With Donald Trump elected as the new leader of the US, its impact has been felt all across the world. So how does the change in voters’ thinking work, and how can the slogan for change may end up with Imran Khan as the next prime minister of Pakistan? It would be a big change but not surprising. Older people and those on lower incomes seem resistant, while younger and more affluent segments of society are firmly for change. Why would people really vote for change? If the Pakistan Tehreek-e-Insaf (PTI) does not face some psychological reasons, they may not be able to bring the element of surprise together. Trump’s election campaign was marred with controversies: his description of Mexican immigrants as “rapists and criminals,” and his war of words with a judge, a Miss Universe, a Fox News anchor and the Muslim family of a fallen soldier. Furthermore, questions surrounding his charitable foundation did not distract a huge number of American voters in key states, and revealed a deep feeing of anti-establishment anger and discontent. Despite lack of political experience Trump’s message clearly resonated with the American people. Without specific attention to data on the role of poverty, place and individual characteristics driving the US presidential vote, this election has shown how the US is divided along economic, educational and social lines. In the aftermath of the Brexit vote and US presidential elections, both individual and party level drivers of the vote can have implications for the wider debate in Pakistani politics.People in Pakistan who feel left behind by corruption, injustice and power games of political dynasties are the ones most likely to support the PTI. These voters face a ‘double whammy’. While their lack of say in parliament put them at a significant disadvantage in national politics, they are also being further marginalised in society by a lack of opportunities and the miseries they face in their everyday life. All these factors could make it possible for the disnfranchised to adapt, grow and change the political scene in future. The geography of the vote has already sparked a debate about a divided Pakistan in which many have traced the vote for the PTI from those who feel left behind. Although many polls differ in terms of their estimated share of the vote for change in Pakistan they did tell a consistent story about which groups would vote in favour. Key findings in Pakistan’s demographic data hint that the poorest households, with incomes of less than Rs 20,000 per year, are less likely to support the PTI than the middle class households, as are the unemployed, people in low-skilled and manual occupations. Clear divides on age, education and ethnicity are present. Put simply, older, rural and more economically insecure people with low levels of educational attainment seem less likely to vote for the PTI than younger people, degree-holders, urban dwellers and the more secure middle and upper classes. Age, income and education matter, though it is educational inequality that was the strongest driver in both the Brexit referendum and the US elections. But to what extent is this frustration among people supported by the motivation to bring out the ‘PTI-exit’ in Pakistan politics, and what role can the PTI play in these decisions? The chances of the PTI-exit also vary across different areas. Whereas some areas are thriving, others are in decline; it shows that this decline consists of numerous factors such as population increase, those with skills without jobs, economic restructuring and de-industrialisation, shrinking labour markets, unemployment, low education and skills, poor health, deprivation and poverty, physical blight and delayed justice from courts. But were poverty, employment and injustice central drivers of the vote to leave the EU or win the US presidential elections? To answer this question, I think we know enough now to offer hitherto unprecedented insight into the dynamics of the Pakistani voters. Findings on individual voters who readily identify themselves as PTI supporters must turn out on the day to win the election. Until now, much of the research on the success of the PTI has focused on the area or ‘aggregate’ level, exploring, for instance, the relationship between the characteristics of communities and their levels of support for fight against corruption or the “Naya (new) Pakistan” slogan. But looking only at the area level masks what is happening at the individual level. For example, knowing that many PTI supporters are young, educated, middle class individuals living in urban areas is helpful, but it does not really tell us much about them as voters. And if the low-skilled, young, uneducated individuals living in the same areas have also decided to vote for the PTI. The PTI would have to push the debate forward by considering both the area and individual-level drivers of support for change as well as how these interact. PTI think tanks would have to draw on data that put the backgrounds, attitudes and values of the indecisive voters under the microscope, painting a detailed picture of what would motivate their decision at the election. This would allow the PTI to contribute to the win in the next general elections, exploring what the findings reveal about issues that need addressing in relation to poverty, skills and opportunity, and in different parts of the country among individual voters. As well as asking for their broad views on the change, and which way they would vote, the PTI should also ask what they thought would happen in the event of change. What did the public think it would mean for justice, the economy and our influence in the world? Speaking of politics, while the majority still think they would vote for change, their views on the two issues of accountability and the economy — are telling. Others warn the PTI against an interpretation of the change that focuses only on injustice and corruption. Economic insecurity and the gloomy economic forecasts resonate within communities. The implication is that it is the shape of our long lasting and deeply entrenched poor economy that drives differences in voting patterns. Or is this the wrong way to think about this issue? It is possible that material conditions determine cultural attitudes, that people would be more comfortable with phenomenon such as corruption if they were better off and did not feel so hard-pressed economically. On the other hand, it is also possible that cultural values shape economic outcomes, that people’s unwillingness to embrace economic opportunities, perhaps due to certain mental shackles, ends up leaving them worse off. The writer is a professor of psychiatry and consultant forensic psychiatrist in the UK. He can be contacted at fawad_shifa@yahoo.com