27 | P a g e inaccurate assessment. Regardless of income levels, people who are depressed are often not correctly diagnosed, while those who do not have the disorder are too often misdiagnosed and prescribed antidepressants. This lack of definitive diagnosis of depression has been marked as a leading cause of disability worldwide and as a major contributor to the overall global burden of mental disease (WHO, 2018). Birhanu and Hassein (2016:28) assert that high rates of depression among university students, coupled with factors such as educational demands and social factors such as alcohol abuse, drug addiction, family problems, family history of depression, and staying away from home, impact students negatively. Both undergraduate and post-graduate students experience depression because high expectations of them keep on mounting on a daily basis.
28 | P a g e impact on the feelings, thoughts, and self-image of groups of people and individuals and impacts the process of diagnosing illnesses and treatment decisions (Aina & Morakinyo, 2010). Culture is also known to have an influence on different aspects of mental illness, which includes the way patients from a certain culture show and manifest their symptoms. People’s coping mechanism is often reliant on community support which also impacts their willingness to seek treatment (Rockville, 2001). Rockville (2001:5) argues that cultural and social influences “…are not only determinants of mental illness and patterns of service utilization for racial and ethnic minorities, but they do play an important role. Chang (2017:5) states that the recognition of cultures in studying depression contributes to: (a) gathering adequate demographics of depression, (b) recording the epidemiology of mental illness on cultures, (c) understanding new insights of the etiology of depression, (d) the expansion of knowledge through the expression or narratives of distress, and (e) patterns of diagnosis and related issues. Chang (Ibid) avers that culture is a critical variable to focus on in order to expand information around depression, which researchers should recognize. The researcher who utilizes a cultural lens will confirm that culture influences one’s beliefs and behaviour to the extent that cultural representations become part of one’s cultural self.
Mwelase (2019) cites Rosenberg (1998) who argues that, to understand human action, one needs to understand the rules according to which it arises, as these rules provide meaning through the lens of cultural perspectives. Therefore, to understand how people conceptualize mental illness, it is important to understand how a cultural context influences what people understand about mental illness (Mwelase, 2019). For example, Amaya et al. (2013) cite the incidence of Asian American students at St Olaf College who failed to discuss the topic of depression due to the language barrier and lack of understanding of what it is exactly. One participant commented, “How can a culture talk about it when there’s no direct definition, so how can it be a taboo? In order for something to be a taboo you have to define what it is”. This confirms the notion that some cultures have no specific word/s to describe depression.
The social constructivism view regarding mental illness centres around learning about the distinct ways in which people create their worlds in relation to others (Jones, 2016). Jones (2016: page) quotes Sampson (1993) who argues that “mental illness is a social construct that is formed through cultural and historical conversations between groups of individuals and not solely from deficits
29 | P a g e within individuals”. Thus stereotyping, stigma, and misconceptions about depression are part of such social constructions as they are words used to paint a picture of what depression is/is not thought to be. These words tend to be believed as meanings of depression. The use of the term
‘social construct’ in this thesis thus refers to how society views and creates their world around depression. It is also true that misuse of the word depression occurs in settings outside the classroom, but when engaged in formal discussions the majority of the student body seems to understand that this is a mental health issue (Amaya et al., 2013).
2.4.2 Misconceptions, stigma and stereotyping
There are many misconceptions about depression and thus students feel that having depression means that they are weak, bad, and that they will never succeed at college. Studies have shown that many people believe that depression is just feeling down or sad and that there is no major problem with that. Aldrich (2016) argues that there is an important aspect that people miss when it comes to understanding what depression is, such as using the word ‘depressed’ when meaning
‘feeling sad’. Knudson et al. (2008, n.p.) expressed this view some time earlier, stating that there had been a shift in the use of the term depression from a purely clinical sense to one that is synonymous with feeling sad. Being depressed has become more generally understood and accepted as a short-term feeling that is elicited by a stressful situation or a bad day, but the truth is that depression involves a constant state of hopelessness that spans a long period of time (Knudson et al., 2018). This is in line with the social constructivism view that states that people’s experiences of self are understood as being formed in the course of their interactions with the world around them.
Another misconception about depression is that only females get depressed. However, many studies have concluded that, in as much as it seems as if females are more susceptible to depression, it affects both genders. Singh et al. (2017) explored the prevalence of depression and anxiety among students at Punjab University, and they found that the prevalence of depression was higher in females because the male gendered role tended to emphasise greater levels of strength, independence, and risk-taking behaviour. Males thus often did not seek help or talk about their suicidal feelings and depression. In African cultures the ‘real men do not cry’ (indoda ayikhali)
30 | P a g e stereotypical notion is embraced and a man is thus not allowed to express his feelings. Men thus tend to suppress their emotions and they bottle up rather than speaking out. Some believe that this is the reason so many African men, and men of other gendered societies that favour the supremacy of males, turn to drug and alcohol abuse (Watson, 2020). It is for this reason, among others, that the suicide rate is higher for males than females in most countries across the globe.
In black African communities depression and its symptoms are blamed on witchcraft, and many have argued that this attitude towards mental health needs to change (Shoba, 2018: n.p.). However, people persist in seeking the help of tradition healers and some believe that if they pray the feeling of depression will go away because it has been caused by sinning or not being obedient to God.
Motau (2015) argues that religion and spirituality have supported many people dealing with depression, but it should not be the only source they turn to because depression is an illness that needs treatment. According to Sukati (2011:48), who focused on the relationship between religion and help-seeking behaviour among university students at UKZN, Pietermaritzburg campus, it was found that “…there was some relationship between the intensity of religious beliefs and help- seeking intentions” as students with greater religious commitment were more likely to rely on God for assistance or guidance than those who were less committed. If the former group needed help, they tended to approach an individual who shared their religious views, such as a pastor or another church member. It is thus thought that people with strongly held religious beliefs will use that belief to regulate their lives and also to provide direction in resolving their personal problems.
Very few such people thus tend to seek medical help for depression.
The above discussion of misconceptions, stigmas and stereotypes highlighted how people of specific societies tend to create their own meanings and views on what depression is and they devise their own ways of coping with their illness according to the way they understand their feelings and behaviour when depressed. Stigma is not associated exclusively with the topic of depression but also with how people choose to cope with it as an illness (Knudson et al., 2008).
The social constructivism theory considers how people’s experiences of self “…are understood as being formed in the course of their interaction with the world around them”. This explains the different understandings of what depression is and entails and has an impact on how people seek help and treatment. What is true and must be understood is that mental illness, particularly
31 | P a g e depression, “…is not a racially selective phenomenon and it is dangerous to dismiss an individual's pain because their race discredits their struggles” (citation). The same may of course be said of gender.