ost people in Pakistan are familiar with the expression “log kya kahein gay?” (what will the people say?). It is often the first response to an advice for seeking professional mental health assistance. Too often, psycho-social well-being is regarded a luxury. It is essentially on account of this deep-rooted bias that we lack on the one hand adequate mental health resources and on the other empathy for people struggling with various kinds of mental health issues. Around one in four Pakistanis struggle with mental health issues, a study by an NGO, British Asian Trust, has found out. Nearly 90 percent of them never seek professional help.

Many mental health issues are misunderstood in our culture. As a result, people seeking professional help are routinely ostracized. There is a general perception in our society that one has to be mentally unhinged to seek professional treatment. Some people believe that professional help should only be sought for psychosis or schizophrenia and that early stage depression, anxiety or emotional disturbance can and should be ignored. This is more than plain ignorance. However, this belief has been passed on through generations. Most people thus keep their emotional or mental struggles private. The attitude is encouraged by advice like, “ghar ki baat ghar mein rehni chahiye” (what happens at home, should stay at home). Seeking outside help is thus not just unnecessary; it is considered a betrayal of the family honour.

Our culture promotes resilience. However, it also glorifies suffering in silence. “Sabr karo” (be patient) is the standard advice for nearly all forms of suffering. While patience and faith are genuinely valuable, they are often invoked to shut down expression. This doesn’t help with recovery. People suffering silently are praised; those asking for help must face scrutiny.

This leads many people who choose professional psychotherapy to do so in secret. This is ironic since the entire point of therapy is not to carry the burden alone. This not only prevents many people from seeking professional help, but also creates a bias against the experience.

Another unhealthy belief is that if someone needs mental health help, something must be fundamentally wrong with them. Illness, in this cultural imagination, is something visible: a broken leg, a fever, a wound one can point to. The invisible weight of anxiety, grief or depression does not easily earn the same sympathy. An invisible wound is often dismissed as a sign of weakness or a lack of good upbringing.

Where mental health is ignored for long, the patient may explode or implode. This comes as either aggression or self-harm. This is not a personal failing but an inevitable result of piling on unprocessed emotions. Traditional family systems have little understanding of this process. No wonder Section 325 of the Pakistan Penal Code criminalised attempted suicide and made it punishable. It was only in 2021 that a provision was made for mental health. Even so, mental illness had to be proved to escape punishment. Last week, the Federal Shariat Court ruled against even the limited decriminalisation of suicide.

The consequences of poor mental health sometimes manifest as physical symptoms like persistent headaches, fatigue, weakened immunity, high blood pressure and disrupted appetite. What was initially a manageable anxiety can deepen into severe depression, panic disorders or chronic illness that becomes significantly harder to treat. Socially, unmanaged emotional pain distorts how people communicate with others and react to being approached. Relationships, families and workplaces end up in jeopardy under the weight of unspoken suffering. Where children grow up watching parents practice such silence, the next generation has learnt a dangerous habit. In severe cases, unprocessed trauma turns outward, causing volatility or violence, including but not limited to self-neglect and substance misuse in the absence of formal treatment.

This is where professional treatment makes a difference. It is neither a luxury nor a last resort; it is a legitimate and effective form of treatment. It treats far more than what most people imagine. Cognitive behavioral therapy, for instance, is widely used to treat anxiety, phobias, obsessive-compulsive disorders and eating disorders. Talk therapy helps people process grief, trauma and deep-seated low self-worth. Couples therapy addresses communication breakdowns. Family therapy examines dynamics that have never been openly discussed. Even people with no diagnosis but feeling stuck, overwhelmed or disconnected have reason to seek professional treatment.

Much of the problem stems from the confusion between mental illness and mental health. Mental health refers to overall psychological and emotional well-being. Like physical health, it is everybody’s concern. Mental illness, on the other hand, refers to diagnosed conditions that significantly disrupt a person’s ability to function. One does not need to be mentally ill to benefit from therapy, just as one does not need to be critically ill to see a doctor. We go to a gym to maintain our physical health; we eat well to prevent disease. Therapy and other mental health resources serve the same preventive and maintenance role for the mind.

This distinction matters because it changes who needs what for psychological and emotional well-being. It is not a service reserved for the severely unwell. It is a resource for anyone navigating the ordinary but often overwhelming demands of being human. And yet, mental health literacy - the basic understanding of what mental health is, what resources exist, and when to seek help - remains incredibly low. Many people are not even aware of the options available to them, from counseling and therapy to support groups and mental health helplines. The conversation around mental health cannot progress if people do not first have access to the resources and knowledge to have it. That said, mental health resources cannot increase if social norms do not create an enabling environment for people to benefit from or demand these services.

A psychotherapist is not there to tell people what is wrong with them. They are there to help people understand themselves, behaviour patterns, triggers, unmet needs and their capacity to heal. That is not a radical concept. It is one of the most ordinary and human things to do.

The change we need is not just institutional, though better services and accessibility matter enormously. The change we need first, is cultural. It begins with how a person responds when someone says they are struggling, and in unlearning the idea that seeking help is a sign of weakness or a betrayal of family honour. Mental health is not something to whisper about or be ashamed of. It is one of the courageous and responsible things a person can do for themselves, and for every person whose life they touch.

The question is no longer whether we need mental health services and resources or not. The question is, how much longer we are willing to continue with “log kya kahein gay?”

The writer is pursuing an undergraduate degree in psychology at the University of British Columbia, Canada. She can be contacted at [email protected].