Is self-care selfish?

That was my thought at one point in my life. Regardless of the circumstances, I was tamed to put people first. In this sense, my mother likes to refer to me as a ‘giver.’ She mentioned that I have had a heart that gives with my soul without thinking about the consequences since I was a child. Indeed, my heart was so enormous that no matter what someone asked, regardless of the scenario, I would make sure I took care of them. Being a giver is not inherently bad; it only becomes so when one neglects their own needs for the benefit of others. I could abandon myself for others, but how far will I go until I burn out or have a nervous breakdown? Keep in mind that hurdles to self-care may exist due to past trauma, mental health difficulties, or family situations, all of which can make accepting self-care more difficult.

It took a while for me to unlearn and accept that I must first look after myself before I can look after others. Of course, I felt like a narcissist. Every so often, my thoughts examined the rejections I made during the day for my own sake— whether I wasn’t in a good emotional state to deal with what is, or I was laying it off because I had something else to deal with. My thoughts were paralyzed by feelings of abandonment toward others. I remember feeling guilty whenever I practiced self-care. Why should self-care make one feel guilty? My definition was flawed, and I believed that prioritizing one’s own needs over those of others was selfish and unethical; certainly, acting differently would guilt-trip me. It took me some time to realize that taking care of myself is perfectly acceptable.

Self-care refers to your overall health, including your physical, mental, emotional, and spiritual well-being. That isn’t self-indulgent or selfish in the least. Self-care is essential since it decreases stress and promotes overall health. Clinical studies have shown that practicing self-care reduces or eliminates anxiety and depression, improves focus, reduces irritation and anger, increases happiness, improves energy, and more.[1] Self-care allows you to have a positive relationship with yourself so that you can transmit your positive energy to others. What you don’t have yourself, you can’t give to others. While people may mistake self-care for selfishness, this is far from the case. When you devote focus to your health, you’re not only thinking about your own needs. You’re recharging your batteries so you can be the best version of yourself for others around you. The revitalized energy and excitement you radiate help everyone around you.

Self-care allows you to have a positive relationship with yourself so that you can transmit your positive energy to others. What you don’t have yourself, you can’t give to others.

Being able to reject something or say no—not because you don’t want to, but because you prioritize your own wellbeing—hits different.

When I was able to grasp a more profound notion of self-care. I’ve never felt better in my entire life. I feel good. I feel alive. It’s like having an inner serenity regardless of what’s going on around you. With peacefulness settled inside of you–you always have the feeling that you’re okay, or that everything will be okay. You don’t fight something over which you have no control. You accept what is, but you never fail to make an effort to improve the situation. The inside feeling is beyond human linguistic comprehension—it’s more like you’re completely happy on the inside no matter what happens on the outside. Of course, there will be sad feelings or fluctuating emotions when faced with a difficult situation. However, your baseline for happiness and peace remains; It quickly returns to the nurtured baseline. Being able to reject something or say no—not because you don’t want to, but because you prioritize your own wellbeing—hits different. Too often, we say yes to every request in order to avoid upsetting the feelings of another person. When you do this at the expense of your own peace or health, you are violating self-care principles. It’s important to recognize that you’re only human and can’t possibly please everyone. Saying yes to everything puts you at risk of burnout and is detrimental to your physical and emotional health. Knowing and accepting that you don’t have to be in control all of the time and that is it’s okay to let go and take care of yourself–that is self-care.

Starting a self-care routine can be difficult at first, especially if you have had a negative concept attached to it, but don’t fret; with a step-by-step approach, you can get into the practice of taking care of yourself. Discover what activities bring you joy, re-energize you, and help you re-establish your equilibrium. Some examples of activities include exercising, meditation, writing, dancing or singing, eating a good diet, reading a book, having a bath, and so on. Begin slowly by adopting the behavior on a daily or weekly basis. Take note of how you feel, and how your energy was before and after—did it improve, remain stable, or possibly decline? Determine whether or not the activity is beneficial to you and make changes accordingly. When you are comfortable with that behavior, you can incorporate additional practices. Self-care can be beginning each day by focusing on your breath for five minutes and setting intentions for the day, as well as reflecting on what you’re grateful for each night. It could be ordering food from your favorite restaurant, putting your phone on airplane mode for a few minutes each night to escape the barrage of notifications, or setting a bedtime and sticking to it. Self-care can occur in many ways. It is personal and unique to each individual.

