Restarting the National Conversation About Depression: A New Anti-Stigma Campaign

Our national conversation about depression for the last twenty years has been on hold, largely reduced to a narrow dialogue about the promise and peril of antidepressants: “To Prozac, or not to Prozac?”  Peter Kramer’s Listening to Prozac raised expectations that antidepressants would soon make depression obsolete. As this proved not to be the case, there was the predictable backlash. In Robert Whitaker’s Anatomy of an Epidemic, antidepressants (and other psychotropic medications) are not only ineffective, but the villain, responsible for worsening the epidemic of mental illness. The next movement will be a backlash to the backlash. If we do nothing different, we can conclude with supreme confidence that all the heated talk about drugs will continue to monopolize the stage and preclude a real conversation about mood and mood disorders.

The continued ascendance of the conventional disease model of depression is part of the problem. The conventional approach tends to view the legions of the depressed and the formerly depressed as a “broken” people, an ever-afflicted group that will likely need repeated assistance over the life course because of their theorized defects. The biological defect model may have been created with good intentions, but it is both belittling and inaccurate. Depression like any mood state has a biology but it is simply not a disease in the same sense that Parkinson’s Disease is.  To try to maintain that depression is a brain disease is to cut off a more interesting conversation at the knees.

Happily there are exceptions to this trend. And Dan Lukasik is one of him. There are people who are hunger for more, and who reject the corrosive, age-old stigma attached to depression and depressed people, and who are fighting for a more honest and more balanced discussion of the topic. There are people who agree that it is high time for our society to revise its stance toward the millions who have battled depression.

I am a depression researcher and former depression sufferer who has looked at the poor state of the national dialogue and has been moved to try and change it. I am using social media, particularly Facebook, to restart our national conversation about depression. We desperately need this not only for adults. We also desperately need it for my daughter, Sophie, and for the rest of her generation, the teens who will soon be young adults. Our youth will face depression in high schools and on college campuses in epidemic proportions that will overwhelm them, their parents, and all counseling resources.

One major obstacle to a more affirmative national conversation is that depression has lacked a unifying public symbol that could bring it out of the dark like Livestrong© bracelets did for cancer or the rainbow flag did for LGBT. When most people think of depression, their first associations are to unfortunate images, such as a dark cloud, the color black, or a noose. One reason that depression stigma lives is that depression has a serious bumper sticker problem.

But this is essentially an issue of failed marketing and messaging. It is very hard to talk about depression when it is always on societies’ terms. Depressed and formerly depressed people are ever on the defensive. To change the terms of the debate, and spark more productive conversation.  I have developed a unifying symbol to function in a depression anti-stigma campaign. These are glow-in-the-dark wristbands that are printed with the phrase COME OUT OF THE DARK.

A few weeks back, I was using my Facebook page to probe for interest in these wristbands and I made an offer that I would give away a glow-in-the dark wristband to anyone who would be willing to send me a picture of themselves wearing it. I bought 200 bands from China and planned to give them away from time to time to readers who were interested. Initial response was rather tepid and I started to think it would be complete flop. Well, last Thursday, after I had given away a few dozen, for reasons that I do still do not completely understand, the wristbands went viral on the internet, and I was flooded with requests from all over the world. It’s hard to get an exact count but it’s definitely in the thousands.

I received requests from parents for their depressed children. From people who lost loved ones to suicide. From teachers for their classrooms. From therapists for their patients. From counselors for their support groups. And from many individuals who have been touched personally by depression, both those who have conquered depression and those who were still struggling with.

I think that part of the viral appeal of the wristband campaign is the slogan, which has several possible meanings

•   Let’s end society’s ignorance about depression.

•     Let’s support depressed people so they get well and stay well.

•     Let’s create an environment where people can speak freely about depression and no one feels compelled to conceal their pain.

And part of the appeal is that total strangers are giving you something for free that will make you feel more comfortable living in your own skin.

In any case, this has been a stunning development and my life has been turned a bit upside since Thursday since this all happened. I have a full-time job as a researcher at the University of South Florida and I have been thrust into the beginnings of a social movement. I’ve bought another 2,700 wristbands from China. I’ve enlisted friends, family, students, and total strangers in an effort to respond to the messages and prepare a mailing.  I’ve asked for donations. We’ve made a plan of action and my goal is to send out these 2,700 wristbands bands by October 1st. This will end the first phase of the campaign. There will be more to come, but I will need to take a break and develop a plan for the second phase.

People who have received  the wristbands are starting to return pictures. If you look at this gallery of the first wave of people who have come out of the dark, I think you can more easily understand why this campaign has taken on a life of its own. It’s both a social media campaign and a word-of-mouth campaign – both of which inevitably will shift the conversation about depression on more favorable terms.

The massive response to the Come-Out-of-The-Dark campaign tells me that change is in the wind. People are tired of hiding, tired of hedging. They are ready to reclaim their identities as fully human.

The stakes are high. Conservatively, 13 million US adults are currently in an episode of depression; more than twice that number have had depression in the past. When we add in caregivers, millions more are indirectly affected by the quality and the quantity of our national dialogue about depression.

But we have the momentum. At this rate I give the stigma of depression about another six months to live.

Jonathan Rottenberg is a leading researcher in the area of emotion and psychopathology, where he has focused on major depression. He recently edited Emotion and Psychopathology: Bridging Affective and Clinical Science, published by the American Psychological Association. Since receiving his PhD degree from Stanford University, he has been at the University of South Florida, where he is an Associate Professor of Psychology and Director of the Mood and Emotion Laboratory. His work has been generously funded by the National Institutes of Mental Health and he has authored over 35 scientific publications, including many in the top journals in psychology and psychiatry. His work has received national and international media coverage, reported in outlets such as Science News, Scientific American, The New York Times. He is author of the forthcoming book, The Depths: The Evolutionary Origins of the Depression Epidemic.

