Anxiety

Anxiety is such a whisperer. In fact, it never ceases to purr upon humanity. Uncertainty fills and frightens many people’s minds. It’s like a constant rustling wind. It can cause you to sweat, feel agitated and tense, and cause your heart to race. It is apprehension or fear of what is to come. It is your body’s normal physiological response to stress. For example, you may feel anxious when confronted with a difficult situation or before making a critical decision, as the consequences may occupy your thoughts. Anxiety is a normal part of the human experience.

People with anxiety disorders, on the other hand, frequently experience intense, excessive, and persistent worry and fear about everyday situations. Anxiety disorders frequently involve repeated episodes of intense anxiety, fear, or terror that peak within minutes (panic attacks). Anxiety and panic disrupt daily activities, are difficult to control, are out of proportion to the actual danger, and can last for a long time. To avoid these feelings, you may avoid places or situations. Symptoms may appear in childhood or adolescence and persist into adulthood. Generalized anxiety disorder, social anxiety disorder (social phobia), specific phobias, and separation anxiety disorder are all examples of anxiety disorders. You can have multiple anxiety disorders.

Risk factors for anxiety disorders?

Biological risk factors, such as genes, If you have a family history of anxiety disorders, you are more likely at risk to develop the disorder. That implies that your genes play a role. Scientists have yet to discover an “anxiety gene.” So just because your parent or a close relative has one doesn’t mean you’ll get one as well. Stressful or traumatic events—Children who have experienced abuse or trauma, or who have witnessed traumatic events, are more likely to develop an anxiety disorder at some point in their lives. Anxiety disorders can develop in adults who have experienced a traumatic event. When you suffer from depression for an extended period of time, you are more likely to develop an anxiety disorder. Certain personality traits, such as shyness or behavioral inhibition — feeling uneasy around and avoiding unfamiliar people, situations, or environments.

What are the symptoms of an anxiety disorder?

Anxiety disorders are characterized by symptoms such as cold or sweaty hands, dry mouth, heart palpitations, nausea, and numbness or tingling in the hands or feet. Shortness of breath, muscle tension Panicked, fearful, and unsettled, Nightmares, Uncontrollable, obsessive thoughts, repeated thoughts or flashbacks of traumatic experiences Inability to remain calm and still Problems sleeping due to ritualistic behaviors such as hand washing. Please contact your health care provider if you are experiencing symptoms of an anxiety disorder.

Anxiety in developed and developing countries.

Developed countries have higher rates of anxiety in their populations than developing countries, according to a finding that even the researchers were surprised by. There was a higher proportion of people with generalized anxiety disorder, or GAD — defined as excessive and uncontrollable worry that interferes with a person’s life — and with severe GAD in higher-income countries. The findings were published in JAMA Psychiatry by the researchers, who are members of the WHO World Mental Health Survey Consortium. Australia and New Zealand, both classified as high-income countries, had the highest lifetime prevalence rates, at 8% and 7.9%, respectively. Nigeria (0.1%) and Shenzhen, China (0.2%) had the lowest reported rates; both were classified as low-income areas. Anxiety disorders affect approximately 18.1 percent of the population in the United States each year. Researchers hypothesized that lower-income countries’ prevalence rates might differ due to relative political or economic instability. These factors may have directly contributed to higher rates — or indirectly contributed to lower rates, because people may not have reported “excessive” anxiety because their concerns were justified by the issues they faced. This could be true because mental disorders are still largely a mystery in most developing countries.

It is not unusual for someone suffering from anxiety to also suffer from depression, or vice versa. Is it possible to have both depression and anxiety? Anxiety disorders affect nearly half of those who are diagnosed with depression. Depression and anxiety are distinct conditions, but they frequently coexist. Anxiety can be a sign of clinical (major) depression. Anxiety disorders, such as generalized anxiety disorder, panic disorder, or separation anxiety disorder, are also common triggers for depression. Several people have anxiety disorders as well as clinical depression.

References

15, Kate Sheridan March, et al. “Rich Countries Are More Anxious than Poorer Countries.” STAT, 15 Mar. 2017, https://www.statnews.com/2017/03/15/anxiety-rich-country-poor-country/.

“Anxiety Disorders.” Mayo Clinic, Mayo Foundation for Medical Education and Research, 4 May 2018, https://www.mayoclinic.org/diseases-conditions/anxiety/symptoms-causes/syc-20350961.

“Anxiety Disorders: Types, Causes, Symptoms & Treatments.” Cleveland Clinic, https://my.clevelandclinic.org/health/diseases/9536-anxiety-disorders.

“Facts & Statistics: Anxiety and Depression Association of America, ADAA.” Facts & Statistics | Anxiety and Depression Association of America, ADAA, https://adaa.org/understanding-anxiety/facts-statistics.

“Risk Factors for Anxiety.” WebMD, WebMD, https://www.webmd.com/anxiety-panic/ss/slideshow-anxiety-risk-factors.

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Why is depression more prevalent in females?

Depression is more common among females (5.1%) than males (3.6%). Women are nearly twice more likely to be diagnosed with depression compared to men. The etiology of depression appears to differ, with women more typically exhibiting internalizing symptoms and males experiencing externalizing symptoms.[1] In a study of dizygotic twins, for example, women were more sensitive to interpersonal interactions, whereas men were more sensitive to external professional and goal-oriented factors.[2]Women also encounter specific types of depression-related illnesses, such as premenstrual dysphoric disorder, postpartum depression, and postmenopausal depression and anxiety, which are linked to ovarian hormone changes and may contribute to the increased frequency in women. The fact that increased depression prevalence correlates with hormonal changes in women, particularly around adolescence, before menstruation, after pregnancy, and during perimenopause, implies that female hormonal oscillations may be a trigger for depression.[3]

Unequal power and status

Regrettably, this is a man’s world. Not only do women have to go to work like men, but they may also be expected to shoulder the burden of running a household, raising children, caring for elderly relatives, and putting up with sexism. Furthermore, we must be concerned not only about our children and families, but also about the rising occurrence of sexual harassment. According to research, nearly a third of women working in traditionally male-dominated trades in the United States said they were sexually harassed frequently or always. A poll was carried out involving 9408 adults(51 percent men and 49 percent women) in eight countries (Australia, Ecuador, Egypt, India, South Africa, the United States, the United Kingdom, and Vietnam), roughly a quarter of men surveyed said, “It is sometimes or always acceptable for an employer to ask or expect an employee to have intimate relations such as sex with them.” Thirty-nine percent of Indian men polled believed it was okay to wolf-whistle or cat-call a colleague on occasion, if not usually. “It is sometimes or always appropriate to pinch a colleague’s bottom in jest,” said 36% of 25-34-year-olds in the United Kingdom. In the United States, “44% of men aged 18-34 stated that expressing a sexual joke to a coworker is sometimes or always acceptable.”[4] Why is society failing to effectively condemn violence against women?

