Mental illness affects all of us, but there are still many myths and misconceptions about these disorders. If people are willing to talk openly about mental health, we can defeat stigma and discrimination against people with mental illnesses.

 ~  Former First Lady Rosalynn Carter

October 10, 2018 marks the 26th anniversary of World Mental Health Day, established by The World Federation for Mental Health (WFMH). This year, the day brings focus to what young people are facing in our world today and the resilience they need in the face of hardship, life changes, discrimination and destruction. We all know the intensity of youth, the adaptations we must make to the multitude of changes within and around us. Add to this the toll of mental illness, and a sobering picture unfolds:

• Suicide is the second leading cause of death among 15–29-year-olds.
• 1 in 5 young people suffer from a mental illness – 20 percent of our population, yet only about 4 percent of the total health care budget is spent on our mental health.
• Every 10 minutes, somewhere in the world, an adolescent girl dies as a result of violence.
• Among nearly 100 transgender youth, ages 12 to 24, 51% reported ever thinking about suicide, while 30% had attempted it at least once in their lives.

Too many people are suffering, with young people and millennials facing an epidemic of mental illness. Lest we forget the people behind those staggering statistics, remember the premise of Sir Austin Bradford Hill, pioneer of the randomized clinical trial:

 Health statistics represent people with the tears wiped off.

Today, the World Health Organization (WHO) estimates that 350 million people worldwide are affected by the illness all around the world. It is the chief cause of disability, and is predicted to be the number one global burden of disease by 2030.  At its worst, depression can lead to suicide, which takes the lives of 800,000 people worldwide each year. In spite of these numbers, and the fact that depression can and does affect anyone, regardless of gender, age, race, ethnicity, or socio-economic status, a stigma still persists around it, because depression remains not quite as “acceptable” as some physical illnesses.  It is certainly not as acceptable as the fairy tale version of early stage breast cancer which  – especially this month – attracts the lion’s share of media attention and most of the research funding.

In fairness, the stigma is certainly not what it once was, with celebrities and royalty speaking openly about their mental health issues as well as increased press coverage of mental illness,  but the fact remains, according to Dr. Jerrold Rosenbaum, psychiatrist-in-chief at Massachusetts General Hospital and professor of psychiatry at Harvard Medical School, that “there is still considerable embarrassment and shame about mental illness, and a desire to hide when an individual suffers psychiatric disorders. Those feelings may not necessarily be coming from the outside. But the individual still feels it.”  Agreeing with him is Dr. Altha J. Stewart, president of the American Psychiatric Association and an associate professor of psychiatry at the University of Tennessee Health Science Center. In spite of our best efforts, she says, many people just don’t want to talk about it:

 There is a stratification by demographics . . . young people feel stigma when trying desperately to feel liked. Minority groups feel stigma because there are differences within cultures about expressing these problems and in willingness to seek treatment.

Why does the stigma persist?  What lurks beneath the surface? We know by now that depression is non-communicable and highly treatable, but it seems there are only certain diseases, disorders, and ailments that are still the subject of “polite” conversation. Unlike the “common cold,” its symptoms unapologetically made public with persistent sniffles, sneezes, loudly blown noses, and a tell-tale trail of balled-up Kleenex in its wake, the “common” depression can sometimes seem more like a secret never to be told.  And that is a crisis we cannot ignore.

In a recent study, The Journal of Abnormal Psychology published its analysis of data collected on nearly 14,000 students from 19 colleges in eight countries — Australia, Belgium, Germany, Mexico, Northern Ireland, South Africa, Spain and the United States. The students answered questions designed to assess their mental health and to identify common disorders, such as major depression, anxiety disorder, and panic disorder. Researchers found that more than one in three  first-year college students around the world struggle with a mental health disorder. One in three.

Given the numerous crises we face – all across the globe – on October 10, it should come as no surprise that depression and other mental health conditions are increasing. Still, we find ways to conceal it – and teenagers do so differently than adults. The WMHD reports the following symptoms as more common in teenagers than in their adult counterparts:

1. Irritable or angry mood. Irritability, rather than sadness, is often the predominant mood in depressed teens. A depressed teenager may be grumpy, hostile, easily frustrated, or prone to angry outbursts.
2. Unexplained aches and pains. Depressed teens frequently complain about physical ailments such as headaches or stomachaches. If a thorough physical exam does not reveal a medical cause, these aches and pains may indicate depression.
3. Extreme sensitivity to criticism. Depressed teens are plagued by feelings of worthlessness, making them extremely vulnerable to criticism, rejection, and failure. This is a particular problem for “over-achievers.”
4. Withdrawing from some, but not all people. While adults tend to isolate themselves when depressed, teenagers usually keep up at least some friendships. However, teens with depression may socialize less than before, pull away from their parents, or start hanging out with a different crowd.