Self-care can lead to a journey of self-discovery. According to the Oxford Dictionary, self-discovery is the process of acquiring insight into one’s own character. Self-discovery not only assists us in identifying our strengths but also in determining how to leverage and develop them. People are more likely to absorb and accept concepts if they know what they are enthusiastic about. As a result, we discover pathways that we want to pursue and that will make us happy.

Self-care is a personal experience, and no one-size-fits-all approach will always work. What drives and inspires you is not the same as what motivates and inspires the person next door. Look for things that give you a sense of aliveness. Make dates with yourself, and stick to your word when you say you’ll work out or do something for yourself. Don’t abandon yourself. You will feel better suited to serve others if you practice good self-care. Take care of yourself and make the most of your life.

References

[1]“The Importance of Self-Care.” Perimeter Healthcare, https://www.perimeterhealthcare.com/about/news/the-importance-of-self-care/.

Lawler, Moira, et al. “What Is Self-Care and Why Is It Critical for Your Health?” EverydayHealth.com, https://www.everydayhealth.com/self-care/.

Your human, its’ okay to feel it all

That’s true, you’re only human, and it’s perfectly fine to experience whatever feelings you want. Feelings and moods are frequently mistaken with emotions, but the three concepts are not interchangeable. What exactly are emotions? Emotion is defined as “a complex reaction pattern integrating experiential, behavioral, and physiological factors,” according to the American Psychological Association (APA). Emotions are how people react to issues or circumstances that are important to them. They are a type of conscious mental reaction (such as rage or fear) that is subjectively felt as a strong emotion focused on a single object and is usually accompanied by physiological and behavioral changes in the body. A subjective experience, a physiological response, and a behavioral or expressive response are the three components of emotional experiences. Emotional experiences give rise to feelings. This is considered in the same category as hunger or pain because a person is aware of the sensation. An emotion produces a feeling, which can be impacted by memories, beliefs, and other variables. Mood on the other hand is described by the APA as “any short-lived emotional state, usually of low intensity.”[1]

Emotions are, on one level, like energy waves that vary in shape and intensity, much like ocean waves. Their nature, like all-natural events, is for them to appear and vanish swiftly. Several things can happen if you try to stop this process by acting out or suppressing it. When it comes to dealing with uncomfortable emotions, most individuals respond in one of two ways: they act out or suppress. The dangers of suppressing those powerful emotions are considerably worse.

Unfortunately (and ironically), attempting to “talk yourself out of your emotions” frequently leads to “greater rumination and perseveration.” In other words, you will continue to think about and hang on to the emotions you are attempting to avoid. Anyone who has had a deep-tissue massage can attest to how the body stores suppressed emotions. Suppression is stored in the body and causes a slew of negative consequences, such as anxiety, depression, stress-related illness, substance misuse, and suicide.[2]

What about Repressing emotions?

Repression is the other most prevalent method. The tendency to ignore unpleasant feelings is referred to as repression. Repressed emotions are unconsciously avoided emotions. This is when painful feelings, thoughts, or memories are pushed out of your consciousness involuntarily. This allows you to forget about them. You might do this to protect your positive self-image. These are feelings that haven’t been processed. They can, however, influence your actions. Over time, repressed emotions might lead to health issues. If you were raised in a dysfunctional family, you may have learned to suppress your feelings. These feelings may include fear, anger, pain, or shame.[3] Pennebaker and his colleagues (1997) found that people who conceal their emotions also reduce their body’s immune function, rendering them more susceptible to illnesses ranging from common colds to cancer.[4]

Repression VS Suppression

Sigmund Freud proposed suppression as a voluntary kind of repression in 1892. It’s the deliberate act of pushing undesired, anxiety-inducing ideas, memories, feelings, fantasies, and desires out of one’s conscious awareness. Suppression, the unconscious process of removing painful memories, ideas, and impulses from consciousness, is more amenable to controlled tests than repression. If you’re grieving the loss of a loved one or the end of a relationship, you may make the conscious decision to stop thinking about it in order to go on with your life. In another instance, you may feel compelled to tell your employer how you truly feel about him and his heinous behavior, but you conceal your feelings because you need the job. The desire is aware in both circumstances, but it is prevented by willpower arising from a rational decision to avoid the behavior. In general, “forgotten” thoughts, memories, and desires can have an impact on actions, conscious thoughts, and feelings, and might manifest as symptoms or even as mental illnesses such as depression, anxiety, and so on.[5]

