The research article titled, “Manifestation, Attribution and Coping with Depression among Asian Indians from the Perspective of Health Care Practitioners” published in the Journal of Transcultural Nursing in 2005 discusses in some detail how the Indian social and religious beliefs impacts us in the US and how those affected with a mental disorder cope with the illness in the US.

The primary reason for Asian Indians not seeking help in the US could be the lack of awareness of resources or the existence of a mental disorder.

Not too long ago Perveen Babi a popular actress in the 70’s and ‘80’s, featured on Time magazine’s cover in 1975, known for her unconventional behavior and roles suffering from paranoid schizophrenia was reported dead on January 20, 2005 in her Mumbai apartment. The oddity of her behavior had been reportedly witnessed by several on numerous occasions. It is said that many tried to help her as best as they could. But alas it was too late. In her later years she lived her last years as a recluse with diabetes. Mahesh Bhatt’s semi-autobiographical movie Who Lamhe is his tribute to their relationship.

Recently there have been a handful of other movies like Hiding Diva, 15 Park Avenue, and Maine Gandhi Ko Nahin Mara that deal with mental disorders, but by an large mental illness remains hush-hush because of the social stigma attached to such illnesses.

Diseases such as diabetes, heart conditions, cancer can easily be blamed on stress, eating habits, and the environment. Some of us even proudly go out in public with our several inches bigger than healthy waist-line because of our age-old belief that the size of our bellies or being overweight reflects our prosperity. But most people suffering from mental illness go unnoticed in society. If they do get attention, it is not the correct type of attention. This is not necessarily because medical help or support might not be available, but because of the barriers associated with seeking and receiving help.

How does one explain to society at large that their autistic child is not their fault? Or the fact that their child has attention deficit hyperactivity disorder (ADHD) is not their fault? And neither is depression or anxiety in their spouse or child?

How do make sure we do not commit suicide or are not responsible for helping our loved ones try to take their lives?

Our first instinct is to immediately deny that no such thing could happen to us. Because we are after all one of the most educated, affluent, upward mobile and politically savvy ethnic immigrant community. We are Indian-Americans.

But let us not forget that we have left our homes to make a new home in a foreign county, some of us voluntarily and others not so voluntarily. Even to the most adaptable of us, this can prove to be stressful. Once we arrive, we have to adjust, accommodate, keep compromise, and keep proving to our selves and others 24/7 that we are just as good, if not better than others at what we do. At some time or another we face depression, anxiety, stress, isolation, feelings of guilt, pressure trying to assimilate into mainstream American culture outside our homes. In the case of some of us, these symptoms are heightened by socio-economic status, family structure, work conditions, cultural expectations, violence, generation gaps, and the universal gender discrimination.

Whereas elderly women report feeling isolated due to lack of established family and social networks, which served as support systems back home.

What and where does this get us? We get to keep our jobs, climb professional ladders, put our kids in good schools, and do our best to make sure their lives are secure at the expense of our health and families. We even try to get dual citizenships.

At the end of it all, if things don’t always work out as we expected or would have liked to, what then? Whom do we turn to? With the change in our family and social structures talking to a friend or two is not always a viable option.

In general, feelings are kept bottled in going day in and day out about our business. And it works for most of us, because perhaps we expect a certain level of disappointments, misery, stress, and aliments because we are originally from another country, belong to more than one place, in more than one sense. We speak differently to the native’s; our English is not quite of the Queens. Ours has color, whereas there is bland. We know this and even make light of our accents and differences during stressful moments in our lives as foreigner. But how do we face problems that persist and do not going away in spite our trying to make light of them?

It not surprising that November 2006 results from the Asian American paper drawn from the first larger National Latino and Asian American Study (NLAAS) showed that overall Asian immigrants have a lower prevalence of a mental illness compared to all Americans (almost half, about 25 percent).

For this paper, the researchers interviewed from May 2002 to November 2003 nearly 2,100 native-born or immigrant Asian Americans who were 18 or older. Participants included 600 Chinese, 520 Vietnamese, 508 Filipinos and 467 other Asians including Japanese, Koreans and Asian Indians.

However, according to the National Institutes of Health (NIH), based on NLAAS, US born children of Asian immigrants are not so fortunate where mental health is concerned. They have more lifetime cases of mental disorders. What is disconcerting is not only that Asian American immigrants seek less help, but also their children show similar patterns in terms of seeking mental health care compared to the general population.

The burden of mental illness is high among Asian Americans. This is reflected in the high statistic for suicides rates, more so in the immigrants from India.

A study done by Patel SP showed that suicide rates of young women immigrants from the Indian subcontinent are consistently higher than those of their male counterparts and of young women in the indigenous populations of the countries to which they immigrate. In most cases, family conflicts appear to be the precipitating factor. More research is needed on the epidemiology of psychiatric illnesses and their contribution to suicide in Indian immigrants.

It is not surprising that Asian Americans show lower rates in terms of seeking help for mental disorders. The associated stigma and importance to social status does not make things easier. In the study presented at American Psychological Association 2005 Annual Convention in Washington, D.C., the investigators found that 74 percent of Asian-American NLAAS participants said they had experienced some kind of unfair treatment and 63 percent attributed such instances to racial factors.

It has been speculated the disparities in treatment could be due to the unfamiliar culture or their proficiency of the English language, making seeking treatment less important.

