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.
