“She had symptoms of depression,” said the national referral hospital’s psychiatrist, Dr D K Nirolla. “She was losing interest in usual activities, was irritable, feeling sad, hopeless, worthless and, at some point, had also wanted to end her life,” said Dr Nirolla. The 35-year old mother of three children also had other biological symptoms like not being able to sleep properly, loss of appetite, loss of weight and frequent crying, according to the psychiatrist.

Illiterate and dependent on her alcoholic husband, a police personnel, fights and assaults had become a part of life for Dema.

Depression, a mood disorder, characterised by sad mood, loss of pleasure or enjoyment and or decreased interest, is one of the most common mental illnesses in Bhutan.

The psychiatric ward in Thimphu hospital sees about three depression cases a week. The youngest case was a 14-year-old and the oldest, a 70-year old.

Although the numbers of depression cases are higher among the rural population, anyone, irrespective of social status, can suffer from depression or any other mental illness, said psychiatrists.

“There are educated people, especially those who have gone for studies abroad, who suffer from depression,” said Dr Nirolla. “They suddenly find that they are homesick and, after some time, start developing symptoms of depression.”

Tandin, 36, a civil servant, was on medication for depression even when he was abroad for his masters. “For five years, he took medicines for depression. But, when he returned, he started feeling that he had contracted a sexually transmitted infection (STI),” said Dr Nirolla.

Despites all tests being negative, Tandin was not convinced. “He had done a lot of reading and concluded that he was suffering from the infection. He thought that he was on the verge of dying and, in the process, had also passed the disease to his wife,” said Dr Nirolla. “He was paranoid.”

Tandin was referred to Vellore, India, and even there he refused to accept that he had a mental illness. “He was then sent to a psychiatric hospital there and, after a month and a half of treatment, his thinking changed,” said Dr Nirolla. “He’s back now and we’re still worried that he might have a relapse and start thinking that he has another disease.”

Besides depression, Tandin was also suffering from delusional disorder, a mental illness characterised by non-bizarre delusions, such as being followed, poisoned, infected, deceived by spouse or having a disease.

Mental illness is caused by multiple factors and not by one single cause, say psychiatrists. Genetics factors, physical changes in the brain and physiological changes in brain, due to chronic alcoholism, nutritional deficiencies and organ failure, can cause mental illness.

Environmental factors such as overcrowding, lack of recreational facilities and social support, exposure to extreme stressors like war, terrorism and man-made or natural disasters can also cause mental illness.

Childhood experiences like lack of parental care, love and guidance, social factors like poverty, unemployment, drug abuse, and chronic diseases like diabetes and cancer can also cause mental illness.

However, mental illnesses are treatable, even if they may not be curable, said Dr Nirolla.

Meanwhile, both Dema’s and Tandin’s health have improved. “She’s more cheerful and, if social factors improve, they may remain without symptoms for a long time,” said Dr Nirolla. “But the problem is that, sometimes, these problems are difficult to go away.”

Characters names have been withheld

10 Ways to preventmental illness -

Build confidence
Eat right, keep fit
Make time for family and friends
Give and accept support
Create a meaningful budget - Financial problems cause stress
Volunteer
Manage stress
Share your problem
Identify and deal with moods
Learn to be at peace with yourself
DoPH