When American film actor, Robin Williams who suffered from depression committed suicide, Kenyan writer Ted Malanda mourned, “I can’t wrap my mind around the fact that depression is an illness. In fact, it is such a non-issue that African languages never bothered to create a word for it”.
Derrick Mbuga Kizza, the executive director of Mental Health Uganda, says such misconceptions largely explain why victims of depression, just like other mental health problems, end up in the hands of traditional healers and herbalists. A lot of mystery surrounds its cause, symptoms, treatment and care.
Dr Ethel Nakimuli Mpungu, a psychiatrist, says tragic events where one takes their life happen and are common among people who have been struggling with mental illness all their lives.
Dr Nakimuli says those who suffer from mental illness all their lives need our support so that they can live with the illness.
According to World Health Organisation (WHO), mental health is a state of wellbeing in which an individual realises their potential in life, can cope with stressful situations, be able to have meaningful relationships, make meaningful decisions that lead to optimal work productivity and contribution to their community
Our mental health lies on a spectrum with one end being good mental health and the other bad. “We are all somewhere on this line hoping we stay on the good side. But stresses beyond our control push us to the bad side,” Dr Nakimuli shares.
The stresses include social issues such as financial loss, marital conflict, and unemployment; psychological issues such as uncertainty, sexual abuse, demotivation, discrimination, and fear; and biological issues such as genes, alcohol, drug abuse and chronic diseases.
For example, if you have genes that make you prone to mental illness, you ought to be extra vigilant of stressful situations so that you are not pushed to the bad end.
Dr Nakimuli adds that some illness is genetic such as bipolar disorder. “If someone has it, there is a 90 per cent chance that another member of their family has it. Therefore, knowledge of your family history is very important,” she says.
From its name, the disease has two poles, at one pole, individuals feel very low, down, depressed, have no energy, want to isolate themselves, lose interest to work as well as in things that used to make them happy.
At the other pole, people are hyper, with so many ideas running through their minds. “At this pole, persons are also impulsive where they act without thought. For example, they could see a job advert and quickly apply for it even when they already have a job. In the end, they make bad decisions. They also suffer from impaired judgment, extravagance where they spend money in a blink of an eye,” Dr Nakimuli explains.
When you see such signs, especially, lack of sleep, racing thoughts, too many ideas, it is really time to talk to a professional.
“People suffering from mental illness, especially during this difficult time of Covid-19 should be encouraged to go to their doctor or psychiatrist for review and to get help on how to manage the difficult social circumstances they may be facing,” Dr Nakimuli adds.
Culture, religion and depression
We are social beings, brought together by many things of which culture and religion are major pillars. Doreen Kanyesigye, a mental health activist, says religion and culture bare a huge influence on our cognitive processes, perception of reality, interpretation of events that occur in our lives and both have particular aspects that can worsen depression
In regards to religion or spirituality, Kanyesigye says it upholds the existence of a higher being, God, who loves, and cares for us and knows us on a personal level. “To that end, it provides a deep sense of hope and resilience in the middle of difficult times because you are assured of this higher being helping you overcome. Hence, a protective factor against depression,” she says.
But where religion is dominated by rules, codes of conduct that are very deep sources of stigma against mental health-related illnesses, depression is heightened.
“I know that several depressed people in the church are very ashamed of seeking help because they perceive that as being weak and not religious enough. As such, they would rather keep quiet and suffer silently,” Kenyesigye says.
Kizza says the church perception on depression varies. “Many people with depression seek solace in church because it can be a great avenue for providing psychosocial support. However, because of lack of regulation, they can also be centres for wrong or unfounded information and abuse. For example, some victims are asked to get off treatment under the belief that God can heal someone so medication is not necessary,” he shares.
Kanyesigye says culture has a two-pronged impact on the prevalence of depression. “Cultures that foster a sense of togetherness act as a form of protection, especially by availing a deep sense of community support, such as having someone to go to when faced with a challenge.
However, that is usually curtailed by our culture’s perception of vulnerability. For example in Uganda, some cultures perceive emotional vulnerability as being weak, not man enough which inadvertently impede seeking emotional help,” he says.
Derrick Mbuga Kizza, the executive director of Mental Health Uganda, adds that to deal with depression, one should have a support system as they walk towards recovery.
“In cases where you find family and community ties intact, you are likely to get lots of support unlike heterogeneous communities as is the case in urban centres. Social distancing, for instance, may accelerate depression as it limits interaction,” he shares. Therefore, social stability and functional relationships go a long way in addressing depression.