The Last Taboo: Breaking the Silence about Depression and Mental
By: Dr. Tedla W. Giorgis
In the waiting room in my office three weeks ago was an elderly Ethiopian
woman sitting next to her twenty-five-year-old daughter.When I asked them if
they were attended to, the mother said they had come to see Dr. Tedla. I
Once in the office, I noticed how gaunt and exhausted the mother looked.
Obviously, from lack of sleep. Her daughter, who was clearly clinically
depressed was experiencing auditory hallucination (hearing voices), sat by her
mother. Sobbing, the mother told me how neither one of them had had a decent
night's sleep in the past six months. The daughter had also lost an inordinate
amount of weight because she was not eating.
It was another heart wrenching experience to see both the mother and the
daughter in such bad shape. The mother, who reminded me of my own mother,
got up from her seat at one point in the interview, to hold my hand, and, kissing
it, pleaded with me to help her daughter. Intense emotions went through my
spine when I saw and sensed the sense of desperation on her haunted face.
In a twisted way, she was one of the lucky ones. Her daughter was still alive. A
lot others are not. Most of us only hear about the unlucky ones on the news,
after being found hanging from a noose they tied for themselves, or their brains
blown away by their own fingers from a borrowed gun. Some kill others and
then themselves. Some die in county morgues, anonymous. And still others are
shipped back to Ethiopia… "Timihirt/nuro asabedew" and we never talk about
I have been a clinical psychologists for the past twenty years. For the past
twelve years, I have been the Director of an outpatient mental health clinic
here in Washington (Multicultural Services Division, D.C. Commission on
Mental Health Services), which specializes in the psychiatric treatment of
ethnic and linguistic minorities. This position has enabled me to make
mental health services available to many Ethiopians.
But it breaks my heart that so many of our brothers and sisters are dying and
suffering needlessly from a very curable illness. Too many of us suffer
needlessly because of the taboo associated with seeking help for psychological
problems. Many do not recognize that their aches and pains, their exhaustion
and irritability, may be symptoms of an underlying depression. So many of us,
culturally, attribute symptoms of depression to personal weakness. And then we
drown in guilt for having the symptoms.
Depressive illnesses are among the most prevalent of the psychological problems
in Ethiopian communities, affecting Ethiopians of all ages,
socioeconomic classes, and educational levels. Depression continues to be
like the "common cold" for many immigrant/refugee communities, including
our own. Fortunately, depressive disorders respond well to treatment. Over 80
per cent of all serious depressions can be treated successfully. Even so, relatively
few Ethiopians who experience symptoms of depression seek professional help.
But I am truly grateful for the trust the Ethiopian patients I see have
bestowed on me; it has been a privilege to guide them in exploring,
understanding, and making sense of their worlds. The trusting relationships
I developed with my patients have given me access to the most intimate
details of their lives. I believe this experience has made me a better and more
empathic person; however, I will let others who know me pass this judgment.
For many of us Ethiopians living abroad, being first-generation immigrants or
refugees has not been easy. Before our arrival, there were no established
communities or role models that either eased our resettlement or guided our
conduct. We have had to redefine our personal identity based on the color of
our skin and on a philosophy that is not part of our upbringing.
The Ethiopian philosophical tradition and outlook is significantly different
from that of the European or Western world. While the Western tradition
emphasizes "individuality", "uniqueness", and "difference",?the Ethiopian
tradition emphasizes "commonality",? "groupness",?and "similarity."??When
these elements are missing, there is a tendency for us to feel isolated and
There are other factors which trigger depression besides difficulty in
assimilating. For a segment of the Diaspora there is also the pain and havoc
caused by the Red Terror in Ethiopia. The deep wounds of surviving genocide
introduce a whole lot of other issues. A lot of Ethiopians, as per our culture's
subscription, have shut down that episode of their lives without coming to
terms with its tremendous and devastating manifestations. Being uprooted,
imprisoned and tortured do not just leave physical scars. They are also
emotionally jarring. Add to that the difficulty in assimilation, and you have
I remember a patient I will call Daniel. When Daniel came to the United States
as a refugee, he left his loved ones, a good job, his home, and everything that
gave life meaning. Although he realized that this was a difficult step to take,
he felt optimistic about his future. Initially, he felt confident about getting a
good job in his area of expertise. He also felt that he had all the academic
credentials and work experience to enable him to find suitable employment.
However, as time went by, the search for jobs became humiliating,
frustrating, and demoralizing. After much effort, the only employment he
could find was an entry-level job that significantly under-employed him. He
barely made enough money to cover his expenses. Daniel worked long and
difficult hours doing tiring physical work. This busy work schedule does not
leave him much time to search for better employment. He became increasingly
unhappy and felt trapped, but is afraid to leave his job. He felt tired all the time,
which made it difficult to think clearly or act decisively. His sad feelings began
to spread to other areas of his life. Even seeing his friends did not make him feel
happy anymore. He also avoided those friends he had known for a long time,
especially those who he thought have adjusted better than he had. Maybe, he
thought, it was a mistake leaving Ethiopia as a refugee. Although he left his
homeland fearing for his life during the Red Terror, he wonders whether he
should have stayed and faced the consequences. His concerns about appearing
weak and unable to take care of himself made it difficult for Daniel to talk to
anyone about his feelings. Instead, he tried to drown his sadness in alcohol, and
started spending most of his time going to the various clubs and Ethiopian
restaurants in the city.