However, there is another technique to control our emotions: feeling and processing them. Allow it to burn at the moment, and if necessary, take a break to regulate your emotions. Although not everyone processes information in the same manner, you should be able to recognize the indicators. Identify and label your feelings while remembering to be kind and compassionate to yourself, and then decide how you’ll deal with them — either by deciding how you’ll fix the problem if you have control over it, or how you’ll cope with them better in the future if you don’t. You can try several ways of processing feelings to see what works best for you. Journaling, painting, venting to a friend, spending time in nature, meditation, and so on are all alternatives. Everyone needs an outlet for their emotions, whether it’s crying or yelling at a wall—it’ll feel a lot better than keeping them bottled up inside. Emotional regulation is vital because it enables you to live a healthy lifestyle, both mentally and physically. Take care of yourself, you know—the majority of the work is done on the inside, and the outside world can only add to that.

References

[1]Posted June 27, 2019 by UWA | Psychology and Counseling News. “The Science of Emotion: Exploring the Basics of Emotional Psychology.” UWA Online, 22 June 2020, https://online.uwa.edu/news/emotional-psychology/.

[2]About the Author Margaret Cullen Margaret Cullen, and Margaret Cullen Margaret Cullen. “How to Regulate Your Emotions without Suppressing Them.” Greater Good, https://greatergood.berkeley.edu/article/item/how_to_regulate_your_emotions_without_suppressing_them.

[3]“Repressed Emotions: How to Spot and Release Them.” WebMD, WebMD, http://www.webmd.com/mental-health/what-to-know-repressed-emotions.

[4]Pub, Open Access. “Consequences of Repression of Emotion: Physical Health, Mental Health and General Well Being.” Pen Access Pub, openaccesspub.org/ijpr/article/999.

[5]Berlin, Heather A. “Defense Mechanisms: Neuroscience Meets Psychoanalysis.” Scientific American, Scientific American, 1 Apr. 2009, http://www.scientificamerican.com/article/neuroscience-meets-psychoanalysis/.

The Memoir of the Girl Child

Who is the Girl Child? Perhaps you are familiar with her. Perhaps she is the same person as myself. Perhaps she is you. She is your child. She’s your younger sister. She’s your mother, aunt, grandma, friend, and coworker all rolled into one. She is the girl in the woman, and the woman in the girl. She is unencumbered and undefined by decades of degrading philosophy, religion, and customs that consider being born female as impure, inferior, and deserving of subjugation.

Families in the culture I was born into are perhaps more extended than nuclear. So one has access to aunties (in my mother tongue, they are called ‘Sengas’- these are primarily your father’s sisters) who teach you what to do for men, how to do it, and prepare you for marriage. They will go to great lengths to ensure that you “keep a man.”

I’ve never understood the concept of ‘pulling.’ Pulling is the elongation of a female’s labia, which is taught to females in schools, particularly boarding schools. Your aunts can also tell you and teach you about it. I heard it in schools and saw several girls doing it; I never understood why, therefore I refused to participate on all grounds. My mother asked if I had heard anything about it, and I told her that I had overheard females discussing it at school. She went on, “Did you do it?” I replied, “No.” I recall laughing out loud when she told me I had to do it. “What are the reasons for pulling?” I inquired. – I continued, maybe I’ll think about it if they seem reasonable to me. These are the reasons: “to keep a man,” “to allow your man to enjoy sex,” and “for hygiene.” For a split second, I thought to myself and said, “So you’re saying, I have to go through this terrible process just to keep a man, but mostly for him to enjoy sex- how about my enjoyment of sex?” Is it not factored into the equation? And if not, why not? Furthermore, is it empirically verified that having long labia makes one less susceptible to infections or possibly STDS’?

