A Cognitive Approach to Mental Health, Across Different Cultures
Mental health, even in this day and age, remains a strong taboo across different cultures. It rears its ugly head through certain behaviours and traits, which are debilitating for the individual, both in terms of their physical health, but more so in terms of their outlook on life.
It is under the norms and rituals of certain cultures that mental health issues are exacerbated, and morph into something greater than the sum of their parts. My country of birth, Pakistan, and my adopted home of Australia, played stage to the plethora of contexts and their resulting mental health outcomes.
Pakistan, in terms of socio-economic and geopolitical factors is well and truly at the tail end of progress. Income and mobility levels and general daily freedoms remain curtailed to the extent that daily living can be claustrophobic and hostile for the lion’s share of citizens. From one’s work life to one’s personal life, cultural norms, still in this day and age, are plagued by primitive cultural practices of patriarchy and nepotism. Any opposition to this is generally looked upon with skepticism, rather than inquisitiveness. Mental health is also one of these factors.
Unfortunately, mental health for the average Pakistani still remains an alien concept. Mental health is taught to many as a state of mind, and that too, as a purely positive state of mind. One should be thankful for all God and country has provided, so feelings of vulnerability, insecurity, and skepticism are pushed down. People are told to be thankful, spend time with family and friends, and the common remedy—pray more. As one of many options, these may have some level of effectiveness, but they undermine the cognitive disposition of the individual, leading to a vicious cycle of self-deprecation and malice. For those who have persistent mental issues, recommendations are often given to visit local shrines, where it is thought that physical healing of mental health issues is possible. For those with some further financial mobility, quacks and faith healers are the choice remedy. It is the only the very wealthy and very open-minded that utilise the dearth of mental health facilities that Pakistan offers.
Australia, even though much more developed socio-economically and geopolitically, has its own contextualised mental health issues. Although a developed country, by many definitions the average Australian still carries multiple burdens. Firstly, the brutal legacy of the treatment of Indigenous Australians. Secondly, the colonial legacy of Australia; being a penal colony, many Australians who were brought across were separated from their families back in Britain, which has significantly affected their sense of identity and belonging. Thirdly, the paradox of a greater global migrant population, juxtaposed against horrendous national human rights policies, courtesy of offshore detention centres and the turning away of migrant boats. This has a created a toxic brew of guilt, which is a huge burden to carry.
Like all problems though, there are white knights working on key issues, and creating a platform for sensitisation and discussion. In Pakistan, psychiatrists and psychologists are increasing in number, filling the vacuum that has been created by the state. The Pakistan Association for Mental Health (PAMH) has been working for over 50 years to provide local needs-based programs, along with advocating for progressive mental health policies. From 2002-16, PAMH provided free clinical services to over 170,000 people, along with awareness campaigns, workshops, and medical camps. PAMH also played a critical role in amending the Sindh Mental Health Act, which explored the linkage between attempted suicide, blasphemy (a key social and political issue in Pakistan), and mental disorders.
In Australia, the issue has been further institutionalised. Many private and public sector organisations have mandated employee medical insurance, which provides access to skilled professionals who remedy mental health issues. It is heartening to see that mental health issues have been recognised as medical issues, rather than social and cultural ones. Access to information through social media has also sprouted conversation on the cognitive background to mental health issues, and has turned an inward lens onto social norms, under which these issues have been masked.
My TCK experiences in both countries have shown me that even though the context differs, the underlying sentiments of isolation, suppression, fear, and shame lead to all sorts of mental issues, which are at times irreparable. In Pakistan, rituals and practices masked under culture and traditions, are the root cause. In Australia, it’s the national legacy mixed with burgeoning globalisation (which the average Australian hasn’t been prepared for) which take the honours. Given this negative context, as TCKs we can only strive to pick up the most progressive cultural practices from each of our cultures, and embed them into our lives. Pakistan provided me with the social safety net of a strong family and friends network, which has greatly benefited my mental health journey. Australia on the other hand provided me strong medical insurance and access to health professionals, who showed me that mental health is much more subtle and nuanced than many make it out to be. Both these experiences have given me impetus to continually strive for a better mental state, in whichever culture I am currently immersed.