Unfortunately, when Asian Americans with mental illnesses do present to primary care providers, providers often find it difficult to identify their patients’ mental disorders, because typically these patients present to their primary care physician with somatic (physical) symptoms such as dizziness, aches, and pains. Doctors don’t tend to ask about mood and feelings, making mental illness under diagnosed in such patients.

Lack of understanding different cultural sensitivities further hinders accurate diagnoses, since unlike other illnesses mental disorders can be diagnosed only from verbal and nonverbal communications with a doctor.

According to the US Surgeon General’s Report, finally when Asian Americans do use mental health services, severity of disturbance tends to be high, because of the delay in seeking appropriate treatment.

When Asian Americans do get prescriptions for their mental health, successful treatment with drugs is often times less, because compliance is low due to more side effects compared with Caucasians or other the races. In short, a lot more needs to be done towards helping Asians have better mental health in terms of medical practices. After all they are an influential race in America in terms of education and financial progress of the country.

It is not surprising that the supplement released by The US Surgeon General in 2001 to a report on mental health entitled “Culture, Race, and Ethnicity,” states that “culture counts” in the diagnosis and treatment of the identified ethnic groups.

The clearly increasing cultural diversity of the country requires that physicians without ambiguity understand how cultural differences impact diagnosis and treatment.

According to the February 2007 survey report released by American Community Asians released there are at least 12 million Asians, a 4.2 percent of the total population, and the number is increasing rapidly. According to a May 2006 CNN report there was a 3 percent increase in Asians in the US from 2004 to 2005, yet the US Surgeon General’s Report shows that there are only about 70 Asian Americans providers available for every 100,000 Asian Americans in the U.S., compared to 173 per 100,000 Caucasians.

The dilemma with mental health is that most consider “Asian Americans” as a single entity, wherein the term includes more at least 43 different ethnic subgroups originating from different countries and speaking over 100 languages and dialects, making effective communication on both patient and physician side challenging and reporting of accurate analyses. Pacific Islanders are also lumped in under the term.

No reliable information is available regarding the Asian language capabilities of mental health providers in the U.S. To add to the problem, overall about 21 percent of Asian Americans lack health insurance compared to 16 percent of all Americans.

The Centers for Disease Control Fact Sheet indicates that disparities in mental health between races in the US exist. Only 25 percent of Asian Americans are likely as whites and 50 percent likely as African Americans and Hispanics to seek outpatient care and are less likely than whites to receive inpatient care, which largely accounts for their under-representation in most mental health services.

If these trends continue, rates for Asian Americans with mental health problems will rise dramatically, especially since we know that patients with chronic illness such as diabetes tend to have a higher prevalence of depression, impacting costs from every angle and at each level.

It is obvious that more needs to be done for this group in terms of research, prevention and treatment, in particular for the Indian-Americans as it has been reported that the suicide statistics for immigrants in general from the Indian subcontinent are at least 2 to 3 fold higher (particularly in the UK) compared to other countries in Southeast Asia.

More needs to be done so that the Asian American community seeks more help before mental health crises.

“INTERNET RELATIONSHIPS”, probably the most newfangled trend in today’s world where people wrap themselves in anonymity, share all their feelings for hours together behind a simple LCD monitor, least they know that the person on the other side is a genuine or not. As we all see the technology is rising to its peaks and so are the relationships, from the days of pigeons to letters; today’s world deals with E-mails and Bluetooth. CYBER LOVE, CBER SEX, CYBER MARRIGES, the world today is submerged in CYBER. If we go deep into statistics and try to analyze, 6 out of every 10 teenagers are addicted to the new type of so called “cyber drugs”. The question “WHY?” remains unanswerable; it could be due to loneliness or depression or a combination of numerous other reasons.

Studies reveal that these new age relationships help in better understanding of each other; but the question is, is it really true? Judging a person through a keyboard sounds ridiculous, but do we stop? I guess, NO. Masking one’s emotions, feelings through words proves that we are all so dependent on technology, more than we would want to.

As life evolves from metal age to electronic age, so do the relationships; from multi media messages to short messaging services, all these inventions have become a threat to the human society. So, has the time arrived where our inventions are acting as our own curse or has the age arrived where machines are, in a subtle fashion, taking over the human world?

Questions always remain as questions or probably could go down the history lane as “the world’s unanswerable questions” but ‘what is the ultimatum?’ remains another question.

They use every possible means to reach the school, to adhere to the rules. Formally, their intent is education, easing the minds of business minded fathers and soothing the nerves of ever fretting mothers. Informally, who knows why each one comes , at such a religious pace, to school. Some come to escape being married off to some old, bride buying fart, who’s already got three wives with seven children each. Others to escape the pressures of home life. Yet others come to loiter around, kill time, make mischief..*their parents live in the vain hope that school will tame them*. And lastly, few , very very few, actually come to study, to evolve, attain knowledge.

Yet no one knows how much this education is worth, and if it will get them anywhere at all. Hope compels them to try!

Every school is a different world behind its four boundaries. The smells tantalize the taste buds of many different kinds, all depending on which scent they pick up, and choose to take heed to! Mischief makers sniff around for a chance to make trouble. Truants snuffle out ways to escape entering the gates of no return (for a few hours anyway!) Others are attracted by the greasy smells of biryani (rice and meat cooked together, flavored with saffron and all spice and lots of other yummy ingredients), and French fries and kebabs wafting from the café, while anorexic girls are repulsed by it. Some follow the trailing uplifting scent of freedom, that is so faint, but glows ever so slightly in the dark smog of ignorance, only very few hold on to the yarn of liberation and find ways to express themselves, spiritual uplifting is sought in the manner of community service to ease the guilt-ridden conscience of those who haven’t been so regular with their prayers lately, and so find solace in giving back to community.

