“I can’t remember the last time I was happy. I have never been happy for 24 hours straight, ever in my life”. These are the words of ‘Paul’, a forty year old university graduate who has been battling depression for most of his adult life. According to the World Health Organization (WHO), there are more than 300 million people living with depression, an increase of more than 18 per cent between 2005 and 2015. The WHO states that depression is the leading cause of disability worldwide and a major contributor to the overall global burden of disease. Depression is just one of the many common mental disorders that affect a significant percentage of the Jamaican population. Data shows that 1 in every 4 Jamaicans will experience some form of mental disorder throughout hi/her lifetime. Depression can begin just about any age and can have serious implications for the depressed person as well as for his/her family. Nonetheless there is a distinction to be made between the daily emotional challenges of life and the short-lived sadness which are a direct response to such stresses. Recently, Paul and I sat down in Kingston for our discussion. Paul is approximately 5 feet 6 inches, a rather unassuming man. Paul vividly recalls not wanting to attend school in grade 6. While many of us can fondly remember our days in primary school which was characterized by a state of happiness and excitement at the thought of attending high school; the opposite was true for Paul, his life of depression was just beginning to take root and would haunt him ever since. Paul’s tone changed from one of eagerness to one of subdued caution as he brought to mind the many days of feeling sad during his primary school days. “I felt like I just had to deal with it, there was nuttin I could do, I couldn’t fight so I just dealt with it. I didn’t know I could tell my parents, even if I did I am sure they would not have done nuttin”. In dealing with depression at an early age of 12 years, Paul said “I just went to school and did my school work the best way I could”.
Persons who are depressed do not walk around with a placard announcing this fact. The face of depression is that face that looks back at you when you look in the mirror. Depressed people look like you and me. Many depressed persons manage to hold down a job while fighting the demon of depression. Sadly, not many depressed persons have been so diagnosed. Paul, however, was diagnosed with depression in his 20’s. The stigma and discrimination associated with mental illness often serves as barriers to treatment. These hurdles frequently prevent those who experience the symptoms from getting medical intervention necessary to adequately manage this medical condition. In many instances our association with mental health comes from seeing an insane person on the road eating from a garbage bin. This perception of mental illness needs to be interrogated and brought into reality that a vast number of mental disorder persons do not live like this. Whether we choose to believe or not, in every family there is at least one depressed individual.
Symptoms of Depression
The American Psychiatry Association Diagnostic and Statistical Manual of Mental Disorders (DSM -5) defines depression as a common and serious medical illness that negatively affects how you feel, the way you think and how you act. Depression is known to be caused by an aberration of neuro-chemicals (serotonin norepinephrine) in the brain. The symptoms of depression identified by DSM- 5: are depressed mood most of the day characterized by sadness, emptiness or hopelessness; irritability or frustration, lost of interest or pleasure in most or all normal activities, such as hobbies, sleep disturbances, whether increase or decrease sleep, frequent or recurrent thoughts of death, suicidal thoughts, trouble thinking, concentrating or remembering things, fatigue or loss of energy every day, feelings of worthlessness or inappropriate guilt nearly every day, significant weight loss when not dieting or weight gain. DSM-5 indicates that if you have 5 or more of these symptoms, one of which must include either depressed mood or loss of interest or pleasure in activities then you should seek medical attention. Paul is no exception to the rule and during the talk; Paul mentioned having suicidal thoughts on a number of occasions. He spoke candidly about the desire to die in a car accident. He has come to the realization that his driving has become reckless in recent times when he is alone. He stated that his appetite is not what it used to be. He has lost interest in food which is another common symptom of clinical depression. Paul said that the depression has worsened as he has gotten older. He is now forced to write down all he needs to do daily as the depression has affected his concentration and memory. A lack of interest in most things around him is yet another sign of depression which Paul has and continues to experience. Paul is often up late into the night, he has difficulty falling and or staying asleep. This sleep disturbance is also a typical symptom of depression. This inability to sleep or insomnia is a typical symptom of depression. According to Paul, there is usually a trigger for his depression. His lifelong phobia of public speaking is one such. University was challenging for Paul especially when it came around for him to do class presentations, he remembers painfully getting a C minus for Communication Task in university. A simple unavailability of public parking space is another of his triggers. In addition, Paul who identifies himself as a gay man finds his sexual orientation a significant causative factor for his depression. The concern about his financial standing and loneliness are also triggers of depression for Paul. He added that he would love to be in a relationship, to have someone to vent his ideas with, and to cheer him up.
Lacking Support Services
Paul bemoans the fact that there are not enough public health facilities in Jamaica to address the needs and concerns of those who are living with depression. He recalls that the doctor who diagnosed him as being depressed referred to him to a psychiatrist. He visited the facility on three occasions and was unable to see the psychiatrist despite having an appointment. Paul added that while there are more professionals in the private sector to treat depression and mental illness, the cost associated with seeing a psychiatrist can be prohibitive for the average Jamaican. It has become quite common for Paul to be stressed daily for up to two to three weeks at a time.
The Way Forward
Paul needs help! He ended our conversation by saying he often thinks about jumping off the roof. In spite of those frightening and poignant words, there are many success stories regarding life after depression. Some chronically depressed persons complain of feeling worse when they take the medication, this was also Paul’s experience; as a result he rarely takes his anti-depressant medication. This side effect of feeling worse can be addressed by the physician’s re-evaluation of the medication and making the appropriate changes. The way forward must include an approach which will address the psychological, medical, spiritual, social and emotional needs of the person struggling with mental disorder. Interestingly, he admits that the spiritual side of his life needs attention. Paul finds some pleasure in gardening and watching old television series such as, “Matlock”, “Murder She Wrote”. “The different mood swings that I have, my moods change quickly and often, maybe I am bipolar, that is why I need the doctor” “Five years I could have my own company and I hope by then I can beat my depression state or learn how to control it. I don’t see myself married with children and white picket fence kinda life. I know and accept I will be alone”. Depression is an illness like any other medical condition and need the attention of those trained to treat it. The consensus in the field of mental health is that the best treatment is medication plus therapy.
Here are some somber, confirming words of Adam Ant: I have suffered from depression for most of my life. It is an illness.
Wayne Campbell is an educator and social commentator with an interest in development policies as they affect culture and or gender issues.