Depression is not a choice

Anxiety. Sadness. Irritability. Moody. Withdrawn. Insomnia.

Simple saying these words takes a toll on me. These are not qualities anyone is keen to have, so imagine having to experience all of them at once on a daily basis.

These are all signs of depression.

Depression is a group of conditions associated with the elevation or lowering of a person’s  mood.

I’ve seen many people judge others for suffering from mental illnesses as if they chose it.

Depression is not a choice.

In a article done by News 24 statistics show that between 6% and 10% of the population will experience a depressive episode in any given year. This just shows how common depression is.

To end the stigma around depression we will dig into what it really is, what causes it, the different types of depression and how to treat it. This will be done with the assistance of Ms Amy Cunningham, a Psychologist currently working at Masizame child development .

• What is depression?

Ms Cunningham describes depression as a mental disorder which causes a persistent feeling of sadness and withdrawal from society. “Depression affects ones emotions, how you think and feel. It can affect you physically as well”.

• What causes depression?

So many factors could contribute depression these include:

• Stress
• Abuse
• Certain medication
• Loss of loved one
• Genetics
• Substance abuse
• Personal problems

These are just to name a few. With depression, there is always an underlying issue which causes it. It stems from a past trauma, one they are struggling to deal with, something they have not made peace with yet.

• The different types of depression are:
• Clinical depression

With clinical depression one is in a constant depressed mood. You isolate yourself from anyone and everything. You basically lose touch with the outside world. Some people experience waves of depression, at some point they will be okay, but with clinical depression the depression is persistent.

• Bipolar disorder

Someone with Bipolar experiences highs and lows, a constant change of emotions. These emotions include being extremely happy or extremely sad. The shift between these two emotions happens rapidly.

• PDD (Persistent Depressive)

With PDD the patient has the inability to socialize. They find it hard to communicate and comprehend  therefore they prefer keeping to themselves.

• Postpartum Depression

Joy and excitement are the emotions commonly felt with the birth of a new born, but emotions such as anxiety and fear commonly occurs as well. Negative emotions are normal but if they occurs for longer than a few weeks it is most likely that you have Postpartum depression.

With postpartum depression symptoms are severe and interferes with your ability to function and bonding with your new born.

You may experience:

• A lot of crying
• Insomnia/ or to much sleep
• Anger
• Guilt
• Resentment
• Feel overwhelmed

Postpartum depression is more common in females it follows about 15% of births. However, males can also suffer from the mental illness.

• Premenstrual Dysphoric (PMS)

PMS normally takes place just before a female goes on her period. PMS leaves one feeling depressed with emotions such as: sadness, irritability, anger, to name a few.

It normally goes away once your menstrual cycle has completed.

• Seasonal Affective Disorder (SAD)

SAD is a type of depression which comes and goes the same way the seasons do. Most people who suffer from SAD symptoms start in Autumn through to Winter, whereas others may get it in Spring or Summer.

• Atypical depression

Atypical depression can be a subtype for either major depression or systemic disorder. With atypical depression the depression is persistent. Atypical depression is quite common.

With the above being said it should show that depression is quite common and that one has no control over it, it is not a choice.

Following will be two cases, the story of Suraya Jooste  and Trevor Stanley both of them suffering from mental illnesses.

The story of Suraya Jooste

A quote from Atticus Poetry once said “Depression is being colour blind and constantly told how colourful the world is”, isn’t that such a poignant quote that resemblances the pain and inner torment that many individuals in the world suffer from. Mental illnesses range from mild to severe symptoms including depression or other mental illnesses such as personality disorders, eating disorders, schizophrenia, anxiety, obsessive compulsive disorder and addiction. According to The World Health report, one in four people in the world will be affected by mental or neurological disorders at some point in their lives, it is likely you have met or know someone who suffers from such conditions or you have shown signs yourself. And while most of us can probably account for feeling depressed from time to time despite not being diagnosed we are still able to recognise the symptoms, however the difference between a normal individual having a bad day and a mental health patient is that we do eventually get better whereas depression patients suffer on a much deeper level. Which brings me to my hypothesis, is depression considered a mental illness? When does a mental health concern become a psychiatric disorder?

As humans, our mental health involves daily cognitive functioning in everyday activities such as going to work, school, and maintaining healthy relationships. Mental illnesses refers to your emotional state in changes in thinking and behaviour whilst dealing with your daily activities. Once the distress of your emotional state starts to affect your social skills and work, this is usually the line it crosses over to a mental illness. Mental illnesses should be given the same level of compassion just as we would sympathises for cancer patients or heart/diabetes patients. Depression is a medical illness and it is treatable, to reiterate some symptoms are mild and other conditions severe who need hospital care.

