Depression: The Hidden Illness
Sufferer’s descriptions of the experience of mental illness can be as varied as the individuals themselves.
“[I feel] as though I don’t have the right to be depressed”; “like being on the opposite side of a glass wall”; “out of control”; anxious”; “sleepy”; “cold and numb”; “like I’m going crazy. Am I going crazy?”; “going through hell”; “desperate”; “betrayed”; “hopeless”; “hidden”; “alone”; “hurt”; “lost”; “low”.
And, almost always: “misunderstood”.
Despite its recent rise to public and academic attention, descriptions of depression date back thousands of years. Aristotle suggested that all those who excel in philosophy, politics, poetry, or the arts are “melancholics.” His straightforward diagnosis has since been replaced by a more comprehensive definition of the mental disorder that we now call clinical depression.
Globally, depression causes more disability than any other psychiatric disorder, and creates the greatest social burden of all mental illnesses. It is extensively interconnected with other mood disorders, so it manifests itself differently in every sufferer.
Depression is an illness that appears to be unrelated to ethnicity, education, income, and martial status. Unfortunately for us students however, 16 — 24 year-olds are considered to be most at risk. Thankfully, it’s a treatable disease.
MENTAL HEALTH – A LOCAL HISTORY“The long corridor outside shines like the leather of a new shoe that walks that walks upon itself in a ghost footstep upon its own shining until it reaches the room where the women wait, in night clothes, for the nine o’clock terror called electric shock treatment. “
— Janet Frame
Mental health has been of concern to New Zealand governments since the 1850s. Before then, no provision was made for the mentally ill by the Crown Colony. Patients were simply sent to gaol if they didn’t have any relatives to look after them, or if they became too much of a problem.
In the 1850s and 60s, provincial governments set up a number of institutions to house and treat people with mental disorders. Such institutions included the Dunedin Lunatic Asylum, and the Seacliff Lunatic Asylum (neither of which exist anymore).
Many horror stories were born out of such asylums: misdiagnosis, patient abuse, electroconvulsive therapy, lobotomies … These past days of mental health treatment have come a hush-hush issue steeped in national shame and controversy.
We’ve come a long way in recognising depression as a health concern. However, we still have an uphill battle creating awareness that depression is a serious illness, rather than an emotional weakness.
CLINICAL DEPRESSIONThe essential feature of a major depressive episode is a period of depressed mood, or loss of interest or pleasure in nearly all activities. A person suffering from depression may describe their mood as hopeless, discouraged, down in the dumps, or just plain “blah.” To qualify as a major depressive episode, symptoms must persist for at least two consecutive weeks, and cause clinically significant distress to the individual’s functioning. Some individuals might report physical aches and pains, rather than feelings. Others may become irritable, angry, and frustrated. Even the smallest tasks — rolling out of bed, pulling on some clothes — become draining and time-consuming.
In addition to mood and activity changes, the following symptoms are often experienced by sufferers:
-Weight loss or gain, or appetite loss
-Insomnia or hypersomnia
-Unusual (such as really slow) movements
-Feelings of worthlessness or guilt
-Difficulty thinking or concentrating
-Thoughts of death or suicidal thoughts and plans
In a “chicken and egg” – like scenario, individuals with chronic or severe general medical conditions (such as cancer) are at an increased risk of developing major depressive disorder, and individuals with major depressive disorder are more susceptible to other sicknesses.
Statistically, the lifetime risk for major depressive disorder varies from 10% to 25% for women and from 5% to 12% for men. Although one in five New Zealanders experiences some form of mental disorder, less than half of people suffering from a mental disorder sought treatment from health services last year.
A STUDENT’S PERSPECTIVEIt’s difficult to understand what a major depressive episode feels like if you’ve never been there before. Caleb, a student at the University of Otago, is willing to share his experience to shed some light on what it’s like to live with depression: “It began with an extremely bad trip on marijuana. That was two years ago now, in October. I’d never felt like that before — I just felt like I was going to die.” Several weeks later, “the same thing happened again, after I came home from soccer one day. I hadn’t touched marijuana since that last experience. I felt like I was going nuts. I started having these feelings over and over; I couldn’t do anything without having a panic attack.”
Caleb struggled to blame his illness on any specific trigger: “At the time, I was worried about my life in general. I wasn’t happy about my course, my dad was sick — that was hard on my family — there was a lot going on, and it just seemed to come together all at once.” On advice from family and friends, Caleb sought professional help at Student Health. After assessments with a psychologist and a psychiatrist, Caleb started taking medication for his depression and anxiety two months after his first panic attack.
Although the medication helped initially, Caleb admits that, “there was a big period there where I was just going day by day. It was easier to sit inside with the curtains closed, doing nothing. There were times when if I stepped outside, that step would be enough to trigger an attack. If I looked out the window, if someone looked at me in a certain way, if someone said something… that would be enough to set me off. I was losing control over my life, and there was nothing I could do about it.”
Caleb acknowledges that everyone who suffers from depression will find respite and help through different means. For him, John Kirwan’s story was a source of inspiration. “One of the things with depression is that, while you’re caught up in this moment of feeling like crap, you feel like you’re the only person in the world with these issues. But then, you read a book, you talk to someone, and it’s a lot better.” From here, life became more positive for Caleb. “I guess the meds were starting to kick in, too. I began forcing myself to go outside. I told myself that I wasn’t going to let this stop me from enjoying myself … it wasn’t going to stop me from hanging the washing on the line.”
