What We Get Wrong About Depression

What We Get Wrong About Depression

Not just sadness, depression is loneliness and a lack of hope. Depression is a chronic fear of disconnection.

Every time a celebrity’s suicide rattles the chain-fence of our collective conscience, we tend to collapse in waves of grief marked by heavy even if repetitive questions—what made them take such an extreme step? Why didn’t someone intervene? How could this have been prevented? What signs were missed?

In the aftermath of popular actor Sushant Singh Rajput’s death, rumour mills started churning incessantly about the possible causes for his painful departure.

Shameless avarice for ratings even led media outlets towards the unscrupulous circulation of his post-death photos till Mumbai police officially posted a warning about it being unethical and a cybercrime. This was a little hypocritical considering the ease with which folks were sharing photos of migrant workers dying in heinous and traumatizing conditions just weeks before.

Once it became common knowledge that the actor struggled with clinical depression, social media and public conversation erupted in wrangling debates about mental health in general and depression in particular.

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Mental health is a hot-button topic that gets a lot of traction during social media discussions but largely the needle movement for universal on-ground care and normalization has mimicked a turtle’s pace in India.

A really tired turtle at that.

In his book ‘Capitalist Realism: Is there no alternative?’, writer and theorist Mark Fisher wrote about the politicization of memory. How our experiences are renamed and reframed as per a dominant group’s convenience about what they denote.

In an extroversion-friendly world, that dominant group is marked by neurotypicality—those who do not experience significant ongoing emotional and cognitive challenges.

Even those who have elected to work within the field of mental health often ignore or simply do not consider it relevant to understand the frames of reference for how the experience of depression isn’t merely a matter of personal ability or strength.

Living with clinical depression all these years, I can nod in vigorous agreement about how depression has slowly been iron-masked in a suspect privatization where a sufferer is often blamed for their condition and left to repair it solely through permutations of willpower and medicalisation.

This pathway is often subtracted from social, political and economic realities that inflame the existence of mental illness and psychosocial disabilities.

As a practicing psychologist with deep-rooted appreciation and understanding of neuroscience, I don’t aim to discredit the scientific insights we have gained over the years about the biological bases for moods disorders of which clinical depression is a part. However, I also implore practicing mental health professionals to pay heed to Fisher’s appeal:

Mark Fisher, write and theorist“It goes without saying that all mental illnesses are neurologically instantiated, but this says nothing about their causation. If it is true, for instance, that depression is constituted by low serotonin levels, what still needs to be explained is why particular individuals have low levels of serotonin. “

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In 2007 I lost one of my parents to depression.

My father and I were estranged and our fragmented relationship took up a foggy residence in two countries, sparse letters dotting the distance between loci of our slightly embittered hearts. The reason for his passing was filed under ‘indeterminate’ and as I silently placed the phone at my work station after hearing the news, I felt trapped in a storm of rage thinking how his death had been shoved into a margin just as his life had been.

I knew he died of a broken heart and aloneness.

This rage soon turned into a debilitating fear as I imagined how I, a survivor of clinical depression, would map out my own life in the coming years as I battled ongoing breakdowns. All this while I worked nearly 10 hours a day to take care of my home and family.

The first time I muttered something about being caught in waves of inexplicable grief alternated with equally inexplicable apathy to someone, I was more afraid of their response than my own pain. It was after a long period of failed negotiations with the speedily expounding grey-dark inside my head.

I hadn’t yet learned the word for what I was sinking into—a major depressive episode.

I would use names of colours to describe the sharp agony and inertia. I didn’t have a sufficient understanding of what was wrong except that I knew how wrong it felt every hour of the day. I was still in my pre-teens and my childhood up until this point had been a covert war of sorts. My identity was fractured and my mind seemed to be following suit. I wanted a comfortable disappearance.

When I finally marshalled every quailing nerve to tell a teacher about it, the response hit me like a snapped rubber-band— “ You are very brainy. Just don’t think too much. It will go away.” It didn’t go away. It stayed for over 2 decades.