Case in point with one individual. Suraya Jooste, who was diagnosed with Bipolar Type 1 in 2016 and was 29 years of age, mental illnesses can appear at many given age but statistically ¾ cases have reported the illness beginning after 24. The bipolar disorder is a life long illness that individuals can suffer from long after getting treated and can continue to show signs post treatment, there are distinguishable types of bipolar disorders and type one involves a period of severe mood episodes from mania to depression. Episodes must last within a period of 7 days in order to be considered distinctive manic episodes.

Ms Jooste relapsed last spring and overdosed on 20 pills, while her manic episodes last for a few days, her emotions are somewhat on a rollercoaster, rapid cycling involves a pattern of severe depression and increased risk of suicidal attempts more commonly associated with women but the matter is still being researched as to why. At the moment Ms Jooste has been given antidepressants but she does not seem to be responding well or 100%. Currently staying over at relatives not a mental intuition means her family members are responsible for her mental state, they’re not equipped to give her professional advice or services making it harder for them to understand the situation and deal with it carefully.

Left alone for a mere 5 minutes, she tried to cut herself in the bathroom. It’s hard to make out what the patient is trying to achieve with this, she states she’s not trying to kill herself but why inflict injury and harm yourself. And the cuts sustained are fairly deep, deep enough that needs medical attention but shallow that it wouldn’t cause one to drain enough blood to die. To interject for a second, according to suicide methods, slashing ones wrist proves to be the least effective method as one needs to cut a very specific vein, a vein that only those who studied medicine would know where to find and even accidentally cutting it wouldn’t drain enough to die so instead the cause of death is ruled by other cases such as an overdose or mixing medication with alcohol. So in the case with Ms Jooste what can we make of this? Can we chalk it up to her needing a cry for help or her needing a break from reality? If a patient is suffering from some mental disorder, try to remember that it does cause a chemical imbalance in the brain that causes patients not to have emotional stability like the average person and all you can do is empathise and be there for them.

After interviewing the rest of the family members, her older brother Rijaaz and her niece Tasneem who were on suicide watch, accounted different versions of the story. Her older brother felt responsible for her relapse having not keeping a keen eye on her over the months and assumed she was doing well and recovering, the error in his past judgment made him feel overwhelmed but at the same time if him being there meant carrying some of his sisters demons then he’ll do it without hesitation while her niece found the experience to be jarring too, she had a more composed and controlled way of dealing with it having growing up with her she’s obviously been exposed to this behaviour before. Tasneem also stated it was hard having to deal with her because they’re not equipped to handle this and had the medical aid funds not have been exhausted she could’ve received proper treatment. Another one of fears was saying something that could upset her or trigger her to relapse or cause injury so she thread carefully across words to choose the right ones. Suraya’s parents had a more cynical view and said she’s depressed because she doesn’t have enough faith in God. It’s interesting to see the different reactions and perspectives of everyone who are all family, live in the same house, dealing with the same situation but accounted different feelings.

In conclusion, Suraya is a mere victim of a mental illness that effects millions of people around the world, it has nothing to do with your lack of faith in your religion or not taking care of yourself, it is simply a condition that with treatment can be overcome. Depression is a disorder that should be considered a mental illness in line with cancer and diabetes why should it not? Bipolar patients shouldn’t be left to feel ashamed or discriminated for an illness that was completely outside of their control or something the patient did wrong. In fact treatments are available but the sad reminder is that two thirds of patients never seek medical attention and professional help. The stigma against depression remains one of the most neglected areas that humans fail to understand. And where there is a lack of understanding there is neglect. World Health Day is marked on the 7^th of April each year after taking effect in 1950, each year it tries to create awareness and highlight one of their core messages which is “every country, no matter what its resource constraints are, can do something to improve the mental health of its people. What is required is the courage and commitment to take the necessary steps moving forward.”

The story of Trevor Stanley

Ever heard of the quote, “you can do anything but not everything”? This is true, overexerting oneself can lead one to burn out or worse self-implode. Once you start feeling like butter spread too thinly across bread is when you’ll slowly show signs of burning out. Including not taking care of your basic needs, your to do list is causing stress, your life no longer motivates you, you’re living on auto pilot and negative thoughts are starting to replace your positive ones. Most commonly beings tend to burn out at work, taking on too many projects or working late or your job is plainly abusing your enthusiasm and work ethic which leads to depression in some cases. Can depression be considered a mental disability in the workplace? How many employees know their rights at work when they’re depressed? According to work place mental health org, a survey in the US accounted 23% of the workers and the managers reported being diagnosed with depression linked to workplace. The bad news is about half of the employees with depression go untreated and yet still their rights aren’t being advocated. With proper workplace treatment, companies can avoid losing as much productivity, which is an estimate of $44 billion each year in loss of productivity, but maybe that’s exactly why its ignored the costs deem too large.

