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Understanding Depression II: Venturing Beneath The Surface

There was a time when the only mental health illness most Sri Lankans knew anything about was psychosis or insanity. Common mental health conditions, like depression, anxiety, and schizophrenia, were relatively unheard of by the masses – not because these conditions did not exist, but because there was so little awareness about them. However, recent years have seen an increase in initiatives that attempt to shed light on all mental health illnesses, including the more common ones, such as depression. Granted, people are still slow on the uptake, with most of the rural populations still attributing any mental health condition to black magic or evil spirits and several others overlooking the existence of such conditions.

The Perception of Mental Health in Sri Lanka

Many people in Sri Lanka do not seek help for mental health conditions like depression because of the social stigma associated with them. Image courtesy thestorybehindmyshadow.wordpress.com

Speaking to Roar about the general response to mental health awareness in Sri Lanka, clinical psychologist, Rushma Mohammed, said, “There are mixed attitudes towards awareness. Sometimes you find 70- or 80-year-old individuals who show more openness to learning about these disorders than younger people. Then there are others who are skeptical, but willing to listen. And of course, there are some who think we, practitioners, are crazy. However, there is an increase in awareness now. Some of the clients I have worked with were aware that they were going through a phase of mental health difficulty, but they were in denial.” She surmised that this was because “the Sri Lankan culture does not much encourage people to express their emotions or thoughts. Therefore, we bottle things up, thinking that it’s the right or mature thing to do, instead of speaking out.”

Coming from a mostly pragmatic society (discounting our widespread beliefs about evil spirits and black magic), it is no surprise that we consider emotional problems to be a luxury that we can ill-afford. Thus, we tend to ignore them, hoping that they will disappear with time. When that fails to solve the problem, we shed all pretense of rationality and invite the local exorcist over to brandish lime and salt in our faces, and mutter a string of unintelligible chants to expel the evil spirit squatting on our soul. In any case, we refuse to acknowledge the existence of an actual mental health condition, because admitting it would mean that there was something wrong with our biological make up.

“There is a lot of shame associated with mental health illnesses in Sri Lanka,” said Dr. Ruzaika Jaufer, medical officer at the Department of Psychiatry of the Colombo South Teaching Hospital, “Most of our patients come to us in secret, without their families’ knowledge; some women come to us without their husbands’ knowledge. They are terrified that if they tell anyone, people will call them ‘pissu’ (mad). Nonetheless, now more people know that seeking help for psychiatric problems doesn’t mean that they have psychosis.”

Dr. Jaufer also revealed, “One of the most common psychiatric disorders that we diagnose is depression. However, most of our patients have no idea that they are suffering from depression, so they don’t seek help for it specifically. Instead, they come to us because they are weighed down with family problems, financial issues, or other emotional problems. Some of them are referred to us by the outpatient department after having attempted suicide. These people have depressive symptoms but they don’t know it themselves. In fact, some of them are not even aware that such illnesses exist.”

She added, “Psychiatric disorders like depression usually go undiagnosed in primary care, especially in peripheries. This is mostly because there aren’t enough resources and also because there is a lack of awareness, even among medical professionals. Unless you have some sort of formal training or experience in psychiatric care, it’s difficult to appreciate the depth of these illnesses or empathise with sufferers.”

How Does Depression Feel?

Depression is different from sadness. It is not just a direct response to a difficult situation. Many people mistake depression-induced inertia for laziness. Illustration by Aaysha Jaufer

The symptoms of depression are not physically evident, which explains why many non-sufferers fail to understand it or envision how it feels. Mental pain is difficult to comprehend, as opposed to physical pain, and there is no way to medically substantiate it. As a result, most people find the concept of depression bewildering. “Everyone feels sad from time to time,” they argue, “Why give it a name and make an illness out of it?” Depression is different from sadness – it is not just a direct response to a difficult situation. It is much more complicated than that.

Not all sufferers can articulate the complexity of what they are going through. In fact, they often find it difficult to make sense of their ever-changing mental and emotional state, especially if they have no prior awareness of the illness. This further confounds a non-sufferer’s ability to understand depression. However, there have been many – and among them, several famous people – who have successfully managed to capture the singular essence of the illness and condense it into words.

It is no secret that everyone’s favourite author, J. K. Rowling, struggled with depression when she was writing the first Harry Potter book. Later, she said of the condition, “It’s so difficult to describe depression to someone who’s never been there, because it’s not sadness. I know sadness. Sadness is to cry and to feel. But [depression] is that cold absence of feeling— that really hollowed-out feeling.” She described it as the “absence of being able to envisage that you will ever be cheerful again. The absence of hope. That very deadened feeling, which is so very different from feeling sad.”

