Overcoming the Stigma of Depression

Douglas Bloch
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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.

* * * * *

Visit Healing From Depression.com for more about overcoming the stigma of depression.

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18 COMMENTS

  1. This is an interesting article to me because there are many things here that speak to my own life experience. I also come from a professional Jewish mid-upper class family–my father was a physician and my brother is a dept head at a highly prestigious research university. He’s the older one, who satisfied the family version of ‘success.’ I was the one who ended up being labeled and temporarily disenfranchised from professional society, which, thankfully, I have long overcome, and have moved on from all of this.

    I have not lived up to family expectations, yet my fulfillment came from personal transformation, and I’m the happiest and most fulfilled one in the bunch. I’m also the one with love in my life, and in my heart.

    At first, I thought they were happy for the all the rigorous healing work I had done, and with which I have succeeded, but turns out that they still have trouble accepting me, and on those rare occasions when I speak to them, there is a still a demeaning quality to their communication to me, sometimes pretty overtly, which had caused me great personal and mental distress for a long time, but, thanks to a lot of spiritual work I have done, especially around detachment, forgiveness, dropping resentment, and personal ownership of my life path, I have learned to accept THEM, and have compassion for where they are in their own personal evolution, despite their judgments (and, perhaps, jealousy? I hate to think and say this, but it’s been suggested to me by my partner and many of my friends). Sadly, these are their demons with which to wrestle, not mine.

    Turning the tables on who accepts whom was pivotal in my healing, and recovering from depression, among other manifestations of stress.

    I had a therapist–back when I was seeing therapists–who suggested that I was depressed because I was not working at that time. Intuitively, rejected that notion, but I was happy he said this to me, because it led me to realize that my distress was caused by feeling that I was not living up to others’ expectations. The solution to this was not at all to aim for living up to anyone’s expectations, but, in reality, to forget about what anyone else expected from me, and to focus on what it was I most desired, which is what has defined my life path. That brought me not only mental health and grounding, but also a kind of magical synchronicity that I continue to enjoy to this day.

    For me, healing depression was about defining my own path in life, and rejecting altogether anything that a judgmental and inherently stigmatizing society projects.

  2. D. B., Your honesty probably affected your colleague as much as any bias she already had about getting down in the dumps.

    (I have pretty much put depression behind me during the last ten years after recurring bouts due to PTSD and alienation in terms of stigma and the official stance on compliance that fuels it. But it didn’t seem like I would succeed at the time.)

    Similarly, my coping strategy currently includes collecting disability, because when I have episodes that involve re-experiencing, fragmented memories, emotional instability, although I have previously worked a job and muddled through, the benefit of enduring the process carried mostly a downside. Without work I can take time to tell myself encouraging truths and remind myself that it’s a bad time to try to think over some deep problem. If my condition eases up, I can invest in learning about my problems overall, etc.

    I hope that you can look forward to putting your episodes in perspective with the stories you share and that your future possibility involves believing in the remittance of your symptoms at least some times. Even if you only believe that things can fully improve for you now and then or in a tentative vain, in that state you will get a different variety of ideas for breaking the tedium of uninspiring thoughts.

    Your therapist sounds a cut above most, by the way. I think you are totally on the right track in tackling the problem of living with depression by getting in touch with your heroic dimension.

  3. Hi, Doug!

    Thanks for sharing your story. Reading the article made me wonder: do you believe your feelings of depression are in any way related to your parents’ rigid expectations about what you should become as an adult?

    I have often struggled with depression and anxiety in my life, and much of it I attribute to being expected to “fit in” to a world that I didn’t ever really feel comfortable in, both at home and especially in school. I am very smart and very emotionally sensitive, and I think saw a lot of hypocrisy around me but had no way to process it, which led me to feel very isolated and alone, and unsafe letting anyone know what I was thinking or feeling.

