Eastern Africa: Sadness, Songs and Stomach Pain

Depression in Eastern Africa?

Does depression exist in Eastern Africa? Short answer. Yes. Although, If you have come to make sense of depression through a Western European lens, you might find some interesting differences in the way that depression is thought about in this region.

First, a bit about me:

I’m a Clinical Psychologist based in London (England). Living and working in this city means that I rub shoulders and treat people from all kinds of backgrounds. The variety of ways that humans have thought about the mind has always fascinated me, and I want to learn more. How might societies across the world conceive of depression? Is anxiety understood in Uganda as it is in Ukraine? What wisdom might we glean from cultures across the world that could change our lives for the better? Let’s see what we find.

Disclaimer: A key pillar of this project will be to elevate the perspective of the culture and nation being discussed. Whilst well known perspectives on mental health come from particular regions (predominantly the Western nations) this project will not treat those perspectives as being the standard, or ‘true’ understanding. This newsletter takes the position that perspectives from all nations are equally valuable. Where relevant, perspectives will be evaluated based on their quality and on existing research. However, I commit to making every effort to elevate all perspectives and be challenged in my own understanding of the mind. A more detailed disclaimer on this topic is on its way!

What is depression?

Firstly, the guidelines to diagnose someone with depression in Europe and US are outlined in two diagnostic manuals. The latest versions of these manuals are called the DSM-5 and the ICD-11.

ICD-11 outlines depression as “a persistent sadness or low mood and/or loss of interests or pleasure; fatigue or low energy”. Along with this outline, the ICD-11 states there should also be the presence of a few associated symptoms, including: sleep disturbance and changes in appetite, amongst others. In addition, the DSM-V notes that this can present as irritability in children and adolescents.

There are also exceptions. In that, someone may be experiencing these symptoms, but ought not be given a diagnosis of depression. For examples, where the symptoms experienced are the result of the physical impacts of substance misuse, or if they are observed after experiencing a bereavement, then the person should not be diagnosed with depression.

That’s a brief overview of how things are done in Europe and the US. Does this differ from the way depression is described in other nations?

Descriptions of depression in the Eastern nations of Africa

Highlighted today are concepts, similar to depression, that were described by participants from the following nations: Burundi, Rwanda, Uganda and South Sudan.

NB: At a later point, I will dig deeper into insights from individual nations and communities within those nations. We’re starting with the region for now, just to get our feet wet!

Burundi & Rwanda

Ibonge. The experience of ibonge, is one where a person is dwelling on their experience of loss, experiencing longstanding sadness and ‘not allowing themselves to experience pleasure’. 

Associated symptoms include: disturbed sleep and suicidal thoughts.

People experiencing this may sing ‘gucurintimba’, songs expressing regret and sorrow about their mistakes they have made and the losses in their lives.

Other terms highlighted in this region are ‘agahinda’ or ‘intuntu’. These are thought of as conditions of ‘deep sadness’.

Uganda

South Sudan: 

‘Nger yec’ which translates to ‘cramped stomach’, refers to those experiencing longstanding sadness.

Associated symptoms include: poor appetite, inactivity, suicidal thoughts, disturbed sleep, diarrhoea, social isolation, excessive guilt. Below is a quote taken from a research participant describing nger yec in an interview.

Summary

Commonly, healthcare professionals experience patients who approach them complaining of headaches and stomach pain. Then after further investigation, it is later discovered that the patient’s is struggling with depression or anxiety, which in turn is causing bodily damage.

Researchers and health professionals are increasingly understanding that our emotional experiences are connected to our bodily experiences. And that the reverse may also be true - our bodily experiences are also connected to our emotional experiences. It appears that in some regions of the world, this understanding doesn’t only sit with professionals, but knowledge that their wider society has come to understand.

Take away

This is a reminder for all of us to pay closer attention to our bodies.

What is your body telling you? It’s probably giving you great insights into your mental state.

Depression (as those in the West might call it) is just as much an ailment of the body, as it is an ailment of the mind (!).

Get in touch

This is an ongoing project of discovery, so if you have any burning questions, ideas for how this newsletter could be better, or want to partner with me - get in touch. My inbox is open.

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There are big plans for this project, so please stay tuned.
Catch you in the next one.’