Schizophrenia across different cultures

Kraepelin was the first to raise the topic of whether schizophrenia is a universal condition in 1960. Is it possible for it to happen to anyone or even different populations, cohorts, and cultures? According to the findings of the World Health Organization’s research conducted in 20 nations, Schizophrenia can affect anyone, regardless of their age, ethnicity, gender, or geographic location. [1] Even though the outcome of schizophrenia appears to be better in developing countries compared to developed countries, the reasons for this are not fully understood; however, it can be safely assumed that culturally determined processes, whether social or environmental in nature, are at least partially responsible. [2]

The pattern for most diseases is clear: the richer and more developed the country, the better the patient outcome. Schizophrenia appears to be different. This paradox first came to light 40 years ago. For further research, in the 1960s, the World Health Organization (WHO) launched the first of the following three landmark international studies: the International Pilot Study of Schizophrenia (IPSS); the Determinants of Outcomes of Severe Mental Disorders (DOSMeD); and the International Study of Schizophrenia (ISoS).

The IPSS included 1,202 patients from nine countries, three developing (Colombia, India, and Nigeria) and six developed (Denmark, Taiwan, the United Kingdom, the United States, the Soviet Union, and Czechoslovakia). The patients’ outcomes were rated from one (best) to seven (worst) based on three factors: time with psychotic symptoms, remission after each episode, and social impairment (worst). After five years, India had the most success, with 42% of cases reporting the “best” outcomes, followed by Nigeria with 33%. However, only 17% of cases in the US and less than 10% in other wealthy countries had the best outcomes.

In the early 1980s, DoSMeD began studying schizophrenia in 12 centers in 10 countries. From a single psychotic episode to a chronic illness, its 1379 patients fell into nine categories. The study found that 37% of underdeveloped countries had complete recovery compared to 15% of developed countries. Chronic illness rates were 11.1% in the developing world and 17.4% in the developed. Patients in developing countries had longer periods of normal social functioning despite taking fewer antipsychotics. The researchers discovered that a powerful element called ‘culture’ can influence gene-environment interactions that cause disease. The present study does not answer the question but simply states that it exists. To see if the prior studies’ better outcomes persisted, the ISoS trial added two more groups of IPSS and DOSMeD patients after 15 and 25 years. It found that half of the patients had positive outcomes.[3]

According to a 2009 assessment by psychiatrist Parmanand Kulhara of the Postgraduate Institute of Medical Education and Research in Chandigarh, India, 58 schizophrenia papers were examined in order to compare outcomes across industrialized and developing countries. The explanation doesn’t make any more sense. As Kulhara points out, “patients appear to be doing better in impoverished nations, even while resources such as health facilities and medical infrastructure are severely constrained,” including treatment facilities and treatment facilities. This could be attributed to the fact that developing countries have a different socio-cultural environment, with a larger reliance on family members for care and assistance, as well as stronger social support and social networking.[4]

If you ever found yourself on the verge of going insane, a supportive network like this would do everything possible to help you regain your composure. 

So does this imply that the greater the amount of support available, the more likely it is that someone suffering from schizophrenia will be able to improve? Perhaps. If you compare developing nations to developed nations, which are known for their individualistic cultures, developing countries are known for their collectivist cultures. To be clear, collectivist cultures place a higher value on the needs of a group or community than they do on the needs of an individual, whereas individual cultures are the polar opposite. As a result, a problem that affects one person affects everyone else.

Most developing countries have limited or no resources, as well as little or no awareness of mental health issues, but the good news is that they have each other. They are extremely supportive of one another, which is amusing because it is not necessarily because they want to, but rather because it is ingrained in cultural norms. And that is the most potent force they have; they either prosper or perish together. If you ever found yourself on the verge of going insane, a supportive network like this would do everything possible to help you regain your composure. Perhaps there is little time for one’s own thoughts because they are predominantly occupied by the group. A patient’s ability to maintain a satisfactory social support system is directly related to reduced hospitalization and re-admission to the hospital among those suffering from schizophrenia. Patients who have a larger network of people who care about them spend less time in the hospital and perform better on tests and assessments.

References

[1] Jablensky, A, and N Sartorius. “Is schizophrenia universal?.” Acta psychiatrica Scandinavica. Supplementum vol. 344 (1988): 65-70. doi:10.1111/j.1600-0447.1988.tb09003.x

[2] Kulhara, P, and S Chakrabarti. “Culture and schizophrenia and other psychotic disorders.” The Psychiatric clinics of North America vol. 24,3 (2001): 449-64. doi:10.1016/s0193-953x(05)70240-9

[3] Padma, T. V. “Developing Countries: The Outcomes Paradox.” Nature News, Nature Publishing Group, 2 Apr. 2014, http://www.nature.com/articles/508S14a.

[4] Parmanand Kulhara, Ruchita Shah, Sandeep Grover, Is the course and outcome of schizophrenia better in the ‘developing’ world?,Asian Journal of Psychiatry,Volume 2, Issue 2, 2009, Pages 55-62, ISSN 1876-2018, https://doi.org/10.1016/j.ajp.2009.04.003.
(https://www.sciencedirect.com/science/article/pii/S1876201809000306)

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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.

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.