A Health Sector Priority in the “New Medieval Ages”
Need for Nationwide Survey of Psychiatric Disorders
By Dr Rezwana Quaderi
STATISTICS are scare in our country, more so in the health area and specially in the field of mental health. Not that the statistics would solve all our problems, but it is surely a good beginning where the magnitude of the problems is quantitatively identified. Health statistics are of vital importance in predicting the future state of any society; how many of its members will remain well or become ill in future can only be assessed by statistical means. Ours is a changing society in a transitory stage, where awareness is enhanced and influenced by mass media; where exists an atmosphere in which predictions and planning are becoming more difficult with passage of time. (At such divergent moments as these, every attempt for an “improved, life friendly” future should be genuinely and effectively chosen and followed).
Now mental health requires more care and due attention, as individual members of the society are more sensitive or susceptible to the stresses of the “NEW MEDIEVAL AGES” and its changes. Mental health, above all, is the most neglected aspect of the new sciences, that has been largely ignored or ‘overlooked’ in our country by superstitious ‘reasonings.’ However, most of us can sincerely feel that the impact of mental health on a country’s economy, growth and development and geo-political status is significant and undeniable.
According to the World Health Organization (WHO) definition, mental health is a part of the concept of what is called ‘Health’: which means physical, social, psychological and spiritual well-being of an individual. In spite of its importance, this area remains largely neglected. This negligence, shortage of service facilities, specialized man power and logistic support altogether do not leave any scope for a wide and extrusive survey of the state of mental health in the country. Systematic ethnographical studies and cross-cultural studies are much needed for policy-makers and planners whenever someone is ‘talking’ about a country’s health policy. At the same time, for the man on the street, this cloud of negligence and unavailability of scientific data and information continue to nurture ignorance, prejudice, superstitions and myths about mental illness.
So, the common phenomenon still observed in the society is, firstly, the attitude that a mentally ill person is mad “Pagol”, secondly, the belief that the causative factors are super natural (beyond control) and finally, the ‘accepted’ use of dangerous forms of treatment – frightfully frequent in use. Some physical tortures include beatings, chaining, dipping repeatedly in pond, forced inhalation of pungent/corrosive fumes, stuffing nose with hot, dry chilies, hot oil, putting mustard oil into eyes (poisonous), causing hot iron rod burns on body, inserting thin bamboo chips under nail-beds; even cutting muscles, nerves and arteries (“to let bad blood out”) are still allowed to be practiced; and death is not an infrequent result.
Although limitations are realities and may even disappoint us, however, need not necessarily discourage us. It is now well recognized that mental health problems in Bangladesh are prevalent in the same magnitude as in developed countries. A small-scale community survey was conducted by eminent psychiatrist Prof A K M N Chowdhury in the 70’s, on a house-to-house basis interview in a rural population of Dasherkandi village near Dhaka, which provided some figures or prevalence of psychiatric disorders. A survey of the general practice in Dhaka and a study done at the OPD medical department of IPGM&R were also impressive. WHO had worked extensively, at international levels, and demonstrated that at any given time, at least 1 per cent of any geographically defined population suffers from sever mental disorders and at least 10 percent will be thus affected at some time in their lives.
Now, here are some statistical figures:
- Community survey: Village Dasherkandi (Population: 1181) 15/1000
- Major mental disorders: (Psychosis, severe depression,
epilepsy, mental retardation)
- Neurotic and psychosomatic disorders; 50/1000
- Psychiatric and physical illnesses combined; 29/1000
- Surveys on General Health Services: (Mainly neurotic and psychosomatic disorders).
- General practice in Dhaka 29%
- Specialist practice: (A survey of 33 specialist’ case records) 13-16%
- Medical OPD at IPGM&R. 31%
- WHO estimate for Bangladesh, 2018:
- Total number of mental patients: 84 Lac (7%)
- Major mental disorders: 12 Lac (1%)
- Minor mental disorders: 72 Lac (6%)
- Mental retardation: 10%
(of total children’s population.)
Epidemiological studies are also essential to define and evaluate strategies to prevent and disability and to help in overall planning and evaluation of mental health programmes on both a local as well as a national level. For such extensive works, genuine administrative effort, appropriately trained manpower, research institutes and service facilities along with other logistic supports are of incomparable value. The studies done above are not representative of the nation and not done recently but the attempts are encouraging. They at least provide us a window with a view of the large magnitude of scope left with us for our urgent attention. The developed countries and most of the developing countries have done nation-wide surveys in mental health and instances can be seen in Sri Lanka, India and Pakistan.
The development of mental health services simply cannot reside only with any single section of a population. The responsibility must be shared, cohesively, and the government, the health planners, and the society at large, specifically the social scientists and the media, have very definite roles to play.
The writer is Assistant Professor, IMHAR. Dhaka Medical College and a practicing psychiatrist.