Thursday, August 5, 2010

Happiness in depression

Bhutan, the land of Gross National Happiness, has been seeing an increasing number of patients with depression, especially from the rural areas. Mental illness, particularly depression, is viewed as a paradoxical mental status for a country which is trying very hard to make the concept of GNH a reality. Being one of the two psychiatrists in Bhutan, I find it really hard to answer questions many visitors ask me about the reason behind increasing number of people suffering from depression. I really do not have any evidence to give an answer right away, however, when I reflect, I cannot help but highlight some factors which might have significant effects on the psyche of our older generation making them stressed and depressed.

We have seen rapid modernization and development over the last four decades. People got exposed to modern ideas, lots of information on health and education was given to them, and many other modern concepts became evident which were unknown until then. Schools were built everywhere. Children of school going ages were encouraged to get enrolled in schools with promise for better future for them. People learnt to take advantage of the family planning services that were extended to every household to cut the family size to a manageable level. “Small family, happy family” was a dream everyone aspired to have! Young parents in the eighties and nineties wanted all their children to go to school. They wanted them to study hard and get government jobs. For those who went to school, there was smooth sailing all the way. While few managed to do graduation, most got educated up to high school level and got into smaller jobs. The more brilliant ones pursued higher education to become professionals, and yet others achieved bigger positions in the civil service. All in all, none of them returned to the villages to live with their parents.

The young parents of those days have become aged now and they are staying back at the villages. Having educated all their children, there is now no one to help the parents in the farming work. The government encourages the villagers to cultivate their land and the “Gup” (village headman) makes sure it is done, at times forcefully. There is no excuse for keeping the land fallow, not even the frail health of the owner. In absence of ready labour force in the form of children and relatives, there is no option for the parents but to toil and toil until they get fully exhausted. To be a farmer in Bhutan, especially where mechanization is unknown, is perhaps the most difficult job than anything else. The day to day work in the field is manual and tiresome.

The global warning is a reality and the impact is obvious. This year alone there were several flash floods and landslides damaging substantial amount of arable lands and crops. Unpredictable weather conditions such as untimely rainfalls, storms, hail storms and drought are other factors that keep a famer always worried. The food grains, product of their hard toil, are never safe until harvested!

To make the matter worse, we have been seeing a number of wild animals increasing over the last few decades; we may call this the adverse affect of conservation of forest and preservation of the environment! People not only have to work hard to grow the crops but have to stay awake in the nights to protect them from wild animals, at times paying with their own lives!

In such a scenario, there is definitely a constant flow of stress hormones, and it is but understandable for a farmer to feel severely stressed. This stress causes a lot of harm to the mind and the physique of a villager. No wonder then, are we, getting more and more depressed people now, even though we would like them to be happy.

There is another factor now in the recent days and that is the rural urban migration, and the educated generation sticking to the urban centres. Life becoming difficult at the villages with all those odds most prefer to earn a living in the cities, even if it is just hand to mouth. They stick to the urban centres, establish a family and then get entangled in the webs of modernization. The salary they earn is limited, and the so called necessities in the towns and cities are many. Every day there is a new thing to be acquired, and the desire for materialist achievements is a never ending! Even if somebody wants to help their parents they become helpless. Few afford to send money to their parents, and most cannot afford to do that too. The attachment with the parents slowly gets distant and the dreams of the parents of a ‘small and happy family” becomes a remote and fading illusion.

Some children who are really concerned about their parents would like them to stay with them in the cities. But for the parents who have always lived in the village, it becomes a great plight to stay in apartments inside big buildings where 12 to 15 families live but never interact! The children seem always busy either trying to make a living, or glued to the television! No one seems to interact much with each other, and the conversations are always brief and precise. The way of life they find in the urban areas is beyond the imagination of a person who has always lived in the village minding his agricultural land and farm. Back home they are used to interact with their neighbours freely, share the common interests among them and help each other in almost every occasion. The building, even though, has as many households and people as in a small village, there is no sense of belongingness. They soon start feeling homesick and prefer to go back to their “home” and live with their dear neighbours where they find more warmth emotionally and feel closer to them than their offspring!

It is, therefore, too much of an expectation for these physically and emotionally fatigued lots to be happy. Philosophy alone will not bring about happiness, and to expect happiness in depression is ridiculous! We need to find out the multiple factors associated with depression and address them effectively if we want to take these rural folks out of the blues!