It’s time to change how we talk about depression.
I’ve been thinking about how we talk, and the terms and phrases we use, contributes to the negativity regarding mental illnesses. For the moment I’m going to take on the first one people tend to think of when the topic of mental illness or mental health comes up, and that one is depression. Allow me to explain:
“My team lost last night! I’m so depressed!”
“I can’t believe they’re cancelling my favourite show, and in the middle of the season too!”
“Why is this happening to me? I’m so depressed”
“It’s Monday, I spilled coffee all over myself on the way to work, and I got a speeding ticket on top of it all! I’m depressed!”
Now, these things certainly can cause an emotional reaction. And an emotional reaction (to some degree) to something that we identify with, or connect with as a hobby or interest, is normal. However, while sadness or low emotion in these cases would be more accurate, we throw in the term depressed to loosely and inaccurately describe this low emotion, sadness, frustration, or the vague ‘emptiness’ that we feel. To be clear, it’s common, in fact it’s normal to have an emotional reaction to circumstances like these. Sometimes it’s the dull boredom that we all experience from time to time, yet as a society we’re quick to throw out the phrase “I’m depressed” when words like sad, frustrated, angry, or bored would probably be more accurate.
The problem comes when we use the same word to describe our emotional state after a major change in life’s circumstances. A job loss, especially after long-term employment. Or breakdown of a meaningful relationship – marriage or inter-family relationships tend to be more common examples. Or the death of a loved one, be it an expected death due to age or illness, or unexpected due to accident, sudden illness, or suicide.
“I can’t believe they laid me off after 10 years of loyal service! I put so much time and effort into helping them grow their business, and it was all for nothing! What do I do now? I’m so lost and depressed!”
“I thought I knew her. I gave my all for her – and she left me for someone else. I’m angry and depressed…. I never saw it coming”
“My Mom and I have always experienced friction. We could never quite see eye-to-eye but now she’s disowned me. I’m depressed. I don’t know what to think or feel”
“I can’t believe he’s gone. I just talked to him on the weekend – everything seemed so normal.“
Of course, these are quite understandable, and have far more depth than a favourite team losing an important game, or a favourite show coming to an end. We all can grasp that if someone draws our attention to it, but probably don’t give it much actual consideration otherwise. Truth be told, major life changes in employment or in a relationship can trigger a depressive episode. No one would question a longer period of low emotion following a major life event like the examples above. In fact I think people would question if an event didn’t have a strong emotional impact!
The problem continues, however.
While these are definitely traumatic and difficult situations to cope with, and while they can trigger a depressive episode, it is just that: a depressive episode. A period of difficulty, which triggers an emotional response. After a period of time and processing, things return to normal emotional health. The new normal may be different circumstances, but emotional stability does slowly return. A depressive episode is a period of time. The beginning of it is usually more defined and distinct, whereas the end is much more of a indistinct transition. There is much less of a line between the “depressive state” and “normal” when coming back to the ‘normal’ baseline than there is when the depressed state begins. The important part to keep in mind is that for circumstances like this, the depressed state is finite – there is a beginning and and end to it. It may be hard to pinpoint the end as definitely as the beginning, but there is a realisation at some point that things are once again “okay”, or they soon will be.
The third aspect of depression is the one that I face, and have been facing for well over half my life. Heck, probably even longer – although how long doesn’t really matter. What I face, and many others do as well, is a condition known as major depressive disorder, otherwise known as chronic depression. There was no traumatic event or circumstances that I’m aware of that triggered it, and as of yet there is no end to it. I don’t know if there ever will be. I don’t know what normal emotional depth feels like, I don’t know what fully “normal” emotional responses are like either. There are days where the slightest little thing can really upset me, and there are days where a fairly major change (for good or for bad) will hardly phase me at all. This is my life, and it’s been this way for so long, I don’t know what life is like for most of the population, as far as emotional responses and feelings go on a day-to-day basis.
So where am I going with this? Well, current stats say that somewhere between 1 in 4 and 1 in 5 people will experience a mental illness or mental health crisis in their lifetime. Obviously this doesn’t include people being depressed about their sports team losing, but it does include major life changes and the emotional response to that, as well as people like myself who face chronic mental illness for much, if not all, of their entire life. This means that “Bob” or “Sally” who experience a job loss, or sudden financial hardship, or a death of a loved one, or a relationship breakdown, are lumped into the same category as myself who deals with an ongoing depressive state (to some degree or another) for most of my life.
While a short-term depressive episode is by no means a walk in the park, usually they only last a few weeks to a few months before life has returned to a normal emotional balance. A few weeks of emotional discomfort, in which time the individual may try several things to return to that normal state. Exercise, a change in diet, lots of fresh air, perhaps yoga or other meditative practice, or perhaps the pursuit of an old (or maybe a new) hobby. Before long the individual has bounced back, or at least is well on their way to being “whole” again.
However, that is the thing that many people cannot grasp is that there is a very distinct difference between a depressive episode and the chronic condition known as Major Depressive Disorder also known as chronic depression. In short, it’s comparing (for example) up to 13 weeks of a depressive episode once in a lifetime, with 4-13 weeks of a depressed state, anywhere from 2 – 4 times per year, for decades. Both seem inescapable when you’re experiencing it – but in one case, it’s typically soon forgotten, as our brains seem hard-wired to minimise the memory of pain. However, for the chronic sufferer, the ‘resurfacing’ or coming back up to ‘normal’ is merely a respite – a breath of fresh air before the next storm yanks them back under the surface. However, because someone experienced a depressive episode but ‘cured themselves’ with daily walks, a strict vegetarian diet, and doing guided yoga sessions, that somehow means that anyone who doesn’t get ‘cured’ using their methods isn’t trying to get better (bad assumption), doesn’t even want to get better (a worse assumption), or that they’re just making it all up – that it’s “all in their head” (obviously the worst assumption of all). Perhaps they’re “weak” and “not strong enough” to face the real world. (Does that sound familiar? Have you ever said or thought any of those things?)