Sociocultural Reinforcements for example “…the ideology of men’s entitlement and privilege over women, social norms regarding masculinity, and the need to assert male control or power, enforce gender roles or prevent, discourage or punish what is considered to be unacceptable female behavior”

CEDAW, 2017, para. 19

This belief system consists of deeply ingrained attitudes, values, conventions, and prejudices against women that serve to perpetuate men’s dominance over women. Unconscious prejudice has a negative impact on women’s autonomy and integrity at work, and is linked to societal gender stereotypes, which can impede women’s professional advancement and most especially contribute to emotional distress.

Cultural factors

Women’s greater rates of depression aren’t only related to biology. Cultural stresses play a role, particularly in developing nations where gender roles are ingrained. Western societies are fortunate in that they seek for equality in women’s rights. In South Asia, the widespread impact of boy preference is predominant. Wife battering and female suicide have been connected to women’s reproductive roles, including their expected role of having children, the repercussions of infertility, and the failure to generate a male child.[5]

The majority of societies are patriarchal in nature. People typically believe that “girls are born to be fed for the rest of their life” and “boys are destined to earn and support the entire family.” A newborn boy’s birth is celebrated, whereas a baby girl’s birth is frowned upon. In some rural areas of India, the situation is even worse, with girls being denied their right to live. In India, sex selection during pregnancy is still widespread, where women are forced to terminate a female fetus. In one of the rural areas of India, it happened that, when a woman returned home from the hospital with her newborn daughter cradled in her arms, her mother-in-law mashed a poisonous coriander into a dollop of oil and pushed it down the infant’s throat. The explanation for this was that sacrificing a girl ensured a male in the future pregnancy.[6]

Evidently, a woman born in this region is unwanted, and if she isn’t killed, she suffers the repercussions and is vulnerable to all of society’s rage. I’m curious, people that hold the believe that they matter more than others–particularly due to differences in gender, skin color, or sexual orientation, etc. If you possess such a mindset– Do you honestly believe you matter more than others? If so, why?

Some countries still hold ancient traditions and customs that promote various sorts of violence against women. These include honor murders, exchange marriages, Quran weddings, Karo-kari, bride price, dowry, female circumcision, doubting women’s ability to testify, confinement to the home, and denial of their right to choose their partner are examples of these practices. If you’re reading this and you don’t live in a culture like this, first-off, consider yourself fortunate; second, imagine living in such a society for a moment. What emotions come to mind when you think about it? According to a study conducted in Pakistan, pressure from husbands and in-laws was the root cause for women to commit suicide. Sad to say, the system in these societies accepts these atrocious acts. There is no way out for this female, and law enforcers are usually hesitant to intervene because they refer the situation as a domestic conflict. Furthermore, women’s mental health is frequently neglected[6].

Let’s discuss female genital mutilation. It entails the partial or complete removal of external female genitalia or other injury to the female genital organs for non-medical reasons. Bare in mind that this practice has no health benefits whatsoever. WHO mentions that more than 200 million girls and women alive today have been cut in 30 countries in Africa, the Middle East and Asia where FGM is concentrated. This practice is carried out on young girls between infancy and age 15. Culture is all fine and dandy until its norms become a violation of human rights. This is beyond anomalous and deviant. FGM is an extreme violation of the human rights of girls and women. It is an extreme kind of prejudice against women, and it represents deep-rooted gender inequity. It is nearly always carried out on minors and is a violation of the rights of children. The practice also breaches a person’s right to health, security, and physical integrity, as well as the right to be free of torture and cruel, inhuman, or degrading treatment, and also the right to life if the process results in death. For the societies that perform FGM, it is considered a vital element of raising a girl in preparation for adulthood and marriage. It is thought to assist a woman resist extramarital sexual acts by ensuring premarital virginity, marital fidelity, and libido.[7] In simple terms, this is depriving women of their sexual pleasure in order to fulfill men’s sexual pleasures. I’m not sure about the females reading this, but I’m enraged.

As a woman writing this, my emotions are indescribably torturous- I have failed to articulate the right words that express the current feelings about this. All these acts, dehumanize girls and women. They rob them of their individuality. They deny girls and women their right to emotions. Because society owns every part of you, they strip you of your dreams, imagination, creativity, and expression. They undoubtedly provoke suicidal thoughts, and many succeed since it is the only way out of the awful reality into which they were born. They deprive women of their right to exist.

No wonder, depression is prevalent more in women than men. Women are simply attempting to navigate this man-made world; Striving for equal rights hoping they will prevail not only in western societies but also, developing nations. Most importantly, the females aim to retain their sanity while contending for equality.

References

[1]Bartels M, Cacioppo JT, van Beijsterveldt TC, et al.Exploring the association between well-being and psychopathology in adolescents.Behav Genet 2013;43:177–90.

[2]Kendler KS, Gardner CO.Sex differences in the pathways to major depression: a study of opposite-sex twin pairs.Am J Psychiatry 2014;171:426–35.

[3]Albert, Paul R. “Why Is Depression More Prevalent in Women?” Journal of Psychiatry & Neuroscience : JPN, vol. 40, no. 4, July 2015, pp. 219–221. EBSCOhost, doi:10.1503/jpn.150205.

[4]Gendered Power Inequalities, https://www.endvawnow.org/es/articles/1930-gendered-power-inequalities-.html.

[5]Validate User, https://academic.oup.com/bmb/article/57/1/33/301595.

[6]Niaz, Unaiza, and Sehar Hassan. “Culture and Mental Health of Women in South-East Asia.” World Psychiatry : Official Journal of the World Psychiatric Association (WPA), Masson Italy, June 2006, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1525125/.

