JEBDU

The Last Taboo: Breaking the Silence about Depression and Mental Illness.
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 introduced myself.

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 them again.

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 lonely.

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 turmoil.

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.