Depression in The Gambia: Understanding, Belief, and the Need for Change

There is a kind of suffering that does not leave a visible mark. It does not show up on scans or announce itself with a fever. It can be found in the energy required to simply get through a day, in the heaviness of mornings and in the silent withdrawal from the people around you. These are all symptoms of depression. In the Gambia, an estimated 110,000 people live with a depressive disorder, roughly 1 in every 20. That is not a distant statistic. That could be someone in your family, someone at your job, maybe someone reading this right now. As mental Health Awareness Month reminds us to have these conversations, it is vital to reflect on how depression is experienced, understood and frequently misinterpreted in The Gambia.

The face of depression shifts from person to person. Sometimes it looks like isolation. Sometimes it resembles frustration or short tempers. And sometimes it is mistaken for someone who just isn’t putting in enough effort. This is one of the main reasons it is often dismissed before it is even understood. Calling it sadness is an oversimplification. Depression runs deeper than mood. It can alter the way someone thinks, strain the relationships they rely on, and make even the smallest everyday tasks feel like an uphill battle.

A lot of the times, anxiety sits right besides depression. Where depression can feel like running on empty, anxiety can feel like your mind is refusing to give you a moment of peace. The worry, the racing thoughts, the sense that something is always about to go wrong. For some people these two experiences blur together in a way that is hard to untangle. You can feel completely flat and unmotivated while simultaneously being overwhelmed by fear about what comes next. What makes this particularly difficult is that each one can make the other worse.

Yet even with all of this, depression is still not widely recognised as a real health issue in Gambian society. One of the more telling patterns is how much the explanations people have about depression end up determining how they handle it. Through various conversations and shared accounts, it becomes clear that mental health difficulties are often made sense of through spiritual beliefs, environmental conditions, or personal hardships like poverty and frustrated ambitions. This, consequently, shapes whether someone reaches out for help and where they turn when they do. If they believe it is simply a result of their situation, they may feel that treatment is unnecessary and that only a change in circumstances will help.

Culture is where this conversation gets harder to navigate. In many Gambian communities, especially those in rural areas, mental health is often understood through spiritual terms. For many people, depression is not a medical condition but a spiritual one, rooted in bad winds, evil spirits or forces beyond the physical. When the illness is seen as spiritual in nature, the response is spiritual in kind, and for a great number of people, traditional healers represent the most trusted and familiar form of care available. While biomedical approaches may offer different explanations and treatment pathways, beliefs that are deeply rooted in culture are not easily shifted. However, what is notable is that there have been genuine attempts to work alongside these systems rather than against them. The National Mental Health Programme has taken steps to train traditional healers in recognising mental health conditions, and in certain cases to support treatment through medication. By 2020, a number of these healers had been formally certified to operate in collaboration with the Ministry of Health. This effort suggests an attempt to meet communities where they are, while slowly introducing a more integrated understanding of mental health. Nevertheless, these long-held beliefs make it more challenging to recognise depression in a way that promotes open conversation because attributing depression to something solely spiritual reinforces the taboo of the subject overall.

How depression is perceived in the Gambia also depends on who is experiencing it. There seems to be an unspoken idea that some people have more of a right to struggle than others. Older people dealing with illness or loss tend to receive more understanding, while younger people are often told they are overreacting or being overly sensitive. The reality is that depression does not sort itself by age or circumstance. It is not something you grow into or earn through a certain kind of suffering. A student drowning in expectations or a parent worn down by financial pressure could all be struggling, just in different ways. So, the question worth asking is, if many people from different age groups could potentially face depression, why does it still feel invisible?

Part of the answer lies in stigma. Gambian society places a high value on resilience, on pushing through hardship without making too much noise about it. In some ways it can be admirable, but it also sets a standard that leaves little room for vulnerability. When being strong is the expectation, admitting that you are struggling can feel like a personal failure. Telling someone to be strong or reminding them that others have it worse might come from a good place, but for someone already barely holding it together, those words can feel like a door closing. Consequently, overtime, people learn to keep it to themselves and wonder whether what they are going through even counts.

Furthermore, in a country where religion, mainly Islam, shapes so much of its daily life, there is a deeply held belief that hardship comes from God and that patience and prayer are the right responses to it. This perspective brings genuine comfort to a lot of people and that should not be dismissed. However, it can also create a resistance to seeking professional help, because doing so can feel like questioning God’s plan rather than trusting it. For many, leaving things in the hands of God is not avoidance, it is faith. In result, people continue to endure their pain in silence and lean only on their faith whilst the weight of what they are going through doubles.

So where does that leave us? The reality is that professional help is not easily accessible for most people in the Gambia. However, organisations like WAYAS Counselling and Peace of Mind Gambia are making real strides in providing that kind of support locally and it is a step forward for anyone who can access them. With that being said, it still remains out of reach for many due to limited financial resources but that does not mean there is nothing to be done. It means that the responsibility shifts towards each other for now. That might mean choosing to check in on someone properly rather than in passing. It can be listening without jumping in to explain away what they are feeling. It might mean being honest about your own struggles so that someone else feels less alone in theirs. None of this replaces professional care, but in a place where that care is still hard to come by, community might be the closest thing to it. Depression is usually quiet by nature, but it thrives in silence. The more we are willing to talk, to

ask and to actually hear each other, the less room it has to grow.

References

Kretzschmar, I., Nyan, O., Mendy, A. M., & Janneh, B. (2012). Mental health in the Republic of The Gambia. International Psychiatry, 9(2), 38–40. https://pmc.ncbi.nlm.nih.gov/articles/PMC4442066/

Jallow, A., et al. (2022). Barriers to accessing mental health services in The Gambia: patients'/family members' perspectives. BJPsych International. https://pmc.ncbi.nlm.nih.gov/articles/PMC9046828/