[7]“Female Genital Mutilation.” World Health Organization, World Health Organization, https://www.who.int/news-room/fact-sheets/detail/female-genital-mutilation.

Depression

For some, its like a crawling thought inside your head that you can’t control. For some, it’s like a cold that challenges the warmth in the body. For some, it’s like aches in the stomach, back, and top shoulders. For some, it’s like urging to get up out of bed but find themselves staying longer than usual or perhaps the wakefulness during the night. For some, it’s like feeling worthless and a failure at everything. For some, it’s like hopelessness. For some, it’s like being tired all the time. For some, it’s eating endlessly despite the feeling of hunger- others quite the opposite, not eating. For some, it’s like being stuck in a loop in time. For some, it’s like barely floating on the ocean. For some, it’s like being lodging between nothingness and striving. For some, it’s like screams inside of you- hoping for someone to hear you. For some, it’s being trapped somewhere but nowhere at the same time. For some, it’s like the thrill of pleasure from pain. For some, it’s like chugging glasses of wine or any other alcoholic beverage. For some, it’s like continuously feeling the void of what is. For some, it’s like being uncomfortable with silence- since thoughts get extremely loud. For some, it’s like being invisible. For some…

Depression is a mental disorder that affects how you feel, think and act. And it can strike anyone. It is a leading cause of disability worldwide and is a major contributor to the overall global burden of disease. People suffering from depression today are over 300 million according to WHO. Depression is different from usual mood fluctuations and short-lived emotional responses to challenges in everyday life. Especially when recurrent and with moderate or severe intensity, depression may become a serious health condition. It can cause the affected person to suffer greatly and function poorly at work, at school and affect relationships. Depression is more prevalent in females compared to males-with statistics of 5.1% to 3.6% respectively. There are different forms of depression, such as persistent depressive disorder (also called dysthymia), postpartum depression, psychotic depression, seasonal affective disorder, and major depression. [1,2]

“It is characterized by a combination of symptoms, including low mood, loss of positivity, feeling guilty or worthless, sleep disturbances, fatigue, lack of energy, changes in appetite, loss of interest in activities you once enjoyed and thoughts of death or suicide,” says Wayne Drevets, M.D, Vice President, Disease Area Leader in Mood Disorders, Janssen Pharmaceutical Companies of Johnson & Johnson. [3]

depression in developing countries.

Not so long ago, many psychiatrists believed depression was a uniquely western phenomenon. One typical branch of this belief was advocated by JC Carothers, a psychiatrist and WHO expert. He wrote an influential dissertation on the “African mind” in 1953, arguing that the continent’s inhabitants lacked the psychological development and sense of personal responsibility required to suffer despair. In 1993, Vikram Patel, a psychiatrist, moved to Zimbabwe for a research fellowship. His goal was to find evidence for the view, which was widespread among psychiatrists at the time, that what appeared to be depression in developing countries was actually a response to deprivation and injustice – conditions compounded by colonization.

He began his research by conducting focus groups and cultures with traditional healers and those who cared for patients with mental illnesses, followed by interviews with patients. He inquired as to what mental disease was, what caused it, and how it could be treated. The most common ailment had a name: kufungisisa, which means excessive anxiety about a condition in Shona, the indigenous language. What surprised Patel the most were the patients’ responses.- No matter what they called it, no matter what they believed to be the cause or the treatment. They highlighted hopelessness, tiredness, unwillingness to face their difficulties, and a loss of enthusiasm in life – classic indicators of depression.

Patel had previously assumed that depression was merely an appropriate response to misfortune. Your husband is an alcoholic who beats you. Your crop was a failure. Your family is evicted. Your children are starving. Of course, you’re depressed. You and your family require alcoholism treatment, fertilizer subsidies, and a secure job. What role does psychotherapy play in this? Well, there is a difference between sadness and depression. Sadness is a natural reaction to misfortune. Depression, on the other hand, is not the same thing. Yes, the poor are more prone to depression but that does not indicate that poverty causes depression- it is a correlation however. Depression is like a veil of negative thoughts that paralyzes the person suffering, preventing her from responding to traumatic occurrences.[4]

Depression manifests distinctively in developing countries than in more developed ones. The causes of depression are disturbing: war, torture, epidemics; stressors of daily life in poor countries, such as poverty, extreme food shortages, death of a loved one, etc. A total of 161 papers in the Journal of the American Medical Association reported on surveys of 80,000 refugee studies found a correlation between torture and depression. Syrian refugees in Lebanon were most typically diagnosed with depression and anxiety, according to Doctors Without Borders. According to one study conducted in rural Pakistan, half of the women examined suffered from depression. This was linked to their early marriage and motherhood, several pregnancies, and adjusting to a new life that they had not chosen.[5]

South Asia represents approximately 23% of the global population and one-fifth of the world’s mental health cases- countries include India, Pakistan, Bangladesh, Nepal, Sri Lanka, Afghanistan, Bhutan, and the Maldives. Characterized by significant poverty rates in this region, roughly 150–200 million people have a recognized psychiatric disease and have inadequate access to mental health services. Major Depressive Disorder (MDD) is the most prevalent in all South Asian countries. In another study, rural India had 430 persons out of every thousand at-risk individuals who were depressed — about half of the population. It was found that 39.6 percent of the population suffered from mild to serious depression according to research. The burden of depressive disorders was higher among females and older adults than among males and young people. Previous studies have found that females are more likely than males to experience adverse life events that are strongly linked to the onset of depressive episodes, such as gender discrimination, physical and sexual abuse, relationship breakdown, intimate partner violence, antenatal and postnatal stress, and critical cultural norms. [6]

Untreated depression can take a toll on physical health. It may crimple your thoughts and affect they way you eat, sleep, feel., cardiovascular diseases, physical pain, et cetera. It can also lead to suicide. Note that -The majority of people with serious depression do not attempt suicide. However, according to the National Institute of Mental Health, more than 90% of people who die by suicide suffer from depression or other mental illnesses, as well as a substance misuse problem.[7] The key to preventing depression from increasing and leading to these catastrophic problems is to get professional help as soon as possible. However, many developing countries do not have this access to professional help. Despite the fact that there are proven, effective treatments for mental disorders, a great percentage of people in developing nations have no access to care.  Mental health services and programs should be addressed in developing countries. A lack of resources, a lack of educated healthcare workers, and the societal stigma associated with mental diseases are all barriers to effective care.

