Depression in Maldives: Part One

This feature takes a deep dive into depression in Maldives, with this article covering topics such as what depression is, what causes episodic states of depression, awareness and understanding mental health issues, capacity and training, therapists in the field, quality care over speed and what an individual can do despite the barriers.

This feature will be covered in two articles, with this one being the first.

Aaiz Ahmed Rasheed, a trained and experienced Maldivian psychologist was interviewed for this article in order to get the clearest picture of depression in Maldives, with a focus on Male’ and touching on the Maldives as a whole. The following is his account on the topic.

Aaiz has a Bachelors (Hon) degree in Psychology and a Master of Science degree in Psychology (Clinical). He has a given title of Licensed Psychologist by the Allied Health Council and is the Chief Psychologist at Therapy Center Maldives. He has clinically practiced for 10 years, with seven of said years in Maldives and three outside of Maldives.

As per Aaiz, depression is a complicated concept where there is a state of being depressed, feeling down, hopeless, helpless, etc and it is also a category of mental illness itself.

It can be considered as a deeply rooted part of the human condition, where everyone goes through depression. When people go through depressive episodes beyond a certain period of time and are beyond a certain intensity which can be considered far from normal, that is when depressive disorders occur.

Aaiz stated that in Maldives, when you take into consideration most societal conditions and the history of the social structure of Maldives, it is made to create depressive states which can continue for prolonged periods, and become complex mental illnesses such as personality disorders, persistent depression, etc, all these long term illnesses.

From a clinical standpoint, Aaiz said that depression can manifest for a period of two weeks to a month. Situations where people remain in a depressive state for longer periods of time is another condition.

This distinction is important due to the fact that depression can be overdiagnosed in Maldives as a condition. By doing that, it reduces the experts’ chances of being able to look at the more complex pictures on an individualistic level.

Aaiz said that for example, when looking at personality disorders, issues that affect the internal system of being a person as a whole may affect their relationships, work, etc. However, if only looked at from a surface level perspective, it can ultimately be seen as depression. If your relationships, work-life, friendships, basically everything is messy, a person would become depressed but that does not mean depression is the root cause.

From a medical model, especially when psychiatrists conduct 15 to 20 minute consultations and go with a depression diagnosis, it becomes overdiagnosed. This leads to limiting experts’ chances of taking a proper look at the individual and figuring out the deeper issues that are causing them distress and that is making them go through a state of depression, said Aaiz.

This is one of the bigger problems when it comes to treating depression in Maldivian society, as was stated by Aaiz.

Aaiz said that typically all the things that people talk about, be it in a social setting or clinical setting, are the things experts see, when it comes to depression.

The housing crisis is one of the top causes of depression in various ways, as per Aaiz.

Firstly, when taking into consideration a psychological theory such as Maslow’s Hierarchy of Needs, the needs that are the foundational levels need to be fulfilled before moving up the hierarchy.

Maslow’s Hierarchy of Needs is a motivational theory that describes a person’s wants and needs in a five-tier pyramid format, with the bottom tiers being the most foundational and basic needs. The needs as you move higher up the hierarchy are the more creative and intellectual needs.

From the base of hierarchical needs to the top, this is what the Maslow’s Hierarchy of Needs describes:

So, Aaiz said that people need to fulfill their base needs before they can move on to higher order needs. Physiological needs have to be fulfilled in order to move up to safety needs, and safety needs need to be fulfilled in order to move up to love and belonging, so on and so forth.

Aaiz went on to say that when physical safety such as having a roof over someone’s head is threatened or is a constant worry, the higher order of needs and well-being are inaccessible. In the absence of well-being, people tend to go toward illness.

In terms of the housing crisis, people also need to have a place to rest, a place to call their own, and along with other places, a reflective space where you can sit down and really think about your life and everything that surrounds it, in Aaiz’s professional opinion.

However, the question that follows is where can people do reflective thinking where it’s not available for them. A lack of such a place can worsen a person’s mental state.

As an example, Aaiz took into consideration the causes of depression or mental illness in general. At its root, if it is being said that improper parenting, trauma and abuse can lead to prolonged depressive states in people, all of those things can be partially caused by the housing crises.

As per Aaiz, it can be said that improper parenting can lead to a depressive state, but then the question arises as to where the spaces for proper parenting are.

