The recent story of Andreas Lubitz, the German pilot who allegedly crashed the Germanwings flight deliberately, has brought to light the stigma associated with mental health issues. One British news outlet reported in an inflammatory headline, "Suicide pilot had a long history of depression—why on earth was he allowed to fly?"
This type of reporting only serves to stigmatize mental disorders and isolate people who suffer from it. Some news outlets suggested that there is a link between depression and a tendency for mass murder. This is simply not true. However, it is important to recognize that depression, like most psychiatric illnesses, is a major risk factor for suicide. By stigmatizing psychiatric disorders, people may be discouraged from seeking help and this can have negative consequences for the victim and the society.Depression affects at least 350 million people worldwide, according to the World Health Organization (WHO). It is estimated that one in every five people will suffer from it at least once in lifetime. A small study of Tribhuvan University found that 44.3 percent of randomly selected geriatric population attending the outpatient department at Tribhuvan University Teaching Hospital were found to meet the criteria for clinical depression.
This suggests that a significant number of people are suffering in silence. What is being done to seek such people out and help them as well as to make the wider public aware of what depression is and what and where help is available. Perhaps this is the first step towards addressing the unjustified stigma of mental illness.
People at high risk of developing depression are socially isolated, elderly, unemployed, and female; have chronic medical conditions and relationship problems; and suffered bereavement, among other things. The symptoms can be grouped in many ways; one way is to divide it into core symptoms and associated symptoms. There are three core symptoms: Low mood, loss of interest and enjoyment of life, and reduced energy. The presence of two of these symptoms is a pre-requisite for a diagnosis of depression.
Depression can also cause reduced concentration, pessimistic view of the future, ideas or acts of self-harm/suicide, disturbed sleep (generally waking up earlier than normal in the mornings), and diminished appetite. It can also lead to reduced self-esteem and feelings of hopelessness/guilt/unworthiness. A combination of core and associated symptoms is required to make a diagnosis.
Medical students generally have a high incidence of depression due to heavy workload and contact with suffering patients. Women are more vulnerable than men. According to studies, up to 25 percent of medical students have depression and 10 percent contemplate suicide. Reasons cited for this are social isolation of medical students, self-blaming, and workplace harassment for female students.
In my college, I know many students who suffer from this ailment. Most did not seek timely help, even though they were aware of the condition. This delay has had a detrimental impact on them. While they had been experiencing symptoms for several months, many did not seek help until a few weeks before their school examinations.
By the time they sought help, it was too late. Their lack of energy and motivation meant they had not dedicated much time on their studies. Consequently, they had to skip exams, which further aggravated the condition. Some have had to temporarily suspend their studies during treatment. In these cases, it was only a matter of not being able to take their exams. In many other cases, people who do not seek help in time commit suicide.
This situation can be changed if we treat mental illness as any other illness. When someone breaks a bone, they do not think they can fix it themselves. They also do not put it off. With depression, it should be no different, as both can be disabling.
Current treatments for depression are incredibly effective. I have witnessed significant improvements in peoples' symptoms after starting treatment. In mild disease, relaxation and exercise can be useful and it may be all that is required. Low-intensity psychological therapy that is self-directed is also effective. For moderate and severe disease, antidepressants are used.
Modern antidepressants, many of which are off-patent and available cheaply, are highly effective in treating depression. After a sustained period of improved symptoms, people can be tapered off medication. Those suffering, therefore, should not put off taking medicine fearing that that they will need to be on them for the rest of their lives, as this is not the case. Psychological therapy by a trained professional is also incredibly effective.
I have witnessed people who changed dramatically, for the better, after starting treatment. If we fail to treat the problem in time, depression can be severely disabling and it is considered the leading cause of disability worldwide, according to the WHO. Happy and energetic people are vital to ensuring a productive workforce.
There is a need to work toward getting rid of the stigma of mental health in Nepal. We can start this by educating people in general and encouraging the people suffering from mental disorder to seek treatment, the same way they seek treatment for an infection. Given the array of effective treatments, we must strive to raise awareness and work to rid of stigma so that people get proper help that they need and deserve.
People trust news outlets. Therefore, it is important that news outlets carefully consider the impact of the news they publish or broadcast. It is encouraging that no inflammatory headlines were found in any of the major English newspapers in Nepal regarding Lubitz's case. It is still unclear if Lubitz did indeed suffer from depression; the basis for this conclusion appears to be a few torn pieces of paper and some boxes of medication found in his home. While it is human to want to give a definitive label as to why someone has committed such a heinous act, it is important to consider the wider implications of making claims based on minimal evidence.
The author is a final year MBBS student at the University of Leicester, UK
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