There are two kinds of stigma when it comes to mental illness. There is the public stigma, which is the negative reaction of the general public to people with mental health issues, and there is self-stigma: the shame, disapproval and disgrace that people with a condition feel towards themselves for having that condition.
A great deal of mental health stigma is born out of stereotypes and misconceptions. The stigma is ugly because it adds an unnecessary layer of suffering to an already agonising problem. The shame of suffering from depression can exacerbate the condition, since shame may already be a core aspect of it. Mental health stigma is also a significant barrier to both opening up and seeking help, which is counter-productive at best (since talking is an effective remedy) and life-threatening at worst.
Mental health stigma will persist so long as misconceptions about mental illness are maintained and perpetuated. Helping people to develop compassion towards themselves, and allowing one’s social circle and the wider public to do the same, begins with debunking these commonly held misconceptions.
Depression is Not Sadness
Low mood does characterise depression but in a way very distinct from what normal low mood is like. Everyone will feel low and sad at different times, but in a healthy and non-disruptive way, and in proportional response to normal life events. Undoubtedly, a break-up is going to make you feel low.
General low mood will improve as one’s circumstances improve. The same cannot be said of depression. The ‘low mood’ which is a part of depression (which is a more intense and painful kind of sadness) tends to last longer and is more likely to interfere with everyday life, such as school, work, relationships, sleeping, eating, sex and the ability to gain pleasure from what was previously enjoyable (the term for this is anhedonia). This prolonged low mood can be an extreme reaction to normal stressful events or it can arise completely unrelated to one’s circumstances.
One reason that the misconception arises is because depression has two meanings: the everyday meaning of feeling low, when people say, ‘I’m feeling a bit depressed’; and the clinical definition, which includes symptoms such as a lack of motivation and energy, anhedonia, hopelessness, irritability, emptiness, tiredness and low mood that is severe, frequent and debilitating.
Anxiety is Not Worry
Similar to misconceptions about depression, worry does characterise anxiety, but in a very specific sense. Again, it is normal to feel worried in situations which we all know elicit worry, such as a job interview. So there is the everyday meaning of worry, when people say, ‘I’m feeling a bit anxious’; and then there’s a condition such as generalised anxiety disorder (GAD), where worry is more intense, excessive, out-of-control, constant, out of proportion to daily events, and disruptive of normal functioning. Other symptoms of GAD can include restlessness, irritability, difficulty sleeping, trouble concentrating, dizziness and heart palpitations.
Anxiety in the clinical sense can be severe. The author Andrew Solomon, who wrote about his experience of depression – and depression in general – in his book The Noonday Demon also suffered from anxiety. He said:
There is a moment, if you trip or slip, before your hand shoots out to break your fall, when you feel the earth rushing up at you and you cannot help yourself, a passing, fraction-of-a second terror. I felt that way hour after hour. Being anxious at this extreme level is bizarre. You feel all the time that you want to do something, that there’s a physical need of impossible urgency and discomfort for which there is no relief, as though you were constantly vomiting from your stomach but had no mouth.
For him, the depression was something that he could endure, but not the anxiety. Elsewhere, he remarked:
If someone told me I had to be depressed for the next month, I would say that as long as I knew it was temporary, I could do it. But if someone told me I had to have acute anxiety for the next month, I would kill myself, because every second of it is intolerably awful. It is the constant feeling of being terrified and not knowing what you’re afraid of.
During his first depressive episode, he said that the anxiety lasted for 6 months, describing this phase of the episode as “incredibly paralyzing”.
Suicide is Not a Cowardly Escape From Life
Suicide isn’t easy to understand or come to terms with. It is an act which wreaks havoc on the lives of loved ones, who may never get over the acute sense of loss. While the pain of the suicide victim may disappear as they wished, their departure from life creates unimaginable suffering for others. This is why suicide is often described as selfish. And because it is so misunderstood, suicide (or a suicide attempt) is often seen as cowardly.
But these misconceptions – although understandable – result from a lack of understanding about why people with severe depression, bipolar disorder, schizophrenia and borderline personality disorder are at higher risk of suicide. This is not in any way to justify suicide, to say that even a hellish level of mental suffering warrants an end to one’s life and the misery caused to others. There is always help, the possibility of improvement and meaning to be found in suffering. Psychiatrist Viktor Frankl said that even in the Nazi concentration camps, the motivation to go on living came from being able to choose one’s attitude towards extreme suffering.
It is crucial, however, to take seriously the inner torture of mental illness and appreciate how this kind of intense and constant pain can become intolerable. In severe cases, suicidal thoughts become so engulfing, demanding and convincing that taking one’s own life will seem like the only option. The author David Foster Wallace (who himself died by suicide) wrote a powerful and pertinent description of suicide in his novel Infinite Jest:
The so-called ‘psychotically depressed’ person who tries to kill herself doesn’t do so out of quote ‘hopelessness’ or any abstract conviction that life’s assets and debits do not square. And surely not because death seems suddenly appealing. The person in whom Its invisible agony reaches a certain unendurable level will kill herself the same way a trapped person will eventually jump from the window of a burning high-rise. Make no mistake about people who leap from burning windows. Their terror of falling from a great height is still just as great as it would be for you or me standing speculatively at the same window just checking out the view; i.e. the fear of falling remains a constant. The variable here is the other terror, the fire’s flames: when the flames get close enough, falling to death becomes the slightly less terrible of two terrors. It’s not desiring the fall; it’s terror of the flames. And yet nobody down on the sidewalk, looking up and yelling ‘Don’t!’ and ‘Hang on!’, can understand the jump. Not really. You’d have to have personally been trapped and felt flames to really understand a terror way beyond falling.
You can only truly understand the torment of something like severe depression and anxiety by experiencing it first-hand. Nonetheless, sweeping away the misconceptions and allowing people to speak freely and honestly will allow more people to gain insight into this kind of suffering. Efforts to understand and trust people who suffer from mental health issues can be a vital source of empathy, which is therapeutic in its essence.