By Uche Akolisa
Dr Richard Adebayo is a Consultant Psychiatrist/Clinical Psychologist at the Federal Neuro-Psychiatric Hospital, Yaba, Lagos. In this interview with UCHE AKOLISA, the Acting Chief Medical Director of the foremost mental hospital says stigmatization leads to poor management of depression:
What state of mind would you describe as clinical depression?
I think you are talking about the common depression people talk about. Depression is a psychological or psychiatric condition or an emotional or mood disorder where the prevalent mood of an individual is excessively low for a period not less than two weeks. It also has other features like anhedona-what an individual perceive as pleasurable is no longer pleasurable.
Maybe watching television or travelling is a pleasurable but you developed apathy to these things. You are not happy most of the time, your mood is low.
Depression is not the same thing as mere sadness. Events can happen and for some few days someone may be sad.
You cannot be happy all the time. Someone fail an exam and is unhappy is not the same as depression or some lost a loved one, it is normal to feel low. But when for whatever may be the cause of it for two weeks or more a person is unable to put himself together, then it is right to say.
Other symptoms beside the two I mentioned earlier (low mood for two weeks or more and anhedonia) include the person not eating well (or you may discover that the person may eat normally), the sleeping pattern may be poor.( You may also have people who have depression and yet they sleep well.
Depression is not what you only see on the surface- May be the person is looking shabby.
Somebody may dress well, powder her face and yet may still be depressed. Depression affects millions of people. 25% of the population will suffer depression at one stage in their lifetime..
Why is it that in the general Nigerian population, we don’t look at depression as a medical condition?
May be it is due to the level of our awareness and development. In the developed world, depression is so common and easily recognized. In this part of the world, when people have depression, they don’t think it is depression. They ascribe it to other factors. Also a lot of them are in the denial stage. They feel mental disorder is only meant for certain people.. “No, it can’t be me’ We stigmatize it. We deny it. That is why a lot of people needlessly suffer.from depression while in developed world, it is picked on time and most of the sufferers access treatment.
Some time ago, a 40-year old man committed suicide because he could not find a wife to marry. What other factors could trigger depression?
80 percent of people who commit suicide suffer depression. So, it is not 100 %, of all those who commit or attempt suicide that suffer depression. So people can commit suicide without necessarily suffering from depression.
Drug or substance abuse may cause suicide. Also, when depression is untreated, not taken care of in time, an individual may get to a stage he feels a sense of worthlessness,. Biological causes can be factor. Some hormones called neurotramsmitters When the brain does not have a balance of the neurotransmitters( some kind of hormone found in the brain), a person can become depressed.
Depression can also run in a family. Somebody can inherit depression. It doesn’t mean everybody in the family will suffer it.
We also know there are psychological factors that can trigger depression- people who have suffered losses, people who have passed through harrowing or traumatic experiences, especially during early childhood. may later on develop depression. People who are going through socio-economic difficulties. People who are victims of Boko-Haram or kidnapping or violent acts, can come down with depression. People who have had psychological, physical or sexual abuse, Socio-economic factors such as job loss, unemployment, noise pollution, overcrowding, .economic downturn can cause depression.
Are there health problems that can cause depression?
Yes, there can be some organic or medical problems which become complicated with depression An example: is stroke. Stroke is a chronic debilitating condition, some of them may not be able to walk and may be dependent on others.
They may come down with depression. Thyriod diseases ; hypothyroidism or hyperthyroidism. can be complicated with immune disorder. Any person passing through any chronic debilitating condition may come down with depression. Besides, stroke, People who have cancer may also come down with depression.
In the case of children and persons like the Chibok girls rescued from Boko Haram, what kind of treatment should such people receive apart from medical treatment?
A lot of people have been in the enclave of the enclave of Boko-Haram and have been incapacitated for a long time, have not been able to go for school or their normal work. They missed their families, some of them have been physically and sexually abused, Some have been physically abused.
Of course, a lot of the would come down with post=traumatic stress disorder. One of the complications of that is depression. There is no meaning medical check-up you will do for them if you don’t involve mental assessment and treatment.
You can treat physical wounds, what of the one engraved in their minds? Often times we ignore psychological injuries and only treat the physical ones and the victims suffer in silence. It is not only the direct victims, what of their parents and family members? Women who could not say their daughters are alive or dead and they cant trace them for over one year now? We have heard of some of them who have died, Do you know whether they suffered depression in silence and died?
So, depression can kill?
Why not? Depression can kill. Depression kills when a sufferer decides to commit suicide. Depression can make a person so depressed he is not able to eat or remain moribund. It can disrupt the quality of an individual?
People don’t know when they or their loved one is depressed.
How do I know or the person next to me has depression? When should one seek help?
If you notice your mood is persistently low for two weeks or more. You are not yourself. You are not interested in things you used to do before, you feel irritable. You don’t want to interact with others, that is it.
But peradventure the person doesn’t discover these, people close to the person should note that; this person is not his usual self, is not happy, does not take pleasure in things he used to love, he is not associating with people again.
There are times it shows in the appearance of the individual. But there are sometimes, the symptoms are masked, in such that the person looks well-kept, appropriately dressed but he is not okay. However, if you are not sure the person has depression or not, you can ask him to see a psychologist or psychiatrist.
What are the modalities for treatment?
The modalities can be biological, that is, through the use of drugs. There are some chemicals that appear imbalanced manner as I said earlier and can be corrected with drugs. There is also psychological treatment called psychotherapy which can be individual or group psychotherapy, or marital psychotherapy or family therapy.
There are people whose depression is caused because they experiencing marital turmoil; divorce or separation. We also know depression is not for adults, children and adolescents can also experience depression.
If an adolescent is suffering depression, and from your assessment you find that family dynamics are responsible,you may need to, as part of the treatment, incorporate family psychotherapy.. There can be social intervention as part of the treatment modalities.
You may need to involve social workers..Sometimes, you may need to rehabilitate the person in terms of occupation, academics, housing.. In such instances, it is not drug alone, social intervention is necessary.
There is an orgy of violence going on in the country; people are beheading people. Husbands are killing wives, wives are killing husbands. Sexual violence, especially against minors is on the rise.
Parents are even sexually abusing their children. Is there a psychological explanation for what is happening?
The cause of these are multi-factorial. Let’s come back to the basic unit of the society-the family. When the family is in disarray, then, there would be issues; domestic violence, child abuse. When there is economic downturn and people are struggling to survive and there is frustration, joblessness, what do you expect?
The economy is down, a man cannot really be what he claims he should be, in effect his personal ego is bruised. If he lost his job and his wife is feeding him, paying the children school fees, in an African setting you can imagine how the man would feel. Or your take-home cannot take you home.
Does frustration explain a man sexually abusing his child or his neighbour’s child?
It can partly be responsible but you should also know that some people suffer som mental problem such that what gives them sexual pleasure is abusing children,They may have 10 wives at home but what gives them pleasure is underage children. Paedophilia is a big problem.. Because it is being reported, that is why we are more aware of it now than before.not that it is new. It has been shrouded in secrecy.
Whatever children beheading people?
Show me teenagers who have done such things and go and look at their families, their upbringing, the number of children their parents have.
And their socio-economic indices. Not in all cases, but in most cases, if you look at them, you find that many of them are from families in disarray or so poor their parents are not able to fulfill their responsibilities and children are left to fend for themselves from a tender age..