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For many years I have suffered from a chronic depressive illness in cycles of varying intensity and duration. Although never properly diagnosed until my second year of graduate school at Harvard, I date my major episodes of depression from my thirteenth year. The following reflections are offered to everyone in the Harvard community willing to take any interest, because the various mental illnesses affect all of us in so many ways: victims most immediately, but also (sometimes drastically) family members, friends, employers, teachers, colleagues and even complete strangers. Please keep in mind that I write only as a layperson and patient, and that medical professionals should be promptly consulted for all diagnostic and treatment information.
It is quite scary and difficult to talk publicly about this, as widespread misconceptions ensure that some will view me prejudicially; yet I have resolved to begin doing so because it is so essential that many more citizens understand. When I was an undergraduate, and indeed through much of my life, no one ever made such vital information readily available.
I have no interest in evoking sympathy for my own situation (anyone who knows me realizes that such a motive is utterly foreign to me), which is comparatively fortunate anyway. yet in striving to increase understanding of this subject I speak directly from my own life because it is so rare for people to learn much about anyone's personal experience of such illnesses. I hope to use my case to shatter common stereotypes that mental illness must involve overt, observable difficulties with ordinary functioning.
While the form of depression I suffer is vastly different from stereotypes of mental illness, it has much in common with millions of other cases: I and most other sufferers have never even remotely verged on any derangement, psychosis, hallucinations, paranoia, catatonia, multiple personalities or even wide mood-swings (the preceding symptoms are associated with a variety of forms of schizophrenia, manic-depression, etc.). Further, I know for my own case through many experiences over decades that I possess more resilience, resourcefulness, clear judgment and tolerance of stress in difficult situations (including several near-death events) than most "healthy" persons can imagine having.
Let me emphasize that I use the phrase "mentally ill" with great reluctance since it so often bears pejorative connotations in the minds of the ignorant: I hope greatly to revise the usual conceptions of the phrase. The most common forms of mental illness are `uni-polar' depressions (meaning tending only toward a depressed rather than a manic state of mind) termed `mild' to `moderate' on the clinical scale-not severe enough to require in-patient treatment, but devastating nonetheless.
You would almost never have any clue whether I am depressed unless I tell you so, as my illness is a biochemical condition having little to do with overt mood and behavior (and I have been compensating for it a great deal for so many years). Although many laypersons and still too many physicians think of depression primarily in terms of "sad" and "blue" feelings caused by neuroses, for me and many others the dominant symptoms have less to do with "feelings" than with physical changes which certainly influence feelings but are prior and more fundamental. I feel sad or blue because my neurochemistry is in its sub-optimal state (diminished levels of the neurotransmitter serotonin, perhaps), but the depression is not caused by the feelings.
For me depression is characterized primarily by unusual sleep patterns (extremely heavy and lethargic sleep, far less common than the usual insomnia most other patients suffer), fatigue, mental misery even in the midst of usually satisfying activities and often what the experts term `anhedonia' (utter lack of pleasure on a prolonged basis). This can greatly burden work and social life. It feels like a case of `mononucleosis' that never ends (I have twice had `mono' and the similarities are striking). Hardly anyone else has ever been aware of my inner mental states, and even renowned professionals have not been able to detect my present condition without my own reports of symptoms. In one sense this indicates that I am fortunate that my illness is less debilitating than many people suffer, but also that it is possible to suffer badly without anyone else knowing.
Understanding, mental health care and socio-economic support are so pitifully inadequate in part because few patients or families want to speak openly, facing social stigma and becoming objects of popular prejudice. Yet few others are in a position to understand or care enough to help the situation. It is bad enough to suffer such an illness without also enduring the ignorant and sometimes malicious speech and behavior of others. There are risks in speaking openly about one's condition, of course, but I have decided to bear such risks to provide a forceful personal testament which would be less effective delivered in impersonal abstraction.
A major change in public attitudes is required if vital measures such as greater health care access with follow-up treatments, vastly intensified research and minimum economic security from disaster (read: universal health insurance, with sufficient mental health coverage) are to be realized. We need many more leaders at all levels to write, speak and effect change on these issues. Among my leading heroes is Tipper Gore for exhibiting the courage to take up the burden of insisting that mental health care become a major national priority.
Now for some essential "awareness-imperatives:" Prevalence: You probably have no conception of how many people around you suffer some kind and degree of mental illness for at least some portion of their lives. Given estimates that at least 20 percent of the U.S. population fall into this category, this suggests that several thousand members of the Harvard community have suffered or will suffer a mental illness at some point in life. Many more of us will have relatives and/or friends directly affected. There are so many degrees and varieties of conditions that it is difficult to say much about the entire group of illnesses; that rarely stops people from trying.
Prejudice. The foremost reason that awareness and understanding are so weak in our society is that there is still quite a stigma carried by anyone labelled "mentally ill." Almost everyone at times, and some folks all of the time, will regard anyone labelled "mentally ill" with an uneasy fear of craziness. But the fact that a brain may fail to regulate a neurochemical at optimal levels has nothing whatsoever to do with personal worth or character evaluation. If anything, the mentally ill endure such huge obstacles to ordinary functioning that any particular level of achievement requires exceptional fortitude, striving and discipline.