The world comprises of have’s and have not’s. Black and white. These two apply in every aspect, be it personality, character, morality, monetary, belief, success, modesty, popularity, family, and values. You either have it, or you don’t. Black or white.

We enter school life, a transitory period, with our own respective black and whites, which are given a chance to change vice versa from their initial state. Three things can happen. Black can become white, and white can become black. Meaning to say, there can be interchanging in the things you once had. For example, you maybe rich today, but poor in the years to come. Black can increase on one side or white can increase elsewhere, creating an imbalance in nature’s well balanced tightrope. For example, your status in the world could lean more towards the categories of the ‘have’s', or the other way around. Or there can be no change at all, meaning to say you could remain as you are, right at square one, just like you started off.

No matter which way the scale tips, the black remains black and white remains white.

The yin and yang of life.

Once school is over, stumbling through those 11 to 13 years, comes the fork fate places in our path. Familiar faces shall soon be gone, there will be new schools and new environments to adjust to. It is up to us to choose the good from the bad, and implement it.

We will all be have not’s in a way, deprived of each other’s company, experiences we might have shared. And we will reminisce wistfully and sigh, every time we drink hot tea and have hot fries, we will think about the time we all soaked in the rain, and the way the thunderous sky wept in torrents, lashing us with rain and cold wind, pelting us with her grievances, purging herself of all the filth we exposed her to. And how all was right in the world again, if only for a while, when Mr. Sun shone through, calming down the great big canopy, making her flash her deepest blue, maybe even a rainbow or two.

So time will journey us by, and snatch away our blankets of security and comfort, leaving us clawing at it, and prizing it from our fingernails. And we will stumble about looking for it, with eyes never drying, the grief never ending, the urge to go back an endless thirst. Fate tipped us out of our cradles, and left us on the cold grey asphalt, while grown ups with ill intent leer at us, and try to manipulate us, knowing we are still wet behind the ears.

Our friends move on to where the grass looks greener, people roam freely, scantily clad despite the cold weather, whether dark or light skinned, but western minded in nature. It makes no difference, limbs fly akimbo, askew, causing the damage they deem as goodness, the warmth of beer rushing down their throats, the heady sensation of the white powder they inject in their veins. We shake our heads and watch on, as these prized fools continue to destroy their brain cells, and prepare to be the new generation, one more ignorant than the last. **

We have not’s sit and thank our blessings for our values, and for being treated as first class citizens, not directly under foreign oppression. We hold our heads up with pride and stand firm on our justly won land, sow as we have been taught, and hold ourselves responsible for what we reap.

Surely, yes, we have corruption and inner conflicts, and heartlessness sometimes. Surely, we have misguided souls who got lost somewhere along the way. Surely, we grumble and complain, and mutter under our breaths when having to submit to our elders, old fashioned ways. But secretly, no matter how annoying, we are glad to be amongst our own, in a culture we have been taught, against which contradictory beliefs are offensive. And we sigh with contentment, after a hearty spicy flavorful meal, and think, that we have not’s are so much better off!!

Author’s Note:

** I hope nothing in this specific paragraph was offensive to any race or any culture, and if it is, please forgive my ignorance, and point it out to me. The idea is not to offend anyone; it is simply a thought that flowed as I wrote. Oversight is possible in the rush to jot down creativity. Forgive me if I made a mistake, it was not intentional.

Over the last hundred years, Western societies have seen a change in attitude, with emancipation and empowerment of women bringing about a major revolution in their status. Unfortunately, Eastern societies by and large still remain mired in centuries-old traditions strongly emphasizing stereotyping of gender roles. However, despite widespread gender-bias in these societies, women are surprisingly resilient and competitive. Four major Eastern nations, Pakistan, Bangladesh, Indonesia and Turkey, comprising at least half the world’s Muslim population, have had women Prime Ministers. Pakistan has also recently elected a woman as Speaker of the National Assembly.

Conversely, when we look at the wider picture, the status of women presents a dismal picture. They are encouraged to be submissive, dependent and subordinate with the majority having little or no control over any kind of economic or political decision-making, as well as in everyday issues like marriage, number of children, dress code, access to basic health facilities and career aspirations. Men, on the other hand, enjoy a privileged existence. A male child has priority over his female sibling in access to food, education and health. Not surprisingly, the percentage of males outnumbers that of females in Pakistan as is evident in a report of The Demographic and Health Survey of Pakistan – a trend opposed to that prevalent in the rest of the world. One of the important causes of this discrepancy is high mortality rate in childbearing young women. This mortality rate for women is estimated to be twice as much as that of men of the same age-group.

A major obstacle in the way to empowerment of women is gender bias leading to economic dependence. The UN Gender Empowerment Measure (GEM) has ranked Pakistan as 100th among 185 of its registered countries. Social constraints prevent many capable women from pursuing active careers and achieving economic independence. According to Government of Pakistan figures, the percentage of working women in Pakistan is only 14% – a dismal picture for the future of a country that badly needs as many working hands as possible in order to not only improve its standing among the developing nations but, actually, to survive.

