By Kashyap Patel

Art by Jenni Li, STEM Fellowship

The Stigma

Mental health is very stigmatized in many cultures around the world. In East and South Asian cultures, mental illness is perceived to be a result of weak character and “bad genes” (1). Middle Eastern cultures view mental illness as a dishonour to the family and weakness in faith. This attitude is also prevalent in some Latino cultures, in which mental illness is perceived as a sign of weakness and dependency. As one of the most prevalent mental illnesses, Major Depressive Disorder (MDD) is no exception — it is stigmatized because it is often seen as a character flaw and not as a serious disorder. In reality, depression is complex with biological, psychological and social aspects that can intertwine at varying degrees to produce countless outcomes.  My experiences with the stigma surrounding mental illness showed me the immense need to address it on both an individual and on a community level. I believe that this is an opportunity for those in STEM fields to translate knowledge across cultural boundaries.

Personal Relevance

I grew up in an Indian family and the stigmatization of mental illness was blatant and disheartening. I have family members who have been diagnosed with MDD and their journey through treatment has been fraught with criticism from relatives and the community. The views that mental illness is “an excuse to be lazy” or “a ploy to get more attention” are quite prevalent in the South Asian community, especially among the older members. Those who support relatives with mental illnesses are also targeted by the community and accused of “enabling laziness” or “being delusional.” Needless to say, these misinformed ideas can create a very oppressive environment for those suffering from mental illness and even exacerbate the symptoms.

I believe that this is an opportunity for those in STEM fields to translate knowledge across cultural boundaries.

In my experience, physical illnesses are less likely to be stigmatized because their clinical aspect is viewed as more tangible than that of mental illnesses. Doctors can often run tests and visualize physical illnesses, such as tumours and organ dysfunction. However, diagnosing and quantifying mental illness seems to be an unknown science to the common person in my community. This is why disorders such as depression are often viewed by the uninformed eye as “a mere phase” and a pathology unrelated to biological mechanisms.

To me, this indicated that there is a notable lack of mental health education in my community. The reality of depression and other mental illnesses has been well-documented in research for quite a long time now. However, the translation of the scientific evidence into daily life for some communities has lagged behind due to deep-rooted beliefs. This is an opportunity for individuals in STEM fields to identify these harmful beliefs and educate their communities. For different cultures, these harmful beliefs might be drastically different, but they must be addressed for the betterment of those suffering from mental illness.

The Anatomy of Depression

The anatomy of depression is a serious one; it involves major changes in several vital areas of the brain. These areas are usually found to be smaller in depressed patients because over time, they have atrophied (Table 1). This causes a widespread rearrangement of the neural circuitry in the brain (2). Furthermore, these changes are very focused and in some cases, even unilaterally inclined. Studies have shown that the left hippocampus is more affected by depression than the right. These changes in the brain are usually accompanied by a decrease in blood flow in the prefrontal and the temporal cortex, basal ganglia, cingulate cortex, and the insular areas (2). Several studies have determined countless deficits in the brain related to the disease. Though physical changes are hardly the only evidence of mental illness, they should be evidence enough to convince those who doubt the biological aspect of this dire mental illness.

Oakes P, Loukas M, Oskouian RJ, Tubbs RS. The neuroanatomy of depression: A review. Clin Anat. 2017 Jan;30(1):44–9. Available from: https://www.ncbi.nlm.nih.gov/pubmed/27576673

The Biochemistry of Depression

Besides evidence for structural changes in the brain, multiple studies indicate a significant lack of regulation in the production and degradation of catecholamines, cytokines, hormones and neurotransmitters (3). Dysregulation of some essential excitatory catecholamines such as dopamine and serotonin is widely believed to be an underlying mechanism of the disease. To make things worse, depressed individuals are likely to have lower levels of melatonin and higher levels of cortisol which leads to disrupted sleep and excessive stress (3). Moreover, the dysfunction of norepinephrine receptors such as the alpha-adrenergic receptor in the forebrain has been associated with the pathophysiology of MDD by several studies (4). Thus, a myriad of neurochemical dysregulations is involved in the pathogenesis and pathophysiology of depression.