References

[1]“Depression and Other Common Mental Disorders: Global Health Estimates.” World Health Organization, World Health Organization, 1 Jan. 1970, https://apps.who.int/iris/handle/10665/254610.

[2]“Depression.” World Health Organization, World Health Organization, https://www.who.int/news-room/fact-sheets/detail/depression.

[3]Reece, Tamekia. “7 Things We Now Know about Depression.” Content Lab U.S., Johnson & Johnson, 29 Sept. 2021, https://www.jnj.com/health-and-wellness/facts-about-depression.

[4]“Busting the Myth That Depression Doesn’t Affect People in Poor Countries.” The Guardian, Guardian News and Media, 30 Apr. 2019, https://www.theguardian.com/society/2019/apr/30/busting-the-myth-that-depression-doesnt-affect-people-in-poor-countries.

[5]“Addressing Depression in Developing Countries.” BORGEN, 14 Feb. 2018, https://www.borgenmagazine.com/depression-in-developing-countries/#:~:text=Depression%20in%20developing%20countries%20looks%20different%20than%20in,and%20homelessness.%20These%20are%20all%20linked%20to%20depression.

[6]Ogbo, Felix Akpojene, et al. “The Burden of Depressive Disorders in South Asia, 1990–2016: Findings from the Global Burden of Disease Study.” BMC Psychiatry, BioMed Central, 16 Oct. 2018, https://bmcpsychiatry.biomedcentral.com/articles/10.1186/s12888-018-1918-1.

[7]Bruce, Debra Fulghum. “Side Effects of Untreated Depression.” WebMD, WebMD, https://www.webmd.com/depression/guide/untreated-depression-effects.

What about culture and mental health?

I once picked up three flowers while out shopping with a friend, who then inquired as to why I chose three flowers. I told her there was no reason; I just felt like three different colored flowers. She explained that in her culture, “three flowers implies someone has died, or perhaps an odd number of flowers means bad luck,” and she went on to explain the meanings of the various colors I chose. I was baffled and inquired about the reasons behind it. This moment intrigued me so much that I thought about it for the following few days—how diverse we are all, how we all have different perspectives on the world and each with our own set of reasons.

Culture is a collective identity shaped by social patterns, norms, rituals, beliefs, values, laws, knowledge, the arts, and behaviors. By the time we reach adulthood, our culture has mostly become unconscious. Culture has an impact on how we communicate with others, as well as how we interpret what they are saying. We also have a delusional belief that everyone perceives things the same way we do. Furthermore, we tend believe that our culture is superior to that of others, or that it is the correct way to conduct things. I’m looking at the core, or possibly the roots. In order to understand the origins, meanings, and effects of mental illness, I’m looking at it from a sociocultural perspective. What does mental health mean in different cultures?

What does mental health mean in different cultures?

Tradition and religion are highly valued in Hispanic Latino communities. There are strong gender roles and gender-based coping styles, for example, severe psychiatric symptoms may be seen as a sign of weakness for men, while women may feel pressured to cope with severe symptoms within the family rather than seek outside therapy. Machismo, a traditional Latino ethic, fosters the repression of emotion and the projection of strength and self-reliance, as well as the acceptance of the position of family provider and protector. Mariansimo, on the other hand, is a traditional Latina value that urges women to be accomondating, submissive, and family-centered. Mariansimo also encourages women to take on the family’s suffering with dignity. Mental illness is seen as a reflection of shame and embarrassment in the family, thus if someone is an outlier, they are explicitly told to remain hidden from the public eye. Since family matters are not disclosed to the outside world, the family tends to keep mentally unstable relatives concealed from the community.

Mental illness is considered a trivial, transient condition; people with mental disorders are often told to “simply get over it” or “slip out of it,” and are also seen as attention seekers. They’ve been labeled as insane. Latinos (particularly females and less acculturated Latinos) are also more inclined to somaticize mental health problems, according to research. Hispanics/Latinos are primarily Catholic. Mental illness is regarded as a misfortune. In the context of religious affiliation– It is linked to sin in the sense that those who are mentally ill believe it is due to a lack of religious faith. As a result, if the individual had more faith and did believe, they would not be sick. Alternatively, if they corrected their wicked ways, the illness would be lifted from them.[1]

Studies have been conducted on mental health and Asian culture. Amongst the participants, were Chinese, Indians, and Filipinos. A significant proportion of participants linked mental illness to a “loss of purpose in life.” Some participants compared mental illnesses to insanity; one participant said that having a mentally sick person in the family was like having a mad person at home. The participant went on to remark that it’s best to avoid such people because there’s no way to get rid of them. They are in a state at which this person is suffering is beyond help. In some Asian cultures, some people view mental illness as somatic illness [2]

Mental illness is associated with superstitious or supernatural origins in Filipino culture, such as God’s will, witchcraft, and sorcery, which runs counter to the biopsychosocial model utilized by mental health experts. Filipinos prefer to seek aid from traditional folk healers who use religious rites in their healing process rather than seek professional help in this cultural environment. Participants in one study corroborated this, saying that “psychiatrists are not a means to deal with emotional disorders.” They also perceive mental illness as a transient affliction brought on by the cold or as a character flaw that must be conquered on an individual basis. The notion that mental illness is a test of faith and perseverance is related to the high spirituality and religious affinities.[3]

“In some cases it is believed that the loss of one’s soul can further weaken one’s body and lead to a state of confusion”

Haque A [4]

In other cultures for instance the Vietnamese, mental illness is attributed to fate or punishment from the dead caused by malevolence and misfortune placed on an individual for misdeeds that angered his/her ancestors. Other widely held indigenous ideas on mental illness are based on the idea of harmony and balance among the universe’s material and non-material entities. Mental disorders are also defined as a discord in the cosmic energies that surround an individual’s physical body and surroundings, as well as an imbalance in one’s interpersonal relationships. Furthermore, it is believed that a balanced flow of energy maintains one’s body balance, and that stagnation in the flow of energy and motion might affect one’s mental and physical health.[5]

In west African cultures, they perceive mental disorders as a taboo. They believe that someone is cursed or possessed by evil spirits and for that reason, your whole family is doomed or perhaps the person suffering from the mental disorder is believed to have brought bad omen into the family. Most Africans have a natural Affinity towards the supernatural. [6] In South Sudan, they believe that a person can become mentally ill from stealing something therefore it is attributed to spiritual revenge- spirits from the mountain, the waters or from the thick forests. In some cases, when a family buys a goat or cow, the animal may be possessed by a spirit that would most likely cause illness to someone in the family; as a result, the family must slaughter an animal to show respect to the spirit.[7]

In Uganda, “Locally people say Mulalu, which literally means you’re mad, you’re useless” says Jimmy Odoki, who also has bipolar disorder. “Where I come from people say ‘that one he’s a walking dead‘.” according to the BBC. 