Blog: http://www.psychologytoday.com/blog/charting-the-depths
Book: http://www.amazon.com/books/dp/0465022219
Author page: https://www.facebook.com/charting.the.depths

 

A Trial Attorney’s Dirty Little Secret: Depression

Once upon a time, I was a trial attorney at a personal injury defense firm. I was good at it.  I always pushed hard; always did the best job possible.  I won a good share of cases, and, of course, lost a few as well.  I was valued highly enough to be made a partner shortly after joining the firm.

But I had a dirty little secret.  I had bipolar disorder, which was well-controlled through a close partnership with a good psychiatrist.  Still, in my mind, if word ever got out, my employers would see me as weak, a liability.  To a degree, I understood.  If the insurance companies that paid the bills learned that one of the firm’s trial attorneys had such a condition, their mandate would be clear: if you want our business, get rid of him. That is what I assumed.

Throughout my career, colleagues would make offhanded remarks about someone “not taking his medication.” I would grit my teeth and ignore it.

Instead, I was able to construct an alter-ego, the “happy warrior.”  I had a smile on my face and a sardonic remark ready on cue. But I went about my daily business feeling like a secret agent in a Cold War spy movie.  If my cover was ever blown, I was certain that my career would be at an end.

Over time, maintaining this secret identity while dealing with the usual strains of trial practice gave rise to a growing depression.  Yet I still performed at a high level and still got results.

Although I had a close friend at the firm, another partner, he would deflect when I tried to talk to him about my depression, so I stopped.  I began to worry that others at the firm might know about me.

Fear and the sense of isolation only fed upon themselves in a continuous cycle.  I finally experienced a severe episode of depression that led to a period of disability.  When I told my boss what was going on, he expressed genuine surprise that I was suffering from depression at all.

When I returned to work, I felt better, but I remained wary.  Instead of engaging in a conversation about what had happened, we all acted as though nothing had occurred.  The computer was rebooted, and business continued on as usual.  I went back undercover, and no one seemed to mind.

Simply due to scheduling conflicts and adjournments, it was some time before I tried another case.  I admit that I was a little nervous, but I was having no trouble handling my case load.  I was puzzled when my boss came into my office one afternoon as I was preparing for the trial.  He asked me if I felt good to go.  He had never done that before.  I said, “yes,” because I felt perfectly up to the task.  I never asked myself, “If he is worried about my performance, why is he even letting me try the case?”

At trial, the insurance company sent an adjuster to audit the proceedings, a routine procedure.  I knew him well, and he had an excellent grasp of the case, even though he had not been involved before trial.  We had constant discussions about what was going on, and we seemed to be in sync.  Suddenly, the insurance company pulled my old friend off the case and replaced him with a mid-level manager who consistently praised my performance.

The case went to verdict, and the jury awarded somewhat less than what the insurance company had offered settle for.  To preclude the possibility of an appeal, the insurance company threw in a few more dollars.  Case closed, on to the next one.  To me, that was a pretty good result.

Was I in for a big surprise.

Shortly after the trial, year-end reviews were scheduled.  I was getting ready for another trial, and I was very excited about it, so I wasn’t really paying attention to what was going on in the office.  Other attorneys were getting their reviews – important because raises would be discussed – but I was never called in.

Ultimately, my case settled after much hard work on all sides, and the usual time for reviews was long past.  I did start to worry then.  I even made a remark to my secretary about it.

The call finally came.  When I stepped into the conference room and saw every equity partner in the firm waiting for me, I knew.  The spy had been caught, but what would happen?

My boss said that they waited to speak with me because they did not want to put pressure on me while I was preparing for another trial.  He asked me if I felt capable of trying cases.  I paused, and then broke under the years of strain.  I wept, and answered, “No.”  Whether that “No” was true then or true now or was ever true, it was the most humiliating moment of a 20-year career.

My boss started to dissect my prior trial, telling me that the insurance company’s representative was reporting that I was doing a bad job.  He even told me that the supervisor at the insurance company knew that I had depression.  After the expected awkward silence, another partner suggested that “we find a creative solution” to keep me at the firm.  I made some suggestions over the next few months.  No replies were forthcoming.  I was quietly being swept out the door.  It wasn’t hard to get the message. I found another job, and moved on.

The whole experience seemed to confirm everything I feared about being a lawyer with depression.  Currently, I am not practicing, and am seeking other opportunities.

But if the story ends there, what is the point?  Can I offer my account as a teaching opportunity?  At the very heart of the tale lies the sad truth that we, as lawyers, trained to be superlative communicators, can utterly fail to make each other understood when it comes to depression.  Should I have been more candid about my condition?  My employers never told me what concerns they had or what they knew.  Could all of us have been proactive for our mutual benefit, especially after I returned to work?  I believe that there had been an opportunity to open a constructive dialogue, but my fear told me to keep my mouth shut.  I cannot speak for my former employers, although I highly doubt that they held any malice.  I doubt that they thought much about it at all, until some critical pressure was brought to bear, whether from within or outside of the firm.  Unfortunately, by the time everyone was talking, my job at a firm I loved was gone.

I miss working there.  I still have close friends there.  I see them when I can, which is not often enough.  Just recently, I ran into my secretary, and we briefly chatted about my plans for the future.  And then she said something that cut me to the quick: “You were a good lawyer.”

— Anonymous Guest Blog

Marked

From the blog Una Bella Vita, a piece about how depressives feel marked for life by their illness like a scarlet letter. Read the Blog

Be A Hero With Depression

I was asked to write a guest blog for the PsyWeb website about what I think of others who struggle with depression.  The best of my thoughts are summed up by one word:  Hero.   Read my Guest Blog

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