The predicament of the lower class woman is understandably worse than that of the middle or upper class female, though both suffer due to unjust social practices. They are battling domestic violence, Karo-Kari, marriage to the Quran, Swara, Wani, Honour killings and much more, besides other less severe forms of discrimination from close family members. Due to economic pressures, female employment is much higher among low-income groups than in the middle or upper class. Unfortunately, these workingwomen do not benefit from their hard work, as they are not independent decision-makers in the use of their earnings.

For the middle and upper-middle class female, social pressures appear to dictate career choices. Medicine and teaching appear to be the most sought after fields, albeit per force. Though both provide excellent career opportunities for women having an aptitude for these professions, many enter these fields for lack of other available options. As a result, they experience little or no job satisfaction and are unable to contribute productively. Only a small percentage of women defy tradition and venture into male-dominated fields, risking the wrath of their own family as well as censure from society. These women have to struggle hard to secure their rights in the workplace. The attitude of male colleagues is often discouraging, as they become wary of competition from those widely acknowledged inferior. Women who aspire for higher management positions meet stiff resistance; while for those who manage to climb the corporate ladder despite all odds, success is attributed to unjustified means, not competence.

Recently however, a change has been observed with women – though still a minority – competing and succeeding in diverse technical fields joining private organizations and getting noticed for their silent contribution to the dwindling economy. They are also making a mark in the political arena with a record number of representation as women legislators in the political decision-making bodies, traditionally considered male-dominated power houses.

One encouraging factor for women in Pakistan, resulting in an increase in participation in non-traditional fields is the burgeoning of the NGO sector over the last few years. It has provided a wide range of job opportunities to women with good salary packages. The ‘glass-ceiling effect’ felt and resented by a large number of women working in many of the government and private organizations, in which the power hierarchy does not allow women to go beyond a certain level despite fulfilling all the pre-requisites, has been challenged by these NGOs who offer jobs on the basis of qualifications. They install women as programme coordinators and send them out in the field to prove their worth, rather than settling for locally-accepted select set of positions. In this regard, the foreign donors having humanitarian, or female-friendly, agendas are playing an important role.

In the Pakistan Armed forces, there has been a change in policy towards empowerment of women, as is obvious from the induction of female cadets in the Air Force as fighter pilots. In the Army, besides the already established positions of females working as doctors and nurses in the Army Medical Corps, other corps are now allowing induction of females in field jobs. The Pakistan Navy has also inducted female cadets. The Pakistan Armed Forces are generally considered female-friendly organizations and their command structure caters to the social needs of female officers who are not posted to what are known as ‘hard-areas’ to avoid social problems. Female medical officers who happen to be spouses of Army officers are only posted to stations that will accommodate both officers. However, the trend in society of bias towards female colleagues extends itself here too and, sometimes senior male colleagues are observed dealing with their female subordinates with undue harshness. Credit for a job well done is many a time not generously given, while male colleagues attribute even genuine appreciation from superiors to mere indulgence.

Despite all odds, Pakistani women have come a long way in the last sixty years and will continue to move forward in order to secure the rights denied to them by an intolerant and biased society but promised by the Constitution of the country, as well as the religion it claims to represent. The winds of change are blowing on the horizon and it might be wise for all concerned to make way for the emancipated, motivated and self-aware woman of today.

This article was first published in SouthAsia magazine; this is an edited version.

Her feet had long forgotten the soft feel of a pair of comfortable shoes or even remotely fashionable sandals; her only comfort was that wooden plateau that would bend a fraction to take the load off her heavy feet. It had been 9 years now working in the city of concrete, carrying the baskets of bricks, sand and helplessness.

Everyday, after a long day’s hard work and on her way home, she would sit in a broken seat of a bus thronged with porters and masons who smelled the smell of their burnt out hearts, she would think of quitting it all. “Today I go back home and never come back; this is all too much for me. My daughter is growing into a woman now, she will be 14 in a few months; I need to spend more time with her.”

The next morning, a rotten drowsy voice would wake her up, “Hurry up you lazy soul, we don’t want to miss the bus; I don’t want to pay for the rickshaw, its too damn expensive. This cursed Government of ours is good for nothing; and so are you, you lazy woman, wake up; I need breakfast.”

That day was more painful. A nail was hiding with a purpose under the thin surface of a sand floor and penetrated into her left foot as soon as she stepped on it. There was no time for treatment; she put some mud on her wound, laughing in her heart as she thought of a day before her wedding when her future husband sang her a song promising her he would spread petals under her feet; she kept working. Each time her left foot touched the harsh surface of the wood, a tear and a smile would battle their way into her eyes; but she would hurriedly lift her foot again to minimize the load.

“This is it, I am not coming to work from tomorrow, I am tired, cant you see?” during the lunch break she finally gathered enough courage to say it to her husband; who, lost in his own thoughts, agreed to her idea. She was surprised, but only for a while; a comfortable lightness eased her shoulders and she started smiling.

Sitting in the bus she kept thinking about the freedom that would be dawning tomorrow morning. She smelled no burning heart anymore. At night she spent good time with her daughter and son and in the late hours went to bed.

She was about to fall into the land of intoxication when a thought struck her mind like thunder; “My daughter will be 14 in two months, and in two years she will be of age to get married. A wedding has its asking.”

It was work tomorrow.

