A friend posted the thought-provoking cartoon on the left on Facebook with the title ‘If Physical Diseases Were Treated Like Mental Illness’ (credit to Robot Hugs). The cartoon graphically points out something that all of us know—“mental” disorders are treated differently than “physical” disorders. If someone has a heart attack, this is typically met with an outpouring of support including cards, flowers, hospital visits, and offers of food and company. Not so with depression. People will often keep the condition to themselves or within their close circle. And with good reason–if others “find out”, they may respond with pity, or worse, as the cartoon depicts, with suggestions that the condition is self-inflicted and if the person would just try harder, they could“snap out of it”.
In 2004, after my son was born with some health issues, I experienced a post-partum depression. I disclose this because I do not want to hide it. I disclose this because even though I am a psychiatrist, I myself must have had internalized stigma about having depression. At first I tried to deny it and then, I tried to “snap” myself out of it. It didn’t work. With treatment (including medication, therapy, and support from my family), the depression resolved. And while the episode was very difficult (aka terrible), it was also one of the most powerful experiences I have ever had. It changed me. Recovering from this episode made me a better wife, mother and doctor. While it is clearly not necessary for a doctor to have experienced a condition to know how to treat it, having had depression has given me an insight that I value tremendously.
The older adults with depression that I treat face a funny kind of double whammy. On one hand, they themselves may not recognize depression as an illness. One older gentleman I saw a number of years ago who had all of the symptoms of a major depression said to me “I don’t know what this thing is. I am a self-made man and I have been able to overcome every other obstacle in my life, but I just cannot kick this thing”. On the other hand, there is a (false) societal belief that getting older goes hand in hand with depression –“Wouldn’t you be depressed if you had (insert condition)?”. So while depression is NOT a natural outgrowth of aging, the older adult and family may believe that it is, and therefore, just something that they have to accept. The irony of this is that depression is very treatable in most cases. In fact, more treatable than many physical illnesses. While depression and stroke are both brain illnesses that older adults experience, sadly, in 2013, one of these disorders is stigmatized and the other is not. Check out the difference between a depressed brain and a non-depressed one in the scans below and tell me that depression is not a brain illness.
What will it take to destigmatize depression and other mental illnesses? Talking about them more openly is a start. Because society (and insurance companies and employers) may still be “stigma stubborn” (footnote for this cool term to the “Just Get Over it Now” campaign I came across online, see also pics below), disclosure must likely be selective. But even limited disclosure is a good start for all of us. In telling people about my bout with depression, I often find out that others have experienced this as well, but had just never talked about it openly. Let’s talk.