Molly (9) visits her mother, Sally, at the psychiatric ward. Sally suffers from severe depression. The next day Molly shares her experience with her classmates. They say to her, “Not to be so stupid, that you [Molly tells her mom] did not go to the hospital with depression. They said all their mummies get depressed.” (Told by Sally Brampton, who lost her struggle with depression by walking into the sea on May 10, 2016, in her bestseller “Shoot the Damn Dog”).
When depression becomes a shared condition at cocktail parties, we rob those depressed of their pain. It is distressing enough to endure mental illness to witness how society appropriates your diagnosis to define its discomforts.
The equation of sadness with depression entails an insensitive pain burglary. Behind what may first seem empathic by popularizing stigmatizing labels lies the delegitimization of a person’s struggle. We must not dilute unbearable pain in a sea of superficial normalization. The pain of mental illness would be rendered invisible if depression and anxiety materialized at the first signs of life’s troubles. As Lucy Foulkes writes in her recent and excellent “Losing Our Minds:” “Most obviously, the expansion of mental illness terminology undermines the experience of the people who are most seriously ill…in a context where everyone is depressed, how do they [the seriously ill] get their voice heard?”
The Covid Deception
The pandemic engendered a deceiving depression epidemic. I first noticed the phenomenon while watching a news report on the “depression” of closed pubs. This depression extended to pool parties, birthdays, or visiting friends. Covid opened a tiny window into what the mentally ill confront. But now that you have experienced depression and anxiety from a distance, you must understand what actual illness is and is not. You must battle stigma because you have been at the tip of the iceberg and can barely imagine the pain below the surface.
It is Dangerous to Be Sad
The confusion between mental illness and usual pain is now official. The prior Bible of mental illness diagnosis, the DSM-IV, instructed clinicians not to diagnose depression if a person has recently suffered a bereavement. It made sense; you lost a loved one and felt deeply sad. But this definition changed with the new edition of DSM V. In this version, the “bereavement exclusion’ was removed. Now, if somebody experiences depression symptoms following bereavement for up to two weeks, they can be diagnosed with depression. Then, a warning! Be aware that if you have insomnia after losing a loved one and cry frequently, you may be diagnosed with a mental illness. Grief and mental illness are now barely separated by 14 days. Sadness in the face of profound loss could become a pathology. Academics Chris Dowrick and Allen Francis describe this change as a “medical intrusion into private emotions.” True, bereavement can undoubtedly trigger depression. But let the usual pain of loss linger independently of illness as much as possible. Once we codify bereavement as pathology, we will make it appear more and more out of its conceptual magic hat. We must be vigilant not to let the depressed fall through the cracks of mental illness. But we should not widen those cracks so much as to make many sad individuals fall into a diagnosis. We must diagnose without creating mental illness.
Your Right to Sadness. My Right to Depression
I ask you, shouldn’t you have the chance to be sad without being sick? Shouldn’t you be allowed to dwell in life’s inherent uncertainties and feel uncomfortable without a diagnosis? At the risk of being politically incorrect, we need more toughness. We must develop more inner-strength resources. Or, more compassionately, we need to give each other more permission to be human.
You Are Not Welcome
May is Mental Health Awareness Month, and you are not welcome. Not because we don’t want you or need you. But awareness must entail a solemn respect for our struggle. And that awareness sometimes requires a discrete distance, a silent witnessing. It is paradoxical. From one perspective, we want to end stigma by normalizing mental illness. But from the opposite angle, we must protect illness from banalization. That’s a challenging balance.