Allow me to use a different example. it would be like someone getting seriously ill to the point it affected their kidneys, but after some time was able to make a complete recovery. However, because they experienced short-term kidney issues, the consider themselves lumped into the same category as someone with chronic kidney disease. The result is that because someone only had to face those hardships for a short period of time, they begin to think that everyone with kidney difficulties should be able to get better, and should be able to get better using the same treatments that worked for them. They might say “I cured my kidneys by drinking 6 glasses of cranberry juice, 4 glasses of lemon water, and eating nothing but salad every day for 6 weeks!” and then take issue when others can’t “cure their kidneys” using the same method.
“Andrew, that’s ridiculous! Those are totally different” you say, and you’re right. A short-term illness that affects one of your organs is a whole different ball of wax than someone who has chronic, ongoing battles with the same organ. Treatments are different. Outcomes are different. Perspectives are different. You will sympathise with someone who may be having short-term kidney issues (maybe a kidney infection, or something similarly temporary) but you’re confident that there will be recovery. Your attitude and sympathy is on a completely different level if you know that their kidney function is chronically affected, and may lead to kidney failure. That’s totally normal, and totally expected. Temporary illnesses are treated (both medically and socially) in a very different manner than chronic ones.
Let’s take this another step, a step into my world. I have talked with many people who have said “I used to be depressed too”, and gone on to give me what I can only assume is well-intentioned advice on how to “cure” my depression. But it rings incredibly hollow, because usually, people who are vaguely recalling teenage angst and labelling it as ‘depression’, or experiencing the loss of a relationship or career and recovering from that depressed episode as being comparable to a chronic condition. I try to smile and listen, because maybe I’ll hear something new to try in order to combat my condition. I mean, you never know right? A new angle, or a new approach is pretty damned rare, and well-worn ideas are common. Walks. Diet. Sunshine. Happy thoughts. Walks. Diet. Sunshine. Happy thoughts. Walks. Diet. Sunshine. Happy thoughts.
To go back to the kidney example, I know 2 people who have undergone kidney transplants. Obviously a kidney transplant is no small thing. They’re not done just for fun, and because it’s so invasive and life-changing, it’s only done when necessary (to say nothing of waiting for a suitable donor). But someone telling me I can ‘cure’ my depression by going for a walk every day and thinking happy thoughts, is like me telling someone with very diseased kidneys that “I cured mine by drinking cranberry juice!”. Kidney infection is no fun, but it’s not on the same level as kidney malfunction or failure. In the same light, a depressive episode is a whole different ball of wax than a chronic condition. One has a trigger (usually, but sometimes it’s a buildup of several things), but through healthy habits and emotional processing, recovery is almost a given. Not a guarantee, but far more often than not recovery from a depressive episode is entirely possible.
For a chronic condition like my own, there is no trigger, no event that caused it. And there is no cure. Yes, there are many many things that help. There are many things that can help offset the impact on my life. Fresh air, exercise, practising specific thought patterns, learning processing skills, medication, and so many more are all parts of treating it. But there is no cure. There can be 2 people with very similar backgrounds, personalities, economic stability, and so forth who have the exact same diagnosed chronic mental illness. Yet, each will experience different symptoms (sometimes vastly so) and will respond differently to various treatments. For one person, a low dose of one medication is all that’s needed to keep them relatively stable and functioning. For another, years of trying different medications in various combinations and doses, different therapies, diets, exercise, meditation, and so forth brings little relief.
To add an extra layer of complexity, while people are quick to be sympathetic to those who experience health issues with any other organ in their body, (be it chronic or short term), those of us who experience chronic health issues with our brain are told to think happy thoughts and get more sunshine. End of story. End of sympathy. Well-intentioned or not, it only highlights the ignorance that is out there.
Equating kidney infection with kidney failure is deemed as be ridiculous. People would be incredibly upset, and rightfully so! Equating a short-term depressive episode with a chronic, incurable brain illness on the other hand is absolutely fine. Nobody bats an eye when it happens! In fact, experiencing a “depressive episode” (but it’s never called that) is far more socially acceptable than admitting to having a chronic mental illness like depression. What’s the difference?
A kidney’s function is well understood, and treatment options are relatively well-known. Medical knowledge is advancing, and there are new discoveries all the time. However, at this point in time – kidneys are very well understood, and treatment options (with risks, outcomes, and side effects) are well documented. On the other hand, the brain (another organ) is far less predictable, and far less is known about how it functions. There are ongoing studies about how the brain functions and how society and economic standing plays a role in that. And again, there are new discoveries regarding how the brain functions and responds to different chemicals, or to various stimuli, as well as new treatments for various mental illnesses and brain injuries. However there is far more about the brain that is not understood, than there is about it that is understood.
In other words, a less-complex and well-understood organ becomes sick, and people have nearly boundless sympathy, compassion, and understanding. But when an incredibly complex (and far less understood) organ falls ill, people are sceptical about it, and sometimes hostile about how it’s ‘all in your head’ – a figment of my own broken imagination.
It’s time – no, it’s long past time – to change how we talk about depression.
Photo by Zach Guinta on Unsplash