“All human beings are born free and equal in dignity and rights”

-The Universal Declaration of Human Rights

Throughout history, mental illness has been associated with factors like weakness of character or possession by demons. As a result, the mentally ill have been isolated, neglected, tortured and even burnt alive – their lives destroyed by stigma and taboo.

The progress in medical knowledge encouraged a scientific approach to mental health problems and resulted in a slow, but steady, change in attitude. Many people began to view mental disorders as illnesses akin to other diseases that required treatment, not condemnation; though many societies still continue to show disdain for the mentally ill, and their mental health services remain insufficient and ineffective.

Understanding mental disorders is a difficult task in terms of the dynamics of disease, and the heavy emotional and psychological toll it takes on family life. Care for the mentally disabled is a serious human rights issue because of its effect on societal harmony and stability and potential for exploitation and abuse. In many mental health facilities, rehabilitation is not always seen as the chief aim of treatment. Human rights violations against people with mental disorders occur in communities throughout the world – in mental health institutions, in the wider community, and at individual level.

The World Health Organization (WHO) strongly urges communities to ensure respect for human rights and dignity in all mental health facilities, and outside. According to WHO reports based on testimonies of the patients and their relatives, it has been observed that many patients face severe discrimination and endure appalling living conditions in the mental health facilities. The following are excerpts from some of the letters addressed to WHO:

1. “Among the professionals who dealt with my son’s psychological illness, I frequently encountered irritation and threats aimed at him (‘if you don’t shape up’ or ‘I’m really having a problem with you today’), as if his psychological problems were subject to his direct control. In the 15 months of cancer treatment that my son also received, I never heard a nurse or doctor express any anger or irritation with my son for the symptoms of his illness.”(Source: Weissman MM. A piece of my mind: stigma. JAMA, 2001, 285(3): 261-2.)

2. “I experienced homelessness at one stage coming out of the hospital. I had nowhere to go. I had no choice. My family at that point was struggling with their own view of my condition and there was no place in the family for me. If my family had been educated, taught how to help me, supported and helped, then my story would be very different. (Source: Stop exclusion – Dare to care. World Health Day brochure. Geneva, World Health Organization, 2001.)

3. “The conditions there are miserable… dirty patients; dishevelled and very skinny [patients] surrounded me asking me for some bread. As for the building, it is pitiful to look at: many broken glasses, walls without painting for many years …The toilets, totally out of order, without running water. Most of the time cooking is done with water caught from the rain.…”

The report goes even as far as to quote a health worker as saying, “Why are you fighting that much? This place is but the waste of society.”
(Source: Letter 78, original in French. Voices from the shadows: a selection of letters addressed to the World Health Organization 1994 – 2002. Geneva, World Health Organization, 2004.)

Investigators from Mental Disability Rights International have found that inmates of mental health facilities who tried to escape were given severe punishments such as confinement for hours in cold, bare rooms without clothes; while over-drugged, unkempt and neglected patients pleaded for provision of basic needs like a glass of water. (A report by Mental Disability Rights International, September 2004)

WHO sources give a depressing analysis of the situation of mental health management worldwide: almost 64% countries have been found to have no legislation regarding mental health, or at least one that is less then ten years old. About 30% of countries don’t have a separately allocated budget for mental health; 20% countries spend less than 1% of their health budget on mental health; 32% countries have no community care facilities and vast differences are observed in the number of psychiatrists available to the populations ranging between more than 10 per 100,000 to less than 1 per 300,000. In Pakistan, though the fiscal year 2006-7 has seen a significant increase in the health budget, only 1% is estimated to be spent on mental health.

Researchers have found that factors such as low income, low education and difficult marital and family relationships expose women to abuse and make them more vulnerable to mental disorders. According to WHO sources, the probability of developing anxiety and depression are higher among women as compared to men, and these findings are constant across a series of studies conducted in different setups. A study by World Bank (1993) that focused on disability from neuropsychiatry disorders among women found that up to 30% women were affected in the developing countries as compared to 12.6 % men.

Pakistan Association of Mental Health (PAMH) declares that of the estimated 44% Pakistanis suffering from clinical depression, the majority are women. In Pakistan, many of the plans working towards social uplifting of women’s health focus on their reproductive health and their psychological and emotional needs are generally not given due importance, as is the norm in patriarchal societies. Women as care-givers have multiple roles to play at home. The burden of responsibility for the household including efficient running of home and fulfilling the needs of immediate as well as of extended family members requires a lot of energy. This burden is further multiplied for working women who have no one to share the burden of domestic duties along with the demands of their job. A culture of suppression prevents women from finding healthy outlets to their frustrations. It is not surprising then that they succumb to nervous breakdowns.

A serious trend manifest in the behaviour of the mentally disturbed is a tendency for deliberate self-harm. According to WHO sources, mental disorders are associated with 90% of all suicide cases; the last 45 years have seen a global increase of suicide rates by 60% and about 1 million people died of suicide world wide in the year 2000. It is also among the top three leading causes of death of individuals aged 15-44 years. WHO finds that though traditionally suicide rates were highest among the male elderly, now the younger age-group mentioned above are at higher risk of suicide in a third of developing as well as developed countries, though reasons and methods vary.

In Pakistan women remain particularly vulnerable to suicide because of numerous factors including social and cultural pressures, domestic and sexual violence, and undiagnosed or untreated mental illnesses. Stigma and discrimination by society allow these mental health problems to go unchecked. The HRCP (Human Rights Commission of Pakistan) report for 2005-6 declares that total suicide and attempted suicide cases increased from 2,712 in 2005 to 3,919 in 2006. There were around 200 women suicide cases reported within the first six months of 2006 along with 181 cases of attempted suicide, most of the victims being under 30 years of age. A 2007 trend analysis report by the HRCP also found young married women to be at highest risk.

