31 May 2024 – While Nepal has made strides in discussing mental health issues like depression, severe mental disorders remain steeped in fear and prejudice. The younger generation finds it easier to talk about mental health, but older generations often struggle with these discussions.
Categorizing Mental Disorders
Dr. Rishav Koirala, a psychiatrist and executive director of the Brain and Neuroscience Center, explains that the World Health Organization (WHO) categorizes mental disorders into two types:
Soft Mental Disorders: Conditions where a person’s insight remains intact, allowing them to distinguish between reality and unreality.
Hard Mental Disorders: Conditions where individuals risk losing insight into reality.
Stigma and Social Perception
People with hard mental disorders face significant social challenges. Bishnu Mahato and Padma Rai (names changed) are two individuals who have struggled with severe mental disorders all their lives.
Mahato, suffering from mania and bipolar disorder since his teens, recalls being regarded as an anomaly and treated as if possessed by a ghost. This lack of understanding led to severe mistreatment, including being locked up and beaten.
Historical Context and Lack of Treatment
Seventy years ago, mental illnesses were often dealt with by confining patients due to the lack of treatment options. Dhulikhel, now home to Kathmandu University, once had a prison for mentally ill patients where they were physically restrained. Mahato experienced similar confinement and mistreatment until he sought treatment in India and later in Pokhara, Nepal, where he received better care.
Continued Stigma and Discrimination
Despite some progress, there hasn’t been much change regarding psychotic disorders. Prejudice and discrimination remain high, especially in rural areas. Aevon Shrestha, a counsellor at the Center for Mental Health and Counselling-Nepal (CMC-Nepal), notes that even mental health professionals who suffer from mental illnesses often hide their conditions due to fear of judgment.
Padma Rai, a counsellor with bipolar disorder, faces significant challenges, including mistreatment by colleagues who doubt her capabilities. Rai points out the discrepancy in how physical and mental illnesses are perceived, noting the lack of support and understanding for those with mental disorders.
The Role of Media and Society
Psychologist Alsodha Rai highlights the negative portrayal of psychotic patients in media, which contributes to their misrepresentation as violent and unstable. In reality, such behaviors are rare and manageable with proper support. She emphasizes the importance of psycho-social counselling to reduce stigma and educate families and friends on effectively supporting individuals with mental illnesses.
A Need for Change
Mahato’s daughter reflects on the generational differences in discussing mental health, noting her father’s anxiety when buying medication. She hopes for a society where people of all ages can openly discuss mental health in a supportive environment.
Conclusion
While the narrative around mental health in Nepal is evolving, significant challenges remain in addressing severe mental disorders. Reducing stigma, increasing awareness, and improving treatment options are crucial steps toward creating a supportive environment for all individuals with mental health issues.
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