Ouch! I'm depressed!

You're tired, your head aches and your tummy just doesn't feel right, but the doctor can't give you a diagnosis. What's wrong? IZELLE THEUNISSEN reports.

Headaches, tiredness, abdominal complaints and muscle aches are some of the most common physical symptoms health care workers in primary health care encounter. But often, the physical examination of the patient and medical tests turn out to be perfectly 'normal' and the doctor or health professional can't find a medical explanation for the complaints.

Dr Jacqueline Muller of the Mental Health Information Centre of South Africa (MHIC) calls these unexplained aches and pains somatoform symptoms. She says they may be transient at first, but can become more enduring and have an unpleasant impact on a person's day-to-day life.

To mental health experts it has become clear that these somatoform symptoms are important symptoms of depression and anxiety. 'For many years psychological symptoms have been the mainstay in the diagnosis of depression and anxiety. For instance, a depressed mood, lack of pleasure in life, guilt feelings, low energy, thoughts of death and sleep or appetite changes were seen as the most important symptoms when diagnosing depression,' Dr Muller says.

'Yet research has shown that almost three out of every four people with depression will present to their primary care professional with only physical symptoms. This emphasizes that primary health care professionals should be aware of the overlap between mental and physical health, else a treatable condition may result in many unnecessary tests or referrals to specialists - with no symptom relief for the patient.'

The reason for this is interesting: some of the same neuro-chemicals and hormones that play a role in stress are also implicated in depression and anxiety. For example, when a person perceives danger, this message is relayed to the brain, and the body changes so that it can adapt to survive the threat.

Various brain areas, neuro-chemicals (e.g. noradrenaline and serotonin) and hormones (e.g. the 'stress hormone' cortisol) are involved in relaying the message via the spinal cord so that the body can prepare to react. The heart starts beating faster, breathing is more rapid, blood flows to the muscles, wound healing is increased, the pain threshold may decrease and basic needs such as eat­ing or sleeping become less important.

'With prolonged stress, however, these changes become damaging to the body, and symptoms such as tiredness, headaches, muscular and back pain, insomnia, indigestion as well as poor at­tention and concentration may emerge.

Chronic stress may also be linked with cardio- vascular disease (e.g. hypertension), diabetes, cancer and various other medical illnesses,' Dr Muller says.

'Although we still have to learn a lot about the complex effects of mental health on physical well-being, and the psychological effects of chronic illness, the inseperable relationship between the body and mind is undeniable.'

Mind vs. body?
Why do we think about our mental and physical health as being two separate things?

The 17th century philosopher René Descartes conceptualised the distinction between the mind and the body, viewing the mind as being completely separate from the body.

But, for almost two centuries, mental health advocates have been trying to put them back together.

'This separation between so-called "mental" and "physical" health has no real relevance to the scientific understanding of health in the 21st century, yet the myths and misinformation persist," says Dr Patt Franciosi, president of the World Federation of Mental Health.

'The time has come to reinforce what we stand for: mind and body are inseparable. Health is a complete state of well-being; there is no health without mental health.'

Ms Charmaine Hugo, director of the Mental Health Information Centre, says it's time for mental health care to be mainstreamed, and for the stigma and discrimination attached to people with mental illness to end.

'There is no excuse for reducing funding for the delivery of mental health services.

'It is vital that the prevention of mental illness and the promotion of mental health receive their fair share of public health resources,' she says.

Mental Health Media awards
The Mental Health Information Centre (MHIC) recently announced the winners of their National Mental Health Media Awards.

'With these awards we recognize the crucial role of the media in raising public awareness about mental health and illness. Relevant, accurate and indepth reporting is an invaluable means of dispelling many myths regarding mental illness,' says Ms Charmaine Hugo, director of the MHIC.

'This helps by reducing the stigma associated with mental illness and helping many people to recognize when they may require professional help. Also, the awards makes people aware that the necessary help is available to them in South Africa.'

The glittering event continued a tradition that started in 1998. Mr Conrad Sidego (Senior General Manager: Corporate Affairs of the Media24 company) was the guest speaker. In his address he pleaded for greater acceptance and empathy with people suffering from mental illness.

'As disturbing as the statistics of mental illness is the derogatory manner in which people with psychiatric disabilities are referred to: "crazy", "malletjies", etc. These have become words of abuse, words that hurt, words that stigmatise. Who are we, who think of ourselves as 'normal', to call anyone crazy? Mental illness can strike anyone. It knows no limits. People with mental illness need our compassion and acceptance, not our hostility, discrimination and stigma,' he said.

He singled out ignorance as the major contributing factor to stigma, and emphasised the vital role of the media. 'We have the choice of whether to go for "healthy headlines", and thus help to eliminate stigma, or "horror headlines", which contribute to stigma,' he said.

This year's media awards went to:

• Category Newspaper: Llewellyn Kriel (Mail & Guardian)
• Category Magazine: Laura du Preez (Personal Finance)
• Category TV/ Radio/ Internet: Ilse Pauw (Health24)
• Overall Winner of the 2004 National Mental Health Media Award for exceptional reporting on mental health matters in the popular media: Ilse Pauw (Health24).

	The overall winner of the 2004 National Mental Health Media Award, Ilse Pauw of Health24 (left), received a special quilt made by women attending the Rape Crisis centre support group in Cape Town. With her is Chantel Cooper, a director of Rape Crisis.
	Charmaine Hugo (left), director of the Mental Health Information Centre, and Conrad Sidego, Senior General Manager: Corporate Affairs of Media24.