While people who are about to become parents may have some great ideas on how to set boundaries, how to properly socialize, what kind of values should be taught, etc, there is a heavy lack of mental and physical space in order to do that. There is a lack of space for their kids to safely explore and develop their own identity without parents being worried and being restrictive when people are living in small, confined spaces, as was said by Aaiz.

Along with that, the chances of traumatic situations goes up when the amount of people living in such confined spaces increases, with the risk of children being exposed to abuse increasing as well. This also increases the chances of people coming into contact with unsafe individuals. Ultimately, these are ways in which the housing crisis can be rooted in depression in Maldives, said Aaiz.

Aaiz stated that in the mental health clinic space, there’s a lot of talk now about how around 50 to 70 percent of the client base consists of children who are 18 years and below. This is a general estimate as there aren’t a lot of proper statistics in most clinics as of yet.

So Aaiz posed the question: Why are more children getting depressed? What is being done differently that is affecting children to such an extent?

Aaiz answered by saying that children are supposed to have open spaces to play, the avenue to discover their own mental well-being, health, etc. But it does not exist. When children spend their growing years forced into screen culture in small spaces where they spend their time scrolling on the couch, it can cause depression, stated Aaiz.

Going out into the cramped streets is also a stressor which is why anxiety (a feeling of unease, nervousness or worry over an uncertain outcome or outcomes) and depression tend to go hand in hand. A person will not feel at ease when they are walking down such chaotic and stressful streets, said Aaiz.

When someone does not experience that ease, it becomes harder to feel and experience joy, and also for people to connect to the nature that surrounds them as well, which is also an issue due to the streets of Male’ not having that much vegetation to begin with. This would also lead to further depression, as per Aaiz.

Aaiz stated that when taking a look at people who are older than 18 years of age, there is hardly any space for recreation, space to freely roam and do activities with ease, etc. This becomes a constant loop of going to work and coming back home where recreational activities tend to be at a minimum. This loop tends to go on until people take their annual leave, most of whom travel out of the country at best, which speaks to people’s inner desire to fill that recreational void.

Aaiz went on to say that when looking at human beings, everyone has a part of their personality known as the child personality that craves pleasure, enjoyment, etc. This part keeps getting delayed until people take annual leave, which limits the amount of pleasure people experience. If pleasure and enjoyment is at a constant low point, it can also lead to depression.

Aaiz continued by stating that these are the material social factors that lend themselves to depression. When looking at society through a wider lens, there is no physical and social safety (in reference to Maslow’s Hierarchy of Needs earlier). When various social issues such as financial, economic, relationships, climate change, etc, challenge people constantly, it creates an air of unease and feeling unsafe. When realistic stressors keep presenting themselves, the mind slips into a state where it becomes harder to deal with depression, said Aaiz.

Aaiz stated that even environmental problems such as worsening climate change in Maldives can have an adverse effect on one's mental state, leading to a depressive state of being. The physical structure of the spaces we have and social structure of the society is at a point where a person’s mental state would be prone to depression, stated Aaiz.

Aaiz went on to say that depression does not exist in a biological vacuum, which leads back to his differentiation of what depression really is at the beginning of this article. While explaining what a biological vacuum is, he stated that depression is both a state of being and a mental illness as well.

It is normal for people to get depressed, due to the neurochemicals in the brain, continued Aaiz. Neurochemicals fluctuate, which explains why people have good days and bad days. As neurochemicals have such fluctuations, it is also sensitive to bodily changes regarding health. When chronic illness itself rises, then chronic mental illness also rises with it, stated Aaiz regarding a biological vacuum.

He went on to use women as an example with those who have PCOS or other related illnesses. When it comes to PCOS, a big chunk of it is the emotional effect that comes with it, not just the physical. There is an emotional effect that comes with the fluctuating hormones and pain that presents with PCOS and so if there is someone who is regularly untreated, or if there is someone who is on treatment with for example being only birth control, it brings about further hormonal changes that brings about a chemical imbalance. This adds on to the issue of depression being posed onto someone.

And that is just one illness, says Aaiz. For an equatorial country, a lot of people aren’t exposed to sunlight, which can cause vitamin D deficiency. Chronic pain disorders such as arthritis and scoliosis would cause physical issues as well.

He went on to say that pain and pleasure are in a continuum, where if pain increases then pleasure decreases and vice versa. So if there is an increase of people who experience chronic pain, there will be a decrease in people who experience pleasure, which is also another big factor in increased rates of depression.