High-profile cases of depression can foster a more mature stance to this common condition, writes BREDA O'BRIEN
AGONY IS a strong word. My father, who would make the Stoics look like weepy wimps, once said he was in agony when I inquired by phone how he was. I was on the bus to Waterford to see him before I was quite aware I had left my house. It turned out he had several crushed vertebrae, and that the word agony was yet again an example of his gift for understatement. Although well into his 80s at the time, he recovered.
Admittedly no Stoic, I used the word agony, too, when I ruptured a disc last year. I was remarkably ill-equipped to deal with all-encompassing physical pain that went on for weeks. When I wrote about the experience, letters and e-mails poured in. Even people who generally would regard me as a blot on the pristine pages of The Irish Times sent words of kindness and advice. Almost everyone can relate to physical pain.
Yet when a good friend of mine who suffers from ongoing bouts of depression used the word agony to describe how she feels, I practically did a double-take. Even though I would have often thought about how distressing and debilitating depression is, the word agony caught my attention in a new way. When I was in extreme physical pain, virtually everything else was blotted out. My focus narrowed to the present moment, not in a positive, live-in-the-moment way, but because there was no energy available for anything else.
But while admitting to being in physical agony usually brings support and sympathy, admitting to being in mental agony is somewhat different. This is Depression Awareness Week, and research published this week shows that two-thirds of Irish people would not tell their employer about a mental health issue. That’s unsurprising, given that almost a third of people surveyed also said that they would be uncomfortable employing someone who had a mental health issue like depression.
Yet more than 400,000 people in Ireland experience depression at any one time. We have a well-documented problem with young male suicide, and a slightly less emphasised but still real problem with self-harm among young women.
Maybe we are uneasy about it because we are all aware how vulnerable we are and, as a result, prefer not to think about it too much. Unlike a broken leg, there is no obvious time limit to mental suffering. Friends and family often feel a certain helplessness when dealing with someone who faces ongoing depression.
Mind you, as people in ongoing chronic physical pain will tell you, sympathy can wear thin there, too. But people who suffer from ongoing or recurring mental pain struggle against something more, a sense of disapproval that almost has a moral tinge, as if it were a sign of personal weakness, or failure, to suffer from depression.
Along with the debilitating nature of depression, people also have to cope with the stigma that attaches to it. Depression has all sorts of lingering connotations of self-pity, or weakness of character. In modern times, as brilliantly documented by Barbara Ehrenreich in her book Smile or Die, positive thinking has become virtually a new religion. Her own experience of breast cancer clarified for her that “stay positive” has become a mantra that does not allow people to grieve, or express fear. Cancer patients can even be made to feel that if they are not getting better, it is because they are not being positive enough.
It is bad enough having such a serious illness, but to be forced to be relentlessly positive is an additional burden. While being positive can be helpful, if pursued with evangelical zeal it can leave people devastated if it does not result in a cure.
In a world where positive thinking is valued over realism, people suffering from depression are completely out of step. Not only are they not positive, they are inhabiting a bleak and apparently hopeless universe.
Of course, a relentless spiral of negativity is as unhelpful as insisting everyone put on a happy face. Distorted thinking which sees everything as hopeless is in itself a symptom of depression.
For example, my friend who suffers from depression says one of the worst aspects is the feeling that it will be this way forever, or just get worse. Somewhere in her mind she manages to retain a shred of belief that she will come out of this, as she has before, and she clings to that while waiting for her current treatment to help.
My point is not that we should all become relentlessly negative, but a society that seems only comfortable with the positive makes it much harder to admit to depression, and therefore much harder to seek help.
I have never read a Marian Keyes book, but I aim to change that, just as a tribute to her courage in admitting on her blog that she is laid low with depression. The world of the internet can be a savage place, but the comments on her blog are extraordinarily warm and kind, proof that some people can empathise with mental agony as easily as with physical pain.
Sadly, not everyone has been so kind, with some commentators suggesting that it is self-indulgent and less than inspiring for someone so comfortably off in every way to be advertising that she is crippled with depression.
I don’t agree. If we can extend compassion and help to those in physical pain, we should not apply a different standard to mental pain, which is no less real. But just like physical pain, there are many avenues of help.
Medication has its place, and there are valuable new approaches, such as mindfulness-based cognitive therapy which combines ancient mindfulness techniques with strategies to identify and change unhelpful thinking, emotional responses and behaviour.
One of the main aims of Depression Awareness Week is to encourage people to seek help for what is generally a very treatable condition that responds well to early intervention and ongoing support. Don’t suffer alone in agony.