Attempted suicide is underreported because it is a criminal offence in Pakistan punishable by up to one year imprisonment, and many successful suicides are also reported as accidents due to stigma. Hence, actual figures elude statistical collection, posing a challenge to effective data gathering.

Effective treatment of mental disorders requires a multi-pronged and multi-tiered approach involving government and private sector, community health services, family support groups and access to individual counseling facilities. Increasing awareness about the rights of the mentally ill, countering stigma and discrimination, training of primary health professionals, improving standards in psychiatric institutions, restriction of access to common methods of personal harm, etc. may be some of the strategies applied in this regard.

People suffering from mental disorders are either not aware of their rights or are not in a position to claim them. It is thus the collective responsibility of communities, institutions and governments to ensure that their dignity and human rights are upheld, and they are helped to resume their normal lives again.

Note: This article was originally published in “SouthAsia” magazine.

In the other room her mother is being comforted by a few friendly ladies, when she shrieks again “Ooh God they ruined us, disgraced us, why did they left her alive after blackening her face, I wish she would die”

She, a twelve year old tender child hears her mothers mournful cries, her pain intensifies, her body aches and her tears flow even more vigorously, she is shattering into tiny bits but there is no one to console her.

Her mother shrieks again “we can’t show our face to any one, they have corrupted my daughter, they have shattered our honor, I wish I would have died rather than being a witness of such a shameless incident. It is all her fault, it was she who wanted to study like a ‘maimsahab’ (lady), and see now she has painted our faces black”

The guilt, the pain and the agony mounts; she spots a knife lifelessly lying on a dish full of vegetable, left carelessly by her mother. “It’s all my fault, I never listened to my elders, I have brought dishonor to my family, let me ease their pain”. The lifeless knife comes alive and blood drips from its tip. The knife is noticed hours later clutched in a lifeless hand.

Sheeesh!… Silence!… Don’t dare say a word, you don’t have the right to mourn or cry, you are the mother who killed your daughter, you are the people who brought death to this innocent child. You are the culprits, the followers of a patriarch society where women’s worth is her virginity and her virginity a man’s pride.

Are women’s human rights given the importance they deserve?

Discrimination against, and exploitation of, women is rife in many societies of the world be they developed, developing or under-developed. Unfortunately, violence against women is also the most socially tolerated form of abuse in cultures across the globe.

“This year, more than 15,000 women will be sold into sexual slavery in China. 200 women in Bangladesh will be horribly disfigured when their spurned husbands or suitors burn them with acid. More than 7,000 women in India will be murdered by their families and in-laws in disputes over dowries. Violence against women is rooted in a global culture of discrimination which denies women equal rights with men and which legitimizes the appropriation of women’s bodies for individual gratification or political ends.” (Broken Bodies, Shattered Minds: Torture and Ill Treatment of Women, Amnesty International, 2001)

The UN High Commission on Refugees advocates that “women fearing persecution or severe discrimination on the basis of their gender should be considered a member of a social group for the purposes of determining refugee status.” (Guidelines on the Protection of Refugee Women)

Types of Violence:

Domestic violence- A personal matter?

Domestic violence violates a woman’s right to freedom of thought and action, and to physical integrity. Unfortunately, it is often viewed as a ‘personal matter’. A woman may be beaten up or tortured for something as simple as being negligent in performing household chores. Domestic crimes are allowed to go unchecked frequently in patriarchal societies. It is important to understand that when the law fails to provide protection to the victim, the state also becomes a party to inflicting torture upon its own citizens.

The Condemned Bride:

In most under developed countries, women are not given an equal status to men in political, social, and economic spheres. Hence, suppression of women is common. Rejecting a marriage proposal, or bringing a small dowry for many women in India, Pakistan or Bangladesh might result in serious repercussions. These women may be set on fire or acid burnt – and die of third-degree burns – or blinded and severely disfigured for life. The statistics for women dying at home from such ‘accidental’ deaths are found to be the highest among young married women.

Killing in the name of “honour”:

In Eastern societies, women are considered to represent the family honour. When suspected of violating that honour, they are savagely punished by their own fathers, brothers or husbands. Once accused, they are treated as ‘guilty until proven innocent’. In Pakistan, when they are accused of the crime of ‘Zina’, which is punishable by death with stoning under Shar’ia law, there is little hope for them to get justice. Sometimes, young girls also become targets of lifelong violence by rival tribes when offered in compensation for settling feuds; or targeted for revenge as a result of a wrongdoing committed by their men folk.

Miseries of women in prison:

Women in jails become victims of further abuse at the hands of the guards because of their total dependency on them. They are pressurized to provide sexual favours to avoid punishment, or to avail relaxation in certain rules. Sometimes they are also denied medical and psychological support to force them to be more compliant to the demands of prison staff.

Trafficking of women:

According to Human Rights Watch, trafficking is “…the illegal and highly profitable recruitment, transport or sale of human beings into all forms of forced labor and servitude, including trafficking into forced marriage…In all cases, coercive tactics, including deception, fraud, intimidation, isolation, threat and use of physical force, or debt bondage, are used to control women.” Without the assistance of corrupt officials, this practice cannot survive. Provision of false documents, and protection provided, help and encourage the perpetrators of this crime. There is further abuse and trauma when the victims are treated as criminals or illegal aliens.

