The Need for More Therapists
Recently a newspaper report related the story of a girl who was being treated at the Dhaka Medical College Hospital (DMCH) for a number of days. She could remember her own name, her father's and of the district, she came from. The newspaper published her photograph with her name, Alo. Later, seeing the photograph and the news, Alo's family members were able to identify her. They came to DMCH and showing proper evidence took her back from the One-stop Crisis Center of the hospital. According to Alo's family her real name was Nafiu Islam Mina. She was from Mymensingh; her father was late Sheikh Shahjahan. She passed her SSC this year and wanted to pursue higher education. She knew her family could not afford this and becoming frustrated and decided to run away from home, thus reaching Dhaka.
More women suffer from depression than men. Photo: Zahedul I Khan
Many young girls in Bangladesh go through psychological trauma because they are often forced to give up their dreams. She may be, for instance, a meritorious student and wants to continue her education so that one day she can stand on her own feet. But her family pressurises her into agreeing to a 'good' marriage proposal as it is too good an opportunity to miss. With growing mental pressure to accept the proposal and thereby give up her dreams, the girl or young woman may even become mentally ill. At one stage the girl may also suffer different kinds of physical problems. She may suffer from headaches, hot hands and feet or even experience what is called 'hysteria'. The medical term for such a condition is called 'Somatoform Disorder' which is the physical expression of a mental illness.
"Girls and women in Bangladesh suffer from depression more than the men because they have to go through such conflicting situations more frequently," says Associate Professor of Psychiatry at Bangabandhu Sheikh Mujib Medical University (BSMMU), Dr Md Abdus Salam. As a result of stress, they become physically ill. He adds, "So women and teenage girls are more prone to Conversion Disorder or Hysteria. Forty percent of the patients who go to doctors of medicine, suffer from mental illness. As for patients who go to doctors with headache, 90 percent of their suffering is caused by mental complexity and the rest 10 percent for physical reasons. 50 percent of the neurological patients' sufferings are caused by mental problems."
Most GPs in the country do not really consider the psychological aspects of a condition because they do not have any course on psychiatry while completing their undergraduate studies. There is only one question on psychiatry in the medicine paper, but the students usually do not address that question as they have other choices. So, in practice the undergraduate medical students do not learn anything on psychiatry.
After completing their MBBS, moreover, few doctors show any interest in specialising in psychiatry, despite the growing need for psychologists and psychiatrists. "Patients of mental illness are relatively less in number than the patients of other diseases," explains Dr Md Abdus Salam.
Chairman of Clinical Psychology in the department of the University of Dhaka, Kamal U A Chowdhury says the reason behind there seemingly being less mentally ill patients than there actually are, is lack of awareness. "In most cases the patient or his relatives do not realise that he is suffering from any kind of mental problem and that he needs proper treatment for cure," he says. "General people usually do not know where to go for proper treatment. At the initial level the problem remains at a mild stage and when it turns complex, people generally go to a quack or religious person. The result of such mistreatment is, with the passing of time the disease, if left untreated, becomes so complicated that it may become incurable. People are usually late to come to a psychiatrist and by that time the disease becomes difficult to cure.
"Another important reason for less number of psychological patients looking for professional help is social stigma associated with mental illness," says Kamal U A Chowdhury. People, who are aware about psychological diseases, feel reluctant to go to the doctors due to this reason. They think others will call them 'mad' if they seek such treatment.
The first general community survey supported by the WHO reported that, total adult population suffering from mild to severe level of psychological disorders is 16.05 percent (out of the adult population). Out of the 16 percent, female suffering from mild to severe level of psychological disorders 19 percent and male 13 percent. The most common forms of psychological disorders are Depression, Anxiety disorders and Somatoform disorders. Dr Md Abdus Salam says, "mental disorders can be divided into major and minor illness. Schizophrenia, severe mental disorder and depressive disorders are described as major illness and anxiety, phobia, obsessive and compulsive disorders and somatoform disorders are described as minor illness. Among the mental illness patients in Bangladesh patients of minor illness are more in number."
Kamal U A Chowdhury says, "The number of mental illness patients is over two crores in Bangladesh while the number of psychiatrists is around 125." Psychiatrists are medical doctors with an MBBS degree followed by specialised degree in Psychiatry. They usually offer organic based treatment such as prescribing medication. Some of them are also trained in psychotherapy (also known as talking therapy in lay terms) and practice. However psychotherapy is usually time consuming (requires around 50 mins to 1 and half hour for one single session with a patient).
There are around 30 fully qualified clinical psychologists. They have a basic degree in psychology which is followed by post graduation in clinical psychology (specialised/applied field within psychology) and then a higher degree usually a PhD, DClinPsych (Doctorate in Clinical Psychology), MPhil, in Clinical Psychology. They are professional psychotherapists and also have expertise in counseling services. Unlike psychiatrists they do not prescribe medication but focus on individual, group and family work for the improvement of patient's mental health status through different kinds of psychotherapy and counseling.
Department of Clinical Psychology in Dhaka University is the only academic setting where a professional training in clinical psychology is offered in Bangladesh. The need to increase more such academic training opportunities for professional psychologists is very important as there is huge gaps between the demand of the service and the number of professionals.
Among the clinical psychologists only five are employed for government posts. There are only three hospitals exclusively for patients with mental disorders, although medical colleges as well as psychiatry departments in several private hospitals which are very costly. According to Dr Md Abdus Salam, "right now Bangladesh needs 500 psychiatrists, but we have one fourth of the required number."
Due to lack of government posts specialised doctors do not get their proper place to practice their expertise. On the other hand, patients fail to get the proper doctor to get the right treatment. Eight psychologists graduating from the Clinical Psychology Department are now working at Botswana employed by the Botswana Health Ministry. It is surprising as well as unfortunate that an African Country is hiring Bangladeshi psychologists and offering them opportunities to work with their population affected by HIV/AIDS and drug addiction while in Bangladesh such scopes for psychologists are hardly there even though drug addiction is an increasing problem in Bangladesh.