To Your Health Series: Depression, stigma, and how to change
“Whether an illness affects your heart, your arm, or your brain, it’s still an illness, and there shouldn’t be any distinction. We would never tell someone with a broken leg that they should stop wallowing and get it together… We shouldn’t treat mental health conditions any differently. Instead, we should make it clear that getting help isn’t a sign of weakness — it’s a sign of strength — and we should ensure that people can get the treatment they need.” — Michelle Obama
Feeling sad, down, and unhappy are all part of the human experience, just as much as feeling joy and happiness.
In fact, negative feelings often help us understand our more positive moments in life — even experience them with greater depth.
However, feeling blue for a long period of time can be a symptom of something more serious.
Depression is often talked about in abstract terms, used synonymously with feeling sad. Depression is actually a clinical diagnosis with a set of guidelines. Sleep and appetite can be affected — and can go either direction, meaning patients may want to sleep more or less, and their appetite may be reduced or increased.
People lose interest in doing the things they used to love. They often feel guilty or worthless, without having much reason to do so. They can have a hard time making decisions. Sometimes their physical actions may be slowed down noticeably. Finally, people may feel suicidal.
If a patient has enough of these symptoms for a period of longer than two weeks, they are diagnosed with clinical depression.
There is also another more chronic type of depression called dysthymia, where patients may experience some of these symptoms less intensely, but have it go on for years.
This form of depression may be more easily missed because the symptoms don’t fit as neatly into our narrative of what depression looks like.
Sometimes, instead of being sad, people may feel angry or irritable. This may especially be the case in men, who have been socialized not to cry from a young age, or have been told that it’s not “manly” to express sad emotions. It may be healthier instead to teach children that it is strong to feel all emotions, grapple with them, and talk about them.
It is brave to seek help, to be vulnerable, and to be open.
Although the national conversation around depression has become more open and understanding in recent years, there is sometimes a real or perceived stigma surrounding mental health. Because it is an invisible disease, depressed people may be misunderstood as being lazy, selfish, or weak. This is absolutely not the case. It is the symptoms of depression that may make people not want to get out of bed, or not want to go to work.
As Michelle Obama articulates in the quote above, a person with a broken leg may also not be able to get out of bed because of pain. However, we do not equate their symptoms of pain with the person — we do not blame them for their illness. Often, in depression, people are blamed for their illness, and their symptoms are equated with their personalities. This is ultimately counterproductive. Depression is a disease just like any other, and we need to treat it as such. Such blaming may worsen the already present feelings of guilt and shame in a depressed person and make it more difficult for them to seek help.
Depression can be a terribly difficult and exhausting disease, especially when people experience both its symptoms and the stigma that society places upon them. Thankfully, we have many effective treatments. First of all, exercise, eating well, yoga and mindfulness are great lifestyle modifications that help patients. If more intervention is needed, your doctor may begin a two-pronged approach that includes medication and “talk-therapy.” Antidepressants treat depression through various pathways, which boost naturally occurring messengers in the brain that control mood and stress, particularly a neurotransmitter called serotonin. People with depression are thought to have low levels of serotonin, so keeping levels higher helps stabilize the disease. Medication may be taken for an interim, brief period, several months or years as needed. Initiating medication does not mean you will always need it and taking medication for depression is not a sign of character weakness.
There are many kinds of therapy. Cognitive behavioral therapy works on challenging unhelpful cognitive distortions and using emotional strategies to combat depression. There is also psychotherapy, which involves talking to a therapist for longer periods of time, trying to uncover buried trauma.
If you are interested in seeking help for depression, please call us at the Block Island Medical Center, and we can make a plan for moving forward. We now have several options for therapy including visits with Dr. Oppenheimer our clinical psychologist who is on island twice monthly, the tele-heath program sponsored by NAMI-BI which involves sessions with a psychiatry resident via Skype at the Medical Center, and several other skilled, private, on-island therapists whom we can refer you to. We may also refer you to the BIHS Wellness and Risk-Reduction Program for a nutrition and exercise program that may be of benefit in reducing symptoms and promoting overall well-being. We would love to hear from you. Let’s change the conversation around depression together.
Medical content edited by Mark Clark, MD, Medical Director Block Island Medical Center.