by Dr Manhal Zarroug, Psychiatrist
Depression in Sudan is a contentious topic that is a fluid concept; a concept that morphs into more socially acceptable difficulties. It has many descriptions consistent with the diagnostic criteria defining depression, however it is rarely labelled as such due to the stigma attached. In a society that strives to define itself through religion, difficulties experienced in depression are perceived as a ‘weakness in faith’ or ‘tests from God’ that must be remedied by prayer and dedication. Depression is also described in varied manners depending on age groups, tribal and ethnic groups as well as rural versus urban areas. Older generations refer to it as ‘fatigue from life’ with vague somatic symptoms, commonly described as ‘a clenching’ or ‘inner ache’ that has no clear cause. There is also the description of ‘irritation/intolerance’ to describe the social isolation and neglect stemming from depressive symptoms. The younger generations commonly use the term ‘stress’ and ‘worry’ for depressive symptoms, and readily link their difficulties to overwhelming social difficulties.
Depression is overwhelmingly underreported and undertreated within all age groups, secondary to stigma in most cases. Mental illness is a stigma that is carried by the individual and the entire family, in both urban and rural settings, despite efforts made to reduce stigma by religious leaders and within religious institutions. Traditional healing practices (through faith healers) are common despite on-going attempts to reduce the practice. The use of biological interventions (antidepressants) is prevalent in the younger generations who have access to psychiatric care, however this is primarily in urban areas. Psychological interventions, including CBT for depression, are available interventions that are self-funded, and consequently accessed by a limited portion of the population; again, mainly in urban areas. Deficits resulting from functional impairment in depression are usually compensated by family and social networks, and not overtly attributed to depressive disorder.
Depression in Sudan is an unnamed ailment that is experienced and seen, yet rarely acknowledged. Access to mental health care continues to be a challenge to those without access to services or funds.
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