I couldn’t even get my head to rap itself around that context. I was about 12 years old at the time. I pledged to my mother that I would never violate my body for the advantage of someone else, regardless of who Ma— mentioned. Of course, she didn’t stop bringing it up over the following years and telling me I had to do it. I inquired of her, “Ma, did you pull?” Yes, she responded, and I asked, “Did you manage to keep your man?” I was completely perplexed! My mother instructed me to quit asking questions and just do what I was told. Yes, this has now become a war—for a second, I reasoned that my mother is extremely religious, therefore I calculated that I should employ psychological tactics to defend myself.

I challenged her, “If you believe in the bible, which you do, show me a scripture where it is written; if you don’t pull, you’re going to hell, or you’ll lose your man, or you’ll never get married,” and then added, “Show me Ma.” Maybe if it’s written, I’ll question my doubts! I was looking for evidence and deliberately asked for it. Guess what, there was no mention of such a thing in the Bible. So I told her I’d never do it. Furthermore, female labia exist in a variety of sizes and shapes; we do not need to alter them in any way to feel or be wanted. Don’t get me wrong, I’m not saying it’s a barbaric practice especially if you reap the benefits—it’s all put to you. Personally, I don’t agree because its rationale doesn’t make sense to me.

From my perspective, these answers all voiced out how girls do not matter as much as men do. And that just didn’t quite match with how I perceive the world. My mind was racing with so many questions at that tender age—aren’t we all human? We all ought to be treated equally, don’t you think? Why does society establish norms based on gender? And, most importantly, who makes these rules? People make these conventions, don’t they? That is, I can set my own rules, right? What do the people who set these standards look like? What was the rationale behind each of these rules? Yes, I was curious because this did not make sense to my naïve mind.

I recall being taught different things from my brother and when I asked the reason why it is so, the answer always came down to because you are a girl. I remember going to different schools than my brother; his were more luxurious, whereas mine were more oriented on tradition and religion. I asked, “Why does he get to go to that school while I get to go to this one?”- Because you are a girl. Everything came down to the fact that I was a woman in a man’s world.

My mother would describe me as big-headed not because I was a troublemaker at school or perhaps an intractable teenager, but because I asked a lot of annoying questions—and not just one or two questions—I never stopped asking about anything and everything! Yes, I was the child who wondered why we were going to this restaurant and not the other! And mainly because I never conformed to the society’s norms laid out especially if they did not make sense.

The pressure from culture, tradition and society can have a detrimental impact on one’s mental health. Women are more susceptible to manipulation and compliance than males are. Conformity is higher in collectivist countries than in individualistic ones.[1] Some people do it unconsciously, for example, because it is what they believe is right, or perhaps it’s what they were taught. Others may present it in an authoritative manner without taking anything else into account. This, however, has a negative impact on the psychological well-being of girls and women. There is the development of unhealthy coping behaviors and anxiety. Depression sets in, and they repress their emotions while also lying about them. They have a hard time trusting others and, even if it takes a toll on them, they tend to prioritize others’ needs over their own. In some cases, chronic manipulation in close relationships may also be a sign of emotional abuse, which can have a similar effect to trauma in some cases—especially when the victim of manipulation is made to feel guilty or ashamed.[2] Women safeguard your mental health.

Strong conformity, overshadows authenticity, straps uniqueness and it exerts negative impact on an individuals’ self-esteem.

I will define ‘The Girl Child’- She is the being with limitless wings to fly. She is the atomic energy of the world. She is the womb of all human beings. She is the power of existence. She is the wielder of extinction. She is a creature that the world cannot afford to lose. She is ‘I am’! To all the girls/women there, stand by what you believe is right. Trust your instincts, and never stop asking questions, no matter how crass they may appear. You wield far more power than the world can comprehend.

References

[1]Jhangiani, Dr. Rajiv, et al. “Person, Gender, and Cultural Differences in Conformity.” Principles of Social Psychology 1st International Edition, BCcampus, 26 Sept. 2014, https://opentextbc.ca/socialpsychology/chapter/person-gender-and-cultural-differences-in-conformity/.

[2]“Manipulation.” GoodTherapy.org Therapy Blog, https://www.goodtherapy.org/blog/psychpedia/manipulation.

[3]Zhang, Peng, et al. “Social Anxiety, Stress Type, and Conformity among Adolescents.” Frontiers in Psychology, Frontiers Media S.A., 20 May 2016, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4873518/.

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.