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In her searing essay titled ‘In Defence of De-persons’, genderqueer Korean American contemporary artist, writer, and musician Johanna Hedva outlines what feels like my own periodic disintegration,

Johanna Hedva, genderqueer Korean American contemporary artist, writer, and musician“A mental collapse, for me, is a totalizing inability to function in this world: I cannot speak, understand language, get out of bed, read, write, bathe or feed myself, sleep or wake without medication—and this usually lasts several months. It is that I cannot “be” in any legible way. Instead of being, I barely exist. I swim in jagged visions and washes of feeling. I pass into a territory, or an atmosphere, where language cannot go, and where none—no one person, and also no thoughts, no definitions, no explanations, no language—can follow me.”

Depression is often misconstrued as a form of sadness and the popular advice meted to those who experience it is to find ways to ‘cheer up’.

Not only is this inaccurate, but it is also almost harmful. Alice Miller, a psychoanalyst whose work about parent-child relationships is profoundly compassionate, spoke about how the opposite of depression isn’t happiness but vitality. The etymology of vitality indicates it is rooted in the French word ‘vitalité’ which stands for life force—the capacity to feel, grow and develop.

It is unfair to equate depression with sadness alone because, for a lot of people who go through it, sadness is peripheral to a paralyzing emotional numbness.

Fisher, on the other hand, speaks of the ‘frozen inner life’ which is common to a lot of people who battle to keep their heads above severe and involuntary low moods. There is a pervasive shadow of meaninglessness. Every pain is heightened and every possibility of healing seems so distant, it is a blur. That’s central to my struggle and of those who deal with an affliction similar to mine.

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Depression as Disability

Depression carries a heavy load of the global disability burden with nearly 322 million or 4.4% of the world’s population currently impacted by it. World Health Organization (WHO) states that depression is the leading cause of disability as measured by Years Lived with Disability (YLDs) and the fourth leading contributor to the global burden of disease.

These numbers are in sharp contrast to depression still being perceived as a character flaw or sign of individual deficiency in India.

There is a heartbreaking story that comes to mind when I think of social alienation and lack of empathy for those who are trying to fight alone.

A young client left his antidepressants at my workplace and would detour from his home-to-work commute everyday to take them. He had to do this because he couldn’t bear to tell his family he was on medication without risking ostracism and rebuke. He shared a one-bedroom apartment with five other family members and there was little to no possibility for personal space or privacy of any kind. He was also scared to keep his medication at work in case someone found out about his diagnosis or that he was seeking help. In sessions, he had often detailed how his immediate supervisor ridiculed mental illness as a figment of the imagination and a sign of poor upbringing doubling the pain of my client coming from a minoritized community. His face bore a tortured determination when said to me directly.

“I can either be Muslim or depressed. I can’t afford to be both right now.”

The fact that this person would daily commit to showing up at the clinic and taking his meds because he was that dedicated to getting better contrasted against the feeble social support granted to him. This is the real obstacle in alleviating the distress for those who are trying to stay afloat while depressed.

“Mental disorders are among the leading causes of non-fatal disease burden in India, but a systematic understanding of their prevalence, disease burden, and risk factors is not readily available for each state of India.” This is according to the paper ‘The burden of mental disorders across the states of India: the Global Burden of Disease Study 1990–2017” published in The Lancet.

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This is alarming and cause for serious concern. The report further stated that 1 in 7 Indians is affected by a mental health condition of complex/varying severity.

Another report by the Indian Journal of Psychiatry states that India currently has 0.75 Psychiatrists per 100,000 populations, while the desirable number is anything above 3 Psychiatrists per 100,000. The number is equally abysmal for psychiatric nurses, psychologists, therapists, counsellors and social workers.

This data in itself is questionable because we do not have a reliable model for reporting the number of mental health practitioners actively operating throughout the country. Psychiatric epidemiology in India is often fallible. However, even if we consider this an estimate, it indeed points to a skew in the ratio between those who are in caregiving roles and those who are in need of receiving care related to mental health and psychosocial disabilities.

