World Health Day: Talk may not be enough!

Every year the World Health Organization marks the 7^th of April as the World Health Day, highlighting a most pressing world health problem. Depression is the focus of 2017 WHD, with the slogan "Let's Talk!". Three hundred and fifty million persons suffer from depression and related illness across the globe, and based on this, mental illness is deemed the main cause of ill-health and disability in the world. The last 10 years has shown a 20 percent increase in this affliction.

Mental illness is primarily the result of depression. The most important immediate action we can take is to recognize this state of ill-health globally and also locally in our nations, and begin remedial work in urgency. And that is firstly to talk to those afflicted. To see that they are in the focus of attention and for them to know that they are being attended to by people who care and are trustworthy in their eyes. In the first place their state is the result of being neglected over an extended period of their lives; perhaps a lot of trust of caretakers is lost during this stage because their concerns were not being addressed in urgency or being pushed to the back-burner because we in our modern families see that there are more urgent things for us to deal with.  When the nascent problem, over time, blows up into an observable phenomenon for the family, the issue is often beyond the pale of the family to address. The usual treatment is therapy and medication or a combination of these. But even in the higher income countries of the world, it is reported that only a mere 50 percent of the needy receive such treatment. The state of low-income countries should be so much lower by comparison. This neglect and related anxiety is also contributing to push up the burden of non-communicable diseases (NCDs) across the world. Anxiety and depression bring on heart disease, and diabetes etc.

Stress and neglect is pervasive even in Maldives. The unmanaged urban condition has much to contribute; at the home, the workplace and in the evolution of the nation. Neglect in the home of the elderly because of the tight physical space and the small nuclear family that lacks the caregiving capacity to the elderly or the physically challenged siblings, the chaotic and politically laced workplaces and national governance, the economic hardship of the urban populace, 50 percent of which live in single room apartments, and having to deal with every aspect of life in that confines, and the congested roads where motor vehicles and human being have to vie for space and the anxiety of those pedestrians who have to move in fear for dear life, etc. are all concerns that cannot be swept under the rug and left to be dealt with later. Indeed, the baby monster will grow inexorably with time into an unmanageable menace; if it hasn’t already!

The causes of anxiety and then the resulting state of depression and mental illness is myriad. There is not one cause, but each having its contribution to a degree depending on the tolerance level of the victim.  Those in these anxiety laden and depressed states, experience persistent sadness, change in appetite, if employed, loss of interest in the job they do and in thing that others normally enjoy doing, and loss of energy for extended periods – for weeks at a time. Often they do so in silent despair. If undetected these lead to thoughts of self harm and even to suicide. Other symptoms are a part of this syndrome; sleeping more or sleeping less, anxiety, reduced concentration, indecisiveness, restlessness, hopelessness, and feeling of worthlessness and guilt.

For any problem to be solved, the best way to begin is by understanding the causes; in this case of the anxiety and the depression. Research indicates the following; the conditions of your past, current conditions, use of alcohol and substance abuse, stress of the present situation, grief, difficult life circumstances, lack of social support, genetics, hormonal changes – in illness, body chemistry of life stage changes. Even the flood of pharmaceutical medications in present use has its contributing effect. These when looked at from the point of view of a nation’s or community circumstance will reveal a broken social and civil system that extends the reason for individual, family or community anxiety. Those with less tolerance will succumb to the stresses faster than others who are more resilient to these. The brain chemistry is critically affected by anxiety and with extended experience, alters the functioning of the brain into a habituation.

A strategy of "Let's Talk" is a good beginning, but it will certainly not be enough.. Talking about it or talking to those affected are both possible, and campaigns can begin a process but let it not fizzle out. Real action to address the issue has to be by tackling the causes; and these causes are dispersed in society. We need to begin right away by correcting these situations of social neglect by advocacy and good governance. Taking the cue from this WHO initiative, nations must take action at the local level to temper the objectives of our materialistic society. Materialism is a non-inclusive philosophy.  Competition and winning by hook-or-crook is the order of the day. in this movement. Corruption and deception seems okay along the paradigm of "the objective justifies the means", however irregular the means maybe. Obviously, these, and the situations precipitated by such actions create the tension that move social and individual anxiety, and many to depression and mental illness. These situations of cause must be corrected, and is best possible by better governance in society. We have to plant these seeds once again, even if it is to begin again from square one, even as we work on the curative methods of therapy and medication. Otherwise, we will be just giving aspirin for the symptoms. As the advocacy wanes, anther social issue will soon occupy the pole position of the  social issue-attention cycle. 

Women and the elderly are, it appears, more prone to depression than men. This maybe because women and the elderly are more prone to the persistent states of stress in the household, in the workplace or in situations of illness when helplessness is most experienced.

Our Nation, like others, is brimming with these concerns. Those in charge of national duty must look into these and systematically, with the involvement of the public, seek to address these before the monster will overpower us irreversibly!