The last great stigma of the twentieth century
is the stigma of mental illness.”
– Tipper Gore
One of the roadblocks to recovery for those who suffer from depression is our culture’s tendency to stigmatize depression and other mental health disorders. After my first hospitalization, I remember the dilemma I faced in trying to explain my three-day absence to my employer. If I told the truth—that I was being treated for anxiety and depression—I stood a good chance of losing my job. Instead, I reported that I had been treated for insomnia at a sleep clinic. In another instance, a client of mine who worked as a nurse was petrified of telling her colleagues that she dealt with depression, but when she shared her diagnosis of cancer, they showered her with with love and support.
Years ago, a survey taken by the National Mental Health Association which revealed that 43 percent of Americans still believe that depression is the result of a weak will or a deficit in one’s character. Many doctors also subscribe to the “defect in character” theory. Consider the observations of physician A. John Rush:
Doctors are still reluctant to make the diagnosis [of depression] because they, too, feel like, “Oh you must have done something wrong. How did you get yourself into this pickle?” which sort of means the patient is to blame. It’s okay if you have a neurological disease—Parkinson’s, Huntington’s, urinary incontinence, a busted spine because you got into an auto accident—but once you move up to the higher cortical areas, now you don’t have a disease anymore; now you have “trouble coping”; now you have a “bad attitude.”
I believe that the stigma surrounding depression arises from living in a culture where feelings of vulnerability are considered weak and unacceptable. This is especially true for men who are raised with the injunction that “big boys don’t cry”—i.e., it is not okay for men to be vulnerable and show their feelings. This fear of being seen (by themselves and others) as vulnerable and weak, leads many men to lose touch with their own feelings and to avoid being in situations where strong emotion may be present. For example, a good male friend who avoided me during my episode later confided, “When you were depressed, I was afraid to be around you for fear that I might ‘catch’ your depression.” What he meant was that being in my presence might cause him to tap into his own latent depression, a proposition that was so uncomfortable, he had to split.
The Challenge of Being a Nobody
For many people, the stigma of being depressed is compounded by shame and guilt about not being a “productive member of society.” The depressed person may become a “nobody” when his disability makes him unable to work or to earn a living. How, then, does an individual measure his self-worth when he or she is not working or producing?
This is the question I asked myself as I struggled to come to terms with not living up to the expectations of my cultural programming. I was the first-born son, raised in an upwardly mobile middle-class Jewish community where competition for entrance into Ivy League schools began in the third grade. Unlike my Catholic friends, who attended a nearby parochial school and were taught to avoid “the seven deadly sins,” I learned that there was only one deadly sin—“not living up to one’s potential.” This potential, of course, was very specifically defined—unless you became a doctor, a lawyer, or ran your father’s business, you were considered a failure. There were, of course, exceptions. One could always teach at Harvard, make a fortune on Wall Street or win the Nobel Prize. As long as the gods of Status and Recognition were served, our parents and teachers would be happy.
Lacking money, power and prestige (the standards by which I was raised to judge myself), my sense of failure and inadequacy plagued me during my episode. One day, I was invited to a potluck dinner, where I met an attractive woman who had just been hired as a professor at the prestigious Reed College, having obtained her Ph.D. from Harvard. After describing her exploits in great detail, she asked the dreaded question, “And what do you do for a living?”
I paused for a moment to contemplate my response. Recalling my father’s injunction to always tell the truth, I responded, “I attend day treatment and collect disability income.”
The woman looked at me with a mixture of bemusement and pity before making a discrete exit. I felt as if someone had placed a name tag on my shirt—the kind you get when you attend a singles group or a self-help seminar—that read “Worthless.”
This interaction (or lack of it) hammered home the question, “What happens to a person’s self-esteem when a lifelong emotional disability such as clinical depression interferes with his ability to be productive in societal terms?” Like the former athlete who is confined to a wheelchair after a paralyzing accident, I had to accept my limitations and find a new way to define my existence. I was helped when my therapist suggested that I look at the label “depression” as not defining who I am but how I am suffering.
“You should separate your inner self from your outer condition,” Pat said. “Think of yourself as a normal person responding to an abnormal situation. Your spiritual essence transcends depression and cannot be touched by it or any condition.”
Pat also suggested that I reframe my battle against depression as a heroic struggle.
“When I work with people who have spent their lives battling mental disorders,” Pat said, “I do not see wimps. On the contrary, only strong and courageous individuals could bear and ultimately transform such intense pain. Your brother may work on the 66th floor of an office building in Manhattan, but given your level of pain, just managing to stay functional, is a major achievement. I’m sorry that no one is giving you stock options for your display of courage. But the absence of financial reward does not invalidate the important work you are doing.”
Upon hearing those words, I was reminded of what Christopher Reeve said about this type of heroism shortly after he became paralyzed:
“When the first Superman movie came out, I was frequently asked, ‘What is a hero?’ My answer was that a hero is someone who commits a courageous action without considering the consequences–a soldier who crawls out of a foxhole to drag an injured buddy to safety. I also meant people who are slightly larger than life: Houdini and Lindbergh, John Wayne, JFK and Joe DiMaggio. Now my answer is completely different. I think of a hero as an ordinary individual who finds the strength to persevere and endure in spite of overwhelming obstacles.”
In this sense, every one of us who has ever struggled with crippling depression or anxiety is a hero–and there certainly is no shame in that.
The $20 Bill Story
After the conversation with Pat, I struggled to release the toxic feelings of blame, guilt or shame that I had internalized. Rather than judging myself as “weak,” “sick,” or “defective,” I strove to affirm myself and wholeness. The following story, which was given to me by a member of AA, helped this process.
A well known speaker started off his seminar by holding up a $20 bill. In the room of two hundred he asked, “Who would like this $20 bill?” Hands started going up. He said, “I’m going to give this $20 bill to one of you, but first, let me do this.” He proceeded to crumple the dollar bill up. He then asked, “Who still wants it?” Still, the hands were up in the air. “Well,” he replied, “what if I do this?” He then dropped the bill to the ground and started to grind it into the floor with his shoe. He picked it up, now all crumpled and dirty. “Now who wants it.” Still, the hands went up into the air.
“My friends,” the speaker said, “you have all learned a very valuable lesson. No matter what I did to the money, you still wanted it because it did not decrease in value. It was still worth $20. Many times in life we are dropped, crumpled and ground into the dirt by the decisions we make and the circumstances that come our way. We feel as though we are worthless. But no matter what has happened or what will happen, you will never lose your value.”
“You are special. Don’t ever forget it.”
This story makes it clear that even if we are dealing with mental health issues, there is a basic core of wholeness and goodness that remains our true essence. There is nothing wrong with those who struggle. Indeed, it may be said that our inner conflicts call forth the qualities of courage, patience, determination and perseverance. These are the qualities of the hero and not someone who is flawed or defective.
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Visit Healing From Depression.com for more about overcoming the stigma of depression.
Mad in America hosts blogs by a diverse group of writers. These posts are designed to serve as a public forum for a discussion—broadly speaking—of psychiatry and its treatments. The opinions expressed are the writers’ own.