    Healing for me has meant (much like Alex said) learning to just be me and stop worrying about what others thought of my behavior. I may be regarded as odd by some, but I live with integrity and have a lot in my life that others wish they had. And I’ve learned to speak my mind when it is needed, even if others may find what I say uncomfortable. I still find the world depressing as hell at times, but I have come to believe that my feelings are a very reasonable reaction to a very dysfunctional society. Does that resonate with you in any way?

    —- Steve

      • Glad to hear this, Sally. It’s why I feel that sharing our stories is so vital to healing, as a society.

        Steve, just for clarification, my behavior was never in question. No one in my personal life ever considered me weird or “inappropriate.” It was my life choices and personal perspectives that were met with judgment, and for which others–both, strangers that don’t know anything about me, and also certain family members–tried to demean me and make me feel shame. I don’t take it on, however, as I know this is about their shame for something or other, and really has nothing at all to do with me. As I’m sure you know, that’s what is called ‘scapegoating,’ which I would like to see stop happening, as it is such an unhealthy and toxic dynamic, based purely on lack of self-responsibility. So I call it out.

        • Oh yeah, and in the mental health world, as well–as student, clinician, and client. Which is why I eventually defected from the field and said, “Watch my dust!”

          When I think about how much $$ I spent trustingly to be subtly and covertly demeaned, grrrrrrr. In the system, of course, it was much more blatant, but we are, somehow, so strangely made to feel we have no choices when we are part of that corporation. I guess that’s why most of us are here, mad as hell, or at the very least, terribly confused.

        • Scapegoating was indeed the proper word for it. I was the family scapegoat for years, until I got really sick and had another sibling born, at which point, my next younger brother got the job. I was less of a scapegoat in school, but I just hated being forced to be there and do everything the teacher said, as well as being forced to spend time with kids I didn’t really have much in common with. I have read that this is a very common experience for kids with higher IQs who are forced to hang around only with kids their own age. They tend to get along better with kids older or younger than themselves. This was very true for two of my three boys as well.

          I think people feel uncomfortable with me or find me “odd” mostly because I am quite honest about what I’m seeing when people ask me (and sometimes when they don’t), and I don’t play a lot of games. I’ve never been very good at disguising my feelings, though I am quite diplomatic in expressing them. People who are suffering find me very agreeable to talk with, but people who want to maintain their “bubble” of ignorance or their entitlement to freely bully and humiliate others don’t enjoy my company quite as much. I used to get down on myself for being unable to “fit in” to certain social circles that were considered “cool.” I now consider such people as mostly a mixture of dull, anxious, and evil, and don’t bother with them any more. My own way of dealing with judgment, I suppose, but I guess hypocrisy was more my button. I have a hard time being in the room with hypocrisy without commenting. Which makes me very unpopular among hypocrites!

          —- Steve

          • I can so relate to what you say, here, Steve. Hypocrites keep me at arm’s length, as well, and I have the same picture of people in general that you do, which can feel maddening at times.

            Although, interestingly, I was a popular teenager and I was also a popular retail manager as a young adult, highly respected by my bosses and by my staff. I was kind of naïve about things, but I had good intuition, and knew how to navigate a culture.

            I was fine in graduate school, too, where I did my MFT training, although this is where the division started happening. I was in a psycho-spiritually based counseling program that was experiential in nature, so we were supposed to talk openly about our issues, as part of our education. I had lived with a diagnosis for a long time and was on meds, although it had never disabled me up to that point. I didn’t know about stigma or any such thing, as I had never experienced this before.

            But in grad school, suddenly, some of my would-be psychotherapist classmates and this one professor couldn’t at all handle it. One colleague called me up during my second semester and literally screamed into the phone, “Stop talking about your mental illness, you’re making people feel uncomfortable!” How would you like to have her for a therapist?!

            And the professor went to my advisor because he wanted me thrown out of school. I saved myself from that fate, however. I was a straight A student and one of the top trainees, given that I had the highest rate of referrals and the largest caseload that this counseling center had ever seen. He was the first one who had ever said to me, “You don’t belong here,” but he was in the minority, as most of the faculty and students regarded me highly. He had something up his rump, but like I say above, it had nothing to do with me.