There is a difference between being ignorant about something i.e. (you have never heard that perspective before) and being aware but still choosing otherwise from that point of view of the world. Some of these cultures, seem to choose otherwise. Nonetheless, others seem to lack awareness and resources for mental health. How does your culture apprehend mental health?

Funny story– When I use chapsticks with my friends during hot pot, I always forget and place them straight up in the dish, but the good thing is that they constantly remind me, so I adapt. When I asked why I shouldn’t place the chapstick as I did, one of them said it was a sign of disrespect in Asian culture. I mean, it clearly doesn’t mean anything to me, but it certainly does in another culture—I had so many irritating inquiries that followed mostly for insight, but I recognized that fact. Culture is awe-inspiring.

References

[1] Etd.ohiolink.edu. https://etd.ohiolink.edu/apexprod/rws_etd/send_file/send?accession=toledo1449868982&disposition=inline.

[2] Web.unbc.ca. https://web.unbc.ca/~lih/Mental%20Health.PDF.

[3] Martinez, Andrea B., et al. “Filipino Help-Seeking for Mental Health Problems and Associated Barriers and Facilitators: A Systematic Review.” Social Psychiatry & Psychiatric Epidemiology, vol. 55, no. 11, Nov. 2020, pp. 1397–1413. EBSCOhost, doi:10.1007/s00127-020-01937-2.

[4] Haque, A. 2008. Culture-bound syndromes and healing practices in Malaysia. Mental Health, Religion & Culture, 11: 685–696

[5] Nguyen, HannahThuy, et al. “Religious Leaders’ Assessment and Attribution of the Causes of Mental Illness: An in-Depth Exploration of Vietnamese American Buddhist Leaders.” Mental Health, Religion & Culture, vol. 15, no. 5, June 2012, pp. 511–527. EBSCOhost, doi:10.1080/13674676.2011.594037.

[6] Ventevogel, Peter, et al. “Madness or Sadness? Local Concepts of Mental Illness in Four Conflict-Affected African Communities.” Conflict and Health, BioMed Central, 18 Feb. 2013, https://conflictandhealth.biomedcentral.com/articles/10.1186/1752-1505-7-3.

[7] Culture, Chic African. “Mental Illness in Africa Taboos.” African Cultures Express, Encourage, and Communicate Energy, Blogger, 20 Mar. 2021, https://www.theafricangourmet.com/2018/12/epidemic-of-mental-illness-in-africa.html.

Misperceptions and stigma on mental illness

You fall into one of two categories: normal or abnormal. Because mental health is non-existent in developing countries, there is no in-between of rather mental disorders. That is, if there is nothing physically wrong with you, you must be fine; otherwise, you are insane, or perhaps your behavior is insane. If your behavior is far beyond what most people can comprehend, you are unquestionably abnormal.

“Look at a crazy man”– that is the most common phrase used for people with schizophrenia in developing African countries. It’s heartbreaking, but no one realizes it’s a brain disorder; instead, someone thinks they’re crazy. In some countries, it is believed that a mentally ill person has been bewitched (black magic) or cursed, is possessed by evil spirits, or suffers from other metaphysical ailments. Not only are you cursed, but your entire family is thought to be cursed as well. If one member of a family is determined to be insane, the entire family may be excluded. Women and girls, for example, are unable to marry into other households for fear that their children will be affected as well. If a mental ailment is thought to have a metaphysical origin, it’s only natural to look for a metaphysical cure. The most common practice is to take people suffering from disorders to traditional healers. Ancestor rituals are performed in voodoo temples in Togo, Benin, and Nigeria[1]. The ceremonies are thought to enlist the assistance of the gods or ancestors. Others take persons suffering from mental disorders to church and leave them there until they recover. People who are disturbed, as exorcists refer to them, are possessed by evil spirits, according to them. They attempt to liberate afflicted people from such entities through ceremonies and prayers— I’m curious, do people suffering from schizophrenia or perhaps any brain disorder get better from church or perhaps an exorcism?

Most people with brain disorders live on the streets, helpless. They have families and friends, but because they believe they are cursed or bewitched, there is no room for them any longer. Others accept them as they are, but if or when the journey becomes frustrating, as it often does in West Africa, if psychological problems are linked to violent outbursts, the person is frequently beaten, confined for weeks or months without food, or chased into the jungle or forest to fend for oneself. [1]

People suffering from mental illnesses are perceived as dangerous and violent, widening Asia’s social gap. The application of supernatural, religious, and magical therapies to mental illness is gaining popularity. The road to treatment is frequently shaped by the skepticism of mental health services and therapies. The stigma imposed by family members is widespread. Furthermore, the societal rejection and devaluation of families containing mentally ill members is concerning. This is particularly true in the cases of marriage, divorce, and marital separation. Psychic symptoms, unlike physical ailments, are regarded as socially inconvenient. [2]

In Malaysia, 15 patients with mental illnesses participated in studies. 12 of the 15 respondents reported severe stigmatization and discrimination from their family. According to a state psychiatrist, there are instances when a patient is discharged from the hospital and no family members are available to pick them up. As a result, an ambulance is dispatched to bring them back. When the patient’s family notices him approaching, they lock the doors and windows. They’re pretending they’re not at home. Eight of the fifteen patients reported having difficulty maintaining friendships. Some people are friendly at first, but once they realize you’re mentally ill, they stop answering your calls or refuse to hang out with you, according to one patient. It’s a tragedy, the patient continued. Seventeen out of fifteen employees reported active stigma from their employers. In one case, a patient told potential employers about his condition at the end of the interview, and they later rescinded his offer. Another person mentioned taking sick leave because he was depressed. When he returned, he was fired[3].

