The Sunday Leader

Depression In Sri Lanka: Taking Pills Or Talking? A Psychotherapeutic Answer

By Dr. Marcel de Roos – (Psychologist PhD,

In Sri Lanka, depression is a leading disease. According to the World Health Organisation (WHO) in 2006 almost 400,000 Sri Lankans experienced a serious mental disorder. In some areas depression was reported as high as a quarter of the population.
The WHO reported in 2008 that suicide rates in Sri Lanka are among the highest in the world (conservative estimate: 24 per 100,000). Depression will be the second most important medical disease worldwide by the year 2020. It has a high lifetime prevalence (about 16%) and at its worst can lead to suicide.

Some well known and important forms of depression are:

Major depression. The two main symptoms are that people have a depressed mood and have no interest in activities for at least two weeks for most of the time almost every day. Furthermore they must have at least three more symptoms out of seven (for instance weight change, sleeping problems, thinking about death or suicide).

Bipolar depression. Some people have periods with depression as with manic periods which are coloured by much activity and energy (hence the name bipolar, two poles).

Post natal depression. About 10 – 20% of the women after giving birth develop a depression.

Not every depression is the same. They vary from mild to severe, from a few to many symptoms. The intensity of the symptoms differs a lot too. There is a still lot of uncertainty about the causes of depression. A few theories have been developed which until now haven’t been completely proven (they are partly hypothetical). Nowadays researchers agree that the origins of depression are multicausal: there are biological, genetic, psycho-social and personality aspects. Each of them can contribute in some form as a factor.  The most important question is of course to determine what the best strategy is to overcome a depression. When someone is suffering from a severe depression (with strong suicidal tendencies) it is clear that medication should play a major role, at least in the first stage of the therapy.  In the case of mild or moderate depression psychotherapy should be the preferred method. With mild depression even jogging (three times a week) can help. There is an abundance of research that shows that with mild or moderate depression psychotherapy (or even taking a placebo drug!) has the same or better results than medication.

This said, while many anti-depressives have an impressive list of side effects, some of those are even worse than the ailment they are supposed to cure. In Sri Lanka psychology seems to be rather unknown. It is often confused with counselling, which is only a (limited) form of psychotherapy. A psychologist deals with the whole range of disorders and methods or therapies, not only counselling. Most people in Sri Lanka when faced with a depression almost automatically end up taking prescribed medicine. Psychologists are trained to try to discover the causes of depression and to help the patient to overcome and deal with it. Apparently psychotherapy seems to consist only of talking. But in reality it is all about FEELINGS. Usually at the start of a therapy, emotions which are suppressed can contribute hugely to the existing problems. Regularly (once or twice a week) venting your feelings and speaking about your issues with a professional psychologist in a safe setting can significantly alleviate your burden.

Feelings of depression are in many cases symptoms of an underlying conflict. Usually these symptoms stem from feelings from the past which are still too painful to be felt. When you succeed in making the connection, then those ‘old’ feelings (usually mixed with present ones) explain to you the cause of your present state. Finally you can start to feel the painful feelings from the past in full. The intensity of these painful feelings will diminish each time when you are triggered in the present by a representative of that old feeling.

Depression often has a double diversion trick. In the first place it focuses our attention to our self instead of towards those who have done us harm. Secondly the attention is placed on the present instead of the past where the cause of the pain lies. This double diversion trick works very well: we endlessly wander in the maze of depressed feelings constantly further away from the entrance. People around us often try to convince us with well meant advice: that you have to think positively, that life and yourself isn’t worthless, that the glass is half full instead of half empty, that you have to do things that you like, and so on.  This won’t help you at all! Feelings and thoughts of depression aren’t cured by well meant positive advice and they keep devastating our lives. It means that all the attention we give towards our own functioning in the present is in vain. The only way out of this gruesome maze is that we consciously release our attention from our own functioning and start looking for the repressed functioning of others in the past.

In therapy you will learn to become familiar with your “personal depression history”. You will recognise the causes, the triggers in the present that link to the causes and you will learn to get yourself out of your depressed state. Moreover, you learn to do this by yourself so that you will become independent of the therapist.   To conclude, the advantages of psychotherapy compared with medication seem obvious. There are no side-effects, you empower yourself to get out of your depressed state by your own, you get insight into your emotions, it’s not a quick superficial fix and you are not dependent (or even addicted!) on medication to feel well.

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