Mental illness is common than most people think, causing more suffering than many recognise and, in the case of one illness, depression, causing significantly more deaths than we have experienced with Covid-19.
Yet in this modern age there is little need for anyone to suffer, or anyone to die. This has not been the case for long. Until about sixty years ago most seriously mentally ill people had to be kept in institutional care and families of those patients who could perhaps stay at home had to put in a lot of effort to care for and control their relatives.
Then came the first generation of modern anti-psychotics, and the world’s psychiatric institutions started emptying as millions of people around the world could go from institutional care to become out-patients. Life was still tough, but a lot better. But science did not stand still and newer drugs were developed.
And in the last decade or two many of these second generation anti-psychotics have come off patent with affordable generic versions available, giving psychiatrists a large armoury to help their patients and allowing many to live a near-normal life and a productive life.
Psychiatric illnesses are frequently chronic illnesses, meaning there is no cure, but with a good doctor diagnosing and figuring out the control regime, and this is different for every patient, the illnesses can be controlled and psychiatric patients can join those with hypertension, diabetes, HIV and other controllable illnesses who live a totally normal and active life by swallowing a few pills each day.
Almost all of Zimbabwe’s psychiatric patients are treated as out-patients. They might have had to spend a week or two in hospital in a psychiatric unit as they are stabilised, assessed and start treatment.
But as the doctors find a workable treatment, and the patient responds, then the patient can go home, especially if there is a supportive family who can do the minor support of ensuring that the patient takes their pills and can offer the major support of making the patient aware that everyone is very happy to see them functioning. Family can then monitor the patient, make sure they refill prescriptions at a pharmacy or at the out-patient’s clinic in their nearest hospital.
But there are still many problems.
For a start most people with a psychiatric illness do not recognise that they are ill. This is where family and community are important. Other people have to care enough to see that the person is ill.
In serious cases this is obvious, and fortunately in Zimbabwe old-fashioned superstition is dying fast. The ill person is taken to a clinic or hospital and the whole referral process starts.
But there are many areas where the illness does not seem so serious, and regrettably the big killer of depression is one such since the depressed person is not actually bothering anyone, just living an ever-more unhappy life.
Sometimes depression is masked by other problems, such as alcoholism or drug abuse, and those in turn can become addictions, giving the sufferer a second chronic ailment.
Depression and addiction are linked, the addiction arising from a misguided attempt of what amounts to self-treatment. Some people who suffer depression feel a great deal better, or feel that they can at least cope, if they are half drunk. But in the end this just adds to their problems and may make the underlying condition a lot worse.
We do not talk about suicide much, and most people do not understand why someone wants to take their own life when so many are able to cope with far worse conditions.
But once we recognise that suicide is a severe symptom of a psychiatric illness, depression, then perhaps we can start to understand and start to recognise what we have to do.
We all at times feel low, feel sad, feel that life is unfair and feel the growing pressures. Bad economic times and other stresses can make these periods more common. But for most of us this depression is not a fatal illness. We cope, sometimes well, sometimes quite badly, but still having that belief in our self-worth and exercising that incredible human ability to trying to figure ways out of problems and stresses.
But for those with clinical depression this is not possible. This in fact is a symptom of depression.
Hardly any suicides are the result of calm, logical thought. There is the odd such death, but almost all cases of suicide are done while, to use the old-fashioned expression, “the balance of mind is disturbed”. Severe depression can be a fatal illness and in fact it is the biggest killer of younger women in developed countries if you want an odd statistic. More younger men die violently in car crashes and fights, but depression takes its toll there as well.
Already Zimbabwe has moved into this realm. No one dies of hunger, for example, any more and our public health authorities have made huge inroads into other potentially fatal illnesses such as malaria and HIV. Our public health system has even made substantial progress in other psychiatric illnesses; you hardly ever see someone walking the roads these days who is obviously psychiatrically ill.
But depression, because it seems normal, is not so well handled by families and communities. Covid-19 and the resulting lockdown and other measures have added to stresses. The Government has taken action to make these stresses survivable for the well through social security payments and other support. But for the ill the stresses can make things worse.
We need to now educate people more and make them aware that depression is a potentially fatal illness but one that can be treated. And this means families, communities, schools and employers need to be at least aware that it is an illness, and be able and willing to take action where they do suspect that someone could be hiding a serious illness.