There is also tremendous pressure from our society to achieve and over achieve,
and that anything short of excellence is unacceptable and mediocre. Students
from the best schools in Ethiopia flounder in the prestigious universities that are
the pride and joy of their parents. But time after time, we lose our children to
depression and loneliness as they struggle to adjust from being the big fish in a
small pond, to being a tiny one in the sea. Most hide their depression because
the rest of us see under-performance as "QibTet". So they drag through classes
and life until they explode. It has happened so many times that I have lost count
of promising young people who were so afraid to face their parents they think
they have shamed, and opt to end their lives. Somehow, still in our society, a
dignified death is considered better than a mediocre life.
In writing the above statements, I don't in any way mean to stigmatize or
make generalizations about the Ethiopian community. I take great personal
pride in being an Ethiopian, and in how well we have adjusted and
contributed to our communities. But we still shield ourselves from pain, and
the pain of our loved ones. At one point, we must come out of our shell.
The Western world has support systems built-in. If you've lost your mother,
there is a support group or therapy available for you. Same if you've lost your
job, feeling unhappy or unsatisfied with life, you've stopped smoking or are
breaking up with a spouse. When children go through divorce or witness a
gruesome scene, they have counselors at their disposal. Imagine, then, the
disparity for a people who have lived through war and disconnect.
In a culture where any form of mental illness is associated with "madness" or
"ibdet," it is not surprising that Ethiopians avoid seeking professional help.
Many of us have difficulty even recognizing when we are suffering from
depression. Our tendency is to attribute depressive symptoms to physical
reasons rather than to psychological causes. Often, we seek help only when
the bad feelings become intolerable. Unfortunately, most of my patients come
to me only when their problems have reached crisis proportions, with feelings
of overwhelming desperation. In such times of desperation, while some can
only contemplate the idea of suicide, others act on it, and some succeed.
There are no reliable statistics available to show the prevalence of depression
and suicide in the various Ethiopian communities around the world.
However, one need only ask any member of any Ethiopian community about
his or her perceptions of the prevalence of depression and suicidal incidents
to get an earful of anecdotes.
Four years ago I published a book entitled "Understanding and Surviving
Depression, Alcohol & Drugs: A Personal Guide for Ethiopians." I don't know
about the experiences of other researchers, but I certainly found that
collecting data by attempting to survey Ethiopians extremely difficult.
(BeTam! BeTam! BeTam! Kebad neger!) The book took longer than expected
because I discovered early on that it is far more difficult to explain
psychological concepts in written words than in a face-to-face treatment
situation to Ethiopians who lack familiarity with psychological terminologies.
Encompassing over twenty years of clinical and research experience, its
purpose was to serve as a self-guide book to provide members of Ethiopian
communities around the world with information about depression. The book,
written in simple English, deals with the signs, symptoms and treatments of
depression, and tells the reader how and where to seek help when it is
needed. A report on new psychological research and the test instruments
used in that research, "Tedla-Hopkins Symptom Checklist-25" (in three
Ethiopian languages -- Amharic, Tgrigna, Oromiffaa), was also included as an
appendix. Since my research findings indicated that, just as in other ethnic
minority communities in the United States, alcohol and drug abuse problems
in the Ethiopian community are on the rise, I decided to include a chapter on
issues associated with alcohol and drug abuse.
During the past seven years, I have also been involved in assisting Amanuel
Hospital in Addis Abeba (located in Merkato) to develop a greater capacity to
treat the mentally ill. Every year I have gone to Ethiopia to assist in the
development of the professional staff, and of mental health services
appropriate to the needs of Ethiopian citizens. This experience has not only
been gratifying and enriching, but it has also developed in me an abiding
respect for those mental health professionals (Ethiopian psychiatrists, nurses,
psychologists and social workers) who toil day and night under the most
difficult conditions. They are my heroes. (I promise to write a story about
their heroic achievements in a future issue of SELEDA).
Depression is a painful taboo. But I keep on holding on to hope that one day
it will lose its stigma in our society. I just hope it doesn't take too many dead
Ethiopians for us to get there.
Very recently, that very same mother and daughter were back in my waiting
room. One of our psychiatrists had put the daughter on a combination of
antidepressant and antipsychotic medications. The mother, to my great relief,
looked rested. She smiled and said, "Lije beTam teshilwatal. Be-sint gizeye
tegniche aderku." She was beaming. I looked at her daughter. There was no
longer a blank look on her face. Apparently the medications had worked and
the critical auditory hallucinations were gone. "Kenezih dimtsoch gar
kememuaget areffku," the daughter said to me.
This is what keeps me going.
Dr. Tedla is author of "Understanding and Surviving Depression, Alcohol & Drugs: A
Personal Guide for Ethiopians." For information about his book and about depression,
please send email to Giorgistw@aol.com. He may also be reached via mail: P.O. Box 73145, Washington, D.C. 20056-3145. And by phone: (202) 671-1212.