rki.news
By Dr Amaal Khalid Chauhan
Earlier in 2026, in Chakwal, a 12-year-old girl was taken to a shrine by her family, seeking spiritual healing. She was allegedly assaulted by the pir running it, and her family later registered a case with the police. This atrocity is not an anomaly in Pakistani courts, journalism, or research, where such cases have recurred in documentation since at least 2013.Men claiming to be pirs, aamils, or faith healers have been assaulting the people who come to them for help. A woman from Muzaffargarh died by committing suicide in 2017 after being raped and tortured with hot knives and rods by a ‘spiritual healer’ she had gone to seeking help. A faith healer from Naushahro Feroze was sentenced to life imprisonment in 2020 for raping women who came to him for treatment. Seclusion, sedation, physical violence and abuse deemed ‘purification’ justified as exorcising jinn; and surveillance used to threaten victims afterwards, are recurring practices across these cases.
The uncomfortable question one can’t avoid asking is why people keep going.
Islamic scholars distinguish sharply between what these men do and sanctioned Quranic healing, ruqyah shariyyah, – which involves only Quranic recitation and the Prophet’s supplications, prohibits payment and seclusion with a non-mahram, and claims no personal healing power attributed to one’s self. Pakistan’s mental health law aims at a parallel standard for psychiatric care itself. Whether hospitals meet it in practice is a separate, and separately documented, question.
In Karachi, a cohort study of first-episode psychosis found patients waited, on average, 16.8 months (men) and 11.8 months (women) for treatment, with rural patients facing nearly double the delay urban patients do (8.6 months versus 4.3). The broader pattern shows up even where faith-healers aren’t the specific subject: a 2024 study of 3,220 postpartum women in Punjab found that among the 1,503 who screened positive for depression, only 2% ever sought mental healthcare and 92.8% sought no medical attention at all, despite 81% recognizing they needed treatment. One Pakistani study found faith-healer consultation an independent predictor of medication nonadherence, and a Peshawar relapse cohort found 96.4% of patients readmitted for schizophrenia had chosen a faith healer’s care over their
Pakistani literature regarding mental health in patient populations is severely limited, however; and it rarely examines the clinical experience itself. Taboos and limited institution support,- or even acknowledgment for that matter -, leave these internal dynamics unrecorded at home, turning our focus to global data to understand and explore dimensions of patient vulnerability.
Fo example, the largest psychiatric inpatient study to examine this, a 2024 Psychiatric Services paper on 814 U.S. inpatients, found 62% had experienced at least one type of institutional betrayal. Thirty-two percent reported no step was taken to prevent a harm they experienced, commonly no explanation of medication side effects before they occurred, and 16% described a covered-up adverse event.
Akathisia sits inside that 32% figure. It’s a side effect of the dopamine-blocking antipsychotics central to psychiatric treatment; an inner restlessness of varying degrees of unbearability that often leaves patients unable to sit still, alongside visible agitation and dysphoria, – a feeling of impending doom. Case reports have linked untreated akathisia to suicide attempts, and it’s both preventable and treatable.
Akathisia, though, isn’t the only undisclosed effect doing damage. A worldwide survey of 502 patients on second-generation antipsychotics found 83.2% experienced daytime sleepiness and 74.7% experienced insomnia. Three-quarters rated the daytime sleepiness and the sensation of “feeling drugged or like a zombie” as moderately to severely disruptive to daily functioning. A patient who can’t sleep, or can’t stay awake, and is never told this is a known and manageable drug effect is living the same undisclosed-harm pattern, teetering on the edge of their patience, struggling to simply get by.
Institutional betrayal predicted what came next: patients who experienced it were 25 percentage points more likely to report reduced trust in providers, 45 points less willing to consent to voluntary hospitalization again, 30 points less likely to disclose distressing or suicidal thoughts to a provider in the future, and 11 points less likely to attend a 30-day follow-up appointment. When someone is searching for answers, their vulnerability should never become their greatest liability.
A different strand of research looks at families specifically. A 2023 study of adolescent psychiatric inpatients found ‘dysparenting’ – excessive parental control – predicted longer stays and more readmissions, independent of illness severity. Neither argues for keeping families out of care; both point to a system that should be able to distinguish an admission responding to documented risk from one substituting for a disagreement over a patient’s choices.
The evidentiary gap here is worth reiterating directly: the 814-patient cohort and the antipsychotic side-effect surveys above are drawn from the United States, Europe, and East Africa. Pakistan has no equivalent audit of its own psychiatric inpatients- no formal study of what share experience unexplained side effects, contested consent, or discharge conditioned on compliance. Though, our rich-cultural context doesn’t leave much to the imagination.
On paper, the legal position is less ambiguous. Pakistan’s mental health law traces to a single common ancestor: the Mental Health Ordinance, 2001, issued at the federal level before healthcare was devolved to the provinces in 2010. Its Section 51, on informed consent, is close to word-for-word the standard every province still operates under: a psychiatrist must obtain written informed consent before any investigation or treatment, and a patient may withdraw it in writing at any point before treatment is complete. Sindh’s 2013 Act, Balochistan’s 2019 Act, and Khyber Pakhtunkhwa’s 2017 Act carry this standard forward; Punjab’s 2014 law is formally an amendment to the 2001 Ordinance. That same 2001 Ordinance’s penalty section names ‘exorcising’ alongside branding, scalding, beating, chaining to a tree, and sexual abuse as criminal offenses punishable by up to five years’ imprisonment. Whether hospitals and institutions meet even that lower legal bar in practice is a separate, and separately undocumented, question.
That legal gap doesn’t end at the consent form. Pakistani law requires freedom from detention on the basis of homelessness alone, but is silent on what happens next: a patient ready for discharge is meant to go to a shelter or community placement rather than be held or turned out, yet no formal channel or conduit connects a hospital’s discharge desk to a shelter, a welfare complex, or a community follow-up team. A patient stabilized at real cost is released back into the exact conditions that produced the crisis, often ending up with a fake pir rather than a clinic, because the follow-up appointment never comes.
Five changes follow from the evidence, consequently. One: because a third of the largest inpatient cohort to date reported no side-effect disclosure before harm occurred, informed consent should mean a documented, side-effect specific conversation, covering akathisia and sedation alike, paired with routine screening and drug/dose modification accordingly. Two: because institutional betrayal specifically predicted reduced disclosure of suicidal thoughts, a family-requested admission without documented imminent risk should trigger an independent clinical assessment first. Three: since homeless patients face nearly double the readmission risk of housed ones with no bridge to a shelter, that bridge needs to become part of the discharge protocol itself. Four: as a complaint mechanism only works if patients can actually reach it, it needs to be low-barrier and known, not merely a clause. And finally, as none of the coercion or side-effect data above is Pakistan’s own, a country-wide audit may provide more insight into community-specific qualitative data and issues.
Fake pirs thrive in the gaps left by a slow, hard-to-reach healthcare system. Men already barbarically committing rape, torture, and blackmail under laws, if enforced, exist to stop them. What happens inside formal psychiatric care is a different failure. It is quieter: consent withheld, side effects concealed, a system that measurably teaches patients to stop disclosing the very thoughts it exists to catch. What’s truly disturbing is, at their core, both are forms of unaccountable power going unchecked, just behind different doors – and that needs to change.
Note: Author is a young medical graduate who has previously worked in psychiatry. She is passionate about tackling social reasons for health inequalities and can be reached at amaal.chauhan1@gmail.com
