By Charlie Artingstoll
Before the coup, mental health was a neglected issue in Myanmar. Now, the situation is even worse.
Mental health in Myanmar is a critical issue. It is an unstable country, both in terms of political and economic factors. Decades of protracted conflict, being home to the longest-running civil war in the world, combined with the impact of the COVID-19 pandemic and political instability, has led experts to argue that Myanmar is becoming a failed state.
This has had and will continue to have ramifications for the mental health of its citizens. According to a global WHO synthesis of 129 studies done in numerous conflict-affected contexts, “one in five people in conflict-affected populations have mental health conditions.”
Conditions identified among these populations include depression, anxiety, post-traumatic stress disorder (PTSD), bipolar disorder, and schizophrenia. The report concludes that, “given the large numbers of people in need and the humanitarian imperative to reduce suffering, there is an urgent need to implement scalable mental health interventions to address this burden.”
In Myanmar, the mental health burden is being placed on an extremely strained system. A 2019 HelpAge International study further demonstrated the seriousness of mental health issues in Myanmar with the following findings: “There is, [effectively], no mental health policy in Myanmar; preventing access to professional support through the primary healthcare system.”
While, as we shall see, some care is given through the private sector, this is limited in scope. Regarding state mental health provision, including funding, staff and infrastructure, the HelpAge study found that “staff are not adequately trained and there is little infrastructure to facilitate these services, particularly in rural areas.”
Much of this stems from a chronic lack of funding. Finally, the study pointed out that stigma and cultural understanding are also key issues: “while there is no data in Myanmar on how stigma impacts mental health, studies from other, similar countries suggest it has serious consequences.”
Myanmar’s mental health legislation is outdated, to say the least. The nation’s mental health policy — I’m not making this up — is legislated by The Lunacy Act, dating from 1912. Violate this law at your peril – you can face a fine of 50 Indian rupees – a currency not used in the country since 1952.
“The public health system is near collapse,” Dr. Mitchell Sangma, at Doctors Without Borders (MSF), told the BBC. “It’s a grim situation,” he added. Those who cannot afford private care simply are going without any healthcare. Though no research is currently available, given how limited the public provision of mental health support is at the best of times. It is to non-existent.
Public understanding of mental health is also an issue of concern. I recently spoke to *Nay Chi Soe, a student who graduated with a bachelors degree in Psychology from East Yangon University, about mental health. Two things stood out. Firstly, how unpopular the course was. It was the least popular course in her year. Even Library and Information Studies had around 10 students, while more popular courses such as Engineering and Law had hundreds of graduates.
Secondly, the reaction she received from friends, extended family members ,and fellow students, when she told them what she studied. They asked her questions like: ‘do you want to go to a Ywa Thar Gyii? (Yangon mental hospital)’ and ‘can you tell me, were the crows black or white originally? (a Burmese equivalent of whether the chicken or the egg came first).’
These kinds of questions show how misunderstood the subject was. Indeed the crow comment is a philosophical question: the chicken or egg, white crow or black crow is a philosophical paradox about the nature of causality that has nothing to do with psychology. And even when people don’t confuse psychology with another subject, they tend to associate psychology with extreme mental illness. The subject is deeply misunderstood.
My organisation, Sin Sar Bar, recently conducted the first phase of a project aimed at addressing mental health issues in Myanmar. It was funded by USAID. Our project had two parts – the first was delivering introductory workshops on mental health to over 2,400 community leaders we identified so that they understood the subject. By ‘community leaders’ we mean people who are active in their communities, which could be teachers, doctors but also shopkeepers, village elders – the idea being that if we can reach these individuals, they will spread this knowledge to their communities.
The second was a communications campaign introducing people to the topic of mental health. These 24 posts were used to create a wide variety of content such as graphics, animations, a cartoon series by the Guys of Rangoon, and multiple videos. This content was shared to Facebook, and our partners, KBZ, Skynet and Mizzima – reaching potentially millions of people. We ran workshops with influencers, singers, and actors, so that they knew how to create their own content, making videos or writing songs.
A key decision was made early on. If we wanted to address the mental health of Myanmar as a whole, then simply delivering this content in Burmese was not enough. There is a huge ethnographic and linguistic diversity in Myanmar with 135 ethnic groups and around 110 distinct languages. We decided to use 17 ethnic languages – S’gaw Karen, Moken, Daai Chin, Khong So, Likhy, Hakha, Karenni (Kayah), Kayan, Mon, Tedim (Zomi), East Pwo Shan (Tai Lung), Ta-ang, Rakhine, Rohingya Lainong Naga and Jinghpaw. We have now uploaded all the resources to our website.
The government estimates that 80 percent of the population speaks Burmese. Aside from being an overestimation, this figure is deceptive. For a good number of that 80 percent Burmese is a secondary language spoken with various levels of fluency. Their mother tongue is often one of the many different ethnic languages.
Given that a key aspect of mental health is the expression of one’s feelings, it is best provided in an individual’s mother tongue. While Burmese is spoken widely across the country, for many it is a secondary language, and therefore, wherever possible we will try to communicate in the language that individuals feel most comfortable with. Furthermore, the reality is that for certain groups, given their political history, Burmese can be the language of the coloniser, one of oppression and violence. Obviously, we couldn’t hope to heal people if we used a language that affected people like this.
As an attempt to unify the country, the government has embarked on a number of policies known as Burmanisation, which is considered “a forced assimilation and indoctrination program.” This is a process where education, repressive laws, religious proselytization, economic exploitation and often brutal force are used to wash away ethnic identities. This is most obvious in schools, where teaching is given only in Burmese, meaning that many younger people are no longer able to speak their native languages, which have become endangered and are at risk of dying out completely. In certain places, education in ethnic languages is even illegal.
Aside from these legal problems, there were a number of other challenges – not only because these 17 languages use a huge variety in terms of different alphabets, but also because different languages have different characteristics. For example, some are much more spoken than they are written, with some barely written at all. However, we felt it was a very worthy endeavour, and the feedback we have had has been great:
One participant said “the resources were very useful – I didn’t know anything about mental health before, and it was great to see resources in my native language – I have never seen that before.”
While the situation seems bleak, the first step at least is clear: we need to carry on trying to deal with the stigma associated with mental health in Myanmar, and to help people realise that asking for support is normal and healthy. Only then can mental health issues in Myanmar be truly addressed.
With regards to mental health in ethnic languages, there is also more work to be done. There are far too few trained counselors, even who speak Burmese, let alone who speak the different ethnic languages. A great idea would be to train individuals who speak different ethnic languages to be counselors themselves so that they can further help their communities in their own languages. Developing further resources on mental health in ethnic languages has also shown to be very beneficial.
*not her real name
For more information, check Sin Sar Bar.