Shahwar* was a girl in her mid-20s, living with her family in an impoverished neighbourhood of Karachi. She was the youngest of four brothers and three sisters. A talented embroiderer, she dreamed of owning her own karkhana (factory) where she would supervise a team of women.
On a Sunday last month, Shahwar overdosed on her psychiatric medication and left the world.
She did this because she could not bear the cruelty of her brothers any longer. Every time I have shared this painful news with others, I am asked, “Physical abuse?” The answer isn’t no. Yet, Shahwar would tell me that wasn’t what got to her the most.
As someone who had been Shahwar’s counsellor in the recent past, I think the best way to describe her cause of death is unrelenting emotional injury. When her father delivered the news to me, he said:
“You know, her brothers had made her life hell. She stopped eating for days and then she took all her pills.”
When I went to her funeral, what struck me was that I could only hear her father’s second sentence being reiterated; those in attendance only paid attention to the fact that she overdosed, and that she was a psychiatric patient.
All that was being discussed was her behaviour. What about the underlying cause? Is the notion that people with a mental illness tend to commit suicide the only conversation to be had?
Also read: Suicide, and the warning signs we miss
Think back to the last time someone you knew of died in a car crash. Did you simply conclude that people who have been in a car crash tend to die? Or did you question the cause of the crash; then go on to discourage friends and family from speeding, drinking and driving or taking that one accident-prone route?
Do the same in this case.
Dig beneath the surface. Don’t hide behind the fact that Shahwar was a psychiatric patient, because this too, has a cause.
Research suggests that people with mental illnesses have a genetic predisposition, but symptoms are most commonly triggered by emotional stress and pain. This ranges from the death of loved ones; major life changes, such as moving or becoming a victim of a crime, to hostile relationships or living under conditions of war or poverty.
Each time Shahwar’s brothers disparaged or shamed her, she suffered an emotional injury. Each beating was a physical and emotional injury. If injuries are not soothed in time, they can form deep-seated wounds. If the wound is left untreated, it can become infected.
We don’t question this when it comes to physical injury, because the wounds are visible. The suffering is visible.
Each time Shahwar’s father defended her or expressed his affection, her emotional injuries were soothed. Unfortunately, her father could not protect her all the time and a wound formed in her psyche. Shahwar went into treatment, but the injuries kept coming. Eventually, she could not keep up and decided to take respite in death.
Shahwar is only one out of six million sufferers of mental illness in Karachi. The statistic is one of the highest in the world; a world in which depression is predicted to be the second leading cause of disability by 2020.
See: The alarming rise of teenage suicides in Pakistan
While there is growing dialogue around physical abuse, more of its emphasis needs to be on its mental and emotional consequences. Even more dialogue around mental illness is needed, with particular emphasis on its causes.
Treatment and support cannot reach everyone in time, nor can it be available to them for as long as they need. Given the escalating nature of mental illness and the dearth of resources, addressing this issue is quickly becoming the need of the hour.
Karachi’s ratio of mental health service provider to consumer is 1 to the 100,000, let that sink in for a moment.
*Name has been changed to protect identity.
Information on existing mental health service providers can be found via the Mental Health Forum. The author works for CareForHealth, one of its member organisations.
Opportunities are available for those who would like to volunteer to educate Karachiites, about mental and emotional health, as well as for those who would like the awareness to be targeted to their community.