COPING MECHANISMS
Depression survivor, Dr Molapisi, warns that mental illness can kill
Society has convinced itself that mental illness does not kill and that is why even though there is mounting efforts to raise awareness on mental illness, ignorance is still rife.
These are the words of a young health professional, a doctor to be precise, who does not only talk about mental health, but has experienced the harsh realities that come with the diagnosis of mental illness. He is currently a General Practitioner in Serowe/Palapye DHMT, seeing all scopes of disease but wishes to soon specialise.
Dr Neo Molapisi, affectionately known as Dondie is a 33-year-old family man who hails from Mapoka in the Northeast district. He says the level of understanding in Botswana communities about mental health is so poor that it is potentially offensive. He explains that the spectrum of mental health illnesses that seem to be known albeit vaguely, are psychotic disorders including schizophrenia and schizophreniform disorder among others. Mood disorders are neither known, recognised nor well understood. This lack of understanding in his view drives and perpetuates the mental illness stigma and hence people die silently and do not seek help until the illness is advanced, difficult to manage and has caused significant morbidity. “Society seems to assume that mood disorders are faked in order to obtain attention and this is untrue. I have heard depressed people being referred to “matepe” until it was too late,” he says. He adds that patients with psychotic disorders are also not spared the wrath of ignorance as they sometimes are referred to as “ditsenwa” and occasionally get assaulted. Dr Molapisi who is the first-born of five boys from a blended family, and now married with a daughter, is a depression survivor. He was first formally diagnosed as having Major depressive disorder in 2011. “I noticed I was depressed in 2008 just after starting Bsc in University of Botswana possibly due to a change of environment and the workload of the programme,” he says. Despite that, he survived without treatment and completed the required 18 months of the course with no retakes and resits.
“In 2011, I started psychotherapy and was put on the antidepressant agent, citalopram, a selective serotonin re-uptake inhibitor. I took the drug for six months but had to interrupt the treatment because I could not tolerate its side effects,” he said.
He had nearly all features of depression including depressed mood, lack of interest in usually pleasurable activities, loss of appetite, hopelessness, guilt and decreased self-worth. His energy levels were extremely low and his social and other areas of function were greatly impaired. “I spent nearly half of my University life sleeping during the days and reading through the nights, fortunately my marks never dropped,” he says. According to Dr Molapisi, a national top achiever in the 2007 BGCSE, subsequent to the first episode, between late 2011 and early 2016 he had multiple brief episodes of depression mixed with anxiety which at the time he did not feel warranted any treatment. “In May 2016, I had one of the worst bouts of depression after starting work in South Africa and was restarted on treatment which I took until the end of 2017. On this episode I lived largely on soft foods and liquids because I couldn’t eat a bit. Chewing felt like a whole job!” he says. Post these two episodes, he had severe but brief depressive episodes for which he did not medicate but depended largely on prayer, positive self-talk, avoidance of maladaptive thinking patterns, exercise, social interaction and combination of sleep deprivation therapy and sun exposure. From late 2020 until now Dondie has been on remission, which he attributes to the company of his supportive wife and daughter in the house. Dr Molapisi explains that the challenges of dealing with depression are
unique to each individual but the common ones are quite common and include lack of knowledge and understanding of the disease. He says this makes it very difficult for both the patient and caregivers to deal with this strange yet extremely common disorder. Other factors are stigma surrounding mental health care users and secondary self-stigmatisation, restricted access to good quality mental healthcare services and severely disabling nature of the disease particularly due to hopelessness. The intolerable side effects of some of the agents used which results in some mental health care users defaulting treatment with dire consequences is yet another factor.