Despite its apparent prevalence, the concept of mental illness continues to elude most of the Maldivian population, still considered closer to myth than stone cold fact. The high levels of stigma surrounding these disorders has failed to diminish over the years as people continue to label those seeking help as ‘weak’, ‘crazy’ or ‘lacking faith’. Yet mental illnesses do not discriminate in their war against the human mind; poor, rich, educated, illiterate, women, children - people of all races and religious backgrounds are all equally vulnerable to its devastation.
Naturally, it may be more worrying to the people around you when you are physically ill. When you feel physical pain, you can easily point it out to someone and show where it hurts. But how do you explain the endless battles you fight with your inner self every moment of every single day? How do you point and show where it hurts when the combat zone is in your mind? The fear of being judged and criticized pushes people back from seeking help.
Common assumption equates having a mental disease with being absolutely insane; although the reference accounts for a substantially small percentage of related disease. Often people who suffer are assumed to be defected in some manner. They are either ‘too lazy to get their life together’ and perhaps if they ‘try a little harder’, it is nothing they cannot get past from. The irony is that people do not say the same thing to a person with any physical disorder or disease. It would not occur to anyone to say such a thing.
The idea that mental illness is somehow ‘made up’ and that ‘it is not real’ or ‘all in your head’, needs to be wiped out from our society. World Health Organization (WHO) has stated that depressive disorders are already the fourth leading cause of the global disease burden. They are expected to rank second by 2020, behind ischaemic heart disease but ahead of all other diseases.
Despite there being thousands of people struggling with mental illnesses, proper statistics relating to the issue cannot be found anywhere in Maldives. Plans to conduct a nationwide mental health survey are reportedly in the works, though the subject has not actively been pursued via any formal agenda as yet, perhaps because the need for such statistics has never before been recognized. However, having proper facts would aid in providing the right medical facilities for those who require it. It would also give a clearer perspective on which diseases to focus on, and which areas require more public awareness.
The sad reality is that only a few people from the entire country will openly admit to battling with a mental disease, and that surely is not enough to establish a stand on the current situation. Even if people are willing to talk about it, there are only a handful of people who understand the current necessity. The public may heavily criticize development in the health care sector, but hardly anyone demands for growth with respect to mental health care. It would seem that no one deems the issue important or urgent enough to be addressed immediately. Surely, a person afflicted by a “make believe” disease could wait until a person suffering from cardiac (heart) disease gets cured? Mental illnesses are low on the list of priorities concerning patients, health sector professionals, policy makers and the public in general.
The struggle of acquiring medical treatment is an added burden for any person suffering from mental illness in Maldives. We are automated to rush to a doctor at the slightest physical pain. We scramble from one hospital to the other until we are able to find a cure for the pain. Unfortunately, in the case of mental illness, the opposite is true. It takes a huge amount of courage and encouragement to say it out loud, and a hundred times more to get help. People choose to suffer in silence because they fear approaching a doctor; children are too scared to say they are depressed and adults are too afraid to say they feel anxious.
Nevertheless Maldives is making strides in the path of development. Our health care has significantly progressed in the past few years. We no longer have to pack our bags and head out to other countries seeking basic medical facilities. Several high-profile doctors serve in our hospitals, carrying out surgeries and procedures that we previously wouldn’t have imagined possible here.
But what about mental health care? This seems to be one field wherein both the public and private sector seems to lag behind equally. While psychiatric consultations are hard to come by within the public sector, it is far more expensive to do so from the private sector. This is especially the case with psychologists, as most of them work at private clinics and hospitals.
It is safe to say that the health sector in Maldives was never set up to deal with mental illness. This medical sector is easily the most under resourced and undermined in the country. Throughout Maldives, the capital Male is the only island equipped to accommodate any cases of mental illness. For all 300, 000 Maldivians, only 4 beds are allocated for psychiatric patients in Indira Gandhi Memorial Hospital (IGMH). There aren’t enough counselors, therapists or nurses who are trained to properly handle a mentally ill patient.
Unsurprisingly, those who are at the professional health care givers are not exempt from struggling to openly say they suffer from mental illnesses. In fact, the doctors and professionals who work in the field are labeled themselves. Though a lot of fresh graduates choose to study medicine, they hesitate to specialize in this field, contributing not only to a lack of doctors, but medical professionals of all levels. Case being as it is, surely none of the atolls, let alone islands, have even a nurse trained to handle a patients suffering from mental illnesses.
Today as Maldivian students flock to different countries hoping to earn their MBBS - very few stride towards psychology. Perhaps part of the issue is demonstrated by whether the parents of a psychologist would proudly declare their child’s professional the same way the parents of a surgeon would. After all, who would dream of their child becoming a “crazy-people-doctor”?
As awareness slowly spreads, the catering gap seems bigger than ever and is bound to get worse. Additionally, experts state that due to the life style led by Maldivians, particularly those that live in the capital, the number of people with mental disorders appear to be on the road to increase even further.
It is not uncommon for the monsters in one’s mind to take over physique as well. According to experts in the field, it is very common for people presenting symptoms like chest pain, headache and fatigue to have an undetected mental illness. In the Maldives, the most commonly diagnosed mental disorders tend to be anxiety and depression related. Interestingly enough, the symptoms here tend to appear in a manner different from anywhere else.
For instance, elderly folk in particular are unable to communicate feelings of sadness, loneliness or anxiety. Instead they complain to their doctors of constant headaches, feeling excessively tired or being unable to sleep. This community in particular, do not consider seeing a doctor because one is feeling sad anywhere close to normal. Rather than admitting to the issue, they present physical symptoms. For them, it is more acceptable to be physically ill than to appear to have mental problems.
Even today, many Maldivians seek traditional treatments to deal with mental illnesses (as well as physiological afflictions) ranging from the more common ‘rugya’ and Quranic based treatments, to seemingly paganistic rituals akin to witchcraft or voodoo. Although folk remedies may offer solace to those afflicted, most mental and general health experts unanimously agree that it should not be used as a substitute for modern medicine.
These are strong beliefs that go way back into the pages of history suggesting that people who suffer from extreme cases are usually due to the disturbances from malevolent “jinni” (spirits). Thus, instead of seeking medical treatment, such people are isolated from the society, causing their disease to worsen. In many communities, being labeled as someone who is haunted or possessed by a ‘Jinn’ is more acceptable than being mentally ill. In many communities it is a custom that is widely practiced and sometimes, preferred.
Fortunately, younger generations of Maldivians are more open minded towards mental illness on social media and public conversation, and are more accepting and understanding of people suffering from such ailments. Slowly, they have begun to acknowledge it out loud. They have started to accept that it is okay to seek help when needed. The conversation has surely begun.
That said, the stigma associated with mental illness, exists not just in Maldives but all over the world. It is hard for people from all means and backgrounds to come forward and seek help. In the words of WHO,
“A lack of urgency, misinformation, and competing demands are blinding policy-makers from taking stock of a situation where mental disorders figure among the leading causes of disease and disability in the world”.
Undoubtedly, the apparent decline in mental health is a global problem. One in four people in the world will be affected by mental or neurological disorders at some point in their lives. Around 450 million people currently suffer from such conditions, placing mental disorders among the leading causes of ill-health and disability worldwide.
Yet it is an issue that can be remedied by raising awareness and pushing policy-makers to recognize the importance of good mental health, and to not simply rely on an apparent absence of diagnosed mental diseases. All evidence seems to indicate that humans must take a more holistic view towards illness and medicine.
After all, if our minds are not at ease, little else can prove to be.