These facts clearly indicate that clinical depression is a matter of public health and human right as much as it is a matter of mental wellness and behavioural medicine.

There are two terms that tumble to the front of my recollection when we frame depression as as a rights-based issue:

1. Responsibilisation - A flawed individual-centric causation for mental illness and disabilities that makes a person feel terribly lonely in their personal responsibility for shouldering their distress. Little known British psychiatrist, Dr David Smail initiated this term to expose how ruling classes often make the disenfranchised feel blameworthy for suffering caused by unjust and inhospitable living conditions. (E.g. If you are always told that if you just work harder and get a better job, you will no longer be depressed but when you work hard and get to a good university, you are continuously harassed about your gender, caste or religious identity)
2. Precarity - An on-the-edge-of-loss existence that threatens ongoing material and psychological deprivation. No coherent, concrete support when it comes to job security, social safety and acceptance, a general lack of stability. (E.g. A diabetic who works two jobs has to run a gofundme for basic insulin dosage)

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In India where caste, religion and patriarchy work in tandem to subjugate entire populations, it is no surprise that we are often rated as one of the most depressed countries in the world.

Accessibility and affordability for mental health services are irresolute and stagger towards unreliable and often privately held options. We still don’t have well-defined and coherent government-led efforts towards bettering the conditions for psychiatric facilities and organised therapeutic interventions. It is astounding that you can swipe right on a dozen people in a matter of seconds on a dating app but still need to depend on several different google docs for reliable mental health help.

My mother was a single parent and there were days from my childhood where she was ‘distracted’. Now, as a trained therapist, I can decipher how her early divorce from my father, bullying at her University plus her social gaslighting and blackballing at marrying a foreigner and having a kid with him had shot her nerves. Back then, she couldn’t even admit it to herself that she needed help which was worsened by the fact that she was studying psychology. To those whom she interacted with then and now, she was and remains a vibrant and chirpy woman of a hundred funny stories. It was only during some wild fights we had when I was a teen that she blurted her plans of setting up an adoption process for me and walking towards an incoming train when I was a baby, unable to cope with the fact that she had no support system as a poor, post-grad student and new mother.

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Sushant Singh Rajput’s Instagram had hopeful bucket lists and a desire to embark on new and exciting adventures. Just as Anthony Bourdain was actively participating in activism during his last days and seemed as snarky and lucid in his public conversations. This signifies that often there is no overarching turn or something explicitly volcanic on which we would like to pin the calamity. In most cases the threat has been simmering under the surface for a long time.

Depression is loneliness. Depression is lack of hope. Depression is a chronic fear of disconnection and of not being enough even when you have anchors.

To emerge from this means radical compassion on an interpersonal level and betterment of socio-economic conditions across the board.

No matter my expertise as a therapist, I can’t do anything about a client who has been struggling to find a job for months and the looming fear of being homeless hangs over their head like the sword of Damocles. Psychiatric facilities and in-patient programs modeled on a prison like structure will never be right. Catharsis can’t happen when we stigmatize psychiatric medication and therapy. Change occurs when people feel a sense of ease about whoever they are without being reduced to their worst experiences or made insigificant.

When I felt disenchanted from the world, my father would say – Dame tu manos. Vamos a ver. Translation: Give me your hand. We shall see.

I regret I wasn’t around to hold hishand when he needed me.The simplicity of a hand held outwithout questions is the first step. To find more hands along the way is awhole journey.

If we want to keep each other alive and intact, we have to work towards a decentralized and compassionate, community-aided approach towards healing mental and emotional distress. We need to integrate psychiatric options within this framework including medication without pathologizing human beings and their lived experiences.

If you are struggling, know that you have time to figure this out and sometimes this means laying low and letting a big wave pass by instead of wrestling it against your own best interests. Every thought is not a command. Every feeling is not a direction. You are allowed to take time and cobble your own comfort in this world which might have been lacking in mercy towards you.

I close with something that poet Anis Mojgani recited and I hold it close to my heart

“Will it make me something? Will I be something? Am I something?

And the answer comes, already am, always was, and I still have time to be”

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