The black dog in Myanmar

Weekend reporter Nick Baker investigates how millions of people across this country are suffering in silence

WINSTON Churchill famously called it his black dog.

The UK wartime leader characterised his depression as an inescapable, unwanted companion – never more than a few steps behind him.

It’s 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.

But despite the potentially harmful consequences to an individual and a society, depression remains one of Myanmar’s most overlooked (if not outright ignored) challenges.

Mental health experts told Weekend that the problem begins with a serious misunderstanding around the causes of depression in Myanmar.

According to the World Health Organization, depression can be brought on by a set of complex factors, ranging from personal circumstances and life events to biological attributes.

As one World Health Organization 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 currently partnering 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 about the causes of depression – and especially the negative connotations – means there is major societal stigma around the condition.

As put by Dr Sun Lin: “People think that they will be regarded as crazy if they admit to being depressed. There’s a lot of discrimination.”

The result? Millions of people all over Myanmar are suffering with their depression in silence.

Professor Ng elaborated: “Due to the stigma of mental illness, people with depression and their family may deny the presence of depression.”

He said that depression can bring loss of “face”, sour family reputations and even damage marriage prospects for the extended family. It’s an outlook that is “potentially harmful in many ways”.

And those who do seek some form of treatment for depression often do so from traditional healers. But despite the best intentions, 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,” Professor 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.

Daw Su Myat Htet is one of the few people in Myanmar offering professional help – by working as a counsellor in Yangon.

She said many people who have depression in this country don’t realise that it 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 Daw Su 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.”

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.

A 2014 World Health Organization report found the annual rate of suicide in Myanmar is 13.1 out of every 100,000 people – the highest in ASEAN.

And experts said the number is likely to be even higher as suicides have a tendency to be under-reported or wrongly-reported in Myanmar.

Globally, depression numbers are ballooning. The latest estimates from the World Health Organization say that more than 300 million people are now living with depression, an increase of more than 18 percent between 2005 and 2015.

Director-general of the World Health Organization Dr Margaret Chan said the new figures “are a wake-up call for all countries to re-think their approaches to mental health and to treat it with the urgency that it deserves”.

Professor Ng urged the Union Government to “make treatment accessible and affordable” which could “have direct individual and community benefits and decrease health care 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.”

Additional reporting - Nyo Me

If you are feeling depressed

  • Talk to someone you trust about your feelings. Most people feel better after talking to someone who cares about them.
  • Contact a medical professional.
  • Remember that with the right help, you can get better.
  • Stick to regular eating and sleeping habits.
  • Avoid or restrict alcohol intake and refrain from using illicit drugs; they can worsen depression.
  • If you feel suicidal, contact someone for help immediately.
  • Myanmar speakers can use the Counselling Centre Yangon counselling service on 09960536736 (24 hours, male counsellor) and 09253258821 (working hours, female counsellor).