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Address the real issues

Tuesday, July 03, 2018

The Ministry of Health must immediately retract and correct the misinformed infographic on depression, says Smita Sahay

The Health Ministry’s ‘To Cope with Depression’ infographic is misinformed and erroneous on so many levels that instead of actually helping survivors or their caregivers with information, it reinforces the very stigma and stereotypes that so many mental health professionals and organisations are working very hard to address.

The text on the said poster claims, ‘To cope with depression

  •  follow a routine
  •  travel
  •  be creative
  •  take multivitamins
  •  think positive
  •  practice yoga
  •  stay clean
  •  sleep for minimum eight hours
  •  eat fruits
  •  go for walks

Great wellness advice. But that is the thing—this is ‘wellness’ advice, not treatment advice. One could arguably reuse the same poster for all kinds of wellness advice. And that is not the worst problem with the message. The bigger problem is that every single one of the ten pieces of advice is exactly what people battling depression find most daunting. Would the Ministry advise flu patients to ‘drop their body temperatures’ in order to ‘cope with influenza’?

There are many places one could read the definition of depression, such as, the World Health Organization website, the International Classification of Diseases Handbook 10 and the Diagnostic and Statistical Manual of Mental Disorders Fifth Edition.

Easier still, one could Google or Bing ‘symptoms of depression’ and learn a lot about this disease which is one of the leading causes of disability and mortality. Through this search one would even stumble upon WHO reports that claim that India is ‘the most depressed country’ in the world.

Let us put some of this information into perspective:

  • Depression is NOT just an extended period of ‘low mood’. It is characterised by an unshakeable existential crisis and a complete lack of self-love.
  • The word ‘depression’ represents a spectrum of depressive disorders that affect a large part of the population, across ages, socio-economic classes and locations.
  • Depression CAN be diagnosed by several psychometric tests, physical examination and blood tests.
  • Certain physical illnesses, such as a malfunctioning thyroid, low vitamin D or B12 levels, low magnesium levels and celiac disease CAN mimic or cause depressive disorders.
  • Depressive disorders left untreated for long durations CAN cause or worsen physical illnesses, communicable and non-communicable, such as tuberculosis, cardio-vascular issues, type 2 diabetes and HIV.
  • Low and middle income households in India ARE the worst affected.
  • Depression IS the leading cause of suicides, ~1,35,000.
  • People suffering from depression do NOT receive help because of stigma, lack of awareness and non-availability of health services.

When life seems meaningless and living is too much of an effort, how can one be expected to take their vitamins on time? Most depressive eating happens in binges of junk or not at all because of lost appetite; simply asking them to ‘eat fruits’ won’t work. When some of the most tell-tale signs of depression are insomnia or hypersomnia, what can advice to ‘sleep eight hours’ achieve?

An effective way to address depression is through a combination of three kinds of efforts in tandem: (i) drugs administered responsibly by a registered psychiatrist, (ii) psychotherapy with a licensed psychologist and (iii) self-care that includes exercise, mental health hygiene routine and good nutrition, in short, the advice on the poster. Take any of these three pillars away and the mental health plan will collapse. The Ministry has, for reasons best known to them, left out two extremely crucial elements of a complete mental health plan—the psychiatrists’ drugs and the psychologists’ therapy, and failed to label the infographic as ‘Self-care to Cope with Depression’.

Of course, self-care in generous doses along with therapy and, if needed, drugs, will catalyse recovery and management of depressive disorders wonderfully. Cases of mild clinical depression might even get addressed through self-care only, but in cases of moderate and severe clinical depression, when co-morbidity, risk of addiction, dysfunctionality and suicide risk are darkly significant, only self-care will achieve nothing for two reasons: (i.) the motivation and ability to undertake self-care is near zero in the patient, and (ii.) even in theory, mere self-care will not help with either the chemical imbalance in the brain and nervous system, nor with the downward spiral of darkness that depressed thoughts are.

The Health Ministry’s role must be to address real issues such as extremely poor psychiatrist-patient ratio through increased number of psychiatry seats in medical colleges, systematic licensing of psychotherapists, and multiple programs to spread mass awareness about mental health issues. In partnership with the Ministry of Culture and NGOs such as the Mental Health Foundation of India, the Health Ministry must also work on bringing about cultural change through the use of responsible language and addressing the shame and stigma that depression brings to patients. The Ministry must correct this irresponsibly tweeted infographic and must come down hard on individuals and organisations that spread misinformation on the spectrum of diseases as misunderstood as depression that hurts and kills millions of people.

Smita Sahay is Founder of the Calm Space Support Group Program

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