Let me begin with a sincere expression of appreciation to the management of the Shalamar Medical and Dental College for the invitation to speak to you this afternoon. And, in particular, my thanks also to Ahmad Hidayat, Curator of this programme.
I have been asked to speak to you on the theme of IZTIRAB : BORN FROM THE UNSETTLED. Ever since receiving the invitation, I have tried to wrap my mind around the title.
It is a curious marriage between an Urdu word and an English phrase. Iztirab meaning agitation, anxiety, restlessness, even mental disturbance and mental unease. The second part is in English and provocatively vague.
Mulling over this duality, I realised that, in a sense, the title reflects our confusion as a people. Our recorded culture may go back over millennia, but our 5,000 year-old heritage is trapped within the body of an eighty year-old. We are full of such contradictions. In fact, if I had been in the medical profession, like many of you, I would diagnose us as a nation of schizophrenics.
Let me explain.
Schizophrenia, as you know, is a mental health condition, a mix of disorganized thinking and behaviour, often delusionary. Schizophrenics are known to lose touch with reality.
In August 1947, we were born with political schizophrenia. We emerged as one country with a split geography. We got one wing in the west and another, 1,000 miles away, in the east. Our national identity was split. We spoke different languages. We had different staple diets – wheat on side and rice on the other. We had different ideologies and disparate political representation.
Even today, residual Pakistan, despite being one geographically contiguous whole, is riven with dissensions. In our politics, too, we are schizophrenic. We have two major political parties, playing ping-pong with each other. There seems to be no place at the table for other players.
Some might argue that as a predominantly Muslim nation, we are an egalitarian society. But even in our religion, we are schizophrenics – divided between Sunnis and Shias, with a shrinking space for minority communities. Ask any Christian, Hindu or Ahmadi.
How many of you, by the way, know that the minorities are symbolised by the white space on our national flag?
Economically, we are schizophrenics. We are split between the haves and the have nots. The writer F. Scott Fitzgerald once wrote that ‘the rich are different from you and me,’, to which his co-author Ernest Hemingway retorted: ‘Yes, they have more money.’
A Gallup Poll conducted in 2025 revealed that wealth disparity in Pakistan was ‘severe, with the richest 10% holding 59% of total national wealth and the top 1% controlling 24%’. The Gallup survey asked people to describe their economic status: ‘4% described themselves as “wealthy”, 46% considered as “middle class”, and 49% described themselves as “poor”.
Although that survey was derived from a ‘public self-perception’, its results were confirmed by other data. According to the World Bank, ‘44.7% of Pakistanis live below the international poverty line of US $4.20 per day / roughly Rs. 1,200 a day)’.
In the 1960s, long before many of you or even your parents were born, the economist Dr. Mahbub ul Haq gave this concentration of wealth a label: ‘22 families’. He revealed that ‘22 elite family groups controlled roughly 66% of Pakistan's industrial assets, 80% to 87% of banking, and 70% of insurance’. Mr. Bhutto’s nationalisation in the 1970s broke their stranglehold.
That economic divide exits even today, except that the wealth has passed into different hands. We are a poor country with uber-rich leaders. We are divided economically, and educationally.
We send our children to different schools. For those who can afford them, there are English medium schools. For the rest, Urdu medium public schools or Islamic madrassas, or a lapse into illiteracy.
I remember asking a friend of mine who ran a private school in Lahore what his school was called. He replied: ‘’Ask any parent. For them, there are only two schools in Lahore – Aitchison, and somewhere else’’.
I myself studied in Aitchison in the 1950s. Later, my son Komail studied there in the ‘90s, and in 2008, I was invited to become its 14th principal. My three-year experience at Aitchison merits a TED talk on its own.
There, I was exposed to the layers of class distinctions that divide our society. I found that parents preferred to create traffic jams on the Mall before and after school hours, rather than minimise the number of cars by pooling transport with their neighbours. They insisted that their sons should be driven alone in a car. They regarded a journey in school buses as demeaning.
I discovered then that 90% of the parents lived in the posh areas of Gulberg, Cantt. and DHA, east of the canal, and only 10% of them west of it, closer to the old city.
Even internally within Aitchison, a class distinction was palpable. Aitchison has a main school for fee paying students. The children of the lower staff go to the Campus boys’ and girls’ schools, where classrooms had been adapted out of disused stables. One incident is a good (or bad) example of the prejudice that may still exist.
