Depression can be fatal in one's darkest hour. Amira El-Noshokaty reports on the stigma surrounding depression and suicide in Egypt Married at the age of 15, Amal Mebid left her family in Deir Al-Ganadla. Just as she was settling into her new home, her husband and father-in-law began to beat her and, five months after the wedding, threatened to throw her out of the house. Even her own family refused to help. Amal Mebid had come to prefer death. One day, as her husband mercilessly insulted her, she poured gasoline on her body and lit a match. "I did not think. I did not feel," she says. "I did it so that I wouldn't have to be at my father's or husband's home." Somehow, Mebid survived. Today, at 29, Mebid recalls her state of mind at the time: "I couldn't take it anymore." A glance at last week's papers shows that Mebid is not alone. Ibrahim Abdel- Daiem, a 32-year-old man raising two girls, was reported to have drunk rat poison after he was unable to pay his daughters' school fees due to financial problems. Twenty-year-old Hoda Mahmoud, suffering depression after her sister's death, set fire to herself. No official national statistics exist on the rate of suicides, attempted suicides or depression in Egypt, according to Mohamed Ghanem, general-secretary of mental health at the Ministry of Health and Population. This is largely because most cases go unreported. In an effort to gain more insight into depression in the country, the ministry and the East Mediterranean Regional Office of the World Health Organisation are researching the rate of depression in Alexandria, Qalubiya, Giza, Fayoum and Ismailia. The results, to be released soon, will inform awareness campaigns and doctors on how to support and treat suicidal patients. Depression, loneliness, domestic violence, economic and social pressure and drug abuse all contribute to suicidal feelings. Internationally, experts are increasingly aware that depression affects young people, and a growing number of parents are seeking psychological treatment for their children. "There are several reasons for depression and anxiety among young people in Egypt," says psychiatrist Wafaa Haggag. "Society is developing quickly and ambitions exceed resources. Society gives young people examples of consumerism and financial capabilities, and they want to achieve them. But in reality there is a lack of job opportunities and they get depressed because they cannot reach such goals." The lifestyle generation gap is widening; the rapid pace of social development has exacerbated differences between the expectations of today's young people and that of their parents. A greater awareness of other lifestyles which, for many, are inaccessible have contributed to depression, says Haggag. The principal symptom of depression is a generally despondent and disheartened mood, making someone feel down and generally view life negatively, according to Haggag. People who are depressed loose interest in activities, resulting in a negative effect on their work, studies and appearance. They also withdraw from social situations and may begin eating and sleeping less. There are different types of depression. Uni-polar depression, for example, is when a person occasionally becomes depressed. Manic depression, or bi-polar mood disorder, is when a person's mood swings between two extremes; from a heightened sense of confidence and restlessness to feelings of despair and inactivity. Haggag argues that, like any other psychological disease, depression is caused by several factors. In some cases, people are predisposed to it. In others, depression can be caused by social circumstances, together with an individual's ability to cope and capacity to adapt to difficulties. Domestic violence and poverty are examples of social pressure that can trigger depression and suicide. Feeling lonely, alienated, having no one to share your thoughts with or having a troubled emotional relationship can also make an individual depressed. The amount of support someone gets from their family and friends is a major factor in helping depressed persons overcome their depression. Although it is not uncommon, there is a stigma attached to suicide and attempted suicide. Mahmoud El-Otiefy, head of the plastic surgery and burn unit at Assiut University and co-founder of the Assiut Specialised Burn Centre, says he can "easily detect" whether a burn is caused by an accident or a suicide attempt. The centre, which was set up in 1988, treats low-income patients as well as providing them with a rehabilitation programme and micro-credit projects to enable them to become self-sufficient. Self-immolation appears to be the most common method as kerosene is a cheap and readily available commodity. "I have seen attempted suicide cases by people ranging from nine-years-old to those in their forties," says El-Otiefy. "But most of those who would burn themselves were young people between 15 to 25." But family members usually deny that their relative has attempted suicide, says El-Otiefy. "They would state in official records that it was an accident, fearing that an investigation would reveal that they are often under stress and being abused by family members and husbands." Some women have other reasons not to tell anyone that they tried to take their own lives. "It is a matter of her honour being at stake, and if her honour is doubted she is as good as dead in our society," says a single 30-year-old woman who attempted suicide and did not wish to be named. Most Egyptians still shy away from seeking psychological treatment, or even admitting they might need it. One woman who attempted suicide remembers how, despite the fact that she was very depressed, refused to visit a psychiatrist because she thought she