Depression and Social Stigma

“Social stigma solely on the basis of the ‘madness’ paradigm of mental disorders is inexplicable, and can only be obliterated by an educated posturing which accepts that the brain is a part of the human body, and hence, its malfunctioning is as ‘normal’, or as ‘scary’, as that of any other organ.”

                                                                                         -Shubhrata Prakash

Anyone who suffers from Major Depressive Disorder (MDD) or Major Depression, often faces a double whammy – first struggling with the disability that MDD brings with it, and then trying to shake off the social stigma associated with it. People talk in hushed tones about depression, and often label someone suffering from it as being “mental”. The derision often comes in the guise of “advice”! Or questions like “What are you depressed about?”

Much of the social stigma arises from a lack of knowledge about the real nature of depression. It is a commonly held social belief that depression is sadness, and a person who is depressed is just very, very sad. This belief gets strengthened with the use of the word depression colloquially as a synonym for sadness. “Oh, I missed the movie show today, I am so depressed!” or “This dark room is so depressing!” What people making these statements probably meant to say was, “Oh, I missed the movie show today, I am so very sad!” or “This dark room makes me feel very sad!”

Well, Major Depression IS NOT sadness. It is a brain disorder, and to differentiate it from extreme sadness, it is referred to as Major Depressive Disorder, in the fields of neurosciences and psychiatry. MDD is characterized by a host of psychological AND physical symptoms, only one of which may be a prolonged and all-pervading sense of sadness. Again, the operative words here are “may be”. It is quite possible that a person with MDD may show some classic symptoms like malaise, lack of energy, lack of interest in things previously enjoyed, but may not be overtly sad or tearful.

This brings us back to the social stigma. If MDD is a mood disorder, why is there so much of social stigma around it?

There are no straight answers to this question, but in my experience - which is rich with the thousands of questions and ‘advice’ about my illness, ranging from “Why are you depressed? You have so much going for you in life!” to “What happened to you? What are you depressed about?” to “Oh I faced such and such things in life but I never got depressed? Why you?” – the probable answers fall into two categories.

The Depression-is-Sadness Fallacy

In order to bust the myth that depression is sadness, one needs to look more closely at what is depression, and most importantly, what causes it.

Major Depressive Disorder, or MDD, has been classified as a mood disorder or a type of depressive disorder, characterized by low moods, lack of energy, lack of interest in activities previously enjoyed, excessive sleepiness or insomnia, excessive eating or a loss of appetite, slowing down of movements etc. If these symptoms are present in an individual for two weeks or more, and there is clinical corroboration, the individual may be diagnosed with MDD. Treatment with anti-depressant medication and psychotherapy may follow, depending on the individuals’ condition and the severity of MDD.

As for what causes MDD – well, surprise, surprise – there is no definite cause known till date! The brain is a complex organ, and hence, difficult to study. It carries out physiological functions and is also the seat of all thought and behavior. If the brain is the DVD player, the mind is the screen. The thoughts which originate in the brain in the form of just electrical impulses, are played out in ultra HD on the screen of our conscious mind. Ergo, the brain is not just a part of our anatomy: it is our whole mind.

A brain scan showing that a ‘depressed’ brain is different from a ‘non-depressed’ brain

Image Source: neurosolutions.com

In recent times, the use of functional-MRI and other imaging techniques like PET scans, have greatly aided the functional mapping of the brain, and studies using such imaging have provided much information about what goes on inside the brain of a depressed person. Study after study has found that the brain of a depressed person is significantly different from that of a non-depressed person in terms of structure, chemicals and electrical activity. Changes have been found in the neural pathways in functional areas of the brain, e.g., in the areas relating to reward perception and memory, and in the levels of neurotransmitters like serotonin. Some studies have found the presence of bio-genetic markers for depression. Some studies have found the excess of an inflammation-marking protein in the blood of people with depression.

However, no definitive cause-effect relationship between the conditions found concomitant with MDD and the development of MDD, has been propounded yet. Often, the results of one study overwrite the results of a previous study. At the present level of depression discourse, the larger picture shows that depression is marked by changes in the brain which are most likely triggered by one of the usual suspects - hormones or hormonal changes, vitamin deficiencies, extreme psychological stress (resulting in excess secretion of cortisol, the stress hormone) and exposure to an allergen or toxin; and that one is likely to be genetically programmed to develop depression, for the triggers to affect the onset of depression.

