Under the dark cloud of depression

In the past few weeks, two fraudulent “psychiatric evaluation” reports of Liberal Party Presidential candidate Benigno “Noynoy” Aquino III have caused a stir in the political arena. The reports were apparently made public to discredit and cast doubts on the capacity of Aquino.

However, the issues go beyond politics and the elections.

These recent events managed to rekindle the stigma associated with seeking professional help for mental conditions. Because of the strong reactions the issue has elicited, people get wrong perceptions about depression. As one who works in the field of psychology and also has seen depression up close, it saddens me to see how Filipinos still have a very backward understanding on mental health issues.

If there is one good thing about all the mudslinging, name-calling, and black propaganda of the 2010 elections, it is that it brings to fore a very important issue that the country has not addressed: caring for one’s mental well-being. According to the Movement for Global Mental Health, statistics shows that even in rich countries, only about five percent of the health budget is allocated for mental health while it is only about one percent in developing countries.

What is depression?

The Diagnostic and Statistical Manual for Mental Disorders – Fourth Edition (DSM – IV) includes depression in its list of mood disorders. This cluster of mental health disorders includes Bipolar Disorder, Cyclothymic Disorder, Dysthymic Disorder, and Major Depressive Disorder. The common thread among these disorders is that they are characterized by disturbances in mood, particularly in the way one experiences feelings and emotions. Essentially, individuals with a mood disorder may have an exaggerated or inappropriate experience of emotions.

Everyone goes through periods of sadness throughout their lifespan. But this may not necessarily qualify them for a diagnosis of depression. The DSM-IV outlines a specific diagnostic criteria which include symptoms such as: abnormal moods that interfere significantly with one’s life and day-to-day functioning; changes in patterns of behaviors such as sleeping and eating; lack of motivation and interest towards things that they used to enjoy; feelings of guilt, worthlessness or “emptiness”; poor concentration or attention; and abnormal thoughts of death and dying, but is not due to physical, medical, or other mental conditions, the use of drugs and alcohol, and normal bereavement.

Depression can be caused by the interaction of genetic, biological, social, and environmental factors that may tax an individual’s resources to cope with the stresses and demands of everyday life. There is no single cause for depression. Rather, it is a combination of various risk factors which can include the following:

Biological make-up and predisposition
Family history
Traumatic or stressful events such as rape, loss of a loved one, or a sudden and/or drastic life change
Personality type
The use of certain medications
Being diagnosed with a serious medical condition such as cancer and HIV/AIDS.
Physical condition and life stage, for example, women undergoing menopause
Poor diet
Age and gender
Season
Lack of social support systems and/or living alone

Myths about Depression

About one in five individuals may experience a major depressive disorder during their lifetime. Half of these people may experience more than one episode of depression.

Given the lack of understanding and information about depression, a lot of misconceptions and myths surround the condition, further ostracizing people with the condition. These perpetuate the stigma of shame felt by the person for experiencing such conditions. Some myths about depression include:

A person with depression is “abnoy” (abnormal) or “ may topak” (crazy). The Psychological Association of the Philippines (PAP) debunks this idea with their official statement on the use, or more succinctly, misuse of psychology by certain groups during this election period. To quote, “the PAP denounces the insinuation that people who see a psychologist or any mental health professional is “abnormal” or “permanently debilitated.” The PAP condemns the insinuation that depression is a permanent disability; and the use of words like “abnoy," “sira ang ulo,” and “may diperensiya sa utak” to label individuals. These irresponsible statements and similar acts perpetuate a profound lack of understanding of psychological concepts, of the nature of psychological problems and dysfunctions, and of the nature of psychological health and wellbeing.”

Only “crazies” need a “shrink.” The term “shrink” to refer to psychiatrists and similar mental health practitioners has been popularized in the media and is often associated with exaggerated descriptions of the process and nature of psychotherapy. In reality, seeking help to ensure one’s mental health and psychological well-being can be seen as a healthy step towards caring for one’s self. The PAP also stressed in their statement that seeing a therapist or any mental health professional does not make a person crazy or abnormal.

Once depressed, forever depressed. Another myth is that there is no treatment for depression; thus it is a lifelong disorder that permanently disables and leaves a person unable to live a “normal” life. This is being insinuated in the case of Aquino. Dr. Caridad H. Tarroja, Ph.D., Clinical Director of PsychConsult, Inc., points out that, while some individuals may be more predisposed to depression, there is a myriad of available interventions for people with depression to help alleviate or relieve symptoms, allowing them to live a healthy and full life. Treatments may include psychopharmacology or anti-depressant medications and various forms of psychotherapy. In an article, Dr. Constantine Della, a psychiatrist affiliated with the University of the Philippines-Philippine General Hospital (UP-PGH) further reiterated that, while recurrences of the symptoms of depression may happen, this can be prevented with continued treatment, understanding and support. With this, a full-blown breakdown or major depressive episode can be avoided. Building up personal resources through journaling or blogging, for example, is also encouraged as part of treatment.

It’s all in the head. Deborah Gray discusses the notion that depression is not a real medical condition in her article. She highlights the fact that clinical depression is a serious medical condition that is supported by research findings indicating differences in the levels of stress hormones and brain scans of people with depression and those without. Furthermore, while others may be able to “snap out” of depression, some cannot. It is not merely a matter or perspective or a state of mind, especially when depression is caused by biological factors.

Depression is a rich man’s disorder. Though there may be cultural influences to the understanding of the notion of “sadness,” the World Health Organization recognizes that depression is a worldwide phenomenon and can affect anyone regardless of race, ethnicity, culture, or socio-economic status. In their estimates, by 2020, depression will trail heart disease as the second largest cause of suffering worldwide. Dr. Joselito Pascual of UP-PGH and the Makati Medical Center said in an interview that, while the Filipino may have a happy, healthy mental frame of mind, they are not exempt from the experience of mental disorders. Actual figures of the disorder, however, may still be difficult to pin down because of the continued stigma surrounding the disorder.

The Experience of Depression

In the television show Grey’s Anatomy, depression was described as a “dark, dark place” where one feels trapped and stuck. Others describe it as a “black curtain of despair.” You feel “off” and there’s something you just can't explain about what you are going through. My personal favorite metaphor for the experience of depression is “dark night of the soul,” as coined by Thomas Moore.

The marked discrepancies of the way depression is perceived in countries such as the United States and in the Philippines can be noted in the way media portrays it. For example, in Grey’s Anatomy, the characters of Meredith, Cristina and Izzie were depicted as being affected by their present mental conditions. They showed a positive perception towards seeking help and going to a therapist. They also showed the importance of working through their issues. In contrast, a local television show features a character battling a mood disorder and is shamed for seeking treatment.

Depression can be a long and painful road. It is often very lonely and debilitating, and it will continue to be so if we do not take concrete steps to demystify the condition by educating ourselves and people around us about the importance of mental wellness.

Photo: “299 Janine's terribly very bad day” by Janine, c/o Flickr. Some Rights Reserved, “284/365: Leaving childhood behind” by Janine, c/o Flickr.

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Maria Andrea (Ria) S. Tirazona, M.S. (cand.), popularly known as Yapatoots in the online blogging and social networking community, is a preschool teacher at Playschool International and part-time lecturer at the Psychology Department of De La Salle University. She is also an Associate Psychologist at PsychConsult, Inc, where she specializes in Psychological Asssessment. She holds a Bachelor's Degree in Family Life and Child Development from the University of the Philippines and is currently working on her thesis for her Master's Degree in Clinical Psychology at the De La Salle University. In her spare time she maintains several blogs, including www.theaccidentalteacher.com and www.yapatoots.com.

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