Women’s sufferings during war times:

Wars take a huge toll of the killed, maimed and tortured from women. Through a planned strategy, physical and psychological violence against women is carried out during wartimes to achieve objectives like creating terror or extracting information; or simply suffer as spoils of war. Women’s rights organizations have found that, for these victims of war-ravaged communities, domestic violence is directly proportional to the increasing family tensions arising from the atrocities of war. Countless women in war zones across the globe are bearing the brunt of wars facing economic and domestic problems, and continue to suffer the worst forms of torture and sexual abuse.

Mental Health Problems of Victims of Violence:

Being a victim of violence can be the cause of severe trauma and emotional stress, resulting in serious mental health problems. Post traumatic stress disorder, depression, anxiety and panic attacks make the victims seriously mal-adjusted in their environment, requiring professional help. They may exhibit uncontrollable crying spells or rapid mood swings, and might appear completely divorced from reality at other times. Loss of sleep and appetite, flashbacks, nightmares and low self-esteem hinder normal functioning and extensive psychotherapy is often the only recourse available to help the victim return to a normal existence.

Rehabilitation:

The rehabilitation of victims of physical abuse is a difficult task that requires long-term commitment

Inge Genefke, Rehabilitation and Research Center for torture Victims (RCT), Copenhagen, states:

“The aim of torture is to destroy a person as a human being, to destroy their identity and soul. It is more evil than murder…. Today we know that survivors of torture can be helped to regain their health and strength, and in helping them we take the weapon from their torturers.”

• After the crime has been reported, proper medical examination must be carried out immediately to establish the veracity of abuse. All available evidence must be meticulously recorded and treatment of injuries done on a priority basis. For all this to take place, however, an efficient medico-legal system needs to be put in place – which is not the case in most under-developed countries, since women’s human rights are not considered high on Governments’ priority lists.
• Too often the victims vanish after reporting, either forced into hiding to escape threats of the perpetrator, or shifted by the family members to avoid attention to the ‘tarnished’ family name. The result is that the charges have to be dropped. The victim must be provided reliable security options and the abuser taken into custody, so that he is not in a position to silence her through intimidation.
• While the process of law takes its course, the victim should be provided extensive psychotherapy to address the feelings of shock, denial, guilt and anger.
• Counseling of close family members and friends is also extremely important, as their moral support is crucial in helping the victim through the period of crisis.

Prevention of Abuse:

Prevention of abuse is a collective responsibility. All members of a society must play their role sensitively for effective prevention of violence.

• Media must play its role in educating public opinion by creating awareness about public responsibility on this issue. Victim’s right to privacy must also be ensured at all costs. Giving a clear direction to social censure about shifting stigma from the abused to the abuser, may bring down many instances of abuse.
• Sale of acid to public should be strictly monitored, and every instance of burning should be meticulously investigated to rule out foulplay. To help the burned and disfigured women restart their lives, reconstructive surgery should be made an affordable option for the victims through sponsorship schemes from government and private sector.
• Special attention must be paid to empowerment of women through focus on literacy. Today, two-thirds of the world’s illiterate adults comprise of women – a fact that speaks volumes about the lack of commitment, and need thereof, of governments around the world.
• Punishing corrupt officials, who falsify documents and protect gangs of traffickers, can effectively check this menace. Poverty-reduction schemes and vocational-training programmes run by government agencies and the NGOs should target, specifically, single-parent families headed by females, and orphaned young girls.
• Governments must be urged by international human rights organizations, to protect women’s human rights during times of armed conflicts around the world and be held accountable for lapses by the UN Bodies.

Peoples of all nationalities should join hands to support Human Rights Organizations in their fight against gender crimes and provision of the rights of the oppressed around the world. It should not be viewed as a choice, but a responsibility.

This article was originally published in ‘SouthAsia‘ magazine.

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In support of every movement to stop violence against women.

A light, satirical view of the fairer approach to driving.

“My missus wants to drive here in Pakistan! Barmy, my missus… mad as a bag of snakes!” confided my British friend one fine day, shaking his head. I smiled to myself, and wondered secretly whether he was more concerned about his wife or other road users – for women drivers in my blessed land are truly a breed apart! Why I criticize my own kind? Well…sometimes it is healthy to look within oneself and ponder some less explored mysteries of life!

So let me enlighten you about the impressive road skills of some women drivers out there…er…especially those who defy and baffle all logic and create havoc on the roads! I will speak of but a few who have crossed my path every so often, and perhaps yours too!

You might be surprised to learn about a ‘driver’ who controls everything despite not being in the driver-seat! She’s called the ‘passenger-seat driver’. Most husbands will know what I mean! Ah, yes…I’ve come across her too. She’s my friend Sharmeen who wants to go shopping. “Drive me to the market, will you?” Miss Charm Personified calls me up at 3:30 p.m. “Huh?” I rub my eyes and look at the clock. Sigh. I know better than to argue with her.

