Depressed or Spirit Possessed? Reassessing Mental Health in Bangladesh
June 2, 2017
Mental health is something of a frontier zone in public health in many world regions. I have heard people scoff at Western preoccupations with the topic as a luxury of indulged societies. But mental health is a universal challenge, accounting for an estimated six to seven percent of the global burden of disease. It causes untold suffering, with effects that ricochet across societies. Stigma and discrimination accentuate the problems, arising both from lack of understanding and the grip of ancient beliefs and taboos.
As in many situations, religious leaders and communities have significant roles to play in tracing paths forward: their wide presence and the esteem in which they are held can exacerbate problems or help to move a society ahead.
Links to religious beliefs and practice was the topic of a day-long forum on May 20 in Dhaka, organized by BRAC University’s Department of Economics and Social Science, the BRAC School of Public Health, the Berkley Center, and the World Faiths Development Dialogue. It began with an overview of a heightened global focus on the issue of mental health, then turned to the specific challenges facing Bangladesh.
Bangladesh, like many countries today, is grappling with how to reform and revitalize national approaches to mental health. The challenges are both starkly linked to resource limitations in a country facing countless demands and to the reality that mental health has had a low priority in public health.
Bangladesh, with a population approaching 165 million, has only 200 qualified psychiatrists and a tiny 0.44 percent of the public health budget goes to mental health. The legal framework has not been updated since 1912 (though new legislation is under consideration). But an estimated one in four people suffer from mental health problems. Suicides are all too common. Studies and anecdotal evidence highlight the special suffering that adolescent girls confront, but mental health issues cut across all social groups and communities.
How, in Bangladesh, do people understand mental health? Ancient traditions label and stigmatize someone who is seen as a pagol, or crazy person. Many assume that possession by evil spirits explains unusual behavior and people may be chained, locked up, or neglected. The mentally disabled face horrible fates in many areas, both they themselves and their families. It is clear that better mental health literacy deserves high priority, as does research to identify better patterns and needs.
Biomedical approaches, however, should not unduly dominate discussions. Mental health cannot be treated in isolation. Social attitudes towards mental health shape how communities react but also influence the way individuals respond. As the government and medical profession reflect on medical and legal frameworks in the context of the sharper global focus on mental health, it is important to set the issues in a broader context.
Many contemporary challenges affect a society’s overall mental health, and this is true for Bangladesh. Wide-ranging issues, from overall happiness of the society to individual emotional welfare, should be understood in the context of what is happening in the society overall. The stresses and discontents linked to modernization have special importance, as people cope with upheavals and with the manifold uncertainties that accompany the winds of change. The large roles of migration and the garment industry, for example, affect how people understand their very identities. The questions that arise are economic, social, and psychological but also spiritual. Coping mechanisms include positive transformations but they also can take the form of heightened domestic violence and ironic responses like marrying off girls at younger ages. Responding to the appeals of various forms of extremism are a way in which some people respond to the disquieting changes they see around them.
The Forum in Dhaka concluded that religious institutions need to be an integral part of the national response to contemporary challenges of mental health. That means engaging religious actors like imams and preachers, learning from positive programs and experience (the l’Arche program in Bangladesh is one example). Religious practice is an ancient response to turbulent times but it can also take new forms in modernizing society. Neglecting the vital role of spirituality and of religious institutions would be a grave mistake.