The Neglected Ailment
Srabonti Narmeen Ali
It happens more often than we would like to admit. Right at this moment, someone you know or are close to could be suffering from depression and you may not even be aware of it. Unfortunately, in our society, the word depression is not only taboo, but also foreign and not something that Bangalis as a whole are comfortable discussing, but it is very much a reality and a growing issue within our urban population.
According to the World Health Organisation (WHO) about 7% of the population in Bangladesh suffers from mental illnesses which include depression, anxiety, schizophrenia and hyper tension. Psychiatrist Dr. Omar Rahman says that psychological disorders such as depression are seriously neglected. Dr. Rahman is currently the Pro-Vice Chancellor of Independent University, Bangladesh (IUB) as well as a Research Fellow at Harvard Medical School and Adjunct Associate Professor at Harvard School of Public Health.
According to Dr. Rahman one person out of every six suffers from clinically depressive episodes. About 4% of this population has chronic depression, which requires treatment. Treatment includes counselling and very often medication such as anti-depressants which are usually prescribed for six months to a year and then continued depending on the patient's progress.
“Contrary to popular belief, anti-depressants such as Prozac and Zoloft are not addictive and a patient may have to use it for the rest of their lives if needed,” says Dr. Rahman. “What is so ironic is that people use sleeping pills, which are addictive, regularly, but are generally reluctant to try anti-depressants. I always ask my patients to consider anti depressants to be like any other medication. For example, people take medication for their blood pressure. The problem is that most people don't understand that depression is a real problem. The truth is that there is not much of a difference between physical health ailments and mental health ailments. Just as other physical problems are disorders of the body, depression is a disorder of a certain part of the brain.”
In most circles however, depression is not seen as a legitimate disorder, but rather a 'character flaw.' It is not considered normal for a person to seek help for their mental problems. This is a problem not only in Bangladesh, but all over the world. People are terrified that others will think they are crazy and therefore no one is very open about their mental problems. Instead many patients develop psychosomatic symptoms such as headaches, stomach aches and other such ailments.
Aside from the usual physical symptoms of drastic weight gain or loss, problems with sleeping (either too much or too little), there are other indications that someone is suffering from depression. The standard question that is asked is “Over the last two weeks, have you felt down or upset for most of the day in the majority of the two weeks?” If the answer is yes then there is a chance that the person in question is depressed. Another indication is if the person has lost interest in the things that they usually like doing. This lack of motivation and interest is medically known as anhidonia, or in Bangla, oniha. The more severe depressive cases may also have a tendency or the wish to hurt themselves. If this is the case, the aforementioned symptoms do not have to be present. A confirmation of that is enough to have a person diagnosed as depressed.
Depression is not always triggered by traumatic events. Like other physical ailments, depression is a biological disorder and is treatable. Statistics in Europe and the United States reveal that two-thirds of depression patients are women. Whether these women are more likely to seek treatment when they are depressed, more prone to depression or a mixture of both is still uncertain. Generally speaking, depression increases with age, but the number of teenagers who are depressed is very high.
“In Bangladesh many teenagers become depressed because of the hyper competitiveness that is very common in our society,” says Dr. Rahman. “They are put under a lot of pressure to do well in school and so on and if they do not do well, they are seen as failures. Also a lot of them get depressed about some relationship that is not working out. It might be a relationship with the person of the opposite sex -- because it is a taboo subject in general it is even harder for them to deal with because they cannot talk about it openly -- or it could be a relationship with someone in the family.”
The concept of family and relationships in family does not only affect teenagers however. Many men and women find it hard to deal with what is called the “dual burden,” which is caused by generational differences.
“Educated middle and upper class people have to deal with all the stress of having to deal with a career, making a living and also having to deal with family ties and traditional duties,” says Dr. Rahman. “Men usually tend to worry and stress more about their careers, which is similar to the men all over the world, whereas women here are more stressed about family and relationships. However, stress does not necessarily cause depression, but rather exacerbate it.”
Unfortunately, although there are many people in Bangladesh who are prone to depression there is a shortage of people who can help them. According to Dr. Rahman there are about 140 psychiatrists in the entire country, 10 of whom have foreign qualifications. Clinical psychologists, people who have not gone to medical school and are not allowed to prescribe medication, but rather only provide counselling for their patients, are even fewer at a paltry sum total of four.
“We are thinking of starting a Masters programme in clinical psychology at IUB,” says Dr. Rahman. “Depression is such a severe problem and we just do not have enough qualified people to treat it. It is important for people to realise that depression is dangerous and something that you cannot treat without help. The problem with this society is that people suffer from the misconception that counselling and treatment is not required. Many people want a quick fix, where they come for the medication but do not follow through with the treatment.”
But a 'quick fix' is not good enough for such a severe problem. The fact is that many people suffer from depression and go through their whole lives not getting treatment because of the stigma that our society has against mental disorders. The truth remains that we should learn to see it as any other problem -- something that needs proper care and attention and not neglect it because it is something that does not fall into our category of what is perceived as normalcy.
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