Employers don’t understand what a key role they can play in supporting their workers by deducting the early signs of depression they can immediately give their workers proper health care and mental working conditions. Better working conditions increases productivity in the workplace, defiantly worth investing in your employees’ health and a win-win situation.

Case in point, with an employee at Wesbank Trevor Stanley, diagnosed with Bipolar Type 2 in 2013 and was unemployed for a year after getting diagnosed. The events leading up to their burnout moved slowly but in an uphill trajectory, bound to crash land as Trevor explained. According to the BCEA, (the basic conditions of employment act) the maximum normal working hours allowed is 45 hours weekly, it would amount to 9 hours per day, overtime compensation works differs from business to other business. Trevor stated he was working on a daily basis between 10-12 hours a day. Already this is a sign of an unhealthy amount of working time which the company allowed on their watch. After returning home every night at 9/10pm from driving all over the Eastern Cape Trevor would continue to work at night, making sure his admin is up to date only going to bed at 3am and would wake up at 6am for work again. Amounting to a total of 3 hours of sleep per day, every day during the week and eventually couldn’t sleep at all. There is a correlation between insomnia and lack of sleep but that’s not to say insomnia are caused only by depression. The human brain can function on very little hours of sleep but it cannot function properly and successfully for a lengthy period of time and that’s what caused Trevor to tie off. After being diagnosed with insomnia, more common symptoms followed, such as a loss of interest in his passions, indecisiveness, mood swings, gained weight in a short period of time, isolation at home and a general demotivation in the smallest activities such as brushing his hair or getting out of bed.

Now fortunately in Trevor’s case, his work did in fact look after him after he fell victim to depression. The work gave him 6 months off, at first paid leave and then after only receiving half his salary, they paid for him to seek a physiatrist once a week and paid for his treatment at Hunterscraig Private Hospital and when he returned to work from his 12 month absence a job with less pressure was offered to him. Good for Trevor’s case, his company really took care of him. In most cases, companies often fail to encourage their workers to do depression screening in health risk appraisals (HRs) and EAP programs.

In 1992, the ADA (Americans with Disabilities Act) allowed people with disabilities to be protected against discrimination and in 2008 the act expanded its territory to people with visible depression to be protected under the act too. The “”visible: depression traits includes not performing manual tasks, not sleeping well, eating well, losing interests in activities and having a history with mental illnesses or not have been treated for their disorders. Usually these conditions needs to be present across a few months for it to be considered a long time problem. Under the act, between the employee and the employer they’re allowed to negotiate reasonable working accommodations. One drawback is that the act does not cover those with substance abuse problems as they believe any person with a substance abuse problem should be held accountable, and that by law the employer is not allowed to ask if you have a disability so it would be up to you to state that well and clear in the beginning which can be daunting for some people considering the worldwide stigma around depression. Too easy are employees not familiar with their basic rights at the workplace let alone how far these basic rights can transcend.

Depressive disorders happen to be the fourth leading cause of global diseases and is expected to rank second by this year. The responsibility of providing information lies on the shoulders of the government, however I understand the government might not have the resources or the means to educate workers and scholars and therefor schools and workplaces should take part in the urgency, up to 60% of people with depression can recover with proper treatment, psychology and anti-depressants. Problem is up to 40% of countries have no mental health policy and over 30% have no mental health program. The effect of mental disorders demands a great deal of attention and in majority of cases it’s those from poor backgrounds that bear the grunt of not receiving proper care.

In conclusion, despite the stigma surrounding mental disorders and depression, it is considered a mental disability in the workplace. Are companies enforcing strict enough policies to make this known? While I can’t say no for certain, but they’re not all doing their best. Should companies be reporting knowledge to their employees about proper treatments and facilities? 100% yes. Companies can also help alleviate job stress by not giving their employees high stress level jobs and exploiting their work ethics. There can be many reasons for employees burning out at work, could be a combination of work related problems and personal problems but the sodium fact remains the same and that is the human body literally shuts down after too much stress and just cannot accommodate too much work burdens. You can still do your best but that doesn’t mean work to the point where you have a mental breakdown. Depression is not an illness to be ashamed of nor discriminated against and the workplace should do well to remember this.

Can depression be treated?

100% yes.

There are treatments available for depression such as:

• Psychotherapy

With psychotherapy a trained mental health professional provides the patient with therapeutic treatment. Psychotherapy along with medication can promote recovery.

• Medication

Medication such as anti depressants, helps management of symptoms  but does not directly cure depression.

• Support Groups

A support group consists of a group of people sharing the experiences (in this case experiences with their mental illnesses), empowering each other all with the hopes of recovering the mental illness.

So to some things up:

• Depression is real
• It is not a choice
• Do not be judgmental towards a mental health patient
• Depression can be treated