At first, finding an urban planner, Dr Noman Ahmed, sitting among psychiatrists and psychologists at an event for World Mental Health day in Karachi seemed odd. But when he spoke of how urbanisation has led to increased stress in our major cities, especially Karachi, few disagreed.
“Factors like poor patterns of commuting, social stratification, a lack of parks and public spaces, inadequate housing choices, a large time spent on making the trip to school, uncontrolled traffic, routine breakdowns of urban infrastructure such as electricity, the water supply… and the poor law and order [conditions] in our country are leading to increased stress,” he said. Stress and depression were the focus of the discussion at the event organised by the Pakistan Association of Mental Health at the Jinnah Medical and Dental Centre on Wednesday.
If we rated stress on a scale of 1 to 100, it turns out that death of a spouse is at the top (95%). Surprisingly retirement does not cause as much stress as the death of a pet. A broken engagement or love affair (57%) is worse than the lack of a son (51%.) Knowledge of your spouse having an affair racks up 80% and marital separation 77%.
While depression is sometimes called the common cold of mental diseases, sometimes it can have long-lasting effects. Jinnah hospital’s head of psychiatry, Prof. Dr M Iqbal Afridi, shared how depression is linked to other psychiatric and medical conditions from anxiety and substance abuse to cancer, cardiac disease and endocrine disorders. Forty-seven per cent of people with depression can develop cognitive difficulties, mainly due to the shrinking of the hippocampus, the part of the brain related to cognition and memory. Depression in cardiovascular illness increases mortality three fold. It also affects mortality in other illnesses such as end-stage renal disease, type-II diabetes and myocardial infarction.
Dr Tariq Sohail, the chairman of SM Sohail Trust, gave a critical review of the theories of depression. Depression is a major dysfunction of the brain and the fourth leading contributor to the global burden of disease. The fact that the prevalence of depression is high in all ages is also confusing.
Dr Naim Siddiqi of Aga Khan University Hospital discussed how to identify and deal with a family member with signs of depression. They become lethargic, let their personal grooming deteriorate, delay manageable work deadlines, are unable to relax, flare up over little provocation, are negative even during good times, and find it difficult to display affection and love. “The proper way to deal with them is to neither compare them with the unfortunate nor tell them what they need to do,” he pointed out. “That’s because it’s an illness, not a weakness.” They need to be encouraged to see professional help.
Published in The Express Tribune, October 11th, 2012.