The door of a child psychiatry room of a famous hospital of Islamabad opens and two women enter. I was a bit shocked that none of them seem to be less than fifteen years old, then why have they came here. The taller and lighter woman placed the file of the city’s famous private psychiatrist on the table and began to cry. I gave the tissue paper and inquired about the reason for coming. The second woman, who was slightly shorter in height but considerably heavier, looked younger on closer inspection and felt lost in herself. After wiping away her tears, the woman said that she has a 12-year-old daughter with her at the moment, who suffers from seizures and has gained a lot of weight due to medication. Facial hair has also grown and she looks several years older than her age.
A twelve-year-old girl or woman, who looked no younger than her thirty-year-old mother, had been taking epilepsy drugs and antipsychotics in doses much higher than her age for 6 months. The girl had been suffering from condition in which she falls while walking and shaking the body for several minutes. The beginning of treatment was done by the Maulvi of the local mosque, then a amulet was taken from a Babaji, and after that it was the turn of the doctor. The doctor also did not think it appropriate to talk much and started the medicine after conducting investigations worth thousands of rupees including brain wave testing. When there was no sufficient benefit and the seizures worsened, the dosage of the medicine was increased. The girl’s weight also increased and facial hair grew. The fits (if they were) did not decrease and following the advice of a loved one, they was in my office today.
There are generally two types of seizures, epileptic and psychological. The treatment for both is completely different. Epileptic Seizures are treatable with medication. The cause of psychological seizures is usually an unconscious feeling or a conscious problem not expressed in the right way. Usually accompanied by symptoms of depression or anxiety. This disease is common among the people of Pakistan, especially women, and the role of medications in the treatment is less and more of solving the psychological problems. Most psychiatrists have little time for this task.
At the first appointment, I believed the seizures to be psychological and began tapering off the medications. Worked on her depression and anxiety and tried to build a doctor-patient relationship so that consciously and subconsciously she could easily give me access to the nooks and crannies of her mind. In the second meeting a few things became clear and a story seemed to be forming around the paternal cousin. The girl’s mother was adamant that the obesity should be controlled only by changing the medications and the seizures should be prevented with the new medications. Some conversations were allowed only on insistence.
In the third meeting, it was revealed that the matter was not of liking or attachment, but of a serious nature, and that the 16-year-old boy had engaged in and continued to engage in sexual abuse with this girl. The girl’s tears did not allow the conversation to progress in third meeting. Within four weeks, the intensity and number of seizures had decreased, but the girl began to lose consciousness. Research had shown that one out of every six girls is sexually abused in some way. The wrong general impression is that having a complete sexual act is sexual abuse, but touching the genitals of an adult, playing sexual games, getting sexual pleasure through the use of various objects, all these fall under the category of sexual abuse. Showing pornography to children, showing genitalia, showing sexual acts and taking nude photos also fall into this category. In this context, how many boys and girls around us have been suffer from this. The research has also proved that most of the abusers are from the family. They are relatives and they live in the same house in a lot of occassions. Alia Bhatt’s movie Highway is also worth mentioning in this regard.
Children who are sexually abused are at high risk of developing many psychological and psychosexual diseases in childhood and adolescence. Depression, anxiety, psychotic episodes or dissociation, substance abuse, personality disorders, sexual dysfunction and sexually transmitted diseases are commonly seen in these children. Physical and chemical changes in brians have also been observed in children who are continuously exposed to this process. Psychiatric disorders are a part of this spectrum.
A bitter memory wandering in the dark streets of mind and a new wound every week. After the third time of this abusive process, the girl told this to her mother. The mother scolded her severely and called her insane. When this happened for the fourth time and she told the mother, the mother again brushed it off and explained that this she is going to be engaged and married to this boy in future as decided by her grandmother. So it should be suppressed. She did not even agree that the girl should reduce or stop visiting the paternal house where this boy used to live and abuse her. Due to non-enforcement of child protections laws in the country, only the girl or her parents could make any arrangements for the safety of the girl. I requested the mother for a family meeting and asked her to call the father. That lady had understood this within a month and a half that I have reached the root of the matter. Since the matter was of a very sensitive nature and the girl was immature, it was impossible to take any step without the help of the parents. “Many children face physical violence. Some are victims of sexual violence or harassment, such as touching a sensitive area or being harassed by sexual conversation. Your daughter is also a victim of the same kind of harassment at the hands of a close relative for some time and as per my information you are also aware of it”. The tears of the mother were shed after hearing this form me. “Doctor, I am helpless. If I take my daughter’s side on such a matter, I will be bad, and if I do not take her side, still I will be bad.” It is not about favouring anybody but about the safety and the matter is very serious. After explaining, they agreed to bring the father next time for the family meeting.
When the father was informed, at first he got angry and started blaming his wife in anger. After some time, he also realized the seriousness and sensitive nature of the matter, so the discussion progressed towards the solution of the matter. Temporarily, the girl was banned from living alone and visiting her paternal grandmother’s house and after that the issue of transfer of family to another city was discussed. Safety of the girl which was the first priority was ensured by these actions of the father, so the meeting ended in more than what was expected. One of the important decisions of the meeting was mutual agreement to completely stop anti-epileptic drugs and start anti-depressant drugs. As their intention was to move to another city, the file was temporarily closed by referring them the nearest Psychiatrist to deal with the effects of abuse and a plan was given to help the girl in future.
This case raised several questions, the answers to which are still unclear. Aren’t children save from close relatives? Do mothers get stuck in the fabric of relationships and give their tender children more trouble than benefit in difficult situations? Aren’t the doctors who don’t even have time to talk to the patient violating the basic principle of no harm?