The numbness Rowling spoke of was famously described by American author Sylvia Plath, in her semi-autobiographical 1963 cult classic, The Bell Jar. Plath, who suffered severe clinical depression nearly all her life, wrote of her experience, “I felt very still and empty, the way the eye of a tornado must feel, moving dully along in the middle of the surrounding hullabaloo.” She described the characteristic apathy and negativity that most depressives feel, with the words, “I buried my head under the pillow and pretended it was night. I couldn’t see the point of getting up. I had nothing to look forward to.”

People with depression often find it hard to envision the feeling of happiness – not only their own, but that of others as well. In her journal, Plath poignantly articulated the question of depressives everywhere: “Is anyone anywhere happy?” Shortly after The Bell Jar was published, Plath succumbed to her illness and took her own life at the age of 30, nipping in the bud the promise of literary greatness.

Depression has been known not only to end careers, but also to make them. For instance, one of the former British Prime Ministers, Winston Churchill, was a manic depressive who spent most of his life ricocheting from bouts of uncontained energy to periods of extreme despondency. It is believed that his disorder not just influenced, but was responsible for his unconventional, but brilliant political career. Once, when he was experiencing a period of normal mood, he expressed in a letter to his wife the momentary sense of relief he felt. “All the colours come back into the picture,” he wrote.

People underestimate how crippling the illness can be, both emotionally and physically, and tend to misinterpret depression-induced inertia as laziness. A depression sufferer, David J, succinctly conveyed how debilitating the condition is and how trapped it can make an individual feel, when he said, “Living with depression is like living with a 40 ton weight on your chest — you want to get up and move, but you just feel like you can’t.”

What Can People With Depression Do To Cope With The Illness?

Depression is not a choice. Sufferers cannot simply choose to get over it. Family and friends of people with depression can help by offering empathy, instead of judgment. Illustration by Aaysha Jaufer

“There is a lot of focus on the medical and psychological treatment of depression, but there is also social treatment, which is important in coping with depression,” said Nivendra Uduman, counselling psychologist from Samutthana. He went on to explain how sufferers can cope with the illness: “Do things – no matter how small – that help you find enjoyment, closeness to others and a sense of achievement, though it might seem difficult and overwhelming. Reach out to people you would like to spend time with. Focus on real-time interaction rather than virtual interaction.”

Uduman also stressed on the significance of physical activity for people with depression, pointing out that even the smallest of chores can help you beat depression-induced lethargy. “Exercise plays a significant role in elevating our mood and therefore is a positive way of coping with depression. It is important to set a balance of activity and rest into your day,” he said, adding, “Good sleep hygiene is an integral part of coping well with depression. Too little sleep disturbs our body systems, and so does too much sleep.”

Talking to someone close to you about how you feel also helps immensely and lifts a load off your shoulders, Uduman revealed. He urged friends and family of people with depression to listen without judgment and refrain from offering unsolicited advice. “Try to empathise. Encourage the individual to participate in social activities. Offer options, not solutions,” he said, “You wouldn’t say ‘Snap out of it’ to a cancer patient, so do not expect someone who is depressed to do the same.”

Where Can You Seek Help For Depression?

While it helps to know how to cope with the illness, it is also important that sufferers seek professional assistance, especially if their low mood persists. There are a number of places in Sri Lanka where one can go for professional help. “Most government hospitals have a psychiatric unit where you can receive treatment and support,” Nivendra Uduman informed Roar, “The National Institute of Mental Health in Angoda is also a good resource to seek treatment and support for those experiencing mental illnesses like depression. They provide specialised care. When you get past the barriers caused by stigma, it is an option to consider when you are looking for help.”

Uduman also recommended seeking talk therapy from psychologists or qualified counsellors who are available at several private hospitals or private practices. Qualified mental health professionals can be found online, through directories that provide information on psychosocial services in the country. Other organisations that offer mental health services include Sumithrayo and the CCC (Courage Commitment Compassion) Foundation, which has a free telephone counselling service that provides emotional support to people suffering from mental health challenges.

Some people refuse to acknowledge the existence of depression because they can’t understand it. However, to overcome it, we need to first accept it as a real illness. Illustration by Aaysha Jaufer

It is important to note that there is no shame in seeking treatment for depression. It is an illness that can happen to anyone. You can have depression and still be brilliant, talented, and successful. It is also imperative that we acknowledge the existence of this condition. Only by accepting it as a legitimate illness can we effectively remove all the obstacles to overcoming it.

In order to beat the illness, sufferers require reassurance and validation, especially from those closest to them. Naturally, it is hard for non-sufferers to comprehend the abject despair, the bone-weariness, the pain, and loneliness that those with depression face every day. To not be able to understand the condition is okay, but to trivialise it is not acceptable. Instead, you could make up for your failure to understand it by offering your unequivocal – if confused – support to those who suffer from it. It would go a long way towards helping them with their struggle to stay afloat. It is, after all, not easy fighting fiends that nobody else can see.

If you found this article useful, you may also want to read Understanding Depression I: The Nuts And Bolts

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