Women bear the burden of mental depression
Saonli Hazra

 Maya is 27, illiterate and has four children whom she supports by working as a part-time domestic help in five houses. She has the reputation of being very good at her job: she is punctual, she informs the households prior to taking leave and is honest and reliable.

Maya earns around Tk 2,500 per month, a sizeable part of which goes towards paying the rent and her children's school fees. Maya's husband does not have a job-he lives off his wife's income. He even uses the money she earns to support his drinking habit and Maya is often unable to make both ends meet. As a result, she has to buy groceries on credit, borrows from the houses she works in and also from her relatives. Even so, the debts seem to just keep piling up.

Since the last six months, Maya has not been her usual gregarious self. She looks distressed, unhappy and lost. She is no longer as efficient and somehow she does not seem to care that she is doing a bad job. She has also lost her appetite and suffers from frequent headaches, chest pains and complains of being low on energy. She dozes off in the middle of her work and now the other maids in the area have started calling her 'crazy'.

Maya got herself checked at the free government clinic where she was prescribed a dose of iron and folic acid tablets, multivitamins and asked to follow a more nutritious diet. But several weeks later, Maya still complains of numbness, weakness and palpitations.

Unknown to her, Maya is suffering from severe depression. And Maya's is not an isolated case. There are many others who, due to poverty, suffer from stress-related disorders. And the irony of the situation is that not only are people who suffer from depression unaware of its consequences, even many doctors do not know how to tackle the problem.

Dr Vikram Patel, a Senior Lecturer at the London School of Hygiene and Tropical Medicine, has done pioneering research in this field. A part of this work has been done at two primary level health centres in Goa. Patel took a random sample of patients who came to the clinics with symptoms of numbness, weakness, heart palpitations and overall lethargy. He found a pattern emerging: almost all these patients came from a deprived economic background.

His research reveals that those who did not have enough money to buy food at some point in the previous month were four times more likely to suffer from depression. People in debt were three times as likely and the unemployed, twice as likely, to suffer from depression.

On the basis of these findings, Patel concluded that there was a correlation between people's economic status and the incidence of mental health disorders. The study also showed that women were a high-risk group, primarily due to their traditional roles as nurturers where they had to bear the strain of poverty more than the men. At the same time, there was also a lack of affordable and accessible services and doctors at the government health centres were unable to identify the problem and hence could only provide symptomatic relief.

One prominent model of depression theorises that depression involves a kind of giving up or 'learned helplessness'. Thus, after suffering a series of setbacks, depressed persons come to the conclusion that they cannot cope with the situation. And slowly they stop trying completely. Simultaneously, their self-image becomes negative. They see themselves as losers and this ultimately is the basic premise that triggers off depression.

The situation is worse for those from the economically deprived sections. Financial instability triggers off a spate of disappointments which then fuel feelings of worthlessness and low selfesteem. Finally, when these feelings extend to almost every life situation, one has a full-fledged depressed patient at hand.

This link between poverty and mental health problems has been amply illustrated by social scientists and economists. Recently, the World Bank's Living Standard Measurement Surveys (LSMS Working Paper Series, World Bank) too have indicated the same. Others have also concluded that the most effective way to combat depression has little to do with psychiatry and more to do with economics.

Nevertheless, the curative side too needs to be revamped, especially the available infrastructure. The prime challenge is to remove the stigma attached to mental health problems. Most people do not believe that mental health is an area that requires policy intervention or professional handling. Instead, faith healers or family doctors are preferred. Maya, for example, goes to the temple two to three times a week, fasts and consults every fortune teller she comes across for a cure to her depression.

Sensitising and training doctors who are most in touch with the poor, especially those in government hospitals, would go a long way. But the ultimate target has to be to get the government to spend more on mental healthcare services. At the moment, the government is spending less than one per cent of the health budget on mental health and the doctor-patient ratio is abysmally low at 1:250,000.

Surely these statistics speak loudly enough to show that this is an issue that needs to be tackled in a hurry.


Source: The New Nation,  Dhaka, February 5, 2002


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