvious from the very beginning. Not only that, but he constantly puts himself at risk by doing things like staying alone overnight in a house that is clearly haunted, running into buildings that are on fire when no one else is willing, and smashing into empty locked rooms, from where he can hear loud and scary noises. Perhaps someone forgot to tell Kipps that he is merely a common solicitor, and not a wizard who had just slain Voldermort.

who released Selene. Later Selene discovers some surprising details about Eve’s origins, as well as her abilities.

Meanwhile, the director of the medical corporation Antigen, Dr. Jacob Lane (Stephen Rea), is shown to secretly be a werewolf, alongside his son, Quint Lane (Kris Holden-Ried). It is also revealed that the antidote the corporation has been working on is in actuality a serum that will remove traditional weaknesses from werewolves, and enhance their overall strengths. To complete the production of this serum, Dr. Lane needs to recapture Selene, and sends his son, alongside other werewolf goons, to get her back. What follows is a lot of tedious action, with the film highlighting Selene, as she rallies vampires to battle both werewolves and humans, while looking to rebuild their race.

In the end, Selene narrates her desire to continue her search for her love, Michael, by which time I lost complete interest. The only way in which the characters from Underworld could be watchable, was if they slaughtered the cast of Twilight: Breaking Dawn 2. Now, 41 that would be a vampire/werewolf film worth watching!

MARCH 4-10 2012

THE HATER

10 things I hate about

1 2 3 4 5

…shopping

BY TARBIA HAMID

The bargaining. One thing I love about malls and high end boutiques are the fixed prices. Nobody ever thinks of arguing there but in the markets it’s a completely different story. Sometimes I feel like I’m a lawyer in

some court, continuously giving justifications as to

why I am right. The judge and the defender, however, happen to be the same person aka the shopkeeper.

Association with girls. For the umpteenth time, not

all girls are born shopaholics. Some of us are just as dumb when it comes to shopping as boys are.

6 7 8 9 10

The so-called sales. Honestly, just stop with the ‘up

to 70% off’ nonsense. The clothes on sale are not even worth looking at. And the stuff you really want is usually not even included in the sale. But of course, it is

well known that if you hang a few sale banners, the women will automatically come.

Running out of money. You know how sometimes in a hurry we don’t bother taking much cash on the way to

shopping because we usually plan on buying this one thing and then rushing out? It always happens that when something really catches your fancy you don’t

have enough money. And of course it’s the last piece available too.

The parking. There is never and I repeat NEVER enough parking space the day you choose to go shopping. Yes, there have been several tickets and even a few towtruck related incidents.

The aimlessly wandering people. While I have no beef with window shoppers, I hate it when they block the way. There should be a traffic rule for these situations.

The ogling. There have been very few times when one can actually make a trip to the mall and escape this.

Boys will be boys but what the heck is up with the star-

ing girls? I never can tell whether it’s admiration or hatred. What’s that? You think its appreciation? What are you, mad?

42 MARCH 4-10 2012

What you’re looking for is never there. Most of us usually have an idea of what we want to buy, and when we

don’t see it, we usually end up wandering from shop to

shop until finally — yes, you guessed it! We go home empty handed!

The regret. Have you ever not bought something you really liked and then obsessed over it for hours at home?

It’s tiring. So very tiring. You step out with just a few things in mind but soon enough one thing leads to another and before you know it, you have your hands full of bags, credit down to half and severe lower back pain.