Life in Lebanon means regularly dealing with the unexpected, and often the unpleasant. From the civil war in 1975 and moving to the consistent bouts of armed conflict that strike the country every now and then, the Lebanese have become accustomed to living with the unacceptable. Less dramatic, though also stress-inducing, are how simple acts such as trying to turn on the lights, taking a shower or even driving your car to work can have uncertain outcomes in this country. With all this stress surrounding us on a daily basis, one has to wonder: are the Lebanese still sane? What do the experts, and the numbers, have to say about the mental health of the Lebanese population?
Between 2002 and 2003, the Institute for Development, Research, Advocacy and Applied Care (IDRAAC) embarked on the first nationwide survey on mental disorders in Lebanon (the Lebanese Evaluation of the Burden of Ailments and Needs Of the Nation – ‘LEBANON’). The sample — 2,857 people over eighteen years old selected from the five different regions in the country — was subjected to extensive one-to-one household interviews based on the World Mental Health Composite International Diagnostic Interview. The participants were also asked about their level of exposure to the civil war.
Results showed the majority of mental disorders prevalent in Lebanon fall under the broad category of anxiety disorders, such as post-traumatic stress disorder (PTSD) and generalized anxiety disorder, and are followed by mood disorders such as chronic depression and bipolar disorder. According to the survey, 25.8 percent had at least one mental disorder, a percentage similar to that in Western Europe.
The survey’s findings are in line with the figures from the Lebanese Syndicate of Pharmacies, which show the largest number of mental health medications sold in 2011 were tranquilizers, or anti-anxiety pills, of which just under one million were bought. This was followed by 642,000 boxes of antidepressants sold last year. According to a representative from the syndicate, these numbers are expected to rise by 15 percent this year.
‘There’s a pill for that’
Doctor Antoine Harb, head of the Ministry of Public Health’s chronic medication distribution center in Karantina, explains that, in the area of mental health, the ministry provides medication for chronic or manic depression and for psychotic disorders, such as schizophrenia. Anti-anxiety medications are not covered by the ministry due to the high prevalence of such disorders, and also because they are cheap and easily available. “Approximately 22 percent of the patients who visit the center come for psychiatric medication. In fact, the majority of patients seeking medication from us are either cancer patients or mental health ones,” says Harb. He adds that since the year 2005, they have been seeing a yearly increase of around 15 percent in mental health patients seeking medication.
“The most prevalent mental health issue we have witnessed in the areas we have previously served, and are serving in Lebanon, is chronic depression. This is actually a global problem and the proof is that the theme for this year’s Mental Health Day revolves around it,” says Hala Yahfoufi, the psychologist advisor for Médecins Sans Frontières (MSF), a nonprofit organization providing, among other services, free mental health awareness and treatment in underserved communities around the world.
The Society psyche
In trying to explain the causes of these mental health problems, doctors interviewed agreed that susceptibility to mental disorders is equally due to the person’s genetic makeup and to his or her innate level of resiliency. “Two brothers, raised in the same manner and exposed to the same environment, can have different psychological responses to the same triggers,” explains Yahfoufi. She is reluctant to attribute Lebanon’s mental health problems solely to the war, saying that there are other every day triggers we are struggling with which also account for these problems. According to her, one of the main triggers for mental health issues in Lebanon, though not necessarily ones leading to psychiatric visits, is repression brought on by societal pressures and traditions.
Harb says that they see a lot of PTSD in the center, and that this is caused by exposure to war traumas. The LEBANON study revealed that almost half the sample interviewed was exposed to war-related events, such as being a civilian in a war zone or being a refugee. According to the study, this exposure increases the risk of developing a mental disorder for the first time.
Doctor Elias Karam, psychiatrist and member of IDRAAC, explains that globally and in Lebanon, it is the younger generation which is suffering more from mental illnesses, which cannot be attributed to the civil war as those most exposed to it are adults by now. Referring to IDRAAC’s studies, Karam attributes the prevalence of mental health problems in youth to various conjectural factors, including different and faster paced lifestyles than their predecessors that include more competition and less social cohesiveness. “With the advances in technology, and the extreme mobility taking place all over, the youth have lost access to a real and comforting social network, and this causes feelings of stress and loneliness,” says Karam.
Though mental health problems are prevalent in Lebanon, only 10 percent of those with moderate to severe mental illnesses are treated, according to Karam. “This may be due to a lack of knowledge on the patient’s part, or because they don’t realize they have an illness and think they can overcome their emotions by themselves,” explains Karam. In contrast to chronic depression, according to Karam, 50 percent of those who suffer from panic disorders do receive some sort of treatment — though maybe not from a trained mental health professional — and this is because symptoms of such disorders are physical and difficult to ignore. If there are no physical symptoms, however, mental disorders seem to be considered part of daily life.
Improving Mental awareness
This is an issue that MSF is earnestly working at through raising awareness about mental disorders in Lebanon. “After three years of working in the Burj Al Brajneh refugee community, people were more comfortable with visiting psychologists and would voluntarily seek sessions with our mental health professionals. This was achieved through a strong awareness campaign which even targeted people’s homes,” says Yahfoufi, who says she hopes to achieve the same level of awareness in Tripoli through the work they are currently doing with the government hospital there.
Though the National Social Security Fund does cover psychiatric medications, only three or four private insurances cover such medications at the moment, according to Karam. Yahfoufi believes that while it is easier for public hospitals to consider taking psychiatrists, physicians that specialize in mental health, on board as part of their medical team, psychologists are still not as readily accepted in public hospitals. Given the pervasiveness of mental health problems in the country, and the ongoing stress we are subjected to on a daily basis, we look forward to the day when mental health intervention and awareness are taken more seriously.