So here’s the thing about coming out about experiencing depression. Or rather, about being in the throes of an ‘episode’. (Such an innocuous word, episode. It should at least be dark and black and infused with the imagery of the lived experience of an episode). The shift in perceptions of depression as a medical illness has generally been a great improvement on widely held views that depression is a weakness, a made-up all-in-your-head-pull-yourself-together flaw. A choice, if you will. I have seen palpable relief in friends and patients who are fighting against their ‘weakness’ when I’ve suggested that depression is much like diabetes (for example) – a chronic condition that needs treatment to be managed. While this doesn’t absolve a person of the responsibility of getting help and doing everything they can to help themselves, it does remove the sense that this is somehow their fault and, if they just tried harder, they’d stop feeling so mad/bad/sad.
But, through this latest episode of mine, I’ve realised that the depression-as-medical-illness perspective can hold its own dangers.
First, we tend to think of illness as acute, not chronic. Like a bad case of flu or gastro, there seems to be the perception that you take your depression to the doctor, get a prescription and in 10-14 days, give or take, you’re well again. Notwithstanding the unlikelihood of stumbling upon the right medication first time around, depression typically doesn’t resolve itself in a few weeks. This is difficult: not knowing when (let alone if) you are going to start feeling like your Self again. More difficult: the expectation from well meaning people in your life that you should be Better now. It’s been a month, right? 6 weeks, right? Two months? You’re doing Better, right? If it’s tiresome to keep getting the “I’m not okay” response to your “How are you?” question, please try to imagine how it feels to live that not-okay, every day, for a month, two, three… Most difficult: the suggestion, implicit in that question, that you are obviously not trying hard enough to Get Better. Depression is hard to deal with. So is a depressed person. It’s easier, sometimes, to pretend it’s not happening (anymore). If you happen to be the depressed person, you don’t get that luxury.
As useful as the depression-as-chronic-illness can be, it somehow doesn’t quite portray the transition from physical to mental suffering. Depression is (largely) unseen. Its blackness unfolds inside you, makes the unreal real, the irrational rational. The very part of you that can rally your physical and emotional resources is the part that is broken. No matter how I’ve tried, I’ve yet to adequately articulate the experience of living with and through this illness. How do you explain an illness so tortured that, instead of fighting to live, you fight to die? In my experience, at least, this is difficult – impossible in some cases – for people who care about you to come to terms with. Confessing such an awful truth is pretty much taboo. And so you live with the thoughts and feelings in silence, alone. You get out of bed, you get dressed, you might make it into work. You look normal. Your chest is clear; your leg’s not broken. But this illness is still there, unrelenting. What would depression look like, I wonder, if it was no longer invisible? If we could see the torment reflected on a person’s skin? Would it evoke more empathy, or more fear?
I have a close friend who broke her leg last month, and was booked off work for 6 weeks (and counting). The experience has been a difficult one for her – a fiercely independent, vivacious person, highly invested in work and relationships, now housebound and ‘out of action’ because of a broken bone, a cast and crutches. I’m sure I’ve never fully appreciated how physically incapacitating a broken limb could be and certainly not what an emotional blow it delivers. I was struck, though, by even my own perception of how legitimate her injury was. Of course you should get booked off work for 6 weeks (and counting) because you cannot walk. Of course you can’t go to the shops to buy milk because you cannot drive. Of course it’s okay if you can’t make it to my supper party because it’s too difficult to move around. Insert “depression” for “broken leg”, however, and perceptions shift (mine included). The difference, for me anyway, is that it is my whole self that is (hopefully temporarily) broken. But it’s not quite so acceptable to not be able to work or go out and buy bread. And it’s definitely not okay if you keep turning down invitations, or don’t have the emotional energy to “keep in touch”.
I am not okay. Not right now, anyway. I’d very much like to be okay again. I’m doing what I can. I get out of bed (most days). I eat. I try to maintain some form of connection to the world out there. On really good days, the 8 long hours spent in front of my computer result in something productive. And I try, with the support of some extraordinary people, to push back against this illness. I’m trying, hard, to Get Better. Part of that, for me, means trying to talk about the experience, no matter how scary or shameful it feels. Perhaps – perhaps – it will make depression a little more visible.