26 April 2017

Nigeria: The Tricky Mask of Depression and the Culture of Denial in Nigeria

Photo: Tsoku Maela
Photographer Tsoku Maela, who suffers from manic depression and anxiety, has visually interpreted the different stages of depression in a photo series called “Abstract Peaces”. The series aims to challenge the stigma around mental illness in the black community.
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Editor's Note: This week our Thought Leadership Article beams a spotlight on the invisible but alarming disease of depression in Nigeria. Dr. Mona-Lisa Kwentoh is a Consultant Psychiatrist in the UK National Health Service. She writes candidly about how depression hides under smiles and pain, and touches on the reluctance of Nigerian culture to accept depression as an illness which needs professional medical care. She points out that family support as well as knowing when to seek care are key for people to recover from depression.

I sit down in my clinic as I listen to Tunde, a high-flying bank executive, tell me about the deep dark hole that he continually feels he is sinking deep into which is all-encompassing. He has tried hard but has been unsuccessful in pinpointing the main cause of the depths of despair he experiences. All he knows is that he has been fighting a deep dark cloud for a long time and is left feeling continually tired. Although Tunde feels he is loosing the battle to keep afloat, he has a pleasant smile at work, is meeting all his targets and is a mentor to others. So, nobody knows what he is going through. Tunde occasionally thinks maybe if he ceased to exist, he could escape the torture of "keeping up appearances".

In contrast, Akachi lost her husband a few years ago and is struggling to make ends meet. With her meagre income from her small business, she has numerous unpaid bills and is about to be evicted from the modest accommodation she recently downsized to. Akachi has run out of the various benevolent gifts she received from supportive friends and can't seem to find any further source of help. She is at the end of her tether and is more traumatised at the effect her life circumstances is having on her 2 innocent dependants. Akachi has one thing in common with Tunde; a deep feeling of despair that is also all encompassing and she sees no way out of her predicament.

Mental Illness is not much discussed but recently the focus of our country has been drawn to the Third Mainland Bridge with events that have sensitized us to the subject.

"Naija people are tough," people remark. We are resilient as we squarely face day to day challenges that would cripple others. After all, we express immense gratitude for what others would call bare essentials of living. Adversity seems to toughen the average Nigerian to weather any storm of life.

"Life is precious" I hear someone say. "How is it possible that someone can take their own life?" Because we are not all built the same way and respond to life challenges differently. Because one may be ill; the way one experiences diabetes, high blood pressure or any other physical illness.

What is depression? One quote I have come across captured depression in the best way I could possibly explain... "Depression is like living in a body that tries to survive with a mind that tries to die" (author unknown). This is hard to comprehend for the person experiencing symptoms, as well as their loved ones or even any member of the public. Because it is an illness, it defies rational thinking although sometimes one can understand that life challenges can precipitate the illness. There are also occasions when someone who "seems to have it all" has the illness too. What does that tell us? What we already know; Illness doesn't discriminate. It is not what one chooses and could also happen to someone despite various steps taken to prevent it. Illness prevention decreases the risk of one becoming ill but doesn't eliminate it.

Symptoms of depression include persistent deep feelings of sadness, feeling tired all the time, loss of pleasure in activities one previously enjoyed, poor sleep, concentration, appetite and sex drive. Some of these symptoms are present in mild to moderate depression. In severe depression, intense feelings of unnecessary guilt, worthlessness and hopelessness become evident as well as suicidal thoughts.

The good news is that depression is treatable with medication and psychological therapies. Of course, social support of family, friends, and faith community is also vital and part of the holistic approach to treatment. Knowing how to respond to anyone experiencing depression is crucial as it is not a case of one "pulling oneself together" or "getting over it."

We all have a part to play in encouraging people experiencing these symptoms to seek help from a psychiatrist, in addition to lending a listening ear and encouraging hand. It is not only those who are easily identified as mentally ill by our society that should see a psychiatrist. It is also worth noting that any ill patient goes to a doctor for consultation in the hope that through their expertise the person could get much needed help. As such, it is nothing to be ashamed of, looked down upon or done in secrecy.

For help concerning mental health in Nigeria: Mentally Aware Nigeria, Nigeria Suicide Prevention Initiative (0806 210 6493)

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