The social belief, however, is that a depressed person is overly sad, and that is so because they are not able to handle whatever trauma there is in their lives. They are ‘weak’ in character, and the ‘strong’ do not get depression. If only MDD was indeed that simple! Another social belief is that some life-changing event brings on the sadness, and thus a person becomes depressed. Neither of the two social beliefs is true. The sadness or low mood prevalent in the course of MDD is not the general sadness that one can overcome. The low moods of MDD are brought about by a rearrangement of the brain’s thought -processes. A sad person is not depressed; a depressed person may be very sad because sadness is what depression brings just like high temperature is what fever brings. Sometimes, a life-changing trauma can trigger a form of depression called PTSD (Post-Traumatic Stress Disorder), but MDD can be triggered by something as simple as a vitamin deficiency!

People who are unaware of the real nature of MDD, do not understand the real disability that MDD brings. Asking a person with MDD to go out and meet people is like asking a person with a broken leg to dance. Not being able to dance is the disability brought about by a broken leg; not being able to socialize is the disability brought about by MDD. In general conversations, the entire cause-effect relationship is understood from the wrong end. A person is not depressed because they don’t socialize; they don’t socialize because they are depressed. As soon as the depression begins to lift, the person begins to socialize again. Just as a mended leg enables a person to dance again.

Depression is NOT weakness of character. The same person who may take one traumatic event in their stride, may trip over another because some unknown or uncontrollable trigger may get activated, e.g., post-pregnancy hormones triggering post-partum depression. Similarly, two persons facing the same trauma may have a different outcome vis-à-vis developing MDD because of their genetic differences, which may predispose one, and not the other, to develop MDD.

The Brain is an organ too!

Sometimes, people who are aware of MDD being a brain disorder, too, fall prey to the taint of social stigma. A malfunction in the liver or even the heart is okay – after all our bodies are machines too – but a malfunction in the brain is ‘madness’! Hence, the social stigma attached to all mental disorders, not just MDD. All I would like to say here is what the Cheshire Cat told Alice, “We are all mad here!” We all have a touch of some degree of neurosis or psychosis. Pulling a padlock to double-check after engaging it is obsessive-compulsive, but which of us hasn’t done that at some point of time?!

Social stigma solely on the basis of the ‘madness’ paradigm of mental disorders is inexplicable, and can only be obliterated by an educated posturing which accepts that the brain is a part of the human body, and hence, its malfunctioning is as ‘normal’, or as ‘scary’, as that of any other organ. A malfunctioning liver causes a lot of stress, but a malfunctioning brain causes a lot of stress, and a lot of gossip! Why?

Then, again, we get carried away with the tattered-rags-matted-hair stereotype. Most persons with MDD are very unlikely to be slobbering examples of this stereotype. And, honestly, the tattered-rags-matted-hair people are the saddest victims of this very social stigma that we are talking about. There is a chance that they belong to families which subsist from day to day, and where taking care of the able-minded is difficult, what to say of the mentally ill. There is also a likelihood that they belong to families which can very well afford to take care of them but turn them onto the streets just to escape the derision from society or ‘Them’ – ‘Them’ as in what will ‘They’ say?!

Image Source: pixabay.com

To Sum Up

Perhaps, there is more playing out behind the obvious as far as social stigma is concerned. Perhaps, the idea of mental illness and the disability it brings is apocalyptic for any human being. What could protect one from falling prey? Maybe some way in which one can differentiate between oneself and the mentally ill? Like conjuring up the whole ‘weakness of character’ and ‘madness’ memes so that one can feel secure in not being ‘weak’ or ‘mad’, and thus being safe from mental illness? Perhaps arrogance arising from ignorance? Who knows – but we could surely do better by educating ourselves about not just MDD but mental illness in general. After all, the mentally ill do deserve to have a safe and well-informed environment in which they can focus on recovery, rather than on protecting themselves from social stigma.

(Shubhrata Prakash is the author of ‘The D Word: A Survivor’s Guide to Depression’; published by Pan Macmillan India, 2016)