“Patients are thrown out of their own homes and they don’t know where to go. So they sleep by the road. Or at back alleys. They are left tattered and dirty. So how to get a job? Without a job, how to get money to live? So they are stuck, having to rely on people for it, sometimes having to beg. They have no power at all”. – [P003, private clinical psychologist].

Mental illness is still viewed through the lens of socio-cultural and religious beliefs, which contributes to stigma. The prevalence of mental disease stigma has been repeatedly demonstrated to be a significant disabling factor for those suffering from mental illnesses. It raises the possibility of a vicious circle of prejudice and deterioration. As a result, individuals with mental health issues face increased stigma and have fewer opportunities in many areas of their lives, including social connections, employment, and health rehabilitation. [3] Mental health stigma is an issue that must be addressed as soon as possible because it has a negative impact on the lives of those who suffer from mental disorders, potentially resulting in social and economic losses. Furthermore, mental health stigma discourages people from seeking mental health treatment. As a result, the significance of reducing mental health stigma cannot be overstated. [4]

The most significant sources of mental illness stigma and misperceptions appear to be a lack of knowledge and awareness, as well as unfavorable media representations. There is an urgent need to eliminate stigma associated with mental illness in society and the health system through education and awareness initiatives.

References

[1] New 21/09/2021 – by Mahwish Gul, et al. “In West Africa, Traditional or Religious Practices Are Often the Preferred Method of Treating Mental Disorders.” D+C, https://www.dandc.eu/en/article/west-africa-traditional-or-religious-practices-are-often-preferred-method-treating-mental.

[2] W;, Lauber C;Rössler. “Stigma towards People with Mental Illness in Developing Countries in Asia.” International Review of Psychiatry (Abingdon, England), U.S. National Library of Medicine, https://pubmed.ncbi.nlm.nih.gov/17464793/.

[3] Hanafiah, Ainul Nadhirah, and Tine Van Bortel. “A Qualitative Exploration of the Perspectives of Mental Health Professionals on Stigma and Discrimination of Mental Illness in Malaysia.” International Journal of Mental Health Systems, BioMed Central, 10 Mar. 2015, https://ijmhs.biomedcentral.com/articles/10.1186/s13033-015-0002-1#Sec34.

[4] Park, Jong-Ik, and Mina Jeon. “The Stigma of Mental Illness in Korea.” Journal of Korean Neuropsychiatric Association, Korean Neuropsychiatric Association, 30 Nov. 2016, https://synapse.koreamed.org/articles/1017812.

Language barrier and mental health awareness.

Communication is essential in everyday life. Language is a powerful tool for conveying information. As a result, the language barrier impedes communication. Language barriers can exist not only when people or groups speak different languages and thus cannot communicate with one another, but also when dialects are spoken. Misunderstandings and communication gaps occur when people speak the same language but have dialectical differences. “India uses over 22 major languages written in 13 different scripts, with over 720 dialects,” for example. [1] As a result, it impedes communication when it comes to mental health awareness.

Most developing countries appear to have a large number of languages in comparison to developed countries, which have a limited number of languages. Papua New Guinea has the world’s highest level of linguistic diversity. They speak 840 different languages. Indonesia comes in second with 711 languages; “only 20% of the population speaks the national language of Bahasa Indonesian at home.” [2]

With more than 2,000 distinct languages, Africa has a third of the world’s languages with less than a seventh of the world’s population. By comparison, Europe, which has about an eighth of the world’s population, has only about 300 languages.

“Why Does Africa Have so Many Languages?” The Christian Science Monitor, The Christian Science Monitor, 21 Apr. 2015, http://www.csmonitor.com/Science/Science-Notebook/2015/0421/Why-does-Africa-have-so-many-languages.

The issue is not so much a proliferation of languages as a barrier to communication as it is a lack of a unified language. There are approximately 328 languages spoken in the United States, with English serving as the common language. Linguistic diversity is fascinating, and I hope that all languages survive. According to a study of 100 people in a city in western Uganda, the average speaker knows 4.34 different languages. [3] Isn’t that incredible? A unified language in a society, in addition to other languages, improves communication, which promotes the development of many sectors, including the health sector. People who are not fluent in an official language are thought to have difficulty obtaining psychiatric care when it is needed, owing to the obvious limitations they face. Making an appointment on time, determining affordability, and obtaining information on mental health care and the location of hospitals or clinics are all examples of these challenges. [4]

The majority of developing countries do not have a unified language. This is a significant impediment. As a result, it is difficult to conceptualize mental health awareness. Because mental health diagnoses are not objective examinations and must be communicated in order to be achieved, it is nearly impossible if the client and medical personnel speak different languages and cannot understand each other to any extent. When explaining the details of a diagnostic or treatment, it is critical to communicate the possibility of the associated risk factors appropriately. Failure to adequately explain the magnitude of the risk could have serious consequences, such as patients failing to follow instructions or declining potentially life-saving treatment. To complicate matters further, people from different ethnic groups describe pain and discomfort in a variety of ways: Even if you have excellent language skills, culturally specific terminology, idioms, or metaphors may be difficult to navigate. [5] It is not possible to establish a close relationship between the client and the medical personnel. It’s difficult to establish rapport when neither party understands the other. The use of a translator or interpretation services is an option, but this compromises privacy. Consider going to a therapeutic session and having a third person in the room ready to translate for both parties. In reality, it is difficult for the client to express their concerns when a third party is present. When you want to be understood but your brain is unable to decode the message of the spoken language, you experience a wave of frustration. High intuitive people, on the other hand, can easily connect with people of any language by absorbing their feelings.

We live in a time when technology is constantly evolving and on the rise. Despite the availability of human translators, technological advancements such as phone translating apps have been made. Despite the existence of phone translator apps, not every language is supported, rendering them ineffective to some extent. I’m thinking about how we might see a world in the future that isn’t hampered by a language barrier. Not because languages will become extinct, but because there will be, or perhaps already is, a breakthrough that transcends language. Is this to say that we should sit back, take a deep breath, and wait patiently? No way are we going to do that. To change the mental health landscape, we must make the most of the resources at our disposal. If that means teaching the next generation how to communicate in a common language, so be it. Allow the curriculum to expand if it means including a mental health subject in schools. Mental illnesses exist alongside physical illnesses, and the younger generation, as well as those yet to be born, must be aware of this.

There is no health without mental health; mental health is too important to be left to the professionals alone, and mental health is everyone’s business.

