"I would go days without going outside. My breath foul from words unsaid. My body numb. I would sit in silence, watching the sun's tragic attempts to break through the thick curtains that I never opened. I lost track of the days. Weeks bled into months." These words were written by a 33-year old Joburg-based Creative, Vus Ngxande, speaking out about his relationship with depression.
His words stand out. They are alarming even. Because for most black people and amongst black people in South Africa, depression is taboo and for a black man to outwardly say he's dealing with depression is even more unusual.
Depression in black communities is not widely written about. According to the South African Depression and Anxiety Group, SADAG the prevalence of depression amongst black South African is largely uninvestigated and undocumented for a number of reasons. "The studies that have been done indicate that the numbers are seriously high, with approximately 18% of black patients presenting at primary health care facilities being found to be suffering from depression. This may even be an underestimation of the figures, as it has been found that GP's fail to detect between 33% to 50% of depressive disorders in patients presenting to them."
Ngxande says that his depression went undiagnosed for many years (until it was uncovered in therapy recently) because at the time he thought it was just a temporary feeling of sadness that would pass - as many people believe. "We view depression as flu, rather than a broken bone," he says.
Depression is deeply misunderstood in South Africa, especially amongst black people. Here are five common myths about depression in the black community:
1. 'There's No Zulu/ African Word For Depression"
A common reaction to depression is: "Yini leyonto ngesiZulu?" (what is that in the isiZulu language). Implying that the absence of a definition for depression means it does not exist.
Let's start here. "There is indeed no word in the Zulu language for depression. IsiZulu does not have umbrella terms, we go straight to the meaning of things. So one would typically describe how they feel as opposed to providing the name for the illness," says Gugu Mkhize, an isiZulu lecturer at University of Kwazulu-Natal (UKZN).
The notion itself is not true. "Depression is a Western construct and a definition for depression in the black culture does not exist. However the phenomenon does exist and is in fact quite common, as it is with other race groups", explains Dr. Thabo Rangaka, a Specialist Psychiatrist.
2. "It's A Bougie Illness"
There's a myth that depression is a 'middle or upper-class illness'. This is closely related to the misconception that depression is a 'white people illness'. While both of these myths are false, it is not hard to see where they could come from.
"One of the obvious reasons is that for the middle or upper-class education and language are far more accessible. The possible interventions for depression are also more accessible than they are for the lower or working class," explains Counselling Psychologist, Thembelihle Mashigo.
According to SADAG, the fact that health facilities in rural and township areas are not adequately resourced means that there is a low rate of diagnosis and treatment for depression in those communities, which makes it harder to have statistics about its prevalence. This easily leads to the belief that depression is not a black illness.
"Mental disorders are very democratic and do not discriminate. Whether people live in abject poverty or are wealthy, they get affected negatively by depression," asserts Nkini Phasha, Spokesperson and Board Member at SADAG.
3. "Indoda Ayikhali" (Real Men Don't Cry')
Unlike Ngxande, many South African black men do not open up about emotional distress nor do they seek help when they are depressed.
"African men do suffer from depression they just don't express their sadness as readily as women do. They tend to suppress their emotions and rather express them externally, by turning to alcohol or substance for instance," says Dr. Rangaka.
Dr. Rangaka adds that most of his black male patients would not have come forward were it not for circumstances (like concerned spouses or superiors at work) who force them to seek help. He said that they usually come forward mostly because they have shown signs of becoming withdrawn, aggressive or abusing substances.
4. "Yizinto Zabantu" (It's Witchcraft)
It's not uncommon to hear people in the township or rural communities loosely calling someone 'ihlanya' or a mentally disturbed person and believing that the cause of this is 'ubuthakathi' or 'izinto zabantu' (witchcraft).
Says Mashigo: "The dominant symptoms of depression are severe helplessness or feelings of a lack of meaning to life. And in the African communities, something that one doesn't understand is linked to ancestry."
Black people with symptoms of depression typically go to a traditional healer with the belief that they will be given traditional counsel or medicine to 'make it go away'.
Mashigo says many people who have exhausted many avenues like traditional healers end up in her office needing psychological assistance or go the psychiatric route, as traditional healing may not be able to adequately treat clinical depression.
5. "Thandaza Kuzolunga" (Just Pray, It'll Go Away)
Closely related to ancestral belief around mental illnesses such as depression is the notion that church and praying will heal depression.
Spiritual healing powers cannot be disregarded, however, there is a danger that patients with chronic cases of depression will go undiagnosed and therefore untreated, which could lead to suicide. According to research, depression is present in 90% of suicides.
"We know that there are some churches who believe they can 'cure' depression symptoms, which they believe are 'demons', by laying of hands or with prayer," says Phasha.
Phasha adds: "We try to go to churches in communities and educate church leaders about medical conditions like depression and to empower them to assist their congregates to get medical treatment for depression."
Depression is real. And yes, it's real amongst black people too. If you're going through any signs of depression, such as persistent irritability; sadness or anxiety; feelings of hopelessness, guilt, helplessness; trouble sleeping and changes in appetite; as well as accompanying thoughts of suicide, please get some help.
SADAG offers free and confidential counseling. Their toll-free number is 0800 212 223 or SMS 32312.
To support the Hope Hike initiative which will be raising awareness to depression on the 15th October (Cape Town) and 29th October (Johannesburg), visit http://www.ithembafoundation.org.za/hopehike.html