Time to Talk 2018
The thing with depression is the word is so misused. We all do it, and without thinking about it. And I want to talk about why that matters.
When mental health campaigns talk about depression, I see people think “Well I often feel depressed and I’m alright... why the fuss?”.
The word depression is used in English in many countries to represent a low mood or a bad day. We all have those, days that are overwhelming, intense or leave us feeling fatigued. This is (sadly) normal in life.
Doctors and Mental Health charities use the word depression in a different way though. In medicine and healthcare, “Depression” is a medically defined term with a set of qualifying criteria.
There are a few recognised sets of criteria that are broadly similar. You can see one of these in the World Health Organisation International Classification of Disease version 10 (WHO ICD-10)
Here depression is classified in several entries rather drily titled “F32-F34”.
You can see that depression is clearly defined by a set of symptoms. A bad day wouldn’t count as depression in a medical sense, because it’s time-limited and won’t prevent ongoing difficulties with maintaining the activities of daily living.
And this is why when someone says they are depressed I am both interested as a person (“why are they sad?) and as a doctor (“do they meet diagnostic criteria for a depressive disorder”). A person can have clinically diagnosable depression and also have a depressing day. The words are the same but the meanings are not.
I have talked about my depression before:
Thought Train Express
Time to Talk 2016
I continue to live with this, every day. A few years on, I have tried to take my own advice, and listen to what my body and mind tell me. I rest more, and I try to take more time for things that are important to me. Saying no is hard, but it has made me feel better. It is very hard to explain the sense of dread I wake with most mornings; I wake and wish I hadn’t most days. I am aware that I have an impact on others around me, but I cannot shake the sense that I have little worth in the world. Scientifically, I probably don’t, but it’s more than that. I suppose it’s a strongly self-critical and unforgiving mindset. The sense of guilt for having these feelings in my very privileged life follows this.
I too have bad or depressing days, and thanks to several factors, I now have lots of really good ones too.
Nothing is more irritating though than when someone confuses the two. It’s similar to someone who sometimes has a tickle cough telling someone with severe asthma that they know how it feels, and also how to make it better.
If I’ve just had a bad day, the advice is welcomed. But thinking that depression can be cured by taking a walk, having a pint or giving me a hug helps is liking blowing in the face of an asthma attack to give them more oxygen.
Like asthma, my depression is endured, not cured. And with a combination of lifestyle and medications, I can minimise the exacerbations and carry on with my day ok. But if I neglect the ongoing work, then I’m more likely to slip.
The key thing about mixing the two up is that it devalues my chronic condition and makes it seem “silly”, or worse than that, a personal failing because “everyone has depression”, and I don’t seem to be able to just get over it.
Time to Talk exists as a campaign in order to encourage us to talk about our health in a constructive way. The stigma of mental health has definitely lessened in the last 5 years, and I’m extremely grateful for that. It’s important that we support our friends on their bad (or depressed) days, and also that we recognise the illness of depression as something distinct, though perhaps related, to that.
So if we are going to talk, let’s talk about how we communicate and what that says about us. Language is so important to me, it’s one of my hobbies. I love how different languages have different phrases and terms for things that help sum up their culture.
I like that Slovenian has a system of changing the ends of words to denote single items, a pair of items and a group; as opposed to most languages which define things as either single or plural. The focus on details is part of the Slovenian mentality of taking time to appreciate the results of your efforts. When you can traverse a country and 3 or 4 different geographical biomes in two hours, there is no need to rush.
There has been a more recent trend to lifestyle advice as a way of living more happily. Christmas 2016 was all about Danish “Hygge”, a term not easily translated to English but meaning something along the lines of “a mood of coziness and comfortable conviviality with feelings of wellness and contentment.” It’s developed so much that hygge became a defining characteristic of Danish culture.
The Swedish term “Lagom” was the Christmas trend of 2017, and rather beautiful encapsulates the Swedish virtue of “moderation” and “balance”.
Both Hygge and Lagom have become global trends in so called developed countries perhaps because we as a society are searching for something that makes us happier and content, and we see that in others. So we want to replicate it for ourselves. The trouble is, that these terms aren’t easily translatable for a particular reason... they represent the places where they come from. In the United Kingdom, we are going through an identity crisis that has yet to have arrived at its solution. We have rejected our European-ness in Brexit. We complain about the lack of respect from others whilst tweeting our complaints to companies that serve us. We bemoan the loss of our communities, whilst embracing the convenience of retail parks and instant delivery of items we want. What is our defining characteristic?
I wonder if it can be seen in our stereotype of queue-loving, tea-drinking, stiff upper lips.
We queue because it seems fair, and we drink tea for comfort as it provides us with solace at difficult times, as well as a way of offering your time to someone else. The stiff upper lip is important, we restrict ourselves from discussing our feelings so as not to burden others. This was important in war time, or perhaps when acting as a colonial overlord, when showing feelings might have been risky, but perhaps serves less purpose now.
Who knows? Nevertheless, finding our UK version of Hygge or Lagom is important, because as a nation experiencing increasing mental illness and distress, we perhaps need to look beyond the individual in front of us to the greater societal concerns that contribute to our growing collective unease, dissatisfaction and mental distress.
What shall we do? It’s Time to Talk.
