Azerbaijan: Confronting Mental Illness

(Originally published by Chai Khana, on the 17th of August 2017)

He’s 34 years old, an Azerbaijani man with a wife, child and full-time job, yet claims that his parents “rarely let me go anywhere alone or even catch the bus.” He suffers from emotional dysregulation disorder, and, finally, after decades, he’s learning to cope with the world on his own terms. But it is not an easy process. “I am 34, and I am afraid to give an interview to you,” says the man, a resident of the Azerbaijani capital, Baku, who requested anonymity because of the stigma associated with his condition. “My parents don’t know about it,” he says of the interview. “If they knew, they would not let me do it.”

An epileptic, the man has struggled since childhood with emotional dysregulation disorder, a condition associated with brain dysfunction that can lead to extreme mood swings or impair verbal expression. In Azerbaijan, as throughout the Caucasus, the stigma associated with visiting a psychologist or psychiatrist means that such problems often can go untreated. Some 96,848 Azerbaijanis regularly receive psychological or psychiatric treatment, according to 2016 government statistics, but, noted one physician, not always disclosing their identity.

The man mentioned above, an employee in a Baku hospital’s registry,  is among those patients who prefer anonymity.

He decided to talk with Chai Khana about his experiences, he says, so that others can learn how to overcome the negative stereotypes associated with emotional disorders.   

The challenges, for him, began when he was a child. Born with a convulsive disorder, he suffered from epileptic fits until he was 13 years old.

As elsewhere in the region, Azerbaijani parents tend to envelop family members with severe health problems in a protective cocoon, keeping them away from the outside world, and trying to prevent them from having to fend for themselves. Over time, that cocoon grew ever broader, the man says.

He recollects one episode when he  was 11 or 12, and went on a school tour of Baku’s Old City: “On the way back, they forgot about me, and I got lost,” he recounts.  “I wanted to ask people the way to get home, but people [instead] took me to the police. The police took me to my family, and my parents were angry [at me] about it. After this, the control [over me] increased,” he says.

When he finished school, his family debated at length where he should continue his education.  His parents cited his partial blindness as the reason for not sending him to a public university, an environment where he could be just a face among hundreds.

Instead, their choice was Baku Medical College, an institution that reflected his mother’s profession as a nurse. The man studied there for two and a half years. He himself had an interest in medicine and very often read his mother’s medical books, but, nonetheless, points out that “Nobody asked about my preference and interest.”

His parents’ protective instincts also extended to his personal life, he claims. They selected his first wife, a distant cousin. The marriage ended after a few months. “After it, [my parents] told me to marry whom I want and that [they] won’t interfere any more in my private life,” the man says. He met his second wife through a friend. The couple and their two-year-old son live with the man’s parents. But his parents’ attempts to shelter him have had its effects, he continues.

He describes his self-esteem as quite low. He hesitates to object if someone cuts ahead of him in line or if a taxi driver rips him off. He senses discrimination everywhere. His relatives don’t understand what an emotional disorder is, he alleges, and, instead, look on him as a person with limited cognitive ability.

“My relatives, when they discuss some important things or decisions, they never ask my opinion,” he claims.  

“When my sister’s husband wants to have a dialogue with me, he approaches and asks the question ‘How much is two times two?’ He basically fools with me,” he continues. “My sister never defends me and thinks it’s normal to check my brain every five minutes.”

He also senses a double standard at work. “When a new employee comes to work, they give him my place and tell me to find another place for myself or make me do someone else’s job,” he alleges. The man’s allegations could not be independently verified, but they appear to reflect a larger pattern of behavior toward the mentally ill in Azerbaijan.

These individuals routinely face stigmas both at work and in their social lives, comments National Mental Health Center psychologist Dr. Gunel Valimammadova.

Even if the Center certifies that a patient with an emotional disorder is capable of work, “when employers see that ‘emotional disorder’ in the report, they don’t accept their abilities,” Valimammadova says. An emotional disorder is often seen as shorthand for “insanity” — including, apparently, at some Baku restaurants, which refuse to make reservations for organized meals for National Mental Health Center doctors and patients, she adds.

Similar obstacles also appear when emotional-disorder patients search for a spouse. As a result,  they instead often “try to marry someone who has mental-health problems, too,” Valimammadova reports. To learn how to address these problems, the man sought a psychologist’s help several months ago. A month-long training at Baku’s Mental Health Center changed his behavior, he says, and he started to believe in himself.

“He has learned how to control himself,” comments the man’s clinical psychologist, Dr. Aygun Sultanova.“He is not rude anymore to people. He is quiet, and can defend himself.”

Currently, he’s taking part in a group drama class in which participants stage reenactments of their problems with other people as a way to identify potential solutions for them. Others, too, have noticed the self-confidence. His interest in photography means that hospital co-workers now ask him to take photos of official events, he says. And the man himself has gained insight as well.

While thankful to his parents for their care, he urges the parents of others with emotional disorders to engage with them; not to restrict their children’s activities, but let them learn from their mistakes. To make the point, the man, a faithful Muslim, cites a passage in a book he has read: “Being physically defective does not mean that we are not able to do anything. The main thing is to have a good heart. God will guide us.”