Friday 22 September 2017

Thank you, Conor and John, for speaking out

IN THE past two weeks several high-profile figures have spoken of their depression. Conor Cusack, a Cork hurler, was the first. Then John Murray, the RTE presenter who returned to the airwaves just one week ago, took the opportunity to explain his absence for six months.

Prior to his return, he was said to have had a "mysterious illness". Courageously, he explained to his listeners that he was in fact suffering with depression. His contribution was powerful.

It is "bravery" writ large to speak publicly about any illness, but depression is particularly difficult since, for many, it is seen as a mark of weakness or "madness". It is neither of these – it is an illness just like any other.

I look forward to the day – and perhaps it is fast approaching – when anybody with any mental illness can speak of it and be shown the same compassion, sensitivity and concern shown to a person with cancer or asthma, with pneumonia or heart disease.

As Murray explained, he was gripped by fear and panic. Things that were part of his day-to-day routine, such as going on air, filled him with dread. He told his listeners that mornings were particularly difficult and he viewed the daytime as something to be endured.

This very personal description of his symptoms is important and explains why depression is often not diagnosed at all or is misdiagnosed. Symptoms of anxiety, such as fear, panic, dry mouths and so on are often simply ascribed to "stress" or anxiety.

And since stress is part of everybody's life, so the thinking goes, you just need to get on with things or else find its cause.

But frequently this search leads the person on a psychological wild goose chase trying to identify some hidden trigger, when in fact there is none. The sadness and flatness that we expect to dominate the person's world if they have depression may be lurking unseen beneath the overwhelming anxiety, so that they are not obvious to anybody.

The difficulty that morning brings, and which is described so clearly by Murray, is a textbook symptom of depression.

The fear, dread, irritability and withdrawal that mark the early part of the day gradually lift and, by evening, the person is chatting, watching television and might even laugh at the odd joke.

The Jekyll and Hyde transformation that the person appears to undergo in the course of the day may be so great that it appears as if s/he is attention-seeking or is just simply moody.

As psychiatrists know, depression is chameleon-like and presents in many guises. One of them is inexplicable anxiety. Sleep is disturbed and may manifest itself as problems getting to sleep or waking early after just a few hours' sleep. The result is exhaustion. And this effects concentration.

Crying and sadness are expected to be prominent but are not always so and, at its most severe, depressive illness robs the person of all emotion.

My patients frequently tell me that they do not experience anything except flatness and a heavy, indescribable cloud. And even the simple joy that a parent feels when seeing their children or the bounce we experience when we wake up on a sunny spring morning are absent in those with depression.

Those who have depression speak of their personal black hole. A place like hell is how some describe it.

Many say they would rather have a visible physical illness than the invisible one they are saddled with.

Without treatment, it can endure and have a serious impact on family members. Marriages break down as a result of the loss of interest, the withdrawal from loved ones and the irritability.

Without treatment, children are adversely affected. But most importantly, depression can be fatal. Death by suicide occurs in around 10pc of those with severe depression, and this is more likely in men although, overall, the illness is more common among women.

A mixture of anxiety and depression is the most common pattern, and community-based studies show that it affects about 8pc of the population at any one time.

Happily, most people with depressive illnesses can be given an optimistic prognosis provided they are treated appropriately.

This involves antidepressants and specific psychological treatments, and most can be helped by their general practitioners.

Those at the severe end of the spectrum or with recurrences are usually referred to psychiatrists and may need indefinite medication if, despite psychological treatments to prevent recurrence, they still relapse.

This is a small price to pay for remaining well.

The availability of educational, self-help and support organisations such as Aware, GROW and Recovery has greatly encouraged and empowered those with depression to speak openly about their illness. Society as a whole benefits from this.

We may be reaching the point when nobody need suffer in silence because of fear of being seen as weak or "mad", as society at last accepts that depression is simply another illness, no more and no less.

Conor Cusack and John Murray deserve our thanks for touching the hearts of the nation with their own very moving, personal stories.

Irish Independent

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