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Driven by demons

THE crime on the surface is simple. On Tuesday, 35-year-old Gul Noor killed four of her own children, including an infant, attacked her husband with a cleaver and also wounded her two elder daughters. Her ways were cold-blooded: she dropped each child into the underground water tank. When her crazed state subsided, she froze into a statue in a corner. Perhaps the most gruesome incident of murder and infanticide in recent times, ironically, it is a crime of sadness.

Gul Noor had been under medical treatment for years before she was put in the care of a spiritual healer. All her symptoms had pointed to postpartum depression, but when the pills became ineffective, her condition was given another dimension — that of being possessed by evil spirits.

Renowned mental health expert Dr Haroon Ahmed maintains that since women in lower income groups are rarely breadwinners, not much is invested in their health. “There are more males coming for treatment than women. They are expected to go to the neighbourhood hakim or healer or just distract themselves as it is seen as an unnecessary expense,” said Dr Ahmed.

Dr Unaiza Niaz, a leading psychiatrist, agreed with Dr Ahmed and claimed that “psycho-social factors play the most significant role in depression cases.” However, a major hurdle in both the perception and treatment of mental disorders remains the age-old recourse to faith healing. Although spiritual centres such as mazars have long served the latent cathartic needs of the hapless masses, who often mistake their relief for mystical intervention rather than a result of expelling old traumas or plain anxiety. However, cases of serious mental disorders are not the only ones that are brought to these shrines. Countless patients of epilepsy, dementia and Parkinson’s disease, to name a few, have also died here.

In Karachi alone, there are a minimum of 2.3 per cent cases of postpartum depression, 1.5 per cent of antenatal depression and 1.4 per cent are caused by an abortion or the birth of an abnormal child. According to international studies, a whopping 80 per cent of new mothers all over the world experience mild depression within a year of giving birth. And the illness is recognized as a legal defence in 29 countries. If unchecked, the blues rise to the dangerous levels of Gul Noor’s postpartum psychosis, a rare condition that is said to afflict one or two in 1,000 mothers. These emotions of resentment and detachment begin to simmer within the first week of birth but in normal cases, they peter out in a matter of months.

According to Kendell, the chances of psychological illness in women are higher after childbirth than at any other time in their lives. Gul Noor’s, however, is a tragically extreme case where a mother loses her sense of judgment and regards violent thoughts and anguish as her reality. At this point, she fails to differentiate between herself and her child and often either commits suicide, kills her offspring or does both. Interestingly, 50 per cent of women who have experienced an episode of postpartum misery are likely to have a relapse after another birth.

These cases call for a new generation of health workers who have the sensitivity to convince both patients and their support networks to proceed beyond diagnosis and disorder and to address their lifestyles and circumstances. Another area of concern remains the acute absence of data about these incidences so that health workers can reach them. However, the most effective prevention can only happen through the increase in the provision of post-natal educational and mental health services, including counselling.

Perhaps Gul Noor has given a human face to a far larger and graver social concern. As she faces a lonely battle with both her demons and her fate, it may be time for society and lawmakers to confront a faceless culprit: when the crimes of the mentally ill cross with our legal system, who really is responsible?
Source: Dawn
Date:11/16/2007

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