The mental health burden on families: a case from Nepal
Contributors: Nagendra Luitel, Bipan Shah, Prasansa Subba, Dr. Mark Jordans
03 October, Kathmandu, Nepal - Hira (name changed) is now sixty-five. She has been married for more than fifty years, and has five children, of whom all except the youngest son is married. Ever since her marriage, she has been a victim of domestic violence from her husband and in-laws. On top of that, her problem grew worst when her youngest son started having problem.
Her youngest son Bikash (name changed) was fine until he failed his class ten exams and experienced bullies from his friends. From that point on, Bikash started showing unusual behaviors such as talking to self, shouting without any apparent reason, scolding, talking recklessly, and loss of sleep. He also had auditory hallucinations and delusion. Such sudden changes in his behavior worried Hira. Neighbors and others suggested her to take her son to traditional healers for his treatment, as they believed that it was all due to evil spirits. When this was proved futile, she consulted few renowned psychiatrists both within and outside the district, where he was diagnosed with Schizophrenia. Although he is taking medicines prescribed by the psychiatrist, this hasn’t been of help either. As a last resort, Hira even took her son to Rachi, India, held religious rituals (saptaha lagaune) at home but that was also of no use.
Hira shared that along with her son she also has been fighting against the problem and that she has suffered equally or even more than her son. She is the one who is standing against all odds, and has been continuously providing care and support throughout the treatment process. She blames her fate for having to live such a life full of sorrows. She shared that she has lost all her property for her son’s treatment. Despite all her endeavors, the problem persists and now slowly, all the family members have become weary, hopeless, frustrated and ignorant towards Bikash. She has been continuously pressurized by her family to abandon Bikash. Being a mother, she said she cannot just give up on her son and that she would be by his side until the end. Because of her determination, she has been despised by her family and all others. The neighbors and even the family members these days mistreat Bikash, and tag him as “mad” (pagal). Bikash is also not accepted in social activities, none in the community wants to associate with him. Because she has to care her son, she has also not been able to involve in social activities. In this way, it has created problem in both her familial and social relations. She is also being looked down and called as the mother of crazy guy (pagal ko aama). Experiencing such scornful comments and behaviors, she sometimes wonders that it would be better off for her to die instead. She feels herself as a big loser. Since she has lost all her economic and social support, she is left totally helpless.
Hira was referred to TPO counselors by Primary Health Care (PHC) staff, where she had sought treatment for Bikash. In the initial assessment/meeting, TPO counselors identified several psychosocial and mental health complaints such as loss of appetite, crying most of the times, loneliness, fatigue, sleeping disturbance, confusion, loss of concentration, nervousness, headache, body ache, low self esteem, etc, which she had been experiencing from the past few months. TPO counselors have been providing psycho education, as in how to support people with mental health problems, and emotional support to deal with her own problems, which have proven effective for her wellbeing. On the other hand, TPO counselors also coordinated with VDC and the district hospital to help her financially for the treatment. The hospital has agreed to provide the medicine free of cost.
As of now, Hira has attended several counseling sessions. Counseling has brought about some positive changes in her life. She feels that the counseling has helped her to building her self-confidence to move ahead, and her capacity to decision making. Not only this, she has regenerated her social networks and has started sharing her worries to those around her. She no longer feels that she is alone. Comparatively, these days she has noticed that she is not as unkempt as before and spend most of her time in cleaning the house, and taking care of her son. She keeps herself involved almost every time, which has helped her not to think about the problem. Now, she has slowly learned to accept the reality.