by Dr Konstantinos Tsamakis, ST5 Psychiatry
The perception of depression is different in Ghana from that in the UK. Most patients seem to be unfamiliar with the fact that depression is a disorder of mental health. They can answer questions about being ‘happy’ or ‘sad’, but being ‘sad’ is not the reason why they come to the outpatient department. The usual presentation is of fatigue and insomnia, and vague somatic symptoms. Sometimes they deny they are depressed, even when symptoms are obvious. I saw a patient who looked depressed, scored his mood as 3/10, was experiencing anhedonia and lack of energy, but would strongly deny there is anything wrong with his mental health and would focus on medical explanation of his somatic symptoms, despite all investigations being normal.
Stigma plays a big role and people don’t want to be labelled as suffering with depression or any mental illness. Depressed people tend to be seen as ‘weak’, unable to enjoy life or do everyday things because they don’t try enough. Society thinks they should just get themselves back together, or should pray more. The understanding of the impact and the nature of depression seems rather poor.
Patients do not spontaneously mention suicidal thoughts. They have to be teased out and on a few occasions I was surprised to find out patients experiencing worrying suicidal ideation, since they had already reassured me they had no concerns. Accidental (due to lack of awareness) or deliberate (due to stigma) minimising of symptoms is frequent. Relatives of patients seem uncomfortable when questions about suicide are asked. Their stress reaction can be to laugh, which in the beginning was very confusing for me. I now realise that this is a way to react to stress, rather than lack of care. Suicide is little spoken about. Even among some mental health professionals here, suicide is thought to be something rare. Yet, in the last 2 weeks in Ghana there have been three suicides of young girls, which have been all over the news: two university students (one hanged herself and one jumped from a height) and one teenage girl. I cannot stop talking about assessing risk in my lectures.
I still bring in my mind the face of a 17 year old boy who was brought to the clinic by his mother because he kept running away from home. The mother could not understand the reason for this and wanted us to ‘advise’ him. Initially, the boy reported everything being fine. He was smiling nervously, minimising what had been happening. I asked the mother to leave us alone; again he insisted there was nothing wrong. Only after empathetic questions and after he trusted me, he became tearful and showed me his diary where he records his daily suicidal thoughts- his father has been abusing him in horrific ways and his mother is unaware of any of these. He feels sad, worthless and has lost hope. We agreed on a treatment plan and I tried to instill hope. I hope he is doing well.
999 is the national emergency number in Ghana.
National Lifeline: 2332 444 71279
Samaritans.org: 233 244 846 701 (24/7 hotline)