Tuesday 17 January 2017

With depression, well-meaning but wrong-headed comments can hurt

Patricia Casey

Published 25/10/2016 | 02:30

There is no particular personality type associated with depression
There is no particular personality type associated with depression

Consider a woman, let's call her Anne, who has been on sick leave for about a month due to a depressive illness, and then returns to work.

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Her colleagues are very welcoming and delighted that she is back. There is no question that anybody is avoiding her because of embarrassment. They have updated her on the goings on in her place of employment and she has engaged in all of the usual banter.

Those who are concerned often proffer advice in an attempt to help the person feel comfortable at being back, and in an attempt to be understanding.

Here are some of the well-meaning but misguided remarks that are likely to be made to her.

"We all get down at times".

This is a clear effort on the part of the speaker to be empathic towards Anne. She is trying to convey to her that she understood how Anne must have felt because she also felt "down" at times. But the type of depression that a person suffering with the illness experiences, is a very different quality to the ordinary feeling of low mood that we all experience from time to time. Interestingly, those who have had the illness can clearly distinguish the different mood states.

This comment will serve to minimise the gravity of Anne's illness and despite her efforts to "feel her pain", she will be unable to do so.

"What you need is something to take your mind of your depression."

The depressed person is constantly in a state of sadness and even blackness. Distraction is very difficult and the ability to cheer up, except for isolated periods, is absent.

Anne had a pervasive low mood and feeling of a weight on her person. Everything for the depressed person seems grey or even black. Simple solutions to an illness like depression, such as finding a hobby, are unhelpful. It's like telling somebody who has just had a heart attack that they need to eat more protein.

"Think of how lucky you are - you've got your family."

Anne is aware that she is lucky to have a loving family, but even things that ordinarily give pleasure, no longer do so to the person with a depressive illness. There is a disconnect between reality and their emotions because of viewing the world from a gloomy perspective. Reminding Anne to count her blessings may intensify her feelings of guilt that she does not emotionally appreciate her family.

"You don't look depressed."

Many people with depression are temporarily able to rise to an occasion and have a "smile".

For many, it is in the sanctum of their own home that they cry (if they are able, because severely depressed people lose that ability).

In the older text-books, psychiatrists described "masked depression", a condition in which there were no obvious facial signs of depression and low mood was not obvious. Only with probing would the person describe the typical features.

Masked depression was considered "deadly" because the diagnosis was often missed, with tragic consequences.

"You don't seem the type to get depressed."

There is no particular personality type associated with depression. It can afflict anybody regardless of age, socio-economic status, nationality, type of employment, and so on, although some have a heightened risk (eg a family history).

The great and the famous have suffered with it, including Winston Churchill, Abraham Lincoln and Frank Bruno to name but a few.

"You need therapy not pills."

This is a common view opined by those who do not understand what a depressive illness is.

Talking treatments have a role, but for those with depression of such severity that require time off work, medication is likely to play a significant part.

A comment such as this is stigmatising Anne because she needs medication. Anne's treatment is between herself and her psychiatrist.

So what should be said to Anne on her return to work?

Apart from welcoming her and asking general questions about her wellbeing, comments, such as the following, are helpful: "I'm sure nobody knows what you felt like"; "I can't even begin to imagine how you felt"; "I'm here for you if you need any help - even practical things like shopping, if you don't feel quite up to it."

Focussing on her illness too much will firmly locate her in the role of patient, whereas now, her life needs to gradually be normalised.

She needs to be seen as an employee who had sick leave and is now healed.

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