Essay: Let’s Go Beyond the Blues by Dr Suhas Chandran
The antonym of depression is more realistically a sense of normalcy rather than elation or happiness, but the bridge is most definitively enablement.
When I was in medical school I had a fall and I broke my arm. I missed an important exam and had to wear a fracture cast for a long duration. When I returned to college, people rushed to me – friends, acquaintances, and even strangers who saw the cast. It was a symbol of pain and disability. People offered to write notes, carry my bag, drop me home and pick me up. People came up to write messages on the cast. Some would write a positive greeting, some an uplifting quote; there were a few jokes, a batman cartoon in between. There was a lot of warmth, but what I remember most fondly is the transformation in these individuals. Ordinary people like you and me with everyday problems pushing so hard so to make a difference. They were a team – doctors, family, friends and strangers. They identified with that simple image of a cast and stepped up for their mate. It made me feel more comfortable with the disability and confident that I would pull through. Today I wonder. What if it wasn’t a fracture? What if it was a mental illness like depression? Would people still react the same way? Neither do most people with the problem want to open up about it nor do the people around them recognize it without something as colossal and substantial as a cast.
The stigma surrounding mental illness including depression remains a barrier to people seeking help throughout the world. Talking about depression whether with your family member, friend or a medical professional in multiple settings like schools, work place, and social media helps break down this stigma. One person talking about depression gives courage to a thousand to come forward and seek help. This is the core of the World Health Organization’s (WHO) campaign for World Mental Health Day observed on 10 October every year, with the objective of raising awareness of and mobilizing efforts in support of better mental health. Last year the campaign theme was ‘Mental health in the workplace’ and it focused upon people working together, people from different walks of life, from different countries coming forward, talking about depression and seeking help as a vital component of recovery.
During our adult lives, a large proportion of our time is spent at work. Depression can have an adverse impact on our ability to work or to work productively and is a leading cause of disability worldwide. According to WHO, globally more than 300 million people of all ages suffer from depression. WHO recognises suicide as a major risk in depression. Every 40 seconds someone in the world commits suicide, a global tally of more than 800,000 suicides a year, according to a landmark United Nations report. Though the warning signs might be subtle, they can be recognized. Suicide is preventable.
We as a society have a tendency to look at these statistics and think ‘so what?’ It’s not me and it has not happened to any loved one of mine, so what? Then I ask you. How do you know that? How do you know if your loved one is not depressed? What do you know about depression? Depression is more than just feeling sad or going through a rough patch. Just like there is a vast difference between having a fever and just being warm. Depression can happen even when everything in life is going perfectly right and even when you have everything that you want. How a person describes the symptoms of depression often depends on the cultural lens he/she is looking through.
In Western cultures, people generally talk about their moods or feelings, whereas in many Eastern cultures, people refer to physical pain. The symptoms of depression often persist constantly over a long duration and include persistent sadness and extreme tiredness, a lack of interest in previously preferred activities, sleep and appetite disturbances, difficulty in focusing on tasks, feelings of helplessness, hopelessness and worthlessness. But sometimes the disorder is subtler, and harder to identify; for example, patients can present with unexplained aches and pains, headaches, twitching in the stomach, aching muscles, joint and back pain or sometimes with outbursts of anger and frequent irritability. Often what patients fear the most is not the suffering from the symptomatology of depression but whether they would be understood by their families or their employer if they spoke about it, whether they would lose their jobs, whether their friends would treat them differently. That’s just that sense of stigma that exists within each of us. People will adapt just like they do when you have a fracture or you’re down with flu. Let not that fear stop you from coming forward, because left untreated, depression can be devastating, both for the people who have it and for their families. Whatever the barriers may be in coming forward, don’t let your unwillingness to seek help tip over into tragedy. Irrespective of the consequences of disclosure of illness, they are far better repercussions than those of untreated depression.
Movie stars, sportsmen, musicians talking about their struggles with mental illness are definitely important and a recent surge in such celebrity disclosures has helped illuminate an often neglected issue but we still quintessentially need the ‘common man’ to talk about mental illness. People suffering from depression need to see people they can easily relate to speak up about mental illness. People coming from a similar background, people with similar contextual issues, people they see, meet and know, people they have shared time and space with, peers and family; then there is an intrinsic connection, a security, an undercurrent of hope; and hope can be therapeutic for these patients, turning mirrors into windows for them. Today we have more means than ever before for connecting with each other via social networking, talking face to face through our computers, mobile phones and tablets; with just a flick or a click we can initiate a conversation with someone in another corner of the world. But do we really connect with others such that they feel heard, validated or cared for? Connecting is not entirely about saying something witty or meaningful, just being an empathetic, patient listener can help in the healing process. Listening can involve hearing the unsaid, something more profound than what one speaks, to whispers of the mind. The rise of technology has transcended geographical barriers but the barriers of social distances hold strong. With so many avenues you need never be alone for an instant; however, patients with depression can have innumerable social media acquaintances, be surrounded by a huge peer group at work and a sizeable family at home, yet to them it might feel like they are all alone. Their silence can undermine self-efficacy and breaking this silence is equated to a taboo. Their isolation and shame is an epitome of our collective failure as a community. We need to rally around these individuals, share stories and keep the conversations about mental health going to normalize these disorders and de-stigmatize the cloaks of depression.
The first step in solving any problem is acknowledging the existence of the problem. Depression is a problem, a massive one. It is not going to fix itself and neither is it going away just because we wish it to. Yes, depression is a well-documented issue, yet it remains poorly discussed. It’s a mental health condition that requires understanding, treatment and a good recovery plan. There’s no single magic bullet for patients with depression, but there are certainly treatments that are effective. It’s often just a matter of finding the right one, or the right combination. But the first step and probably the most significant one is to open up about it. Remember, you’re not alone. Lots of people deal with and recover from depression – the more people talk about it, the easier the road to recovery becomes. Depression is not an identity, not a weakness. It’s an illness like any other such as diabetes or hypertension or a viral fever. It’s no less important, no less debilitating and requires treatment just like them. The paradox here is that in most cases the accommodations needed to be made for patients with depression are often minor and predominantly involves non fiscal denominators such as your time and empathetic listening.
Depression is indeed every individual’s unique problem but every problem is best dealt with as a team, much like my fracture. During our adult lives, we spend a large proportion of our time at work and what this means is that you are probably the one who is best equipped to detect signs of depression in your peers. The antonym of depression is more realistically a sense of normalcy rather than elation or happiness, but the bridge from the synonym to the antonym is most definitively enablement. Together we need to work towards enabling every individual to recognize the symptoms of depression, encouraging each individual to open up about it, to speak and share their experiences without fear of being judged. Your hindsight might become another person’s foresight. In exercising channels for sharing, we exhibit courage that drives one person to stand up for the other. Then one becomes many, and in those moments we become infinite. The mental health team of a country doesn’t comprise only psychiatrists or psychologists; at the very core of the team is it’s most important cog – common individuals who will be the gatekeepers of mental illness. So together let’s become the catalyst for change, let’s make a difference before it’s too late. Let’s start talking about depression. It is time we went beyond the ‘blues’ together, as a team.
Dr Suhas Chandran, is consultant psychiatrist at St John’s Medical College and Hospital, St John’s National Academy of Health Sciences, Bengaluru. Having worked closely with patients with depression and their family members, Dr Suhas believes that demystifying the myths surrounding the illness and breaking the barriers of stigma is the best step forward in promoting early intervention and treatment of mental health disorders such as depression.