A number of the mentally ill may need to take time away from a school or job to get well, pursue new options, change focus, etc. (and many people with no mental illness may also pursue such paths as well). One of the best things to happen in recent years is the greater tolerance and affirmation of such varied life options: The old mentality that life is a treadmill of college, professional school, job, without any pause or variation, is fading. Yet the use of pejorative expressions such as "drop-out" continues.
These words can be both inaccurate and very hurtful. Recently a friend was talking with a student life official at Harvard who made pejorative remarks about how I have "dropped out" because I am not presently toeing the line in the Yard, as though for self-important bearers of Harvard's standard I died after earning my master's degree. Like Mark Twain, I want to say that "Rumors of my death are greatly exaggerated."
Ignorance: Attitudes are improving, perhaps, but still I hear so many ignorant and callous remarks and actions. With regard to attitudes and acceptance, the Harvard community can be a better place than many for the highly functional mentally ill. (It would be terribly difficult for anyone to last around Harvard if burdened with the gravest forms of mental illness.) In my experience most people here are relatively enlightened and compassionate compared to society at large.
Privacy: Until now I have lived with my depressive illness kept in a tight, private, highly secretive compartment, as does nearly everyone who knows the risks of sharing such extremely sensitive matters. Even when events sometimes cause more people to know, the huge need for privacy remains. Only a handful of people, such as intimate family and friends, have known anything of my illness from me. This is absolutely no reflection upon many other friends and colleagues who would surely prove compassionate, fair and supportive: It simply reflects the sad fact that a few will treat you prejudicially if aware of your condition, and it is difficult to predict such reactions.
Biochemical Revolution: My own condition and that of many others have been treated effectively only with the contemporary biochemical options available. The vast majority of depressive and manic-depressive illnesses can now be considerably improved and well-controlled with medicines. I also find certain psychotherapeutic perspectives valuable, but more for dealing with the effects of depression and with the life issues that everyone faces than for alleviating any symptoms of depression. I would rather discover therapeutic insights and enrich my community service commitment talking with Robert Coles than anyone else, but I will benefit and contribute a great deal more if I am already being treated with the appropriate medicine.
On a most personal note: Thank God (actually, certain biochemists) for __! (I cannot name my current medicine here because someone may wrongly conclude that they need the same thing, when there are many medicines available and no two brains are the same). I share the widespread aversion of sensible people to the intake of chemicals and anything that seems "unnatural," yet I know for my own case the existence of__is a medical miracle. It went so completely against the grain for me to accept that any pills can be so important to my well-being that for too long I resisted the idea and appropriate treatment. Now I know that it is a basic fact of my life.
The Good Life: Such medicines are not any part of life's 'telos' (sorry, Aristotle), they are more of a precondition for returning to the world of energy, mental concentration and varied feelings. Some very loose analogies can be found with thyroid medication for those who need it, insulin for diabetics and in fact adequate nutrition for everyone: intake of any chemicals and nutrients to sustain a decent life is not the final goal but the means to be fully capable of pursuing other goods.
Whether or not the widespread need for extreme privacy in these matters ever changes, there are several suggestions I have which affect everyone who reads this. Because I went through far too many years of life untreated for chronic depression and misled by several well-meaning but ignorant people, I make these imperative statements:
Anyone who suffers or thinks they might suffer a signficant mental illness should seek evaluation and treatment immediately. There may be no panaceas, and some conditions will improve or subside with time, but if you suffer very much for any length of time there is hope for improvement if you get medical help; the sooner you start, the better.
It takes enormous resilience, determination and courage (both for the patient and for people closet to her) in order to seek obtain and carry through on treatments; there are often false starts (unhelpful medications, useless therapists, etc.) and tough times ahead before improvement occurs.
The patient has to do a lot of informed seeking. Many physicians and patients need to be more eclectic in welcoming whatever combinations of treatments may help. Persevere and find out the more relevant options.
Please, everyone, strive to help each other! Not to play amateur therapist, but to learn when and how to try to steer someone toward help. Everyone encounters people daily who are silently suffering in ways we may not imagine. We can all be much more alert for warning signs: often changes in sleep patterns, diet and weight, energy levels, and/or mood (`affect'), or perhaps simply the arrival of midterms can indicate some underlying condition which should be addressed.
A huge variety of more recognizable `physical' illnesses may involve changes in these areas, but the tricky thing about mental illnesses can be the lack of a simple sign on the forehead saying "Help, I'm depressed!" In my own case, it was after being exhaustively tested for a myriad of other possibilities that my perceptive and enlightened M.D. at UHS told me, "The times I have seen such persistent unexplained symptoms have usually been cases of depression."
I have never wanted to make my life such an open book, but I will regard this as worthwhile if enough good comes of it. Many silent sufferers need treatment and loving support, and our society's public policy needs drastic reform in this area.
For students, I think the structures and resources for assistance at Harvard are generally impressive, although much better training of resident tutors and proctors for recognizing subtle signs would help greatly. Please, make my public "soul-baring" more than an exercise in agonizing self-exposure! Your education, indeed your lives, should be better for it.
John Duvivier received his M.A. in philosophy from Harvard in 1988. He was the head teaching fellow of "Justice," and served for seven years as director of the First-Year Outdoor Program.
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