In Pakistan and much of South Asia, psychiatry is often misunderstood, misrepresented, or avoided altogether. The term itself is surrounded by cultural stigma and caricature, frequently reduced to labels like “paglon ka doctor.” This perception has done significant harm, not only to those who need care, but to the broader societal understanding of mental illness as a medical condition.
But what is psychiatry, really? And why is it a vital part of comprehensive health care?
Defining Psychiatry
Psychiatry is a medical discipline concerned with the study, diagnosis, treatment, and prevention of mental disorders, including emotional and behavioral disturbances. According to the Shorter Oxford Textbook of Psychiatry, psychiatry bridges the biological sciences and the humanities requiring both scientific precision and clinical empathy. Unlike psychology, which is a non-medical discipline, psychiatry is practiced by trained physicians who can prescribe medication and manage complex cases where physical and mental health intersect.
A psychiatrist’s work is not limited to the treatment of psychotic illness. It extends across a wide spectrum, from mood and anxiety disorders to neurocognitive decline, substance misuse, and personality pathology.
The Scope of Psychiatric Disorders
Contrary to popular belief, psychiatric disorders are not rare. They are prevalent, often disabling, and typically underdiagnosed especially in cultures where emotional expression is discouraged. The range of disorders includes:
- Mood disorders (e.g., major depressive disorder, bipolar disorder)
- Anxiety disorders (e.g., generalized anxiety, panic disorder, phobias)
- Obsessive-compulsive and related disorders
- Schizophrenia and other psychotic disorders
- Trauma- and stressor-related disorders (e.g., PTSD)
- Eating disorders
- Neurodevelopmental disorders (e.g., ADHD, autism spectrum disorders)
- Dementia and cognitive decline
- Substance use disorders
Many of these conditions are treatable, particularly when identified early. Yet, in South Asian communities, delays in seeking care are often caused by myths, moral judgments, or reliance on spiritual explanations alone.
The Psychiatric Assessment Process
A psychiatrist does not merely offer advice or prescribe medications indiscriminately. Instead, the clinical process involves a structured and nuanced approach that includes:
- History taking, including developmental, medical, family, and psychosocial history
- Mental state examination (MSE)
- Risk assessment for self-harm, suicide, or harm to others
- Physical examination and relevant investigations when needed
- Diagnostic formulation using ICD-10 or DSM-5 criteria
- Treatment planning, which may involve pharmacological, psychotherapeutic, or combined interventions
Importantly, psychiatric evaluation always involves assessing the biopsychosocial context of the patient’s symptoms not simply categorizing behavior as abnormal.
Medication and Beyond: The Treatment Spectrum
Psychiatric treatment is often misunderstood as being limited to the use of medication. While psychopharmacology plays a significant role, especially in severe or biologically rooted disorders, it is rarely the sole intervention.
Other components include:
- Cognitive-behavioral therapy (CBT)
- Family therapy
- Psychoeducation
- Supportive psychotherapy
- Social rehabilitation
- Liaison psychiatry in medical and surgical settings
In many cases, multidisciplinary care involving psychiatrists, psychologists, general practitioners, social workers, and occupational therapists is ideal.
Reframing Psychiatry in Pakistani Contexts
The reluctance to seek psychiatric help in Pakistan is not due to lack of need—it is largely due to fear, shame, and misinformation. Many individuals struggle with depression, anxiety, PTSD, and addiction in silence, often misattributing their symptoms to spiritual weakness, “overthinking,” or “bad character.”
Yet psychiatric illness is not a moral failing. It is a disruption of mental functioning that can and should be treated with the same seriousness as a physical illness. Just as one consults a cardiologist for hypertension, one may need a psychiatrist for a persistent inability to sleep, concentrate, or feel emotionally stable.
Conclusion
Psychiatry is not about labeling people as “mad.” It is about understanding the complex interaction between the brain, the mind, the body, and the environment, and restoring individuals to a state of mental wellness where they can function, relate, and live meaningfully.
At Mind Valley Clinic, we believe psychiatry must be scientifically grounded, culturally sensitive, and clinically compassionate. It is time to reframe mental health not as a taboo, but as a vital component of every person’s well-being.
References
Shorter Oxford Textbook of Psychiatry, 7th Edition. Gelder, Mayou & Geddes. Oxford University Press, 2017.