Ourselves
Anxiety and depression are very common symptoms of mental illness, which are often not addressed early enough. As nurses we are mostly women living and working in a society that is inherently dominated by men and also by a male biomedical world. In many ways our world does not respect the innate feminine or women's wisdom that many of us contribute to our families, communities and workplaces. This leaves some of us on the back foot in having to assert ourselves.
At the same time we are subjected to bearing the burden of work within families and communities, of caring for and supporting households. l am ,sure we have all felt anxious at some stage during the past month when thinking through our salaries monthly expenses, wondering how we are going to, balance these. The cold winter months see us negotiating the heating of our homes, feeding our families - who want extra usually yummy but expensive calories given the cold - dealing with piles of washing and having family illnesses with the season's colds and flu to cOntend with.
These are all stressors that take up our inner resources and engagement with the world. The challenge is how to deal with them, how to manage these issues which can lead to us feeling down and lethargic. Add to this the additional stress of violence that is so pervasive in our communities, and we really are a living recipe for challenges regarding mental, health.
As healthcare providers we are well aware of the insidious nature of violence against women and that emotional abuse - shouting and arguing -is not as visible as the physical bruises of a black eye, but equally and perhaps even more devastating.
So the challenge is to try and manage these issues. Here are a few pointers:
- We know that exercise is a good method to helping us increase. our blood endorphin levels and it gives us a detached space to address some of the stressors. Can yOu commit to doing three or four 3o-minute slots of exercise a week?
- Do yOu have someone yOu call talk to and share your challenges with? Nurses are some of the most impossibly self-reliant people on the planet. Can you ask for help?
- Are you experiencing abuse? What would it take for you to ask for help? As a nurse you know the help lines and NGOs who assist in this area. Can you take a step and ask for help for yourself?
- If you can't manage financially, have you spoken to your bank? It is much better- to deal with financial issues earlier than lateler. Banks can assist with budget planning and with helping you plan your credit payments. They might even be able to rearrange your interest rate and loan periods,
- Are you eating well? Are you over-eating or under-eating? Are yOu drinking more than you should be? As nurses we know what we should be eating/drinking and what would constitute bingeing. Bingeing or under-eating habits are often an indicator of how we are doing. If you are not managing, find help. The Anonymous Fellowships for eating and drinking challenges would be a good place to start.
- Are you wOrried about your HIV status? Have you been tested? Do you know what your access is to treatment? Are you able to ask for help? Do you know Who your DENOSA HIV peer suppoters are?
The reality is that we all experience these stresssors that make us feel anxious and depressed or down. The key is to try and mitigate and deal with these early. We owe it to ourselves to care for ourselves.
Our clients
I am going to refer to some interesting research that has recently been released into the public domain.
The HSRC publicised work by Professor Melvin Freeman on the Af-Aids list (10 June 2008) noted that there are no specific mental health services for people living with HIV. The study found that some 44 percent of 900 HIV-positive individuals suffer from a mental illness. Mental illness, according to Freeman, can be a risk factor for HIV. Some illnesses lead to greater promiscuity others can make sufferers more vulnerable to sexual abuse and exploitation.
Even depression can increase an individual's risk. If you don't feel that there's much point in your own survival, you won't see the point in taking precautions to protect yourself. He suggests that conversely people with HIV illness are more likely to develop mental illness than the general population. The effects that HIV and Aids can have on an individual's mental health range from depression and anxiety that may accompany an HIV-positive diagnosis or the death of loved ones to the dementia and psychosis that can occur when the disease becomes advanced and affects the brain.
Dr Rene Brandt, Skye Foundation post-doctoral research fellow and clinical psychologist at the Aids and Society Research Unit, University of Cape Town, completed her PhD on the impact of HIV/Aids on the psychological adjustment of South African mothers in the era of HAART Her key findings were:
- HIV-infected women living in pOVerty exhibited higher levels of psychological distress than non-infected women in tile same community. Just less than one in three of all H1V-infected wOmen reported levels of depressive symptoms consistent with probable depression. This figure was nearly one in four among women not mceiving antiretroviral therapy.
- Longer-term use of antiretroviral therapy was associated with loweler levels of depression in HIV-infected women, although their mental health was still poorer than non-infected women in the same community.
- HIV-infected women who perceived their health as poor, used avoidance to cope with their positive status (denial, selfblame and giving up efforts to cope), and liVing in a household with an irregular income were mom likely to be depressed.
- Living in a household without a stable, predictable income was as distressing to women as being HIV-infected.
- The realities of being poor were a strong theme in women's own accounts of their lives, suggesting that being HIV-positive was about being poor and HIV-positive for these women.
There are efforts to integrate mental health services into mainstream services and to ensure that those with mental health challenges are not being marginalised and excluded from treatment. It is also important to note the particular vulnerability women experience and how poverty exacerbates one's experience of depression. Let's not forget to honour and respect ourselves this month of July. |
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