Looking Back, Looking Within: A Journey Through Bhutan’s Mental Health Landscape
I began my journey as a medical doctor in 1989, a time when Bhutan’s health system was still in its early stages of development. As a young medical officer, I moved across five different postings over 13 years. Those years shaped my identity as a doctor and taught me the value of service, resilience, and humility. Yet, when I look back on that period, one thing stands out with a quiet but unsettling weight: I do not recall ever treating a patient for the psychiatric conditions that now dominate my daily practice.
It was only later, after training and returning as Bhutan’s second psychiatrist, that I began to question this silence. Did mental illness not exist in those days? Or did we, as medical professionals, fail to recognise it?
In my memories, I can still see “odd” figures wandering the streets — men and women who behaved strangely, muttered to themselves, or lived in hidden corners of the community. They were the ones people avoided, the ones children were warned against as potentially dangerous. At the time, we had no framework to understand them. Mental illness was not part of our diagnostic vocabulary. Alcohol use, meanwhile, was dismissed as a weakness of character and a lack of discipline. We had no tools, no interventions, and no hope to offer.
Our focus in those days was elsewhere. We were young doctors serving in a young nation, where communicable diseases, maternal and child health, safe drinking water, sanitation, and nutrition were our urgent priorities. Public health campaigns — immunisation, malaria control, iodine deficiency, leprosy eradication, and family planning — consumed our attention and rightly so. Hospitals were places people turned to only when local healers and shamans could not provide relief. Our task was to win their trust in modern medicine, to prove that science and compassion could complement tradition.
Yet, beneath this progress, a hidden suffering remained unaddressed. Only years later, after serving as a psychiatrist for more than two decades, do I recognise how much we might have missed. Mental illness was there — in silence, in stigma, in shadows — but it went unseen, unnamed, and untreated.
Today, the picture is very different. Thousands of people come forward seeking psychiatric help, each story unique, each pain deserving of recognition. Families, schools, and workplaces are more open to conversations about mental health. Awareness campaigns, training programs, and media discussions have brought the invisible into the light. Sometimes, though, I wonder if in our effort to destigmatise mental health, we may have swung the pendulum too far in the other direction.
I find myself reflecting on whether we have created a kind of over-reliance — a belief that every stress, every worry, every difficulty must be solved by professionals like us. While clinical care is essential, I firmly believe that true mental well-being also requires personal responsibility, resilience, and community support. People must learn not only to seek help when needed but also to nurture their own coping skills and inner strength.
After 36 years in Bhutan’s health sector — 20 of them as a psychiatrist — I remain humbled by the journey. From days when mental illness was invisible to today, when it is openly discussed, we have come a long way. Yet the work is far from over. We must continue to expand services, reduce stigma, and strengthen care. But equally, we must empower individuals to take ownership of their mental health, to recognise that healing is not only in hospitals and clinics but also within families, friendships, and the choices we make every day.
As I reflect on this path, I realise that the greatest lesson of all has been to look beyond symptoms and statistics, and to see the human being in front of me — vulnerable, complex, yet resilient. That, perhaps, is where true healing begins.
