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The stigma lives on

BY Khethokuhle Mthethwa / North-West University | 25-Oct-2018
Depression in the black community is largely undocumented. The stigma surrounding this significant matter continues to silence many black people - young and old. In worst case scenarios, some are silenced forever.
The loneliness that is depression.
The image was sourced from Unsplash - https://unsplash.com/ - a stock image website.
Three years ago, Lesedi started experiencing unusual episodes of sadness and irritability. She knew that all those emotions are normal, but not when they are recurring. After six months of experiencing roller-coaster emotions, Lesedi was referred to a clinical psychologist who then diagnosed her with clinical depression. She is part of the 18% of black South Africans that live with the condition.

For many years’ depression has been labelled as a “white-people” illness. And it is no secret that depression has for the longest time been stigmatised in the black community. The sudden death of a renowned cardiologist, Dr Bongani Mayosi, sparked the conversation around depression and its acceptance amongst black people. Stigmatisation of any illness poses a threat to those who want to seek help causing many deaths linked to depression to not be documented. According to SADAG (South African Depression and Anxiety Group), “depression amongst black South Africans is largely uninvestigated due to problems relating to language and cultural differences”. Besides, black patients often grapple with the condition for a long time before they seek help and understand what it entails.

Lesedi’s experience was no different. She had to deal with coming to terms with depression and also the stigma connected to it. ‘Crazy’, ‘pyscho’, ‘bewitched’ – these are the labels that stuck with her after she told her family about her condition.

Depression is treatable

Karen Pretorius, a senior psychologist at the North-West University’s Student Counseling and Development Center at the Potchefstroom campus (Ingryp), describes clinical depressions as a unipolar mood disorder, which means that to one polar, a patient feels a certain type of polar emotion. “It is either high or low, and with depression it’s only the lows that a person experiences,” she says. This means that a person will experience a low mood most days over a certain period of time. Symptoms can either be physical or psychological, and according to Karen, can vary from “diminished interest in activities that a person once enjoyed, insomnia or hypersomnia, weight differences whereby the person could be eating more or less and then there might be ideas and thoughts of suicide”.

However, what most people do not know is that depression is like any other illness. It is treatable and manageable. Lesedi says she only understood what was happening to her after she was diagnosed. “For the longest time I did not understand why I felt the way I felt; it was unsettling not knowing and obviously the dark thoughts would constantly engulf my mind”. She turned to cigarettes and alcohol, which seemed to comfort her at that time.

The labels never stop

Ignorance is one of the many reasons why depression stigma is still strongly rooted in the black community. However, even after being enlightened about the issue, there are still labels that are attached to the illness.

One of the most prevalent stigmatising labels is that of witchcraft. However, for Lesedi, the experience was different. Her family initially suspected that she had to be trained as a sangoma. “My mother thought that ‘izinto zamadlozi’ (ancestral things), and she just couldn’t understand how my feelings were related to my body not functioning well. But I thank God for my father, he understood, and he wanted to learn more about my depression.”

Florinah Sizani, a psychology lecturer and part-time clinical psychologist at North-West University in Potchefstroom, emphasises how myths and some cultural beliefs in black communities play a role in instigating the stigma. “Often black people do not seek help because of discriminatory labels, [such as] depression [being] linked to witchcraft”. However, she emphasized the importance of not “playing-down” a patient’s culture and beliefs.

The idea that black men are not susceptible to depression also adds onto the stigma. There is a widely accepted phrase in the black community that suggests that men should never show their weakness. The phrase “Indoda ayikhali” (Real men don’t cry) points to a relationship between patriarchy and depression.

Essentially, the role of societal standards that determine how men and women must behave should not be downplayed. In the case of black men, they choose to suffer in silence out of the fear of being labelled as ‘weak’. The labels stick, and awareness does not seem to eradicate them entirely. On the other hand, people understand better when a concept or idea is explained to them in a language they know.

Language is a stumbling block

Lesedi’s challenges came not only from the labels, but also the language. “I remember one day when I had to explain to my aunt what depression is in seTswana, I stumbled over my words so much that she ended up saying, “Wa bona lerata dilo tsama kgowa” (you like white-people things).” Language and cultural barriers play a formidable role in harbouring the stigma, according to Florinah.

“I always stress the importance of using simple language when dealing with patients. As a psychologist, you do not have to be technical. Use the patient’s language and the symptoms they present to you,” Florinah says. It is important to understand the patient, the environment they come from and their use of language. Using language familiar to the patient removes the barrier.

All these ideas and misconceptions about depression will never stop unless something is done about it. Lesedi believes that educating people and opening up about her relationship with depression is the best way to lessen the stigma and misconceptions. “People misunderstand things when they do not know about it, and that’s why I think that awareness campaigns and just opening up could make a huge difference. People do not have to suffer in silence when help is available.”

Florinah stresses the importance of advocacy. It is very important that we have awareness programs that will provide education about psychology, either via the media, word of mouth and even our clinics.”