To disseminate this evidence to the public, culturally-competent workshops and media campaigns can be formulated for the South Asian community. Building a team of community leaders, community care providers, and educators to carry out these programs can be transformative. On an individual level, people should share evidence and perspectives with their family and community through tools such as social media and conversation. Making the information more accessible and digestible for this community should be the first step to tackling this issue. This exposure to new information will show the community that discussing this issue should no longer be considered a taboo.

A film on the neuroscience of depression, via The Atlantic

A Genuine Plea

Depression affects 300 million individuals (5) around the world and despite its grave outcomes and high prevalence, it continues to be stigmatized. Realizing the presence of a problem is just as important, if not more, than actually solving the problem. This ultimately leads to depressed individuals not receiving the care they need because they are scared of being ridiculed. As someone who has seen the harm stigmatization can incur, I am asking you to use your knowledge to make a difference. The next time someone brushes off depression, or any mental illness, as a “phase”, “bad genes”, “a lack of faith” or “laziness”, be sure to politely educate them about how real mental illnesses are.

Be sure to start this dialogue, if necessary, because these kinds of conversations not only transcend outdated beliefs, they also save lives.

In my case, I showed my family the overwhelming evidence that depression is a legitimate disorder to educate them and challenge their preconceived notions. Family doctors, community leaders and members of the family’s circle of care are good resources to consult in this process of knowledge translation. Sometimes, my family members and family friends were not open to these conversations about mental health. However, it is important to demystify and de-stigmatize mental illness by exposing them to evidence and challenging their beliefs in a respectful manner. From my experience, it is a good idea to find out why they hold such beliefs and asking them if their sources are credible. It is important to facilitate critical thinking and avoid telling people what to think. This change in behaviour is more long-lasting and impactful if it happens through self-reflection and curiosity.

Be sure to start this dialogue, if necessary, because these kinds of conversations not only transcend outdated beliefs, they also save lives.

Kashyap Patel

Kashyap is a third-year Health Sciences student at McMaster University.

References:

1. Abdullah T, Brown TL. Mental illness stigma and ethnocultural beliefs, values, and norms: an integrative review. Clin Psychol Rev. 2011 Aug;31(6):934–48. Available from: https://www.ncbi.nlm.nih.gov/pubmed/21683671

2. Oakes P, Loukas M, Oskouian RJ, Tubbs RS. The neuroanatomy of depression: A review. Clin Anat. 2017 Jan;30(1):44–9. Available from: https://www.ncbi.nlm.nih.gov/pubmed/27576673

3. Peacock BN, Scheiderer DJ, Kellermann GH. Biomolecular aspects of depression: A retrospective analysis. Compr Psychiatry. 2017 Feb 1;73:168–80. Available from: http://www.sciencedirect.com/science/article/pii/S0010440X16300414?via%3Dihub

4. Maletic V, Eramo A, Gwin K, Offord SJ, Duffy RA. The Role of Norepinephrine and Its α-Adrenergic Receptors in the Pathophysiology and Treatment of Major Depressive Disorder and Schizophrenia: A Systematic Review. Front Psychiatry [Internet]. 2017 [cited 2019 May 9];8. Available from: https://www.frontiersin.org/articles/10.3389/fpsyt.2017.00042/full

4. Maletic V, Eramo A, Gwin K, Offord SJ, Duffy RA. The Role of Norepinephrine and Its α-Adrenergic Receptors in the Pathophysiology and Treatment of Major Depressive Disorder and Schizophrenia: A Systematic Review. Front Psychiatry [Internet]. 2017 [cited 2019 May 9];8. Available from: https://www.frontiersin.org/articles/10.3389/fpsyt.2017.00042/full

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