Vikram Patel

References

[1] Davis, Ben. “Home.” Mvorganizing.org, 22 May 2021, http://www.mvorganizing.org/what-is-linguistic-barriers-in-communication/.

[2] Ang, Carmen. “Ranked: The Countries with the Most Linguistic Diversity.” Visual Capitalist, 27 Jan. 2021, http://www.visualcapitalist.com/the-countries-with-the-most-linguistic-diversity/.

[3] “Why Does Africa Have so Many Languages?” The Christian Science Monitor, The Christian Science Monitor, 21 Apr. 2015, http://www.csmonitor.com/Science/Science-Notebook/2015/0421/Why-does-Africa-have-so-many-languages.

[4] Ohtani, Ai, et al. “Language Barriers and Access to Psychiatric Care: A Systematic Review.” Psychiatric Services, 1 May 2015, ps.psychiatryonline.org/doi/10.1176/appi.ps.201400351.

[5] Meuter, Renata F. I., et al. “Overcoming Language Barriers in Healthcare: A Protocol for Investigating Safe and Effective Communication When Patients or Clinicians Use a Second Language.” BMC Health Services Research, BioMed Central, 10 Sept. 2015, bmchealthservres.biomedcentral.com/articles/10.1186/s12913-015-1024-8.

Mental Health resources in developing countries

I noticed something while browsing and learning about the World Health Organization’s (WHO) website. There are homepage tabs such as health topics, countries, newsrooms, and so on. When I clicked on the countries tab, regions essentially dropped down, and I tapped into each one; all regions, with the exception of Africa and Southeast Asia, had a slot for mental health. WHY? You might as well have already come up with an answer (Leave a comment below). Clearly, there are few or no studies on mental health in these areas. Because there is a scarcity of existing data and facts about mental health in these areas, they are predisposed to mental disorders. The lack of awareness makes it impossible to move forward with sensitization and resource allocation.

Mental illnesses account for 7.4 percent of the global disease burden. Despite this, only 2% of the country’s health budget is spent on prevention. Low-income countries spend less than 25 cents per person per year on mental health, whereas high-income countries spend $44.8 per capita. [1] In terms of physical resources, there are 0.61 mental health outpatient facilities per 100,000 people globally, but there are huge disparities. In low-income countries, there are 0.04 outpatient facilities per 100,000 people, while in high-income countries, there are 2.32 outpatient facilities per 100,000 people. [3] Similar disparities exist in the availability of mental hospitals. The global median rate of mental hospitals is 0.03 per 100,000 people, ranging from 0.002 in the World Health Organization’s (WHO) Western Pacific region to 0.16 in the WHO European region. There are also significant differences in the number of psychiatric hospital beds available. The rate per 100 000 people in the WHO African zone is 1.7, compared to 39.4 in the WHO European zone. In some parts of the world, mostly developing countries, there is less than one psychiatrist for every 100,000 people, compared to 8.6 psychiatrists for every 100,000 people in developed countries. [1]

According to research, many developing countries lack adequately trained medical and nursing professionals to treat brain disorders. “For example, in India, there are approximately 3,000 psychiatrists and 565 neurologists to serve a billion people, whereas, in Zimbabwe, there are 10 psychiatrists and 29 neurologists to serve 11 million people. [4] In Indonesia, the ratio is one for every ten million people. In Uganda, the total number of human resources working in mental health facilities or private practice per 100,000 population was 1.13, with 0.08 psychiatrists, 0.04 other medical doctors, 0.78 nurses, 0.01 psychologists, 0.01 social workers, 0.01 occupational therapists, and 0.2 psychiatric clinical officers, not including auxiliary staff, non-doctor PHC workers, and health assistants. [5] The World Health Organization reported in 2005 that a number of countries, including Afghanistan, Rwanda, Chad, Eritrea, and Liberia, had only one or two psychiatrists.

The Uganda Ministry of Health (MoH) requires at least one encoded psychiatric nurse with a two-year certificate to work in outpatient communities, and clinical and medical officials to work in health centers, despite the fact that both levels have many vacancies. Regional referral hospitals have psychiatric units supervised by psychiatric Clinical Officers (Diploma-prepared professionals), and two National referral mental health facilities with psychiatrists and psychologists provide mental health treatment. Private international non-governmental organizations (INGOs) and health facilities that provide mental health care are expensive, concentrated in urban areas, and tend to focus on HIV/AIDS, limiting access for the vast majority of people who require assistance. [6]

I attended a boarding school where HIV/AIDS was noted on every sign on campus. When you arrived at the school’s gate, there was a large blue sign with the words “abstain from sex” written in white on it. As one walked from the staff building to each class, the dining hall, and the kitchen facility, one could see every HIV/AIDS signpost. All the way to the dormitory’s gates. Every day, there was either a play or a declaration about HIV/AIDS at assembly, or the matrons would make a point of telling a scary story about a boy or girl who died as a result of the disease. It was engraved on our unconscious minds because that is what our thoughts were focused on when we closed our eyes at night. Each year, the majority of the music, dance, and drama performed focused on HIV/AIDS. I remember reciting a poem about the disease, and our team did indeed win. According to the argument, HIV/AIDS is a topic of discussion and activism from the time a child is born until they reach adulthood. The government made every effort in this regard, and I believe we were all aware on a daily basis, which was greatly appreciated. How about we devote the same amount of effort to raising mental health awareness as we do to HIV/AIDS?

“It is time for governments to make mental health a priority and to allocate the resources, develop the policies and implement the reforms needed to address this urgent problem. One in four people will suffer from mental illness at some time in life,” added United Nations Secretary General Kofi Annan.

“Mental Health Care in the Developing World.” Psychiatric Times, http://www.psychiatrictimes.com/view/mental-health-care-developing-world.

References

[1]World Health Organization. Mental Health Atlas 2011. Geneva:
WHO, 2011

[2] World Health Organization. Global burden of mental disorders and
the need for a comprehensive, coordinated response from health and social sectors at the country level [monography in internet]. Geneva: WHO,
2012 [cited 2017 Dec 6]. Available from: http://apps.who.int/gb/ebwha/
pdf_files/EB130/B130_R8-en.pdf

[3] Octavio Gómez-Dantés, and Julio Frenk. “Neither Myth nor Stigma: Mainstreaming Mental Health in Developing Countries.” Salud Pública de México, vol. 60, no. 2,mar-abr, Mar. 2018, pp. 212–217. EBSCOhost, doi:10.21149/9244.

