It’s not bad behavior: Recognizing ‘warning’ signs of mental illness

Even as a young man, Ahmed showed signs that he struggled with mental health problems, but his family confused it with teenage rebellion. Forty-two-year-old Ahmed was diagnosed with schizophrenia 10 years ago.

Mental health awareness has always been limited in Pakistan. Many people like Ahmed suffer from serious mental health challenges, which could have been managed had they been identified at an early stage. Often, the signs stare you in the face but the average person can’t spot them.

“The longer the delay, the more severe the symptoms,” says Dr Uzma Ambareen, a clinical psychiatrist and the medical director of a psychiatric rehabilitation centre, The Recovery House in Karachi. If the illness is detected at its premature phase and professional help is provided, it becomes possible to protect the person from developing the illness further, she explains. She was speaking at a seminar on Early Warning Signs of Mental Illness on Sunday.

Mental illness is a condition that leads to mild to severe disturbances in thoughts and/or behavior, resulting in an inability to cope with day-to-day tasks. Changes in mood, personality, personal habits or social withdrawal are all symptoms of an underlying mental condition. The signs will gradually become obvious to everyone around them.

Some symptoms can be mistaken as ‘normal’ behavior, says Dr Ambareen, but she says you need to keep track of how often a person is showing these “warning signs”. If it happens once in a while, it can be ignored but if the symptoms keep occurring every other day, it is time to start seeking help.

Younger children

Depression and anxiety can start to develop at an early age. If your child starts making excuses to refuse to go to school or bed, frequently throws tantrums, has persistent nightmares or changes in sleep or eating habits, and has poor grades despite studying a lot, there are some chances that they are facing a mental health problem.

Dr Ambareen says young children have difficulty explaining what they are feeling, so they sometimes describe their mental disturbances as a “stomach ache” or “not feeling well”. Teachers and parents should be trained to spot these signs. If the warning symptoms persist, they should seek medical help.


In older children or pre-adolescents, attitude changes are different. If they display an inability to cope with problems and daily activities, experience changes in sleeping and eating habits, have excessive complaints about physical pain and are unable to manage responsibilities at home or at school, it could be a cause of something serious.

Defiance of authority, truancy, theft, vandalism, intense fear, prolonged negative moods (often accompanied by poor appetite and thoughts of death) and frequent anger outbursts are also warning signs. Older children suffering from mental illnesses will also stop dressing up or caring about looking good, which is alarming behavior because most teenagers are conscious about their appearance.

Adolescents, young adults and adults

If a person has difficulty making decisions (confused thinking), demonstrates prolonged sadness or irritability, feelings of extreme highs or lows, excessive worries, fear or anxieties, social withdrawal, “dramatic” changes in eating or sleeping habits, strong feelings of anger, delusions, hallucinations and growing inability to cope with daily routine, they are likely to be suffering from a mental illness.

‘It can happen to anyone’

In Pakistan, there is a stigma attached to mental illness. Most people, when advised to visit a therapist, reply with Kya main pagal hu? (Do you think I’m crazy?). Often the stigma causes people to hide their illness.

Dr Ambareen says we need to accept that everyone is at risk of developing a mental illness. “The issue of stigma can only be acknowledged if we understand that it can happen to anyone,” she says. Between 20% to 30% of people visit a psychiatrist at some point in their lives, she adds.

One in four people will struggle with mental health or neurological disorders at some point in their lives, according to the World Health Organization. Unfortunately, almost two-thirds of those with depression or other known mental health issues never seek help from a professional, it reports. The reasons are many: stigma, discrimination, neglect and a lack of awareness about who to talk to.

Who is ‘more’ at risk?

While it is true that anyone can be affected, Dr Ambareen explains that some people are at a higher risk than others.

If you have a history of mental illness in your family, you there is a “risk factor” for developing it yourself. The closer the blood relation with your relative who has the illness, the greater you are at risk.

Stressful life situations such as frequent electricity load-shedding, traffic problems, financial problems, divorce, and death of a loved one can cause stress buildup, which can lead to a mental illness in the future.

Chronic medical conditions can make a person lose hope and get frustrated with their life, hence putting them at a risk. People with brain damage due to injury are also likely to develop a mental illness.

Trauma can cause the person to become mentally disturbed. Accidents, exposure to crime and war can all cause lasting damage.

Use of alcohol and recreational drugs can change the brain’s chemistry and lead to development of a psychiatric disorder. This can also happen at a later age too.

Children who did not get much attention from their parents are likely to develop a mental illness when they grow up or even while they are young.

Loneliness may also be a factor behind a person’s mental illness development. When you stop socializing with people or don’t have a good support system – of friends or family – you will start internalizing your feelings. Isolation is both a cause and a symptom of mental illness.

If someone has had a psychiatric episode in the past, they are likely to have one again. Relapse is often caused by triggers and certain stressful situations.

What can be done?

The first step is making the person realize that they are “ill” and that it is not something to be ashamed of. She suggests speaking to them openly about their symptoms. However, she warns against self-diagnosis, which means that one should not link the symptoms to a specific illness and think they are suffering from it.

Dr Ambareen advises that one should trust their instincts and develop a close bond with their loved ones so that they can open up about their problems. A psychiatrist should be consulted in case you think that you (or someone you know) is suffering from a mental illness.

Originally Published at

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