THE world could not have been more unequal in contemporary history than what it is today. It has always been unequal but the present trend set in when the Cold War ended with the fall of the USSR giving neoliberal forces a free rein. With the countervailing force of the socialist bloc withdrawn and respectability granted to elitism and the exercise of unabashed corporate power, inequality became rampant. Not that inequities did not exist before. But today, inequality and its discontents are unparalleled.
The outbreak of Covid has made this problem more complex with the rich becoming richer and the poor poorer. A victim of the phenomenon has been the health sector, notably mental health. In Pakistan mental health is in the doldrums.
The theme appropriately selected for Mental Health Day on Sunday is ‘Mental Health in an Unequal World’ which accurately reflects the scenario today. Inequality is an issue that is in dire need of entering the public discourse if awareness is to be created. The fact is that generally few, even in the medical profession, understand fully how inequality itself gives birth to illnesses, not simply by spawning physical conditions that promote disease but also, in fact more, because of attitudinal factors. Many of us, seemingly good-hearted people, unwittingly become the perpetrators of social injustice and economic exploitation.
Further, it is not clearly understood how demeaning inequality can be for the victim. Mental health is not a well-understood issue generally and is highly stigmatised as well. Inequality has implications for the weaker parties that are beyond the understanding of most people.
The issue of mental health is not understood well.
In a class-based society the weak suffer from lack of self-esteem and an inner sense of insecurity as they have no control over their own lives due to the lack of resources. The state does not provide any social security.
In class-based societies such as ours, where a huge majority is the underdog and is fully aware of its status, it is inevitable that a pervasive feeling of resentment and inferiority prevails. These negative traits are exacerbated by a sense of helplessness.
It is these problems that need to be addressed. They are not even defined in the textbooks of mental health practitioners. But they are a fact of life in Pakistan that need to be collectively recognised and addressed not just by health professionals but also the policymakers and elites who create them.
Meanwhile, patriarchy inflicts its own brand of violence on women. The Pakistan Association of Mental Health will launch on Sunday a neat little booklet it has published for the occasion. Titled Criminal Abuse of Women and Children: Updating Perspectives, this publication draws attention to inequality in the gender context. Nine writers take up various dimensions of violence against women and children. The themes covered by a seminar held 30 years ago on the same subject have been revisited and updated. Seen in a historical perspective, the issue of violence has been quite comprehensively addressed by the writers, who are veterans in their field. What emerges is that there has been progress in many areas but there has been serious regression in others. On the ground, matters have worsened for the majority.
The fact is that the class divide mentioned has also put its stamp on the landscape of the women’s struggle nationally. In the past decades women from the privileged classes have managed to empower themselves. It is no coincidence that all the horrible evils that befall women affect mainly those from underprivileged classes. They are doubly burdened by patriarchal oppression of the rich and the poor alike.
This reality should be conceded by feminists. We take pride in how our movement has reached the grassroots. This is not the full truth. We live in what economist Kazim Saeed refers to as Do Pakistan (the title of his book) where the majority lives below the poverty line. The two parts are not equal.
That would explain the higher incidence of mental illness in women. As Dr Haroon Ahmed in the editorial note writes, “Twice as many women suffer from mental health problems as compared to men, especially depression and anxiety disorders. Besides the biological reason of procreation, the restrictions imposed by traditional roles do not allow them to achieve their suppressed and full potential.”
Obviously this patriarchy imposed discrimination in the gender inequality context is frustrating and often results in various mental disorders.
What Dr Haroon describes is the health, psychosocial and cultural dimensions of inequality. It also has economic and political implications as well that can destroy the country. By not admitting this candidly, we tend to gloss over the bitter truth.
The full truth is that the women who suffer from heinous crimes are from the impoverished classes. They do not have the luxury to walk away from their husbands.