[4]“Mental Health Care in the Developing World.” Psychiatric Times, http://www.psychiatrictimes.com/view/mental-health-care-developing-world.

[5] Kigozi, Fred, et al. “An Overview Of Uganda’s Mental Health Care SYSTEM: Results from an Assessment Using the World Health ORGANIZATION’S Assessment Instrument for Mental Health Systems (Who-Aims).” International Journal of Mental Health Systems, BioMed Central, 20 Jan. 2010, ijmhs.biomedcentral.com/articles/10.1186/1752-4458-4-1.

[6]Kopinak, Janice Katherine. “Mental Health in Developing Countries: Challenges and Opportunities in INTRODUCING Western Mental Health System in Uganda.” International Journal of MCH and AIDS, Global Health and Education Projects, Inc, 2015, http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4948168/.

Mental health in developing countries

Let us discuss the facts about mental health in developing countries. In developing countries, there is little information or research on mental health. If it does, I’m predicting it’s only a handful! In developing countries, there is little or no mental health awareness and advocacy. The World Health Organization launched Project Atlas to catalog mental health resources around the world. The Project conducted a survey and discovered the following findings:; 41% have no mental health policy, 25% have no legislation on mental health, 28% have no separate budget for mental health, 41% do not have treatment facilities for severe mental disorders in primary health care, 37% have no community health care facilities…[2]

There are numerous types of mental disorders, each with its own set of symptoms. They are generally distinguished by a combination of abnormal thoughts, perceptions, emotions, behavior, and interpersonal relationships[1]. They include but are not limited to, anxiety, depression, bipolar disorder, schizophrenia, and other psychoses, dementia, and developmental disorders such as autism.

According to a statement by Gro Harlem Brundland, M.D., Director General of the WHO, he mentions that “mental health — neglected for far too long — is crucial to the overall well-being of individuals, societies, and countries and must be universally regarded in a new light”…[2]

The ignorance about mental health

One of the most common mental disorders is depression. It is the main cause of disability worldwide–Globally, an estimated 264 million people are affected by depression…[1] It is characterized by sadness, loss of interest or happiness, feelings of guilt or low self-esteem, loss of sleep or appetite, fatigue, and inability to concentrate.

There is a blanket of ignorance about mental health in developing countries. Growing up, I had never heard the term “depression”; instead, we referred to that kind of state of mind as “sad.” People would tell you to snap out of it or grow up no matter how long you were sad. The term “SAD” is simple; everyone experiences sadness; therefore, it was never taken seriously that being sad for a longer period has its own term: depression. Yes, depression is unheard of in most developing countries; you had to be a robot and resilient — you had to be strong or drink your misery. Emotions are undervalued; it’s as if everyone is a walking machine that follows whatever society dictates. There were no questions asked! Oh, wait…regardless of how inquisitive one’s mind may be, who are you going to ask the questions to? There are no answers because mental illness is uncommon in these societies and cultures.

People in developing countries are left with wandering minds, more akin to a state of limbo when you know there’s something seriously wrong with you because you can feel it in every inch of your body, and it’s screaming at you excruciatingly—becoming louder and louder with time. You, on the other hand, have no idea what is or could be. People in the same environment have no notion what’s going on, so they resort to making fun of it. Is it possible to blame them? No, they have no idea what they’re doing. They find it amusing, but also strange because it is unusual. How long will this be amusing? Is it only a matter of time before more people die as a result of mental illness? Because there is no concept of mental illness in developing countries, more lives that could have been saved will be lost. My heart bleeds as I write this; I feel the agony of both ignorance and insight. Knowing right now is intensely painful.

When you live in ignorance, there is no suffering– the pain comes when you understand what is.

I recall my cousin sister from when I was younger before I emigrated to the United States of America from Uganda. She was one of the brightest persons I’d ever met, and she was a strong young woman. She motivated me to succeed in whatever I set my mind to since that’s exactly what she did: she succeeded at everything. She was a straight-A student who was constantly at the top of her class and set records at every school she attended. She began to detach randomly just before starting college. She couldn’t hold a conversation and went from one subject to the next, with no beginning or conclusion to what she said. The sweet girl was slowly dissipating. It got to the point where whatever was going on with her became so threatening that those around her picked up on something strange. They could hear her shouts, see her wilt, and sense her agony at not knowing. Regardless, they were at a loss for what to do. They took her to doctors, but nothing appeared to be wrong with her physically. They offered her some medications, but nothing seemed to improve her condition. They took her church in the hopes of enlisting the help of an exorcist, but nothing seemed to alter. Trying to make it to the next sunrise day after day. People who cared about her were left roaming in the wilderness, trying to figure out what was wrong but only finding dead ends. Uncertainty paralyzed her every day, and whatever ailment she had progressed on a daily basis. Later, the family opted to take her to the country’s only known psychiatric facility. Unfortunately, it was too late when the hospital called in a flash to inform her that she had passed away.

What occurred in the psychiatric facility? Did they assess her and run tests to figure out what’s wrong with her? Or did they simply give her some medicines to mask her signs and symptoms? Were there any certified psychiatric doctors on hand, or were the nurses doing the best they could in the absence of any doctors? What happened is that in underdeveloped nations, there is such little/no knowledge of mental health disorders that by the time persons with these conditions are transported to the hospital, there is no longer room for survival.

Several factors may influence the prevalence of mental health in developing countries. Some examples include language barriers, a lack of mental health resources, misconceptions and stigma surrounding mental disorders, and so on.

“We need to recognize that there is no health without mental health.”

Prince M, Patel V, Saxena S, Maj M, Maselko H, Phillips M, et al. No
health without mental health. Lancet. 2007;370(9590):859-877. https://doi.
org/10.1016/S0140-6736(07)61238-0

References

[1]“Mental Disorders.” World Health Organization, World Health Organization, http://www.who.int/news-room/fact-sheets/detail/mental-disorders.

[2]“What’s in a Word? Taking the Measure of Thoughts in Schizophrenia.” Psychiatric Times, http://www.psychiatrictimes.com/view/whats-in-a-word-taking-the-measure-of-thoughts-in-schizophrenia.