My mother, who passed away in September last year, was one of the estimated forty million Indians, who experience depression each year. That number comes from the National Mental Health Survey, a report on the largest ever head-count of mental disorders in this country, published by the Ministry of Health in October. The Survey also reported that the majority of these individuals, up to ninety percent or more in rural areas, received no treatment, at least one which is based on science, for their illness. My mother was no exception, for much of her life.
Despite being an illness as old as mankind, depression remains poorly understood. A particular challenge lies in the fact that as most people who suffer depression often do so in the shadow of some crisis in their lives, it is hard to distinguish the understandable misery which is so very normal in everyday life from a ‘clinical condition’. There is, for example, no blood test or x-ray which can reliably ‘diagnose’ depression. Even if our ability to diagnose depression remains constrained by this seemingly old-fashioned approach of an interview, we do know how to help affected people recover and, most importantly, without the need for mental health professionals who are an extremely scarce commodity in our country. Some of the most promising innovations in recent years are the development of internet based psychological treatments which a person can guide themselves through, with even greater effects if there is support from someone who cares, whether a friend, relative or a community health worker. For those who need more intensive treatments, there is robust evidence that brief psychological treatments delivered by front-line workers or antidepressants prescribed by primary care doctors are effective. Despite this evidence, the vast majority of people with depression go without any treatment, waiting for the spontaneous remission which will ultimately occur in a significant proportion of people. However, the delay in recovery, and the chronic and relapsing course that some may experience, leads to profound impairments in their lives. Put simply, it is damn hard to be productive and enjoy life when one is tired all the time, one’s mind is unable to concentrate, and one’s heart is filled with despair. Poor physical health, in particular leading to worse cardiac health, and suicide (shockingly, the leading cause of death in young Indians) are not infrequent outcomes.
On April 7th, we celebrate World Health Day and the focus this year, for the first time in the history of the WHO, is on depression and suicide. The campaign theme is ‘let’s talk’, emphasizing the central role of disclosure “as a vital component of recovery” by targeting the stigma surrounding mental illness which acts as a barrier to people with depression seeking help. Significantly, the WHO campaign recommends that talking can involve a wide range of potential listeners, from family members and friends to health professionals, as well as encouraging open discussions about this condition in settings such as schools, the workplace and in the media “ultimately leading to more people seeking help”.
It is becoming increasingly common-place, even trendy perhaps, to talk about depression not least due to the growing number of celebrities, from Bruce Springsteen to Deepika Padukone, disclosing their personal experiences of struggle and recovery. However, to move this discourse beyond celebrities to the general population, we need to encourage and support people to talk openly about depression, to promote knowledge and skills in the community on self-care, and to demand action by the government to improve access to clinical interventions for those who are severely affected. It is in this context that the website ItsOktoTalk (www.itsoktotalk.in),which offers a space for young people to share their accounts of struggle and recovery, is timely. There is no doubt whatsoever that we must talk about depression more openly, but we must ensure that people experiencing depressive symptoms are always at the heart of the conversation.
Vikram Patel works with the Public Health Foundation of India and Harvard University.