Islamabad-In today’s world people casually throw around the term ‘depressed’, if they’ve had a fight with a loved one or if they didn’t do well on an exam, as if depression was synonymous with mere sadness. When the word ‘depression’ is used so carelessly for every negative emotional state, somewhere the significance and seriousness of the actual disease is lost.  According to the World Health Organization, around the world, nearly 300 million people, of all ages, struggle with depression each year. In Pakistan, depression and mental illnesses in general are a big taboo, something people don’t want to be associated with. The lack of dialogue surrounding this serious illness contributes to the stigma attached with it. In 2017, depression topped the WHO’s list of causes of global disability and ill health. Depression often presents itself in four ways: mood changes, cognitive changes, physical changes, and behavioral changes. It is a common mental illness characterized by persistent sadness and a loss of interest in activities that people normally enjoy, accompanied by an inability to carry out daily activities, for 14 days or longer. It can be debilitating but is treatable, with behavior/talking therapy or antidepressants or a combination of both, depending on the severity, cause and type of depression. Depression dates back to the Age of the Pericles when Hippocrates attributed depression to an imbalance of the body’s four humors. He recommended balancing the body’s systems with the help of healthy living strategies and relaxation, including blood-letting and leeches.

Depression can stem from the mind or from the body. In some cases, the patient develops depression due to hormonal changes and imbalance e.g. Post natal depression, Pre Menstrual Dysphoric Disorder, Hyperthyroidism and various other diseases. Whereas, in other cases depression can be caused by severe emotional trauma, changes in environment, grief, genetics and other personal problems. Feeling suicidal and severely depressed before menstruation is a sign of Pre Menstrual Dysphoric disorder wherein symptoms are more severe than those experienced during Pre-Menstrual syndrome. In most cases, the symptoms stop when, or shortly after, the period begins.  According to the National Women’s Health Information, Postpartum depression affects about 10% of new mothers. Depression followed by childbirth is very common, especially in C-section patients. 1 in 6 women who have given birth are affected by it. Postpartum depression can be treated with professional help, without which it can last for a long period and can have adverse affects on mother and child’s health. Moreover, in women, Perimenopause and the resulting fluctuating reduced hormone levels can also trigger depression. In men, depression is linked with low testosterone levels, though researchers have been unable to ascertain the correlation between both. Just like Obesity and Diabetes, men are more likely to develop depression. Long-term use of drugs also leads to changes in dopamine production and has been implicated in the onset of depression which can lead to the development of agoraphobia (fear of going out) in such patients, furthermore, it is also common among people suffering from eating disorders. Depression is a battle that the patient fights in his head so it is sometimes difficult to notice, since those suffering from it,  put an extra effort into making loved ones believe that they’re alright. But there are signs and symptoms that you can look out for, in people around you.

Recently, a famous YouTuber and Beauty Mogul Jeffree Star opened up about his battle with depression and self mutilation in a YouTube series about his life. His confessions led to a big debate about self harm on social media, particularly among the youth. People suffering from depression are more likely to get involved in self mutilation, as a call for help and to express that they’re suffering from severe mental agony. Such patients tend to say that they are cutting themselves to feel alive, to overpower the emotional pain and to curb the numbness inside them. If you or anyone you know is involved in self mutilation, please seek help immediately, as it can lead to serious diseases and even death.  Depression can be a life altering disease that not only affects the patient but those around him as well, but the stigma attached with mental illnesses often hinders the patient in seeking professional help. It is pertinent to destigmatize depression, so those suffering from it could seek medical help, just like patients of any other physical disease do.

Clinical Psychologist Saadia Batool says, “Seeking help is the first step that people are normally reluctant to take, mostly because of social pressure .They have an irrational fear that others will look down on them, but proper screening and treatment can improve the quality of life of such people, so it is vital to seek medical help.” It can be very difficult to live with someone with depression but support from loved ones can help the patient recover from this illness. For patients who are afraid to seek professional help, family members and friends can encourage them to visit a professional and can offer to accompany them to appointments. If someone you know is thinking about self-harm, or has already intentionally harmed himself remove items such as medications, sharp objects and firearms and do not leave them alone. If you think the patient is in danger, don’t leave him alone, immediately contact emergency services. When you live with someone suffering from a mental illness, you can help them recover, but you need to take care of yourself first, in order to help them more effectively.

I asked *Sara, a medical student and a patient suffering from depression about how we could break the taboo surrounding the illness to which she said, “We need to talk about it and normalize conversation about it, but most importantly we need to reach out to people who we suspect are showing warning signs of depression, also we shouldn’t attempt to be their savior because this disempowers those who suffer more”. While telling me about the issues she faced and how other people’s behavior changed after finding out that she suffers from depression, she said, “I find myself retreating sometimes because most people don’t understand what I feel and trivialize my very real clinical depression by comparing it with their circumstantial depression, both of them are devastating setbacks but I find that external acknowledgement of my pain is often what I need most and now after cutting off ties from toxic people in my life, I have more of that.”

Stigmatization and glorification of an illness can be equally harmful, it can aggravate attention given to a person who is not actually suffering from depression and so can have adverse affects on the support of those patients who are actually clinically diagnosed with depression.  Cinema, television and the music industry plays a big role in the glorification and romanticisation of depression and the medication attached with it. Lana del rey, a famous musician has often been criticized for romanticizing pain and depression, especially due to her dark lyrics such as “I wish I was dead”. Not only Pakistani TV dramas, but mainstream Hollywood and Netflix series like “13 reasons why” have played a part in the romanticism of depression and self harm, but surprisingly the most affective glorification comes from an unlikely medium i.e. Tumblr and Instagram, where hundreds of profiles and groups can be seen glorifying self-harm, and depression by using Images which can easily trigger someone with an addiction to self-harm. Images, hashtags, and posts that romanticize the idea of a person being depressed for simply experiencing typical alterations of feelings have turned it into a trend aided by social media and the easy access to it.  To glorify or romanticize a genuine mental illness that impacts 300 million people worldwide to appear relatable and cool does a disservice to society as a whole. It diminishes the credibility of the actual disease and those working to destigmatize mental health. This online cultivation of a beautifully tragic life is pretty susceptible to teens, all it takes is to upload a black and white photo with a quote about agony, and automatically one is gratified with compassion and pity from social media followers and friends. This ocean of dark poetry can easily drown those are actually suffering from a mental illness, especially those in their teenage years, when this trend of being considered as deep, dark and mysterious by Tumblr and Instagram “followers” can be very tempting, which often leads to more teens believing that they are actually depressed, followed by self-pity and self-harm.

In low income countries like Pakistan, private therapy is very expensive, and lack of therapists at public hospitals leave no option for poor patients but to rely on themselves.  According to WHO’s Mental Health Atlas 2017, “Levels of public expenditure on mental health are very meager in low and middle-income countries and more than 80% of these funds go to mental hospitals.  Globally, the median number of mental health workers is 9 per 100 000 population, but there is? extreme variation (from below 1 in low-income countries to 72 in high-income countries)”.  It is vital to work on mental health legislation, especially regarding human rights protection of people suffering from mental illnesses, involuntary admission in psychiatric asylums, professional training and medical infrastructure. 

*The name has been changed to protect the privacy of the individual.