Let me ask you something. If your arm breaks, what do you do?
You go to the doctor. No question. No shame.
But what if your mind breaks? What if you haven’t slept properly in weeks and anxiety follows you everywhere — to work, to family dinners, even to bed?
What do most Pakistanis do?
They stay quiet and pretend everything is fine. They say “sab theek ho jaye ga.” And that silence that deeply rooted, culturally protected silence and costing us millions of lives.
The Numbers Are Impossible to Ignore
Here is something that will surprise you. An estimated 24 million Pakistanis are currently in need of mental health support. That is not a small number. That is huge population struggling with depression, anxiety, trauma, addiction, and mental health stigma.
And how many of them are actually getting help? Almost none.
Pakistan has just 0.19 psychiatrists per 100,000 people. The government allocates only 0.4% of the health budget to mental health. That means for every 100 rupees spent on healthcare in Pakistan, less than half a rupee goes toward the mental health of 240 million people. This is not just a gap. It is a crisis hiding in plain sight.
Why Does Pakistan Ignore Mental Health?
This is the big question. And the answer is not simple. It is a mix of culture, religion, money, family pressure, and fear. Let’s break it down honestly.
Pagal” — The Label That Destroys Everything
The moment you say you are struggling mentally, the first thing many Pakistanis think is: “Woh pagal ho gaya.” One word. Five letters. And it ends careers, breaks marriages, and isolates people from their own families.
In our culture, mental illness is not seen as a health problem. It is seen as a character flaw. A sign of weakness. Something to be ashamed of and not just for you, but for your entire family.
Imagine a young woman in Lahore. She has been feeling hopeless and exhausted for months. She finally gathers the courage to tell her mother. And her mother’s response?
“Kuch nahi hota. Namaz parho. Sab theek ho jaye ga.”
So she stops talking about it. She buries it. And the depression gets worse. This is happening in thousands of homes across Pakistan every single day.
We Mix Mental Illness With Spiritual Failure
Pakistan is a deeply religious society. And that is a beautiful thing. Faith can be a source of incredible strength. But somewhere along the way, we confused mental illness with a lack of faith. If someone has depression, people say: “Uski ibadat mein kami hai.” (Their worship must be lacking.) If someone has anxiety attacks, they are told: “Jinn ka saaya hai.” (They must be possessed.)
If someone cries too much, they hear: “Allah par bharosa rakho — roona band karo.”
Now, faith and therapy are not opposites. In fact, research shows that spiritual support and professional mental health care work beautifully together. You can pray AND go to therapy. One does not cancel the other.
But when religion is used to dismiss real pain, it stops people from getting help they urgently need.
“Log Kya Kahenge” (What will people say) — The Four Words That Rule Our Lives
This phrase might be the single biggest enemy of mental health in Pakistan.
What will people say?
A man in his 30s is suffering from severe anxiety. His hands shake at work. He can’t sleep. He knows he needs help. But he also knows that if his relatives find out he saw a psychologist, they will talk. His mother will worry. His boss might judge him. Someone might tell his future in-laws. So he doesn’t go.
Studies show that in Pakistan, over 60% of people believe mental health conditions are exaggerated or not even real. Think about that. The majority of people around you genuinely believe that your depression is just you being dramatic. That kind of environment makes it almost impossible to ask for help.
Therapy Is Seen as a Luxury for the Rich
There is also a very real, very practical reason people avoid therapy in Pakistan. It is expensive.
A single therapy session can cost anywhere from 2,000 to 5,000 rupees. For a family earning 40,000 rupees a month, that is not just difficult, it is impossible.
And in rural areas, the problem is even worse. There are barely any trained mental health professionals available at all. For instance, In the entire province of Khyber Pakhtunkhwa, there are fewer than 50 mental health professionals.
So for millions of Pakistanis, therapy is not even a choice they get to make. The option simply does not exist where they live.
We Run to Spiritual Healers First
When someone in a Pakistani family starts behaving strangely, the first call is not to a psychologist.
It is to a peer, a maulvi, or a spiritual healer.
But when someone has clinical depression or schizophrenia, a taweez is not a treatment plan. When someone is in a mental health crisis, reciting duas alone is not the same as evidence-based therapy. Studies show that 68.5% of Pakistanis prefer traditional or spiritual healing methods over professional psychological care. And this is not because they are wrong to value faith. It is because they have never been taught what therapy actually is, or what it can do.
What Does This Silence Cost Us?
Let’s be honest about the real-life consequences of ignoring mental health in Pakistan.
Marriages break apart because one partner is struggling with untreated depression and the other calls it “attitude problems.” If they had known it was depression, they might have sought help. Instead, they separated and the root problem was never addressed.
Students fail their exams because anxiety disorder makes it impossible to concentrate and everyone around them says they are just lazy. With the right support, they could have thrived.
Young men turn to drugs because heroin numbs the emotional pain that nobody ever helped them process. The addiction is the symptom. The real problem started years earlier in silence.
Mothers suffer alone through postpartum depression because admitting it would make them look like “bad mothers.” So they struggle in silence, and their children grow up with a mother who was never truly well.
This is the cost of our silence. It is not abstract. It lives in our homes, our schools, our workplaces.
What Needs to Change — And What You Can Do Right Now
The problem is big. But it is not unsolvable. Change always starts small. It starts with one conversation, one family, one person willing to say: “i am not okay, i need help”
Start talking. The more we speak openly about mental health — at the dinner table, with friends, on social media — the more normal it becomes. Every honest conversation chips away at the stigma.
Stop using the word “pagal” as an insult. Words shape how we think. When we use “pagal” to mock someone, we make it harder for real people with real conditions to come forward.
Learn the difference between sadness and depression. Sadness is a feeling that passes. Depression is a medical condition that does not go away on its own. Knowing the difference can save a life.
Support the people around you. If someone in your family is struggling, do not tell them to pray harder. Tell them you are there. Ask if they want to talk to someone. Offer to go with them. That kind of support can change everything.
Know that therapy works. It is not just for “impu;sive or chaotic people.” Therapy helps with anxiety, stress, relationship problems, grief, addiction, low self-esteem, and anger issues and the other things every single one of us faces at some point in life.
Final Thought
There is a young man sitting somewhere in Pakistan right now. Maybe in Karachi. Maybe in Lahore, Peshawar, or a small village in Punjab. He has not slept properly in months and feels hollow inside. But, he does not know why. He wants to talk to someone — a real professional, someone who will listen without judging. But he is afraid. He is afraid of being called weak. Afraid of being called pagal. And, afraid that his family will see him differently and his faith will be questioned.
So he stays quiet. And the pain gets louder. That young man deserves better. His family deserves better. Pakistan deserves better.
Mental health is not a luxury. It is not a Western concept and not a weakness. It is health. Plain and simple. And it is time we started treating it that way.