One summer, I suggested that as the main school was closed, the campus boys should be allowed to use the swimming pools. There was opposition to the idea. As the Senior School Headmaster put it, ‘They will dirty the pool.’ As if their colour would come off in the chlorinated water.
Another embarrassing example – embarrassing for me but clearly not for some parents – occurred when I suggested that we hold one class – not a series, not a course, just one class – on comparative religions. A surprisingly significant number of parents objected. They felt the faith of their Muslim sons should not be tested even though their boys would be going to universities abroad with a multi-religious student body.
Those of you who are parents must have had parallel experiences. What I deplore is not that we have such irrational religious or social prejudices. It is the fact that we embrace them so easily. We have become complacent schizophrenics.
If we have social divides, we have also linguistic barriers. You may have noticed that we begin our conversations, like the title of this talk, with Urdu and then continue in English. Our local channels converse in Urdu. Foreign channels speak to us – as many of us do to each other - in English. It won’t surprise you to know that when our students apply for places in foreign universities, in response to the question about which foreign languages do they know, they invariably write: ’Urdu’.
We are schizophrenics even in the compatriots we send abroad. Manual labour, the skilled and semi-skilled we send to the Gulf countries. Our educated classes or their children vote with their feet. They migrate to the U.S., Canada, the U.K. or Australia.
In the 1800s, Britain dumped its criminals in Australia. As recently as the 1950s, British unemployed were offered a financial incentive of £10 per adult plus free passage by sea, to relocate in Australia.
There is an interesting anecdote of how times have changed. A recent visitor to Australia was asked at the Immigration counter whether he had a criminal record. He replied: “Why, is that still a qualification for entry into Australia?”
I have spoken about Iztirab – of mental agitation, of unease. This malaise permeates every corner of our social, religious, economic and educational mindsets, causing us to suffer national schizophrenia.
Let me now address the second part of the topic – Born from the Unsettled.
We may be 80 years old as a country but we are still unsettled as a state. Even after 80 years, we do not have borders accepted by our neighbours. In the north, we have the unresolved dispute over Jammu & Kashmir. In the west, the Afghans and we have yet to agree an impermeable border to replace the McMahon line. And in the south, we have a running argument with India over Sir Creek and therefore maritime jurisdiction.
Let me speak now of the challenge of national integration. Communities are still labelled as ‘muhajirs’ or isolated as ethnic groupings. We have districts aspiring to become provinces. We have provinces agitating to become break-away countries. In many ways, we have not yet recovered from the unsettled traumas of 1947.
How does one cure national schizophrenia?
There is no pharmaceutical company I know of that has invented a panacea for national schizophrenia. To be cured needs inexhaustible patience, a collective resolve, and above all, aeons of time.
One is reminded of the story of the American academic who visited his counterpart in Oxford University. He admired the trim, green quadrangles in its colleges. He enquired of his British colleague how they managed to maintain them in such pristine condition.
‘’Oh, all you do is water the grass, and then roll it.”
“Is that all?” the American countered.
The British don replied: ‘’Yes, that’s all you need to do. Just water and roll, water and roll. But you have to do that for 800 years.’’
When will we as a nation emerge from this unsettled state of Iztirab?
Invite me again after 800 years, and I will tell you whether Pakistan has achieved an equilibrium - attained a mature statehood, or not.
Until then, we must each do our best and live peaceably with others, and within ourselves.
Let me conclude with a revelation I received after one of our Aitchisonians who had completed his first term at a leading medical university in Karachi.
I asked him what subjects had he been introduced to – anatomy, diagnostics, pharmacology?
“No,’’ he replied. ‘’They gave us classes on art, history, music, and the social sciences. They told us that we have five years to make a doctor out of you. We have only three months to make a human being out of you”.
So while we may be trainees, nurses, doctors or specialists in this room, and occasionally in due course even patients, we are all human beings. That is why I – a geriatric retiree - am honoured to be part of this initiative by SMDC and to share my experiences and thoughts with you today.
F. S. AIJAZUDDIN
SPEECH AT TEDxSMDC, Shalamar Hospital and Dental College, Lahore, 27th August 2026, 5.00 pm:
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