n the last few decades, depression has shed some of its stigma. People now talk more openly about it; they are more apt to seek treatment for it. And yet, there is still something to it that causes its sufferers to feel differently about their condition… That has to change, argues If I Stay and I Was Here author Gayle Forman.
In the first, a 17-year-old with leukaemia has to miss several weeks of school.
In the second, a 17-year-old with depression has to miss several weeks of school.
Are you more sympathetic to one than the other? Does one have a real disease, the other, something else – something which, though not quite hysteria, is not quite life-threatening either?
Does it matter that both conditions are disorders, both thought to be caused by something gone haywire on a genetic or biochemical level – leukaemia when blood cells acquire mutations; depression when neurotransmitters are out of balance – as well as environmental factors? Does it matter that both are quite treatable – the five-year survival rate for childhood leukaemia is 85% – and both are potentially lethal? The overwhelming majority of people who take their own lives – 90% or more – have a mental disorder at the time of their deaths, the most common being depression.
Does it matter? Perhaps it should.
In the last few decades, depression has shed some of its stigma. People now talk more openly about it; they are more apt to seek treatment for it. And yet, there is still something to it that causes its sufferers to feel differently about their condition – a mental illness – than they might if they were sick with something more obvious – a physical ailment.
Even that term – mental illness, or mental disorder as it’s commonly called – suggests an element of control that sufferers often don’t have. Because if it’s a mental illness, then it’s in your head, right? We control our minds all the time – deciding not to call up an ex, deciding to skip a late-night party because there’s work tomorrow – so can’t depressed people, just, sort of, get over it?
Sometimes they can. More often they can’t. And here’s where calling depression a mental illness muddies the water because depression operates much like a physical illness, which is something most of us understand we cannot control. Many of depression’s symptoms – exhaustion, insomnia, nausea, headaches, weight loss, weight gain – are physical ailments.
Researchers have shown the link between depression and a lack of neurotransmitters like serotonin, which is responsible for feelings of wellbeing. New research suggests other causes, like one study that looked at a link between inflammation and depression, suggesting that depression might be a response to an infection of some sort.
And yet, it’s still thought of as something lesser, a weakness. Even the term, depression, doesn’t convey the enormity of the condition. How often do we use the term depressed to mean disappointed, mildly bummed out or sort of blue? “I’m depressed about the weather.” “I’m depressed that Arsenal lost.” Yes, a “lower-case d” depression is on a spectrum of symptoms with a major depression, but they are different orders of magnitude. Giving them the same name is like calling a stomach bug Ebola because they share some of the same symptoms.
If the spectrum linking everyday depression to Major Depression sometimes hinders understanding of it, it also offers an opportunity for empathy. Because almost everyone, at some point, experiences feelings of sadness, of hopelessness, of emptiness, not to mention lethargy and irritability. This is less a condition of a biochemical imbalance than it is a condition of being human. The trick is not to conflate one person’s blues for another person’s full on clinical episode, not to confuse, as it were, the stomach bug for the Ebola.
My upcoming novel I Was Here deals with the aftermath of a young woman named Meg’s suicide and looks at what happens to those left behind, particularly Meg’s best friend Cody, who, in obsessing about the what and the why around Meg’s death, begins to circle the drain of self-harm. At one point, in describing the ubiquity of suicidal thoughts, a friend tells Cody that “everyone goes there,” meaning everyone imagines at one point or another, what it would be like to throw in the towel. I believe that. Most of us have days or weeks or months so awful, we wish we’d never been born.
I have never suffered a major depression, but when I was writing I Was Here, I had to try to get in the head of someone like Meg. I thought about the periods of being low, of my own days of “going there”. I also thought about the migraines I suffered as a child, a pain so terrible that I could only lie in the dark and imagine slicing open my temples to relieve it. I imagined that kind of pain, all-encompassing, everyday, all day, without relief. Wouldn’t I want to cut it out? To do anything to end it? In such a light, suicide becomes less a selfish act of cowardice than a most desperate attempt to cut away the pain.
The tragic thing is, there are far less drastic and final ways to alleviate the pain. There is treatment, ever-improving. It’s difficult to come by accurate statistics when it comes to depression treatment success rates, in part because treatment can vary (though the standard is a mix of mood-stabilizing medications and therapy) and because what qualifies as cured is so subjective. That said, one major study says that up to 80% of those treated for depression show an improvement in their symptoms generally within four to six weeks of beginning medication, psychotherapy, attending support groups or a combination of these treatments.
Another says that every one of the 22 FDA-approved (the FDA is the organisation that decides which drugs/medicines are to be used in the US, the UK equivalent is the Medicines and Healthcare products Regulatory Agency or MHRA for short) that antidepressants currently on the market in the United States has been proven significantly more effective in reducing depressive symptoms compared with a placebo. Further studies have shown that short-term behavioural therapies like cognitive behavioural therapy can greatly reduce suicide attempts.
But treatment only works if it is sought out. In order that people who suffer from depression seek treatment without a second thought, the stigmas must further fall until we reach a point in time when that person with leukemia and that person with depression both receive the same level of sympathy and the same level of rigorous treatment. Both people deserve it.
This article first appeared The Guardian, on 11 January 2015.