Medical Bytes with Dr. K
It’s a beautiful sunny day. Most people are outdoors enjoying the weather while 15-year-old Mere is in her room. During the past eight weeks Mere has become withdrawn. She has not been outside for a whole week and has refused to speak to anyone at home. Mere did not pass her Year 10 examination and is extremely disappointed. She has been teary most of the time and refusing to have her meals. Her parents had high expectations of Mere as their eldest child and she feels that she has let them down. She feels like a failure and has been thinking about ending it all. She takes her bed sheet and decides to hang herself from the fan in her room. Meanwhile, it’s been seven weeks since 26-year-old Seema had her first child - a beautiful baby boy. Seema is feeling exhausted, teary, and finding it hard to sleep. She feels overwhelmed with the care that a newborn baby requires. She is even scared of holding her baby because she is afraid she may drop him. She feels petrified of being left alone with this little being that depends on her for everything. It’s been extremely difficult for Seema because her husband works long hours and her parents live overseas. She knows that she should be happy, but she feels miserable. So miserable that she wants to jump off the balcony. Then there is 65 year old John, who retired a few years ago and lost his wife Mary to breast cancer three months ago. John now lives alone and greatly misses his wife. Since her passing he hasn’t been outside the house and he’s taken to drinking half a bottle of whiskey every night to ease his pain. He’s lost over 10 kilograms, wakes up at 3am and thinks constantly of Mary. John’s doctor gave him some sleeping pills to help him through this difficult time. It’s been very tempting for John to overdose on his pills so that he can end his life without Mary. Common to all these scenarios is the Black Dog that is forever lurking in the background that just cannot be shaken off, consuming a person from within -- depression. Some would claim it is the plague of our modern society. April 7 marks World Health Day. This year it is on the theme ‘Depression - Let’s talk about it’. An estimated 350 million people of all ages suffer from depression (World Health Organisation, 2017). That is 5% of the world’s population – more than the entire population of the United States of America. Depression is the leading cause of disability worldwide, and is a major contributor to the overall global burden of disease. Depression is a mood disorder, the exact cause of which is unknown. But we know there are several factors that increase the risk of it developing. Stressful life events such as bereavement or a relationship breakdown can trigger it. Certain personality traits such as low self esteem and being overly critical may make you more vulnerable to depression. There is a genetic predisposition. The risk increases if a family member has a history of depression. If you’re a woman you are more likely to suffer depression. Women are particularly susceptible after pregnancy due to hormonal and physical changes as well as the added responsibility of looking after a baby (postnatal depression). The use of illicit drugs and alcohol may spiral the effects. About 1 in 4 people in Fiji have mental health issues, and depression is the most common form of mental illness. There is no doubt depression is a huge problem worldwide, so why don’t people seek help for it? Why is there so much stigma when it comes to mental health? In my experience as a General Practitioner in Australia and now in Fiji, I have seen greater awareness of mental health in recent years. At least in developed countries people are starting to realize the importance of visiting their doctor when they are not coping with life, when they are feeling blue or depressed. Help is available in the form of counseling, medication, family support, helplines, relaxation therapy and healthy diet and exercise. With therapy, most people improve and are able to lead a normal life. In Fiji however, the situation is still very different. Very few people visit a doctor when they are depressed and most times the illness goes unrecognized by family members. Some think that their loved one is possessed by a spirit and they go to a witch doctor. The name St. Giles hospital evokes images of being locked away in a cell, never to emerge again. We need to change this attitude by educating people to understand that mental health is real and is just as important as physical health. Over the past few years, the rates of suicide have increased tremendously. According to University of Texas psychiatric expert Dr Cheryl Person, Fiji’s suicide rate is the third highest in the world, with 34 suicides per a population of 100,000. Every 36 hours, one person commits suicide and far more attempt it (Fiji Police Force, 2017). Children as young as 12 years old are part of these statistics. Alarmed? So am I. What’s causing these people to take their lives? Relationship breakdowns, chronic disease, poor grades, and the inability to meet family expectations are some of the reasons. What can we do to prevent suicide? Let’s start by recognizing the symptoms of depression – whether you’re experiencing them yourself or someone in your family is. The most common signs to look out for include a persistently low mood, loss of interest in activities, poor sleep, reduced energy levels, difficulty concentrating, feelings of hopelessness, helplessness and at the more heightened level - thoughts of suicide. Most people who commit suicide have a history of depression.
And then let’s talk about it: at school students need to discuss issues that they’re facing with teachers. In addition, schools should not place too much pressure on students. At the workplace, we should encourage dialogue and discourage bullying which is a very common occurrence. All of us in society need to become more tolerant, nonjudgmental and compassionate towards the psychological needs of individuals. And let’s seek help for it: As medical professionals, general practitioners can also play a huge role in identifying people who may be depressed - referring people for counseling and if needed, prescribing antidepressants. Have a regular GP and if you’re experiencing any symptoms of depression, talk to your GP about it. There is also a National Children’s helpline, which is available 24 hours for people who are distressed (they also help youth and adults.) Whilst we have these great facilities, we desperately need a clinical psychology program in Fiji so that we can train psychologists locally. There is a huge gap with virtually no qualified psychologists available. We also need more psychiatrists in Fiji – doctors who specialize in Mental Health. Without appropriate trained specialists we have a very slim chance in making progress in recognizing and treating the issues. We all need to work together to give mental health a voice. We need to break the silence and speak up so that it becomes a part of our lives and is not a tabu subject. Let’s acknowledge the black dog and learn to deal with it. Let’s not run away from it. One day, we may be able to unfriend the black dog, stand up tall and look into the horizon with a clearer and happier state of mind. An organization called Empower Pacific provides counseling services based in Suva, Nadi, Lautoka and Labasa. If you are feeling depressed, please make use of these available facilities.
“About 1 in 4 people in Fiji have mental health issues, and depression is the most common form of mental illness. Why is there so much stigma when it comes to mental health?”