Being open with people was a significant step in Caleb’s recovery, and he urges others to keep looking for help, “don’t stop until you find someone that you’re happy to talk to. It’s important that if there’s a counsellor or a doctor that you don’t like, just ask to see someone else, try to find someone that you’re comfortable with.” Caleb admits that depression can also be a difficult time for friends and flatmates. He recommends that, “you should always offer to do things with them. The worst thing is leaving them alone and not including them.”
Now, as he reflects back on that time from a healthier perspective, Caleb can see a silver lining: “I think I’m a better person now. I value certain things in life much more than I used to, I realise now how good it is to feel good. And when things don’t go my way, I’m much better equipped to deal with them than I used to be.”
TREATMENT: STUDENT HEALTHBoth Mark Chignell, clinical group leader for Student Health’s counselling service, and Christine (Chris) Griffiths, heath education nurse, are in the business of helping students like Caleb get through mental illness. Although mental health is considered a “special field” in medicine, Chris asserts that it’s “part of every aspect of health, because it’s part of wellbeing.”
However, Mark acknowledges that there’s “a big difference between sadness — not having a good day, week, month — and having depression. Having a bad day, is that mental health? No, that’s normal life. Clinical depression, that’s mental health. A student’s age, background, and experiences will determine how well they cope with sadness.”
Student Health provides numerous treatment pathways for students suffering from mood disorders, as Chris says, “The person has a lot of choice – it depends on what they want in the way of therapy, and what therapy means to them. Do you manage and lift their feelings through medication? That’s very much an individual thing.”
Although the Mental Health Foundation indentifies women as being more susceptible to depression than men, Chris suggests that this may be masked by masculine misnomers: “The ways that boys and girls present themselves are very different. Boys tend to use a lot of alcohol, and other drugs. They may not talk about issues so easily.” Mark says that, “Guys’ guys tend to call it ‘other stuff’. They might call it rugby, drinking, casual relationships, missing classes…”
Looking into the relationship between alcohol abuse and depression is Chris’s specialty: “My experience of working with 353 students last year regarding alcohol-related harm, is that grief is hugely connected to alcohol. Untreated grief sort of sits there, and gets sloshed up with alcohol and other drugs, which doesn’t make it go away. That can compound, and make people feel low and depressed.”
Chris and Mark recognise that the transition from school to university life can cause dramatic emotional changes in a young adult. Chris points out that, “it’s an opportunity for young people to find out who they are. A lot of therapy is wellbeing stuff, and for many, that’s all they need. Even simple lifestyle changes can be quite healing, rather than just popping a pill.”
Both Chris and Mark stress that if you’ve got a friend who is suffering from a low mood disorder, you must encourage them to seek help — it’s not your responsibility to support them by yourself.
G.R.O.W. WELLBEINGBefore heading to Student Health, self-help is often encouraged as an initial form of treatment, or encouraged as an additional treatment, for students who are suffering from low mood disorders. With developments in technology, online wellbeing services are becoming increasingly valid sources of indication, management, and even treatment for depression. Thomas Mitchell, a student of neuroscience at the University of Otago, is employed as Chief Technical Officer of a new website, Global Review Of Wellbeing (www.growhq.com).
Based in Wellington, this online tool was the brainchild of four PhD psychologists. It now has an extensive and well-published range of academics, scientists, and ethicists on board, including one of “the top ten wellbeing psychologists in the world”, according to Thomas.
Thomas explains, “The problem with the current wellbeing market was that there wasn’t a scientifically valid assessment online. We’ve basically taken the gold-standard tests, and put them out there for people to use.” This makes the website helpful not just for individuals, but also for health professionals: “We know for a fact that if you walked into a clinical psychologist’s office tomorrow, you’d be answering many of the same questions that we ask online. So we see it as a diagnostic tool for counsellors, to give them a heads-up about their patients.” GROW is also committed to promoting research into wellbeing, and the company freely shares their data with genuine academic researchers. According to Thomas, all students should give it a go. After all, what have we got to lose? “No more than fifteen minutes,” he points out.
John Kirwan’s interactive website, depression.org.nz, and his book All Blacks Don’t Cry, have also become well-regarded sources for people seeking comfort and hope. In All Blacks Don’t Cry, John Kirwan promotes the “little things” which together make a big difference to one’s quality of life: taking the time to appreciate overlooked activities such as showering, having a cup of coffee, reading a book, and exercising outside.
BE WELL, STAY WELLShortly after arriving at university, students can get caught up in the habit of doing, well, nothing. It can seem impossible to discover daily doses of inspiration and hope when pessimism and boredom are blocking the way. Part of maintaining a healthy mind is allowing yourself to be curious. Make an effort to see new places, do exciting things, and engage with lots of other people.
It’s baffling that such a common illness as depression remains so stigmatised. As one interviewee put it, “If someone has a broken leg, they can say, hey, I need some help getting to class each day. But if you’re mentally ill, it’s much more difficult to ask for help. There’s all this blame, and people don’t want to speak to you because it makes them uncomfortable.”
Practice makes perfect, right? There is no better time than right now to start talking, listening, and most of all understanding.
Many thanks to all those who contributed their personal experiences and opinions to this article.