Major Depressive Disorder

A Question of Dignity


By Louise from her own experience with depression
Written for Internet Mental Health
June 1998

During an episode of depression accompanied by anxiety, I shared aspects of my illness with a large number of people. In retrospect, now that the depression is lifting, I realize that this was a grave mistake, at least in light of the way our society functions. Or perhaps I should qualify that statement. It has proven to have been a mistake with some people. What has occurred?

When I was deeply depressed, I noticed that some friends departed. I understand now that they could not cope with depression and withdrew. In a few cases the rejection was rude and cruel and those who had seemed to be friends were found not to be so. Other friends stayed and steadily offered their help.

When the depression began to lift, I noticed a phenomenon that all those with some form of mental illness must suffer. The friends who had withdrawn and other individuals who knew that I had been depressed now treated me in a different way.

  1. In some cases I became a “second class citizen.” I could be treated with a briskness and dismissive air that had never been present before. I could be rudely dismissed and ignored on special occasions. My presence was clearly thought to be potentially threatening. Perhaps I wouldn't be happy enough or would introduce inappropriate topics. I had laid bare my weakness and other were not about to forget it. These people, like all human beings, probably thought that they were doing the right thing. They were saving others from my presence. They also probably thought that they were treating me as my merits deserved. I had permanently lost the respect and consideration that I had once received.
  2. From others I received different treatment. As I felt better, these people felt it was now time to inform me of all the ways in which I should improve. Their intention was clearly kind and generous. They did not want me to grow depressed again. They would mention area after area in which I should change. On the one hand, I was grateful that someone cared enough to make these suggestions. On the other hand, I felt in a way that I had become “fair game” for others to criticize because I had been depressed. The suggestions to change would seem quite appropriate if the depression derived:
    1. specifically from my behavior or attitude to life
    2. from my childhood and upbringing
    3. from my relationships with others
    4. from my inability to cope with life's challenges.

Perhaps some of these things are factors in depression but the actual cause of this illness has not been clarified. Its nature is attended by a chemical imbalance in the brain which can be positively affected by anti-depressants.

Copious advice given to the depressed person can prove detrimental to recovery. The person cannot change the past nor childhood upbringing. The person could make changes in current behavior but whether this behavior should be the center of focus during the recovery from depression is questionable. The person who encounters another giving abundant advice cannot help but feel a loss of dignity and respect. And yet the person advising expects gratitude for the trouble taken and the wisdom offered.

The person recovering from depression is vulnerable. The last thing that is desired is a return of the depression. When advice is given, this person has to consider: what should I do? Should I make these changes? Should I take up that activity or establish that relationship? One is afraid to act and not to act. What if the advice is incorrect? What if these new activities are counter-productive? Advice is often given in a confident and assertive manner which the person recovering from depression does not have. This air makes the advice seem correct but it may involve suggestions that the advised person cannot implement.

What would be best? The person recovering from depression needs quiet support. “You are getting better! How wonderful!” When the depressed person expresses very real fears that the illness will recur, words of encouragement are best. “Don't think of the dark times any more. Be confident. Trust that you will be well.” Only when the person has been well for many months is advice appropriately offered and then, only if requested.

It is no wonder that people conceal serious illnesses, whether cancer, heart disease, or mental illness. Once exposed, these illnesses prove to be unforgettable to others. People never walk with the same dignity again. Their weakness has been exposed and it is this that others always observe. To some this weakness justifies treatment that shows no respect to the person as a human being. Somehow the person is seen to be responsible for the weakness and therefore appropriately blamed. The person has lost the right to be treated with honor. This honor is accorded only to those who are strong, healthy, and successful. To others the weakness calls forth much advice to change. The weakness must become strength again and only then will the person be treated as someone deserving respect. If illness happens to be an episode that happily comes to an end, even then it is never allowed to be forgotten. If signs of mental illness return, for example, instantly the person is accused of not taking the advice that was given long ago and being essentially responsible for the current condition.

How much we need to understand the road that any suffering person walks. If we do not walk that way, how grateful our hearts should be and how full of compassion for the other. Human nature is too fragile and frail for anyone to presume on continued strength. With a mind that perceives that any suffering could be ours, let us hold out a helping hand to all. Let us place ourselves ever beside, never above another, for one day it may be we who have to take the lowest place.

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