29 September 2016
From the section Asia
Copyright, All Rights Reserved
Copyright, All Rights Reserved
Secrecy and silence surrounds the issue of mental health in Pakistan. Those with money can afford treatment but families in rural areas often fall back on ancient superstitions. BBC Urdu's Saba Eitizaz visited a centuries-old Sufi shrine in rural Punjab where impoverished families bring their ill relatives.
Ahmad, 20, keeps looking to his mother as if for reassurance, his eyes wide and scared. He leans towards her to accept a morsel of rice. The chains around his ankle which bind him to an old tree rattle with every movement. Safia Bibi sits beside him, her face prematurely wrinkled with the etchings of a hard life.
A mother's sorrowThe last of her borrowed money has been spent in travelling from her native town of Gujranwala to this ancient Punjabi shrine in the south of the province. "For two years, he kept running away and I ran after him until the soles of my feet were bleeding," she said.
"He used to roam the alleys and children would pelt him with stones until I couldn't take it any more."
In the scorching sun, sweat rolls off her face and mingles with tears.
Ahmad is now playing with his chains and she can't stop looking at them.
"I have no money to get him medical treatment," she said. "But then someone told us that there's a baba in Punjab, you people are poor, take your son there, they will bind him with chains and when he gets better, God will undo the chains, they will open by themselves."
Dozens of desperate families scattered around the courtyard of Sufi saint Haji Sher Baba near the city of Burewala share the same belief.
Waiting in hopeHundreds of mentally ill individuals from impoverished families spend every season of their life here, chained to trees and waiting for a cure. In a society where mental illness is often not acknowledged and frequently ridiculed, the families say the shrine offers a sanctuary.
Psychiatric experts say that most of the people brought here appear to be suffering from diagnosable and treatable mental conditions. But the people who come here do not have the money or the awareness to access this treatment.
Their belief in the shrine and its power to cure gives them some hope that their loved ones will return from the darkness within their minds.
A state of the art hospital has recently been built just a few kilometres from the shrine but thousands still flock to this holy place, reflecting a deep contradiction within Pakistani society between modernisation and ancient religious beliefs.
A bare-chested old man with a long, flowing beard is struggling against his chains, the tendons in his neck straining from the effort. He is constantly murmuring something under his breath. His wife is seated beside him. "He is not mad, he used to practise black magic and now he's been possessed by an evil spirit," she tells me. Atta Muhammad, who has been the custodian of the shrine for two decades, defends the living conditions of the people against accusations they are too harsh. "We give them food and a place to sleep. What else can we provide for the insane?"
"Their chains open automatically when they are cured. It's their vow to Sufi Baba that they must sleep on the mat and sit on the floor."
He also says the number of "patients" appears to have doubled over the past few years, reflecting a growing crisis.
Lack of resourcesMore than 15 million people in Pakistan suffer from some form of mental illness, according to the latest estimate by the Pakistan Mental Health Association. But there are only five government-run psychiatric hospitals for a population of 180 million. And there are fewer than 300 qualified psychiatrists practising in Pakistan. In conservative areas, there is often a social stigma attached to even talking about mental illness and it is dismissed as a "weakness of character".
Dr Usman Rasheed is the director of Fountain House, a private mental health hospital, based in Lahore. He says the lack of resources is matched by a failure to raise awareness and show that mental illness is a disease, not a disgrace. "Our society tries to degrade anyone who is suffering from this, by alienating or ridiculing them," he said.
"Even those who can afford to seek help are afraid to admit that they are suffering. What hope is there for the disempowered poor but to resort to saints and superstition?" Back at the shrine, the courtyard is cluttered, full of the personal effects of each resident. The families often camp close to where their loved one has been chained. But sometimes years go by, they lose hope, leave - and the sick are left behind.
A young man wearing a garland of chains seems to be one of them. He is mesmerised by the mystical Qawwali music that takes place at the shrine every evening. The chains clink as he dances, eyes closed, hands reaching out to the sky, feet whirling to the beat of the drums. I ask the custodian who he is. "No one knows, it's been so long since they left him here, he belongs to the shrine now."