At the 13th year of her life, she was worried due to the recently started bleeding from her vaginal area without any manifested injury. She ran to her mother and asked that what is happening to her. Her mother scolded and asked her to put some piece of cloth over there so that the bleeding nobody could notice the bleeding as it would be a source of embarrassment for the family and for the girl herself. Her mother then sent her to a special house which was full of menstruating girls and pregnant women. This is the story of 13 years old Huran Bibi from Kalash valley of Chitral, who was one of the members of Bashleni (the house built specially for the menstruating and pregnant women). The cultural view of Kalash people is based on the concept of purity and menstruating and pregnant women are considered impure as per their cultural beliefs. Being a girl from a primitive culture I always thought to explore the different strong and weak parts of our culture which may impact the mental health of people in a healthy or unhealthy way respectively. The reason for choosing this topic is the trial to understand the impacts of our culture on our mental health.
Numerous studies have been conducted on relationship between Culture and mental health. Mostly, the concept of being well or sick is well-defined according to the cultural background, cultural beliefs and cultural practices used by a specific group. Koneru, Mamani, Flynn, & Betancourt (2007) defined culture in relations of objective components (houses and tools) and subjective components such as societal norms, roles, dogmas, and principles, further argued that culture is a dynamic practice designed by an individual’s commitment within their social set-up. Pumariega, Rogers, and Rothe (2005) explained culture as a way of life which includes traditions and customs. These customs transmitted through learning and play a vital role in molding the beliefs and behaviors of the people exposed to them. Generally, people in social groupings who share same religion, children and adolescents who play together and adults who work in same professions have their own cultural beliefs and practices. Culture is largely defined as a collective tradition or fixed dogmas, standards, and ethics. Culture frequently changes and is influenced both by the views of people and the burdens of their surroundings (Lopez & Guarnaccia, 2000). People are bound to their customs and traditions because they think that their ancestors have transferred these practices to them so these practices are to be preserved for their future generations.
Different cultures have different practices and beliefs regarding mental illnesses. In some cultures mental illness is thought to be the result of bad deeds and going against almighty Allah. In addition to that, a concept of bad evil entrance into the body is also found in few cultures. For the treatment of those mentally ill patients people incorporate religious/spiritual treatment. Sometimes religious treatment enhances coping mechanism of mentally ill patients but sometimes its themes may incorporate into religious delusions.
Prevalence of Mental Illness in Pakistan
According to Mirza and Jenkins (2004), the prevalence of depression and anxiety in Pakistan is 34%, out of which 29-66%women are affected and 10-33% men are affected. Furthermore, the study also highlights the prevalence of pediatric mental disorders which was found to be15.8% in Pakistan. Khan, Mahmood, Badshah, Ali, & Jamal, (2006) studied the prevalence of anxiety, depression and their associated factors on medical students in different institutions of Karachi (Jinnah Postgraduate Medical Center, Karachi, Departments of Medicine and Medical Students, Aga Khan University).Approximately 70% of students were suffered by anxiety and depression. Among 70% about 59% of the students were female and 43% students were Urdu speaking.
Causes and outcomes
Cultural beliefs and traditional practices are the root cause of mental illnesses and mental disorders. Referring to the scenario, the cultural practices and beliefs of purity made the little girl isolated from the society. Living away from family once in a month makes the girl feel guilty and being an alien to her. Not having a bath till the menstruation period ends make the young girl to think of being untouchable and lowers self-esteem. Such kinds of practices can lead to social isolation or depression with many other mental health problems. Similarly many other traditional practices are found in our culture which influence our mental health such as gender based violence, divorce, forced and early marriages, domestic violence, son preferences, concept of being virgin, duty to be obedient, polygamy and honor killing. Furthermore acculturation is also known cause of mental illnesses in immigrants and ethnic minorities.
Gender based violence/ domestic violence. According to data collected by an organization named as The Aurat Foundation in 2009, a total of 8,548 cases of gender based violence were reported (Parveen, 2011). In addition to that, the duty of obedience is considered as the main cause of spouse abuse. A lifetime incidence rates of wife abuse in global range is from 16% to 50% (Douki, Ben Zineb, Nacef, & Halbreich, 2007). Disobedience and clashes with the in-laws are specifically the major causes which explain wife abuse. Being part of culture women are thus advised to forgive or say sorry in order to safeguard their kids and their home. Abused women are more prone to mental disorders namely self-inflicted injuries, sleep or appetite disorders, and suicidal attempts. Depression is the most common mental disorder in abused women (Douki et al. 2007).
