Stigma Busting and the Broken Leg: Clinical Depression also called Major Depressive Disorder, is a serious, and very VALID medical illness. It can be acute (one episode lasting a few weeks) or more often chronic (numerous episodes over the span of many years, waxing and waning). For this post, I am referring to Chronic Clinical Depression and is for those of you who have suffered from Postpartum depression, chronic depressive episodes over the years, or have loved ones who suffer from Chronic Clinical Depression.

Society still stigmatizes mental illness and as a Maui Psychologist, I am determined to make a dent in reducing the stigma for our community members who suffer from this very common, but often misunderstood illness. Depressed patients often have trouble getting through day to day tasks, sleeping, having any energy at all, and especially concentrating. Depression encompasses emotional, physical, and cognitive symptoms that can be debilitating if left untreated, even lethal. Suicide is just as lethal as heart attack, but no one blames or shames the cardiac patient like the mentally ill patient. But it is NOT the patients fault! It IS the patient’s responsibility to seek help and work towards recovery. All too often I hear my patients say things like “I should just be able to snap out of it,” or “I have no reason to feel this way.” Yes you do! It’s called Major Depressive Disorder, a MEDICAL illness just like any other. If you had Diabetes (a chronic medical illness due to lack of insulin produced by your pancreas), would you shame and blame your pancreas for insulin dysfunction? Even if you had a good diet, exercised, and took your Diabetes medications or insulin as prescribed by your physician but had a blood sugar spike or an elevated Hemoglobin A1C on your latest lab work, would you say “Just snap out of it you darn Pancreas?” or “Pick  yourself up by your pancreatic boot straps!” No!

I use this example a lot with my patients: The world expects people who suffer from Clinical Depression to run a marathon on a broken leg. Ridiculous right? Well, think about it…if you were a marathon runner and break your leg your told, stay off of it! I’ll carry you to the car! You need to go to the hospital where they take an X-ray, put up the picture and shine a bright light underneath it while your doctor says sympathetically “Well of course you are in pain, look…it’s broken here and here.” You are ordered to stay off your leg, given crutches, a solid cast is put on, and then all your friends and ohana sign it with well wishes with pretty hearts and flowers. “Get well soon!” You go back in for follow up, get another X-ray, and see with your own eyes that the break has healed, the cast comes off and now you are in an orthopedic boot, instructed to slowly start using your leg. You get lots of physical therapy to rebuild your range of motion and strength, but everyone still says empathetically “Take it easy, you broke your leg, it needs time to heal.” Over time, you heal up and can walk, then jog, and then maybe sometime down the line you can run a marathon again. Nobody says to the marathon runner, “What’s wrong with you? You JUST broke your leg, stop pitying yourself and get up and run already.”

This is what I think the world does to patients with Depression and is the result of societal stigma of mental illness. Depressed patients are told, “just get up” or “why can’t you snap out of it?!” Depression sufferers are treated by the world as if they should run a marathon on a broken leg.

Not in my office! We have much more challenging work to do. We take an X-ray with our words, with empathy and understanding of what feels broken in the mind; exploring the patient’s story of suffering or chronic negative belief patterns about themselves that may have been broken for awhile. We conceptualize if there is a biochemical basis with thorough assessment and history taking. We start to understand that your leg is broken, it is not your fault, but we need to start treating it, slowly learning how to walk again, changing negative core beliefs, healing traumas, and providing the support and therapy to rebuild your strength. Next time you are faced with someone who suffers from severe depression, imagine their leg is broken and they are trying their best to walk again.