And although there has been a rise in teenage depression in the US, according to a 2016 American Academy of Pediatrics study, there has not been a corresponding increase in treatment for teenagers.  In response, the American Academy of Pediatrics now recommends regular depression screening for all adolescents between ages 11 and 21, given that the symptoms of depression are often missed by adults such as parents, teachers and even doctors.

Back home in Ireland, a study by SilverCloud Health reports similar findings with almost half of young Irish people saying that financial difficulties and money worries contributed to their poor mental health during the country’s financial crisis. Of these, 50 percent have said they did not seek help or mental health support during this time. The  2019 budget allocates an additional €84 million – an increase of 9 percent – for mental health services in Ireland.

There is work to be done, and until we figure it out, people from all walks of life, young and old, will find other ways to cope, to camouflage depression perhaps with the routines and rituals by which other people have always defined us.  So let’s talk about it. Let’s talk about depression and find ways to help leash the black dog.

In the Public Service Announcement, I had a black dog. His name was depression,” writer and illustrator, Matthew Johnstone, and WHO, provide some insight into depression, how to recognize it, confront it, and overcome it.“

In my own life, I have known the black dog of depression too – first, as an adolescent – and again years later, shortly after I was diagnosed with breast cancer, and then again, following the death of my husband, my daughter’s father. I recall slipping into these dark, altered states, in what I can only describe as a deep, gaping despair. Somehow, I found words and a way to talk about it and through it, which brings me to the woman ensnared within the story by Charlotte Perkins Gillman –  The Yellow Wallpaper . . .

 There are things in that paper that nobody knows but me, or ever will.

Like Gillman’s character, I too felt diminished. Diminutive within cancer’s giant complexity. Depressed by it. Altered by it. Often wondering if the woman I used to be had disappeared forever within its labyrinth and willing her to come back.

Why had Charlotte Perkins Gillman written such a story? On World Mental Health Day, it seems fitting to share the story behind the story. In 1913, a century ago, she explained:

Why I Wrote “The Yellow Wallpaper”

Many and many a reader has asked that. When the story first came out, in the New England Magazine about 1891, a Boston physician made protest in The Transcript. Such a story ought not to be written, he said; it was enough to drive anyone mad to read it.

 

Now the story of the story is this:

For many years I suffered from a severe and continuous nervous breakdown tending to melancholia–and beyond. During about the third year of this trouble I went, in devout faith and some faint stir of hope, to a noted specialist in nervous diseases, the best known in the country. This wise man put me to bed and applied the rest cure, to which a still-good physique responded so promptly that he concluded there was nothing much the matter with me, and sent me home with solemn advice to “live as domestic a life as far as possible,” to “have but two hours’ intellectual life a day,” and “never to touch pen, brush, or pencil again” as long as I lived. This was in 1887.

 

I went home and obeyed those directions for some three months, and came so near the borderline of utter mental ruin that I could see over.Then, using the remnants of intelligence that remained, and helped by a wise friend, I cast the noted specialist’s advice to the winds and went to work again–work, the normal life of every human being; work, in which is joy and growth and service, without which one is a pauper and a parasite–ultimately recovering some measure of power.

Being naturally moved to rejoicing by this narrow escape, I wrote The Yellow Wallpaper, with its embellishments and additions, to carry out the ideal (I never had hallucinations or objections to my mural decorations) and sent a copy to the physician who so nearly drove me mad. He never acknowledged it.

The little book is valued by alienists and as a good specimen of one kind of literature. It has, to my knowledge, saved one woman from a similar fate–so terrifying her family that they let her out into normal activity and she recovered.

But the best result is this. Many years later I was told that the great specialist had admitted to friends of his that he had altered his treatment of neurasthenia since reading The Yellow Wallpaper.

 It was not intended to drive people crazy, but to save people from being driven crazy, and it worked.”

Together, we should be able to stomp out the stigma associated with mental illness, shouldn’t we. We should be able to talk about it in ways that will encourage those suffering to talk about it too – without shame or embarrassment – and to treat it with compassion and appropriate care.

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