As we hit the road, Sharmeen remarks, “Is your door closed properly?” I maintain a dignified silence. Undaunted, she leans over and checks. Then she takes to dictating the way – which I already know, but never mind! “Stay in the middle…why, you almost hit the curb!” “I know where I’m going!” I manage through clenched teeth. She leans over and switches on the left indicator. “What are you doing?” I try not to scream, turning it off. “Aren’t we going to turn left a little up ahead?” Innocently she asks, “Better to let other drivers know well in advance!” ‘A little up ahead’ is actually a kilometer away yet. Humph. “Don’t slow down… don’t let that smug dude in his shiny car overtake us!” She grabs my arm. “Sharmeen, it’s his right of way!” I try to free my arm from her steely grasp! The car swerves and almost hits the side of the Mercedes. The driver glares and makes an obscene gesture. I turn red. Sharmeen smiles contently while admiring her neat French-manicured nails. I’ve just about had it! I pull over and yell: “Get out of my car!’Then I go back home and read a book on anger management. Sharmeen? Oh she has a lovely day shopping and takes a lift home with …guess who? That’s right…how could the Mercedes dude resist Sharmeen’s little-girl-lost charm?

Another type of a woman driver that you must’ve spotted by now – because she’s the commonest type there is – is the ‘sleepy-driver’. No, she’s not actually sleeping at the wheel! She only seems that way because of her persistent refusal to go beyond 40km/hr even on the widest road! She sits there serenely, unruffled even when the cyclists pass her by with wide smiles! She won’t leave the left lane and wouldn’t overtake if her life depended on it! She seems truly impressed with the tortoise’s tenacity, and was quite possibly related to it in a previous life. She really has a problem parking her vehicle as she wants to do it just right. She usually manages to take up the space of two, sometimes three, cars in the end, though!

Then there is the aggressive feminist. Her type is also pretty easy to spot on the road…half leaning on the steering wheel, pursed lips and sharp eyes reduced to narrow slits; she is one to be wary of. My last encounter with her was when my old four-wheeler refused to budge outside my office, and my colleague Maliha offered me a lift. Having no alternative, I reluctantly agreed. As she started the engine I fastened my seat-belt and started praying silently. She drove head-to-tail with any car that happened to be unfortunate enough to drive in front of us, and if the driver slowed down even a little, she honked so hard that she literally hounded the poor thing off the road! All I could do was to shrink further in my seat whenever someone waved a punch in the air menacingly! In response, Maliha would mouth an obscenity that I seriously couldn’t repeat! Once or twice I tried to tell her that driving at breakneck speed might actually break her neck some day (I was more worried about mine though!), but she shrugged it off. “Rubbish … didn’t you know according to figures compiled by …um…responsible agencies, more men than women die in road accidents?”” Uh-huh?” I wondered if it was because of women like her…but didn’t have the gall to tell her so! She continued, “Well, if they wouldn’t turn their heads 180 degrees while driving whenever they spotted a woman, the statistics would be much different!” Ah…that’s a thought.

I was darned glad to be home that day in one piece! She’s one to watch out for, I tell you! She also knows so much about her rights – women’s lib being the order of the day – why it sometimes even confuses the poor traffic sergeant foolish enough to stop her! And you can guess her favourite past time I’m sure! Yes, you’ve got it…it is to hunt down the Casanovas who stand on bus stops and sing the hottest hits to girls waiting for their ride. I once saw Maliha drive right into the boy just when he seemed to have impressed the object-of-his-attention. Had he not by sheer luck – or premonition – jumped aside quickly, Maliha would have had one less target on her list! And of course, as she proclaimed innocently, all she was doing was parking in a hurry…he just happened to be in the way!

By the way, have you ever noticed how these emancipated women on the roads make extremely charming damsels in distress? You see, they’ve mastered the art of impressing fellow drivers with their shock-and-awe driving skills, but when the machine presents a challenge, well, there you have her…totally lost. She hasn’t an inkling about the workings of the thing she drives around so proudly! But then, why should she bother with the technicalities when she only has to extend that slender arm and flick that delicate thumb, and guys will actually fall over each other to help her out of her ordeal! There’s no dearth of those wanting to change the tyre for her, re-start her refusing-to-budge engine, arrange for a mechanic or simply arrange an alternative ride for her – especially in their own car! Ah, whoever said men are mean and repressive and controlling, in my culture, must’ve been mistaken…why they’re the most helpful creatures God made!

In case you’re wondering if there is a ‘sane’ woman driver category or not…well, of course there is! She abides by rules, never runs a signal, lets others get ahead when it’s their right of way, and is a pleasure to ride with as well as drive behind! She’s the truly emancipated woman who has enough road sense, and enough common sense to be mindful of other road-users’ rights. Unfortunately, she’s an endangered species, and it won’t be long now before she becomes extinct. The reason is simply lack of appreciation for her very appreciable conduct by fellow road users – chiefly, men. She gets generally abused so often by road-bullies that she’s reconsidering her approach. So, watch out all you naughty guys out there on the roads who are looking for a little fun at her expense! Be nice to her, will you? Otherwise, you’ll just have to deal with more Maleehas and Sharmeens than you care for!

Think about it…while I rush and get myself a new cell number – Sharmeen’s calling!!!

Mothers of the nations that burn.

Burn with the insecurity of our kings,

who sit back and see the mothers of nations

beg for the lives of their sons.

The sons they bore with equal pain as Queens did.

As queens bore their princes.

These mothers waited for their sons to return home,

now they wait for their funeral.

They are the mothers of nations

rich in oil; such a sin!

So let us cut throats and spill oil;

Let us celebrate funerals and light candles

at their graves!

Let us call this celebration as democracy!