‘Depression-Related Stigma Affects Both Upper & Lower Classes’: A Psychiatrist Speaks

Posted by Shivangi Shankar in #LetsTalk, Mental Health
May 2, 2017

“Depression is the leading cause of ill health and disability worldwide. According to the latest estimates from WHO, more than 300 million people are now living with depression, an increase of more than 18% between 2005 and 2015. Lack of support for people with mental disorders, coupled with a fear of stigma, prevent many from accessing the treatment they need to live healthy, productive lives.

The new estimates have been released in the lead-up to World Health Day on April 7, the high point in WHO’s year-long campaign ‘Depression: let’s talk’. The overall goal of the campaign is that more people with depression, everywhere in the world, both seek and get help.

WHO has identified strong links between depression and other noncommunicable disorders and diseases. Depression increases the risk of substance use disorders and diseases such as diabetes and heart disease; the opposite is also true, meaning that people with these other conditions have a higher risk of depression.”

– (WHO news release, March 30, 2017).

Never Always: Sushmita DJ(MMC)
Never Always

In view of the ongoing campaign, a set of questions and answers were compiled to help the layman understand the implications of depression better. In fact, depression and mental health issues (in general) have been discussed a lot in recent years.

Dr Anil Kumar Nagaraj, a faculty member at the Department of Psychiatry in Mysore Medical College & Research Institute (MMCRI), Mysuru, has provided insights into the disease to help us understand and act for the betterment of those suffering from mental illnesses.

Question (Q): How can one differentiate between regular sadness and depression? Can one transition from one to the other, given the environment?

Answer (A): Yes, all types of sadness are not depression. Sadness in relation to a situation is transient and can be resolved. Sadness, in association with low energy levels, not experiencing pleasure from any pleasurable activity, feeling hopeless, guilty and low self esteem which persist almost daily for at least two weeks, should be considered as depression.

Q: The fear of medication and professional treatment seems to prevail even today. How would you advise the layman in this regard?

A: Depression is an illness like any other illness of the body. When we have fever or headache, we take medication to get rid of it. Similarly, depression can also be cured with medication, because it is also an illness – but of the mind.

Q: Treatment remains evasive for some people because they also have to ‘balance an added stigma’, when they seek therapy. People have to fight years of conditioning to accept mental illness.How does this added burden of stigma affect those seeking help? Does this pose a challenge in the therapy?

A: With time and education, the stigma is becoming less – at least in the urban world. But of course, stigma causes delay in treatment – and hence, the chronicity and drug-refractoriness of depression increases.

Q: People shy away from seeking professional help. Even when they’ve overcome the social stigma attached to it, the cost (of treatment) seems excessive, especially for people belonging to the lower income strata (which also faces more stigma due to lack of education). What are the trends in this regard?

A: Depression-related stigma can affect both the upper and lower stratas of society. However, not all medicines are costly. Many anti-depressants are actually quite affordable. Moreover, government hospitals in India provide free treatment for all.

Q: Is the incidence of depression higher in marginalised sections of the society?

A: Depression affects upper as well as lower classes. But, its incidence is slightly higher in marginalised sections of society, owing to the high socio-economic stress under which they live.

Q: What do you think can be done to help?

A: Awareness about depression, consequences and the importance of its management, on a large scale, can provide insights to the common man.

Q: The WHO handout on ‘Living with someone with depression?’ concludes with “Take care of yourself too.” Try to find ways to relax and continue doing things you enjoy.What are the difficulties faced by friends and family members of those living with depression?

A: Caring for a person with mental illness is always stressful. A significant amount of their time is spent in the care of these patients. If it is the primary earning member of the family who is affected, then they face more distress. They also need to monitor  the use of medication by patients.

So, caregivers also need to look after their own health in order to remain healthy. Depression among caregivers is a significant issue. In fact, there is a 12-step program called Caregivers Anonymous for them.

Q: What advice would you give to a caregiver?

A: Caregivers need ‘ventilation’. They can be invited for a session of supportive counselling to discuss their problems or issues. Thus, it is tailor-made and they may require such sessions once a month or once in two months depending on the situation.

Q: The 21st-century lifestyle has been blamed to no end for many diseases. How far do you think the current lifestyle is responsible for aggravating depression?

A: In the Indian context, population is both a boon and a bane. High competition in both the educational and occupational fronts is stressful. When ambition and achievement do not overlap, people tend to regress mentally depending on their psychological vulnerabilities.

Poverty and illiteracy among people, in the midst of the technological advancements of the 21st century, also pose lots of challenges. In fact, a lot of people are deprived of many opportunities, and hence, become victims of depression.

Q: What are the dos and don’ts you would advise a lay-person, to prevent depression?

A: Depression can be endogenous or exogenous. Endogenous depression cannot be tackled by dos and don’ts. A healthy lifestyle comprising of quality sleep, a balanced diet, exercises and relaxation techniques, maintains the hormonal balance, and hence decreases vulnerability.

We also need to enhance our coping strategies in the face of crisis and adversities. In fact, there are personality development workshops and assertiveness development programs to enhance one’s resilience.

Q: The social media is a powerful tool in creating awareness regarding important issues. However, there is also the unreliability factor of information available on the internet. Misleading articles and ‘listicles’ can make a healthy individual doubt his health. Artistic representations can sometimes be misleading too. Has social media helped more than it has harmed, in this regard?

A: Many movies have directly or indirectly picturised depression and the consequent suicidal attempts. Many newspapers also keep publishing articles on depression. All these serve to enhance our knowledge.

Q: How far, do you think, a misconception of the illness plays a role in aggravating/alleviating it?

A: Sometimes, due to illiteracy, depression is considered to be due to supernatural experiences. Valuable time is wasted, as timely treatment is not provided. This can lead to treatment-refractory depression. Thus, misconceptions are always hazardous.

Q: How can the internet be used as an effective tool to combat mental illness? To what extent should it be relied upon?

A: Google search provides very useful information on depression to the common man. Thus, it can be more useful than social media.

The take-home message for us (from this conversation) is that we should treat mental healthcare as every individual’s right. It isn’t and shouldn’t be a privilege. Naturally, information is power and information about various mental disorders is just a click away. The idea should be to listen without judgement or bias.

For further information regarding depression and the campaign, visit here.

The author is a member of the NSS Team, MMCRI, Mysuru.

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