This is an edited repost of something I wrote nearly three years ago. You can see the original post and comments here.
Over at Dr. Isis’s blog, there’s a post answering a reader’s question about whether to tell her postdoc advisor about her troubles with clinical depression. I agree with Isis’s advice – without knowing the advisor really well, you can’t be sure of how they’ll react. If the postdoc had become ill due to something like a diabetic episode, where the change in schedule and environment caused by taking a new job messed up the PDs control of their blood sugar – well, there wouldn’t be an issue. The PD would be able tell their advisor they had a medical issue without worrying too much about repercussions. But mental illness is different: the fact is that there is a very strong stigma attached to mental illness, which makes it different from other illnesses.
This is something that’s very important to me. I have people very close to me who have dealt with profound mental illness, and I’ve seen them suffer from the effects of the stigma associated with it. And I am mentally ill myself: I have clinical depression.
Clinical depression is a thoroughly miserable illness. I’m incredibly lucky to live at a time when there are effective treatments for depression. I’m even luckier that I’m one of the people for whom medication is, essentially, a cure. I just to take a pill every morning, and it’s almost like I never had depression at all. But if I stop taking my medication, after a couple of months, it will return – and there’s nothing that I can do to stop it.
The point of writing this isn’t to tell the world that I’ve got clinical depression, or to say “Gosh I like my drugs”. The reason that I’m writing this is to talk about the stigma, and how foolish and hypocritical it is. I get to see it on a fairly regular basis, by seeing how people react when they hear that I take antidepressants. I don’t make any effort to keep it secret – I’m very open about the fact that I’ve got a depressive disorder. And when people find out, for a large number of people, the fact that my brain has a problem that’s easy to fix using medication is somehow considered to be a huge strike against me, an inexcusable sign of personal weakness.
I’ve got a somewhat unusual perspective on this, because, frankly, I’m not the healthiest specimen of humanity. I take several different medications every day – for allergies, for gastrointestinal troubles, and for depression.
For me, the hypocrisy of the stigma against mental illness is easy to demonstrate using my gastrointestinal troubles. I’ve got serious stomach problems. It’s not actually something with a simple name; basically, it’s classic reflux disorder, but combined with an extremely irritable stomach which triggers extremely painful muscular spasms. Those two together are a bad combination: the spasms behave almost like a pump, spraying acid up my esophagus. (Which is exactly as much fun as it sounds.) Anti-acid medications didn’t work well enough, so in order to treat this, I needed surgery. The surgery mostly cured the reflux, but it had other effects. Post-surgery, I now get espohageal spasms, which are excruciating; according to people who’ve experienced both, they feel very much like having a heart attack. The difference is that they are more or less continuous for weeks at a time.
To treat this, I take three different drugs. One is quite expensive; about $6/day. The other two are cheap, but both have unpleasant side effects, and one of them is addictive (it contains a benzodiazapine).
For my stomach problems, if I didn’t take my drugs, the main thing that would happen would be that it would hurt. It wouldn’t be life threatening or dangerous. It would just be painful. (I might have some short term withdrawal symptoms from the addictive ones, but that’s supposedly very unlikely.)
How many people have heard about my stomach problems? A lot of people. I need to take the drugs three times a day, so people see me popping pills. And the spasms can create some peculiar symptoms that are visible to other people. Out of the dozens of people who’ve heard about my stomach problem, and know about the drugs I take for it, how many have lectured me about how I shouldn’t take those nasty drugs? Zero. No one has ever even made a comment about how I shouldn’t be taking medications for something that’s just uncomfortable. Even knowing that some of the stuff I take for it is addictive, no one, not one single person has ever told me that I didn’t need my medication. No one would even consider it.
But depression? It’s a very different story.
What happens if I don’t take my medication? I turn into a zombie. Everything turns flat, it seems almost as if things lose their color, like all the colors fade. I feel like my body weighs so much that I can’t even hold my shoulders up. I become lethargic – I can’t get myself to do anything. I don’t feel sad; I feel nothing. Empty, blank, flat. Great things can happen, but they don’t make me happy. Awful things can happen, but they don’t make me sad.
What happens when I take my medication? I’m myself again. The medication doesn’t make me feel happy; it makes me feel. With the medication, my emotions come back; I can feel happy or sad. I enjoy it when things are going well; I get sad or angry when they go poorly.
But how do people react?
Somewhat over 1/2 of the people who hear that I take an antidepressant express disapproval in some way. Around 1/3 make snide comments about “happy pills” and lecture me about how only weak-willed nebbishes who can’t deal with reality need psychiatric medication.
I confess to being thoroughly mystified by this. Why is it OK for my stomach, or my heart, or my pancreas to be ill in a way that needs to be treated with medication, but it’s not OK for my brain? Why are illnesses that originate in this one organ so different from all others, so that so many people believe that nothing can possibly go wrong with it? That there are absolutely no problems with the brain that can possibly be treated by medication?
Why is it OK for me to take expensive, addictive drugs for a painful but non-life-threatening problem with my stomach; but totally unacceptable for me to take cheap harmless drugs for a painful but non-threatening problem with my brain?
Stigma. The foolish notion that mental illness isn’t really an illness. Mental illness isn’t considered a legitimate, real illness by most people. It’s treated as a personal weakness masquerading as a genuine illness. And so people like the postdoc who wrote to Dr. Isis are caught in a vicious trap. They’re really ill, and that illness does affect their work, just like any other real illness. But they’re unable to actually talk about it. It’s better for an unknown advisor to believe that you were lazy for your first few months on your job, than to risk telling them that you’ve got depression. That’s truly reprehensible.