            Although at that time, I wasn’t so inured, so it was devastating to me, and I processed it all during grad school, and beyond. I call it the beginning of my dark night.

            I was later told a few years later by a voc rehab counselor that I “didn’t fit in,” which ended up costing her big time at a legal mediation.

            I was in my 40s at the time, and had never experienced this kind of marginalization, and it was rough for me. Not only did it cause me tremendous mental distress and a suddenly horrible self-perception, but it also blocked me from working in the field, where I was trained. Big mess for me, and the first time I had ever felt disenfranchised in any way.

            I found my way to doing theater as I as exited the system (that’s another long story, how that occurred, it was a bit of a miracle), and became a popular Bay Area actor, so I felt back in my game, and I was healing from all that stigma and marginalization.

            Then, I joined a speakers’ bureau with an advocacy agency to speak publically about my healing and to talk about how devastating the stigma had been to my life and health, and suddenly, I was back to being considered second class, even though I had been working as an actor, and I also had my healing practice. They just couldn’t help it, the stigma was just automatic, no rhyme or reason.

            It was only in the mental health world that I’ve been told that I don’t ‘fit in,’ and they made sure I felt it. It is a deeply entrenched internalized program, and so incredibly damaging to the heart, mind, and spirit.

            While in society as a whole, I was perfectly in the flow, and, in fact, revered, regardless of whether I was sick or well, on meds or not, anywhere in the mental health world, including professional ‘advocacy,’ because I had a psychiatric history at all, even after it was all behind me, I was considered marginal and, basically, dismissed and not worthy or general human respect.

            So guess where I don’t hang out any longer?

            Oy, what a crazy world!

          • How very bizarre! It sounds like you were a tremendously successful counselor, precisely because you were in touch with your emotions and didn’t judge or stigmatize those coming to talk with you. It sounds like the hypocrites could not tolerate the idea that a person could both be a recipient and provider of counseling or other mental health services. Which is a bizarre position to take, but also a common one, because so much of what passes for “mental health treatment” is about creating an “us vs. them” mentality where we are able to distance ourselves from the “mentally ill” whom we supposedly are helping but whom we secretly or not-so-secretly believe to be beneath us. Of course, you NOT doing that is what made you successful. But if that was true, then it meant they were all doing it wrong and they might be no different from their clients and their own issues might be affecting their counseling success! Egads! That can’t be allowed! So you had to carry all the pain they were denying and be judged wanting because you had the courage to be a genuine human being.

            Disgusting!!! And what a waste for the profession. You’re the kind of person we NEED as a counselor. The rest of them need to get some counseling themselves.

            Thanks for sharing – while our personalities are different, it appears our values are very similar!

            —- Steve

          • Bulls eye! Absolutely brilliant mirroring, Steve. And thank you so much for your very kind words. I’ve always noticed on here how so very astutely you read others, and I do pick up that your heart is very kind. I imagine you do excellent work, as well. When I read your post, I thought…hmmm, kind of sounds like we may have been separated at birth. Lol.

            I just read this exchange to my partner, and he said, “Wow, I’ve never heard anyone get it like that.” Yes, I went through the looking glass (as I say in my film). What you say is precisely why I made the film. This cannot go on.

            Voices That Heal also got a review on Spirit Enlightened film festival website this morning, that I posted onto my own website a few hours ago, that very much speaks to what you say, here. It was made by a clinical therapist. More magical synchronicity. Check it out:

            http://www.embodycalm.com/Film–Voices-That-Heal.html

            Well, I’ve established myself as a spiritual counselor and teacher now, and my work seems to be good, I have very affirming testimonials. So their loss is my good fortune, and all is well.

            Thank you for this beautiful and heartfelt dialogue, Steve. Made my week 🙂