Bhutan is known for being one of the happiest countries in the world, but mental health professionals say its people are suffering in silence due to cultural stigma and societal expectations of positivity.
Dr Chencho Dorji is the country's first qualified psychiatrist, and works at the Jigme Dorji Wangchuck National Referral Hospital — the only hospital in Bhutan that specialises in psychiatry.
He is also a Professor of Psychiatry at Khesar Gyalpo University of Medical Sciences of Bhutan.
He said even now, only six psychiatric doctors were catering for a population of over 750,000.
Although mental health care has improved since Dr Dorji first started practising in Bhutan in 1999, he said there was still a long way to go.
According to the latest Gross National Happiness report published in May 2023, 93.6 per cent of the Bhutanese population considered themselves happy.
However, Dr Dorji said limited ways to express emotion in the local dialect further compounded the issues around mental health awareness.
Cultural stigma
Since the COVID-19 pandemic, Dr Dorji said mental health awareness increased by leaps and bounds, as the population collectively went through a distressing time.
But cultural norms and societal expectations kept a lid on open conversations and reinforced mental health as a taboo topic in many communities.
Dr Dorji said there were broad cultural beliefs that feared mental illnesses such as epilepsy were contagious, further fuelling the stigma.
"These are misconceived ideas, which we are really trying to dispel, but it's difficult, you know, something stays in the culture for generations," he said.
"A lot of the rural communities are still by and large, very superstitious — they believe in supernatural causes of illnesses, especially in mental health."
Many Bhutanese people live in mountainous areas and therefore prioritise physical health.
"Physical needs are given more importance over emotional needs of people say a lot of people would not even dare express emotions because they're not taking as as understandable," Dr Dorji said.
Societal pressure to be happy
Deki Choden, a Bhutanese counsellor studying in Western Australia, said many people were suffering due to the pressure of constant happiness.
"Mental health is very new in Bhutan, most people do not understand what depression or anxiety is," she said.
"We never realised that mental health needed this attention, because it's a very calm and peaceful country."
Ms Choden began counselling in 2016 and has since seen many more choose the career path as Bhutan works to improve awareness.
The ability to set boundaries is another major cultural difference Ms Choden found between Australia and Bhutan.
"In Bhutan, I think compassion has been so rooted in us … after coming [to Australia], I realised that I can say no, it's okay," she said.
"I'll take care of myself so that I can take care of others."
Having spent time in Australia to hone her abilities, Ms Choden said she felt inspired to apply her new-found knowledge to the Bhutanese system.
Becoming Bhutan's first psychiatrist
With no psychiatry school accessible at the time in Bhutan, Dr Dorji gained his credentials from universities in Sri Lanka, India and Australia.
He was inspired to study in the field from personal experience caring for his family.
"I had two of my siblings who had schizophrenia … so we were doing all sorts of the traditional treatments at home, but those were not working for them," he said.
"I became a doctor first in Bhutan, and then I realised that I have to take up psychiatry, at least for my own brothers' sake, because nobody else is able to treat them.
"So I became a psychiatrist, and fortunately for me, both my siblings responded to treatment to modern anti-psychotic drugs, and both of them have a relatively reasonably good life."
His exposure to other mental health care systems overseas has allowed him to set clear objectives for Bhutan's system.
Dr Dorji hopes to train more psychiatric doctors and build the number of mental health support workers in Bhutan.
Eventually, he wants to see at least one psychiatrist working at every hospital in the country.