Divorce: It is a process of breaking marital relationships due to many reasons including cultural incompatibility of women and her husband or family of husband. It is the most stressful condition for husband as well as for wife. When a women is given divorced then it is thought to be a very shameful act for women because the low status of women in Pakistani culture. On the basis of this, society labeled women with bad deeds and bad character. This stigma leads to discrimination and women end up with severe mental illnesses like schizophrenia, depression, fear even commit suicide.
Polygamy: Polygamy is officially permitted in the Islamic tradition which is definitely a stress for women. Polygamy appears to increase exposure to psychiatric disorders in the wife; of those in monogamous marriages, 17.8% were cases, in contrast to 39.1% of women in polygamous marriages (Ghubash, 2001). El Sherbiny, Nabulsi, & Sendiouny (2003) declared Polygamy as a high tensioned condition triggering a neurotic anxiety, and in severe cases somewhat serious mental disease.
Honor killing. Douki et al. explained that in some Islamic societies, the only way to cleanse the family honor is to kill the “offending” woman or girl. Depression and a number of anxiety disorders, somatoform and eating disorders, or suicide attempts are the most common psychiatric situation in Islamic women.
The duty to be a virgin: According to Douki et al, the loss of virginity is thought to be equated with young women worth. So losing virginity is the major reason of suicidal behavior in teenagers. They are also in threat of being killed by a father, brother, uncle or cousin in order to restore the family’s honor and place in the community. As a result to the duty of virginity, illegal pregnancies are severely fated and are related with several social problems (running away from the family/home, aggression towards these girls by their own parents, or even homicide) with a high occurrence of depressive and anxiety reactions with suicidal behavior.
Forced and early marriage: Traditionally, it is expected from a daughter to shy away from expressing her wishes and her parents are responsible to decide for her. An arranged marriage is the decision of parents to select a life partner for their daughter, often with either a cousin or someone completely unknown before the marriage. This can lead to depression, anxiety, fear and isolation (Douki et al).
Acculturation: Unfavorable and shocking life experiences can change the brain chemistry of the people e.g., migration from one country to another for many reasons such as natural disaster, education or job opportunities. This can give the concept of acculturation in which culture-of-origin and host cultural characteristics can disagree autonomously (Koneru, Mamani, Flynn, & Betancourt, 2007). Furthermore, acculturation is a dual process of cultural and psychological change that takes place as a result of contact between two or more cultural groups and their individual members (Berry, 2005). Acculturation may assists daily social interaction and encourages management opportunities. Conversely, it may escalate tension or clash between two opposing cultures or can be related with a decrease in family support (Koneru et al. 2007).
In conclusion, some cultural beliefs and practices are leading to mental illnesses such as, the concept of keeping a menstruating girl in a separate house without taking bath till menstruating period ends. Likewise, gender based violence including domestic violence, rape cases, abusing women at home as well as on work place can be the leading cause of mental illness in women. In some cultures it is the responsibility of parents to take decisions of selecting life partners for their daughters which mostly results in cultural incompatibility and domestic violence. Furthermore, marrying more than one woman or separation from an intimate relationship can increase the risk for mental health disorders. Honor killing and being not virgin are interrelated to each other in which the only solution to cleans the family honor is to kill the offending girl which includes virginity also. Our parents and grandparents are unaware of the worse impact of our culture on mental health and they are strongly stuck to traditional practices. It is our responsibility to open their minds by providing those evidences which have been bad impact on someone’s mental health. As discussed above that people strongly believe in religion for the treatment of mentally ill people, so it is best opportunity to negotiate with the religious leaders about the worse impacts of culture on mental health. With the collaboration of religious leaders we can arrange awareness sessions in holy places (Mosques, Jamat Khana, Church, and Mandir). Similarly, media can also play a significant role in the coverage of cultural practices and their impact on mental health. Different awareness programs can also be run by media which can be helpful in the limitations of practicing such harmful beliefs.