was strong enough to deal with her problems. According to Haggag, the shame of psychological disease prevents patients from revealing the nature of their illness. Society views those who seek psychological help as weak, lacking faith, or selfish. For those who want to talk through their problems there is help available. Befrienders Cairo offers a free counseling hot-line in Cairo. Established in the 1950s to reduce suicide cases in the United Kingdom, Befrienders International was set up in 1974, which is considered the mother organisation that sparked branches in 40 other countries. Established here in 1991, it remains the only organisation that offers free counseling services to depressed and suicidal people in Egypt. "None of the people on the end of the phone are professionals. What they share is an ability to listen," says Rafik Bedeir, spokesperson for Befrienders Cairo. The confidential service is offered in Arabic and English by 40 volunteers from all walks of life. Befrienders Cairo receives up to 400 calls a month, of which one third from callers expressing suicidal feelings. Sixty per cent of callers are under 40 years old, and one-fifth of all callers are under the age of 20. "We help them see their problems from different perspectives," says Bedeir. He says that the organisation cannot solve a caller's problems; that is something only the caller can do. Instead, they provide support and help them find strength to get through their difficulties. The majority of callers are lonely, but others seek help because of financial, relationship, family, friends or work problems. Refugees in Egypt and ex-pats also call. According to Befrienders Cairo's statistics, an estimated 30 to 40 per cent of callers in all age groups express feelings of depression. However, younger people tend to deny that they are depressed, even though they describe the physical symptoms of depression. It is estimated that half of all callers are unaware that they are depressed. "We do talk about suicide and we take it very seriously. But we keep no written records," Bedeir says. "What may seem a trivial problem may be serious. Troubled love relationship lead teenagers to consider committing suicide. We respect people's problems. A problem in itself is not what is important. It's the effect that is has on an individual that we are interested in." Many suffering depression have sought not only to talk about their problems, but treat their condition with medication as well. Haggag explains that the development of effective medical treatment for conditions such as schizophrenia and depression in the last 50 years has increased people's faith in medications. "This is a worldwide phenomenon," says Haggag. "The image of psychological disease and psychological patients began to change through the invention of effective medicine and other complimentary treatments, and better knowledge about how the human brain functions." Because of embarrassment or shame, people with symptoms of depression visit specialists or primary care doctors instead of psychologists or psychiatrists, according to Haggag. Of those, between 30 and 70 per cent are suffering from a psychological illness. Stress, for example, can lead to an increased heart rate which can prompt a patient to visit a cardiologist. Depression affects the immune system, making an individual more susceptible to disease, or cause other psychosomatic symptoms such as headaches, indigestion and urinary problems. On the other hand, physical illness can spark depression. Around 40 per cent of stroke victims and patients with chronic medical illness become depressed because they start to fear death. Worldwide, the separation of mentally ill patients from those with physical illness has been rejected in favour of integrated care. "You cannot properly treat a patient with a physical disease, without also considering their psychological state. The brain is the maestro of the body," says Haggag. Some facts about depression: Depression should be taken seriously as 10 to 15 per cent of people suffering from depression attempt suicide. 1- Know if you are depressed. Depression is different from feeling sad. Losing someone close to you can make you sad, and this bereavement will heal with time, and does not necessarily have any long-term impact on being able to function properly. But depression affects all aspects of an individual's life; professional, social, and personal. Depression can cause low self-esteem and distort perceptions, increasing the tendency to generalise and exaggerate. 2- Depression is a curable illness. 3- The earlier an individual seeks therapy, the earlier they may be cured. If someone feels depressed and the symptoms have not yet had a negative impact on their life, they have a better chance overcoming their depression. 4- Depression can be treated with medication, combined with other complimentary and integrated therapies. 5- Know yourself and your capabilities. Failing to reach high expectations can cause depression. Psychiatrists can help people to identify smaller goals that can be achieved. 6- Get support. A doctor can help patients take a more positive view on life and themselves, and can teach skills to deal with stress. 7- Through treatment, a person can get to know what is wrong in their relationships with others and learns how to develop interpersonal skills. 8- One should not be ashamed of weakness. It is part of human nature and, at some point, everyone needs help from others. Seeking help from others for our anxieties is no different from finding help for a physical illness. Asking for help is part of the treatment. 9- Between 15 and 25 per cent of the world's population suffer from depression at some point during their lives.
