Stigma is defined as a sign of disgrace, disrespect or discredit which results in society excluding an individual. Unfortunately, individuals who have diagnosis of a mental illness, experience a great deal of stigma from society, especially a conservative society such as Pakistan, and at times are even subject to ostracizing by their close friends and family.
Consider a bad fall followed by a leg fracture. Would you be ashamed to go to the doctor, take medication or go for physiotherapy to heal and treat your leg? In fact, many individuals might show off their casts. Why should then anybody feel that sense of discomfort when it comes to opening up about mental illness? With the association of stigma, judgment, lack of awareness and knowledge, societal pressures and various additional factors, we tend to ignore our mental health and forget the importance of healing and taking care of our minds.
Let’s take cancer - an autoimmune disorder in which our own cells begin to destroy themselves - as another example. There is no such stigma attached to cancer and treatment is imperative for recovery. Just as there is a scientific reason behind someone suffering from cancer, there is a scientific reason behind someone’s mental illness also. For example, someone with depression has lower serotonin levels, and hence, will be required to take medication to treat this imbalance. There is a vast difference between how society reacts towards a medical condition and how they react towards a psychological condition, and treating a mental illness does not always fit within the norms of the society.
So what happens when individuals going through mental health issues are subjected to societal stigmas?
The scope of psychology and psychotherapy, and the role they play in emphasizing the importance of mental health has immensely grown over the years; mainly due to the increase in individuals going through and accepting their mental health problems.
Pakistan, a developing nation, which has been resilient through its sufferings in the shape of terror, trauma, loss, and faces an increase in stress levels- can vastly benefit from the aspects the field of psychology has to offer. The fact is that mental health services are a dire need of Pakistan; yet, ironically, are unacceptable by the society. The little ‘progress’ that has been made has been through less than accurate practices, making them ineffective in cultures such as Pakistan.
It should be noted that more than 60% of the individuals  with a mental health condition do not seek help because of the fear of being labeled; resulting in the stigma that they encounter which is a much bitter experience than the experience of the illness itself.
Several barriers exist that seem to be responsible for a deficiency in mental health service providers as well as the number of individuals who try to seek help. In Pakistan, it can be said that some of the most significant barriers are the strong beliefs rooted in the Pakistani culture, and the lack of trained professionals and quality service delivery. Before attempting to provide mental health services, such barriers need to be considered and addressed in order to increase acceptability and effectiveness.
So what exactly would these barriers include? Below we will try to understand some of these barriers in the context of Pakistan:
Your self-esteem is generally not at an all-time high when going through a mental illness, so when you look around and see people stigmatizing your illness, it's easy to adopt their views and stigmatize yourself. It's easy to wonder if maybe you really are just weak and wallowing. Maybe it is a choice you make on your own and you just need to snap out of it. You forget the factors that cause mental illness, and if no one else cares, why should you? This self-pity only tends to worsen mental illness. What may seem like a few thoughtless words from friends or family can have a lasting impact on you. In many cases, it is common to hear statements such as "I mean, we all have problems!", “He/she is just being difficult/disobedient”, “Stop being dramatic”, “Everyone goes through this, why are you making a big deal of this”, and “We don’t talk about such things, whatever you are feeling will go away”
Note: It is important to communicate again that a mental illness is not in the sufferer’s control.
In Pakistan, one of the most consequential factors in avoiding mental health services seems to be family, social and cultural barriers. The concepts of social bond, social approval, conformity and financial dependence on males are most emphasized in Asian cultures, unlike the western culture. Thus, a strong reliance on other medical/pharmacological intervention has become common in the Pakistani population, with disregard towards considering one’s thoughts, feelings and actions being responsible for psychological distress, leading to people ignoring psychotherapy.
As discussed in the previous point, psychotherapy is considered less meaningful or a less effective treatment option in comparison to pharmacological treatments. This is largely due to the lack of psychological sophistication towards the field of mental health and psychotherapy. Obviously, this makes people focus more on diseases with bodily symptoms like cough and fever rather than mental health problems (e.g., depression, anxiety, schizophrenia etc.). Therefore, ignorance of society becomes one of the main barriers for individuals going through mental illness. Lack of awareness is also what allows society to easily stigmatize individuals with mental health concerns.
Research has shown that majority of the people living with mental illnesses want to work and are fully capable of being productive members of the workforce . However, a whopping 50%  of employers say they would be reluctant to hire an individual who is being treated for a mental illness. Such a fact is extremely worrying, not only because those with a mental illness, just like everyone else, also require an income to sustain themselves, but also because, for many individuals, the structure and productivity of a work day can be therapeutic and help in the recovery of the illness. Furthermore, not surprisingly, many individuals who are employed may report feeling disliked by colleagues if information about their mental illness is discovered. It should be noted that not all people who stigmatize mental illness are doing so on purpose, but thoughtless words and outdated and misinformed attitudes and lack of knowledge and awareness can help perpetuate such harmful stereotypes.
Another aspect that comes along with societal stigmas is the loss of trust. If someone anticipates judgment and an accompanying lecture about how e.g. "happiness is a choice," or “everyone goes through ups and downs, there is no need to be dramatic”, they are not going to be open with their family and friends about their struggles with mental illness. This is unfortunate, because when family and friends are supportive they can be a great source of hope and strength to the one battling with a mental health concern. Mental illness can be isolating and while no one single person can change that, support from family and friends can be a great source of comfort. The empathy received can help those suffering realize that they have support, motivating them to seek treatment.
Muslims in Pakistan have a strong belief in “Magic, Nazar (evil eye) or Saya (possession) ” behind any psychiatric or psychological illness. This has strongly been ingrained in the culture for ages, beginning from the belief of spirit possession, especially in cases of schizophrenic patients. Hence, proceeding towards mental health services is not always on the list of solutions being considered. Therefore, even before coming to a mental health professional, many are likely to seek help from faith or religious healers first.
Barriers are not only restricted to socio-cultural factors, but can also be attributed to other factors such as availability of competent human resource. In Pakistan, there is a lack of trained, competent psychiatrists or psychotherapists to attend to the population. The few mental health facilities and competent professionals that are present in Pakistan tend to be centralized towards big cities such as Karachi, leading to rural areas being largely neglected. This along with the ignorance of policy makers in terms of overall health funds, lead to noticeable gaps in training and service delivery. All such problems are reflected in the current psycho-therapeutic practices in Pakistan. Furthermore, there has always been a blind application of western-based therapies in Pakistan, ignoring cultural and religious factors, which tends to push people further away from seeking help from mental health professionals.
 Scott, S., Quinn, S. (2014). One in five young people struggle with mental illness but few seek help: report - ABC News (Australian Broadcasting Corporation). Retrieved from http://www.abc.net.au/news/2014-06-18/young-people-with-mental-illness-do-not-seek-help/5530748
 Scott, E. (2017). New research reveals people with mental illness are facing a “locked door” when it comes to getting a job. Retrieved, from http://metro.co.uk/2017/07/27/new-research-reveals-people-with-mental-illness-are-facing-a-locked-door-when-it-comes-to-getting-a-job-6808819/
 Maki, D. R., &Tarvydas, V. M. (2011). The Professional Practice of Rehabilitation Counseling. Springer Publishing Company. Retrieved from https://books.google.com.pk
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