Mental illness: Experts explain why it’s not all in your head

A recent study showed that a quarter of South Africans are probably depressed. File image.

A recent study showed that a quarter of South Africans are probably depressed. File image.

Published Jul 27, 2023


Johannesburg - The World Health Organisation (WHO) defines health as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity”.

It states that “there is no health without mental health”. This is an apt reminder of the importance of mental well-being, in conjunction with physical well-being, and how these should be prioritised.

A recent study showed that a quarter of South Africans are probably depressed, with almost a third of the population having experienced a common mental illness in their lifetime.

Studies revealed that at the height of the Covid-19 pandemic, mental health disorders increased from a base of 193 million people worldwide to 246 million. In South Africa, the rate of distressed or struggling individuals increased by 8%, from 8.5% in 2020 to 36% in 2022. Although conversations around mental health are being held, the stigma attached to mental health still exists.

There are multiple links between mental health and chronic physical illnesses that significantly impact people’s quality of life, yet the stigma attached to mental illness is such that many are too ashamed to get the help they need.

CEO of the Innovative Pharmaceutical Association of South Africa, Bada Pharasi, said in South Africa, the escalating prevalence of chronic illness and its high co-morbidity with mental disorders revealed a need for integrating mental health more comprehensively into chronic care in the country’s health-care system.

“The treatment gap in South Africa is also high, with only one in four people with a common mental illness receiving treatment of any kind. Underprivileged South Africans are worse off, due to the lack of capacity, accessibility and resources in the public health sector,” said Pharasi.

He added that metabolic hormones such as insulin, cortisol, leptin and others, have been found to impact a wide range of mental health problems, from ADHD and depression to anxiety, addiction and eating disorders. Research shows that the interaction goes both ways. Metabolic problems such as diabetes, hypertension or even prolonged periods of poor nutrition can cause stress-induced changes to the brain that lead to mood and neurodevelopmental disorders.

“Similarly, certain mental health disorders can cause stress that triggers metabolic changes that, over time, can develop into those same metabolic diseases. Research shows that people with a mental health problem are more likely to have preventable physical health conditions,” he said.

Mental health disorders come with physical symptoms. Depression can present as a feeling of acute sadness, tearfulness and hopelessness, or anxiety and irritability, leading to angry outbursts; a loss of interest in most activities; insomnia or sleeping too much; having a lack of energy to tackle even the smallest tasks; weight loss or gain; feeling anxious; experiencing slow thinking, speaking or moving; having trouble concentrating and remembering; experiencing memory loss; and having suicidal thoughts. Anxiety can result in stomach disturbances, feeling weak or dizzy, having headaches or other body pains, breathing more rapidly or with difficulty, experiencing hot flushes, grinding teeth at night, having panic attacks, finding it difficult to manage daily tasks, and more.

“Anxiety is also problematic for the heart. Research shows that living with ongoing and untreated anxiety makes a person more likely to develop heart disease, including tachycardia (rapid heart rate), increased blood pressure, and an increased risk of heart attack. While symptoms of a panic attack can mimic those of a heart attack, anxiety can actually increase one’s chances of having heart problems or a stroke,” Pharasi added.

He said almost everyone experiences some degree of anxiety or depression during their lives. People sometimes feel lonely, sad or disinterested when faced with difficult, life-changing events. In the appropriate circumstances, anxiety is actually a fight-or-flight response that helps people handle a potentially dangerous or stressful situation with extra care. However, when these feelings get out of control, the impact on people’s lives is significant and they need to be assessed and treated.

“When a person begins experiencing these symptoms, there are things they can do to help themselves. The physical and mental health benefits of regular exercise cannot be overestimated. All exercise can boost one’s mood by lowering levels of stress hormones, increasing the production of feel-good chemicals known as endorphins, and bringing more oxygenated blood to the brain. Exercise improves muscle mass and function as well as metabolic function, reduces inflammation, strengthens the immune system, improves cardiovascular and respiratory health, and even contributes to creating healthy gut bacteria,” he said.

July is the South African Depression and Anxiety Group’s Mental Health Awareness month. Sadag educates and provides support for people suffering with mental illnesses of all kinds. This month, the organisation will be unpacking the complexities of anxiety and sharing helpful coping strategies, information and resources. Visit for more information.