Condemned to rehabs

Ken Kesey’s 1960 novel “One Flew Over the Cuckoo’s Nest” was an immediate success. This novel, which was adapted in 1975 into an eponymous film, painted a bleak picture of the state of psychiatric hospitals – or mental health rehabilitation centers – in the United States.

In the novel, Kesey suggested that the psychiatric hospitals do not exist to heal people with psychological ailments; rather they are there just to label a section of society as “mad” and to keep such people confined for the rest of their lives.

It is said that Kesey’s novel and its powerful cinematic adaptation – which bagged 5 Academy Awards – later brought about a great deal of reforms in the psychiatric practices and institutions in the US.

Today most of the people suffering from mental illnesses in America are not admitted to in-house facilities. Most of the patients take medicines from psychiatric clinics while people seeking psychotherapy also usually don’t have to get admitted to some facility for treatment.

According to Afsa Ahmed – a psychotherapist based in Ontario– now only four types of people have to be admitted to inpatient psychiatric hospitals in the US and Canada.

“These include people suffering from complete psychosis; drug addicts; people suffering from extreme forms of clinical depression in which the patient may attempt suicide and psychiatric patients who can no longer be provided help at home,” she said.

However, the situation in Pakistan is different. In the country a number of inpatient facilities are dedicated to treatment of drug addicts. However, the psychiatric hospitals which in reality are pretty similar to lunatic asylums are also available in every big city in dozens.

Most of these hospitals are run by psychiatrists while the role of psychologists in such institutions is subsidiary. The staff at such facilities also include occupational therapists, social workers or case workers and paramedics.

A psychiatrist who wished not to be identified said the situation of psychiatric hospitals have improved a great deal and most of them cannot be described as lunatic asylums any more.

According to the psychiatrist who worked in Pakistan before moving to the United Kingdom, one of the major drawbacks of mental health institutions in Pakistan, however, is that they do not have the facility to gather and maintain data about their patients.

“When a patient is admitted to a facility, the therapists have to ask the patients or their wards if they had got psychiatric help before and as to what was the nature of their problems.”

He said in Pakistan rehabilitation depends on the help of a patient’s family, which takes the patient to the facility for treatment.  In Pakistan, he said, rehabilitation can take place only at a facility but in the UK rehabilitation process continues at a patient’s residence. “Every rehab offers ‘services’’ that ensure provision of all relevant facilities to such patients.

“In fact in the UK, the services reach the patients rather than patients reaching the services. This concept is called patient centered care. However, as this facility is not available in Pakistan, the patients have to be admitted to psychiatric hospitals for treatment that sometimes continues for years.”

Naheed Khan – a psychologist – shared her experiences of working as the director of The Recovery House, a leading mental health rehabilitation center in Karachi. She said the rehab that she worked at provided a quality living environment to its clients, who, Khan said, were not mistreated or oppressed.

“Daily group activities, counseling as well as psychiatric consultation was available in-house for all clients. Cleanliness of clients and their environment was ensured by competent and polite staff.

“The goal was to encourage each person to become as functional as possible whether they are day-clients or residents in the facility. For this purpose seminars were held to educate the patients’ families and wards; outings were also occasionally arranged for the clients.”

According to Khan, during her tenure she witnessed a number of clients improve and even saw a patient of schizophrenia becoming functional to the extent of rejoining work.

“Cooperation and participation of families is required to continue the good work when the clients are well enough to go back home to become functional as members of the family.

“If rehab centers are of this quality, more like home than hospital, the possibility of improvement in mental health can be expected.

“These centers are necessary for the benefit of people with mental health problems that make living with the family difficult. Such centers may have emerged from mental asylums that were more like jails and kept the patients manageable only with medicines but now many of them have transformed.”

However, Dr Farhan Kamrani, an assistant professor at Psychology Department of the University of Karachi, disagreed that the psychiatric hospitals have left behind all the semblance of lunatic asylum.

He said lunatic asylums did not exist in the Muslim world including the Indian Subcontinent before the arrival of the British. Even prisons, he said, were not as rampant and the prime purpose of those jails was either to confine rebels or possible heirs to the throne.

“But there was no concept whatsoever of lunatic asylums. In those times even the people labeled as mad or lunatic were part of the society, which sometimes threw stones at them and sometimes patted on their heads and offered them food.

“These people might have to face ridicule, scorn or mistreatment but they were not prisoners. If they were ever incarcerated, they were confined to their own homes. However, the British established lunatic asylums in the Indian Subcontinent.

Dr Farhan said as the western mind is mired in the statistical concept of norm.

“The west has been making a desperate effort to create uniformity among things and people. That is why we call mentally healthy people ‘normal’ as if the norms determined by a society are necessarily reflective of mental health.”

According to the academic, the western mind is pretty much slave to structures and institutions. The result of this mentality is that the western societies in particular and all modern societies in general are based on the model of a prison.

“A mental asylum is also a prison within the larger prison of modern society. It is a prison in which those people are confined who are not ‘rational’.

“It means that ‘rationality, intellect and reason’ are the precondition to membership of a society or the larger prison and a lack of these qualities compels the society to confine that individual to the smaller prison of a lunatic asylum. The society also punishes people who break its norms and puts them in jail.

“In fact, it is a hallmark of the western civilization to confine all people with deviant ideas and actions.

“In my opinion, the psychiatric hospitals are still by and large mental asylums. Their aim is not to heal people. At the most, they can only make an individual financially independent or help them participate in their social life, often by making them numb.”

He said these institutions exist just to label some people as mad so that the societal norm may be declared equivalent to sanity. According to Dr Farhan, psychiatric hospitals are a lucrative business while psychiatry is directly linked to a multi-billion dollar pharmaceutical industry.

“It is not in the interest of this industry to allow mental illnesses to heal as every patient is a consumer of their medicines. In fact the so-called mental health community doesn’t have the power to cure mental illnesses as it is a part of the system that is creating these illnesses.

“Now, the mental health practitioners declare that absence of the symptoms of an illness means health. The psychiatric institutions which have been churning out various manuals of mental illnesses have failed to come up with a comprehensive definition of sanity.

“In fact this entire system aims at labeling some people as ‘mentally ill’ in order to frighten the rest of the people into conforming to societal norms. In order to remedy mental illness in the real sense, there is a need to define sanity in a new light.  Mental health or sanity is based on some principle; it is not about conforming to some norm,” he added.