How COVID-19 changed mental health discourse in India and Pakistan

“It all happened so suddenly that even after almost two years, I still am not able to accept that he will not be coming back,” said Zia, whose husband, Dr. Zia Ullah of Lahore, Pakistan, succumbed within a month at 60 years old. “When this happened, there was no one I could cry with or just get a simple hug because everyone was afraid of the virus.”

Amina Zia with the late Dr. Zia Ullah, (her husband). (Photo provided by Amina Zia)

The pandemic has worsened mental health in Pakistan, India and around the world, sparking depression and anxiety and amplifying existing mental illnesses. But this huge global upheaval has also begun to bring mental health out of the shadows and reduce stigma as more people share their experiences – and offer help – on social media and elsewhere.

Dr. Ruksheda Syeda, a Mumbai-based psychiatrist and psychotherapist in India, adds that the pandemic and the mix of being indoors and more online, and facing an increase in acute mental health stressors, meant that virtual spaces became safe spaces for mental health concerns.

“Mental health was spoken about with the pandemic, and it got more normalised and slightly more acceptable. The awareness definitely widened and there was an increase in mental health knowledge,” she said. “A major positive of this was that therapy or counselling became and continues to be more acceptable.”

In many cases, these stories reach across borders, giving people a glimpse of their similar struggles and common humanity.

Digital analyst Hammad Anwar of Lahore, Pakistan. (Photo provided by Hammad Anwar)

Digital analyst Hammad Anwar of Lahore, Pakistan, who founded an online platform called Sukhan, held a series on mental health during COVID, which he described as a way to stay mentally healthy while also helping others in uncertain times.

“Mental health is the most ignored subject in our society. During quarantine days, I put my skills to use and started live Facebook discussions with a couple of psychologists to understand the human mind, the kind of issues they face in such lockdowns and dig for solutions,” he said.

“I observed how the traffic was increasing in online spaces. Young people were talking about domestic pressures, job insecurities, the helplessness and loss of loved ones and financial crunch. But interestingly, we also saw creative juices churning and coming into play, a lot of cross border collaborations also took place,” such as when musicians from India and Pakistan played a “home concert” on Instagram.

Pakistani singer Ali Sethi, the man behind that collaboration, wrote:  “If there’s anything we can learn in this difficult time, let it be the value of cooperation across borders. Love conquers all.”

HOW COVID HARMED MENTAL HEALTH

Since the pandemic started, fear of the unknown disease rose with each passing day.

Over the pandemic, Pakistan had more than 1.6 million confirmed cases of COVID-19, and more than 30,600 people lost their lives, according to the Ministry of National Health Services Regulations & Coordination. In India, there have been 44.7 million cases and more than 530,000 deaths, according to the World Health Organization.

But the virus not only spread illness and death; it also prompted lockdowns, hurt economies and exacerbated problems such as domestic violence. All of this harmed mental health. The World Health Organization said the global prevalence of anxiety and depression increased by 25%.

Dr. Syed Ali Wasif, consultant psychiatrist in Karachi, Pakistan. (Photo provided by Dr. Syed Ali Wasif.)

Dr. Syed Ali Wasif, a consultant psychiatrist at Dr. Zia Ud Din University Hospital and acting president of Pakistan Association of Mental health in Karachi, said younger people were greatly affected. They were at a stage of life where they were mulling plans for the future, and the pandemic changed those plans.

Experts say humans are social animals who are extremely reliant on each other. Hardly anyone can live in isolation for long. Although some people liked working from home and spending more time with their families at first, problems soon arose. Child abuse and gender-based violence went up. Work was interrupted and families suffered financially.

The pandemic made some of the most difficult things in life even worse. When people died during quarantines, it was nearly impossible for others to pay their respects as they had before. People in India and Pakistan often spend days or weeks performing rituals after a death. But fear of the virus made most people avoid funerals – even the funerals of close loved ones – to protect themselves and their families.

Such changes aggravated mental well-being across societies.

Zia said her family changed drastically after her husband died. Her adult children turned silent; she said their house was “no more the same.”

At first, people called to check up on them. “But slowly, the frequency of calls started slowing down, and one day they just ended like his death. We were all alone. That was the worst time of my life.”

Dr. Syeda added that while mental health became more normalised, the nuances were still missing. “As a psychiatrist, I saw that mental health was still looked at from a situational point of view (loss of job, family, etc.). Mental resilience was still stuck in a binary, still viewed as black or white, strength or weakness - rather than a skill to be built.”

The pandemic saw a boom in mental healthcare, but also a dangerous rise in non-evidence-based practices. “But I’m optimistic,” said Syeda, “as the increase in conversation did bring some families together, and helped parents understand their teenagers and young adults and some tensions eased. However, there has also been a rise in abuse - domestic violence, sexual violence - and in India especially, an increase in deaths by suicide.”

So did the conversations about mental health not impact how people really understand it? “Not entirely. Changing understanding is a long process, and the trickle-down effect of more awareness will occur in time,” she said.

“The improved awareness isn't just limited to the metros, but even in second and third-tier cities, I have patients who are seeking out therapy and looking up their symptoms online before sessions. That’s a definite improvement,” said Dr. Syeda.

VIRTUAL AND IN-PERSON SHARING

While people have long been reluctant to discuss mental health problems, the sheer prevalence of these problems during the pandemic began to erode the stigma.

Many people, particularly younger people, described some of their struggles on social media. They began sharing memories and pictures of loved ones lost to the virus.

Dr. Sona Kaushal Gupta, a psychologist from Dehradun in India. (Photo provided by Sona Kaushal Gupta)

During this period, doctors and psychologists started providing online services in India and Pakistan. People of all ages called or messaged, asking for help. Dr. Sona Kaushal Gupta, a psychologist from Dehradun in India, provided psychological help to parents and children who had trouble coping with their mental health under lockdown.

“Parents, apart from dealing with other crucial issues, were having a hard time with their young children because they missed their school and friends, which was resulting in bad behavior. They were showing signs of loneliness, sadness and depression,” said Gupta, founder of Psychological Assistance and Rehabilitation In Children.

“A large number of students from higher grades also called us for help as they were afraid of the unknown virus. The death count was taking a toll on them and then their future study plans were being impacted. To date I get calls from parents and students saying that they have not gotten back to normal life as their life routine was disturbed during lockdown.”

Mental health is still not understood through a multidimensional, biological and social model. There are no quick fixes, and a devastating global event like the pandemic is bound to have a deep, lasting impact. Mental resiliance can help us weather storms, and Dr. Syeda said she hopes the increase in awareness and uptake of counselling services can help build resiliency.

Dr Gupta added: “The positive side of this pandemic is that people have started taking mental health seriously as compared to earlier times.”

Dr. Syeda said that in India, “Gen Z has a better understanding of mental health and parents are slowly realising that. My advice would be to listen to the kids. I have told my adult patients to ask their children for help on how to do a digital detox to cure social media addiction for example.”

As for Zia, she said her family is healing. They all go to therapy, which she said is expensive but helps a lot. As a growing number of individuals face their mental health struggles head-on, she said they need more support from their governments.

“The government should look into mental health more seriously for our society to grow into a healthy society,” she said.

(This project is part of a three-year program coordinated by the East-West Center to encourage Indian and Pakistani journalists to identify important stories of common interest in both countries. Devina Buckshee is a health journalist and MPH candidate at the Yale School of Public Health. She tweets at @DevinaB21. Rabia Umaima Ahmed is a freelance journalist from Pakistan and tweets @Umaimablogger.)