YANGON — Winston Churchill famously called it his black dog.
The United Kingdom wartime leader characterised his depression as an inescapable, unwanted companion – never more than a few steps behind him.
It is a feeling that many in Myanmar would be all too familiar with. According to the recent Global Burden of Disease Study, almost two million people here suffer from depressive disorders.
Yet depression remains one of Myanmar’s most overlooked (if not outright ignored) challenges.
Mental health experts said that the problem begins with confusion around the causes of depression in Myanmar, where the black dog is attributed to everything from evil spirits to the wrath of ancestors. Those who do seek help often start with traditional healers, which can make things worse, or at the very least, delay diagnosis. Men tend to be even more reluctant than women to seek help for fear of appearing weak and it does not help that Myanmar has an acute shortage of psychiatrists.
The result is the highest suicide rate in Asean (Association of South-east Asian Nations), at 13.1 out of every 100,000 people each year, according to a 2014 World Health Organization (WHO) report.
POSSESSED BY GHOSTS
Globally, the WHO says that more than 300 million people are now living with depression, an increase of more than 18 per cent between 2005 and 2015.
According to the WHO, depression can be brought on by a set of complex factors, ranging from personal circumstances and life events to biological attributes.
As one WHO mental health fact sheet sums up: “People who have gone through adverse life events (unemployment, bereavement, psychological trauma) are more likely to develop depression.”
And importantly, the United Nations body stresses that anyone can develop depression as “it affects people of all ages, from all walks of life”.
But the reasons for depression are viewed very differently in the Golden Land.
“Common beliefs about causes of depression in Myanmar can include evil spirits, character weakness or punishment from ancestors,” said Professor Chee Ng of the Asia-Australia Mental Health Group, a consortium that works with various Myanmar mental health entities.
These deeply held cultural beliefs are something that Dr Sun Lin from the mental health education department of Thingangyun Sanpya Hospital has experienced firsthand.
“Once, I had to treat a child in Myaungmya with mental health issues. The family and friends thought the child was possessed by a ghost,” Dr Sun Lin said.
Such misinformation means there is major societal stigma around the condition.
“People think that they will be regarded as crazy if they admit to being depressed,” said Dr Sun Lin. “There’s a lot of discrimination.”
SUFFERING IN SILENCE
The result? Millions of people all over Myanmar are suffering from depression in silence.
Prof Ng said that depression can bring loss of “face”, sour family reputations and even damage marriage prospects for the extended family”.
And those who do seek some form of treatment for depression often do so from traditional healers. This can often do more harm than good.
“Excessive use of traditional healers can delay proper diagnosis and treatment, and may incur unnecessary costs to the family,” Prof Ng said.
He said that those who do use traditional healers often become despondent after not receiving relief and then are more reluctant to seek professional help.
Ms Daw Su Myat Htet, a counsellor in Yangon, is one of the few people in Myanmar offering professional help. She said many people do not realise that depression is curable with proper help.
“These people think they have to suffer in their daily lives and stand firm.”
There seems to be a gender divide among the people that Ms Myat Htet does treat.
“Women appear more likely to suffer from depression than men,” she said, crediting this in part to high rates of domestic abuse. However, she added that men are far less likely to seek professional help for their depression due to a cultural norm that men should not show weakness.
“There’s an attitude of ‘we are men’. If they are experiencing some sort of sadness, they don’t want to show it. Especially to their family.”
SHORTAGE OF PSYCHIATRISTS
Regardless, advanced professional help is not an option for most people in Myanmar. There are only about 200 psychiatrists for a population of 54 million – meaning that each psychiatrist is responsible for roughly 270,000 people.
This environment of misunderstanding, cultural barriers and scant resources surrounding depression goes a long way in explaining why Myanmar has such a high suicide rate, even with the tendency to under-report in Myanmar.
Prof Ng urged the government to make treatment accessible and affordable, which could “have direct individual and community benefits and decrease healthcare costs” in the long run.
And Dr Sun Lin had a simple message for the millions of people experiencing the black dog of depression in Myanmar: “Remember, anyone can be depressed. So if that’s you – talk to people who will listen, talk to a counsellor. Don’t stay silent.” MYANMAR TIMES