My reaction? "That's great!"
The nurse gave me a second glance on her way out. Probably not your typical patient's response to a random depression screening, I guess. But on a personal level, for the last couple of years, I’ve been deeply attentive to moves toward de-stigmatizing depression and recognizing the holistic physiology of mind-body-spirit health. So I was more than just casually intrigued by this unexpected, timely development with my local healthcare provider.
Still, I couldn't resist texting my husband, only half-joking: Now depression screening is part of my annual appointment. I better start scheduling that appointment in spring instead of fall.
My husband, well acquainted with the cutely coined "fall blues," texted back: Uh oh. I'll bail you out.
Self-deprecation aside, it's a bittersweet improvement in a chronically under-resourced awareness of mind-body-spirit health that impacts so many of us in my local community. We know there's a need for more comprehensive counseling and care services, and we know there simply aren't enough well-equipped counseling or care workers to go around. As depression gains recognition as a mainstream health epidemic shouldered by the public at large, it’s encouraging to see healthcare providers partnering to share the load.
So there I sat, left to myself for a few minutes of quiet contemplation in a cold, clinical exam room. Serenity vs. the screening questionnaire, with a heart both gladdened and burdened by the same gesture of care.
After all, if I'm going to keep speaking out about de-stigmatizing depression, then I had better keep speaking honestly about my own struggles with depression, right?
Actually, yes, I can. The people around me (including pastors and counselors) tend to describe me as one of the most annoyingly positive people they know. That doesn't mean I’m immune to struggles with depression. If anything, an optimistic outlook sharpens the losses over what “could” and “should” be, compared to what “is.” For instance, statistically speaking, I can 100% guarantee this topic applies to someone you know, and you might have no idea they’re struggling. Possibly, someone you know has never shared about his or her struggles at all, for fear of shame or stigmatization. This should not be… and we can change it. How's that for happy thinking?
What if the doctor asks questions? What if she wants to put me on medications? What if she tries to refer me for psychiatric care? What if I blow my cover?
I've learned, over time, that these are not questions which occur to folks who've never felt compelled to conceal feelings of depression out of shame, fear, guilt, or self-defense. A healthy response recognizes feelings of depression as abnormal and seeks help to combat them; a depressive response sees offers of help as a pointless exercise in despair and inconvenience.
It’s been a long road, coming to what some might consider an obvious level of self-awareness about these things. So, reminded of commitments made before God and others, I self-talked my way right on into putting pen to paper. For the first time in my life, on one of those forms, I told the truth to the question, In the last 30 days, have you experienced any thoughts about harming yourself or thoughts of suicide?
When the doctor came in to speak with me, the following discussion was rather anti-climactic. She glanced through my responses, nodded slightly, then asked, "Do you have any concerns about any of this right now?"
"No, not right now," I said.
She looked me in the eye and gave me time to go on. So I did.
"I stay accountable," I shared. "I’m active in recovery groups. I go to counseling when I need to go to counseling. I have a good support network--my husband and some friends in faith. They know when I'm not okay, and we deal with it."
"Fair enough," my doctor said. She's been my doctor for over three years, and this is the most we've ever talked about it. Odd, all things considered, but it just doesn't come up in conversation that much, when we treat the mind-body-spirit in pieces delegated individually to psychiatrists, physicians, and preachers. But we're catching on. Progress has been slow, but we're beginning to understand it's the whole that needs healing.
My doctor and I went on to discuss the other health matters on our agenda for the day, and I left with a little more pep in my step than when I'd arrived. On a day when I'd walked in feeling harassed and discouraged, dreading this doctor’s visit, I walked out with a glimpse of renewal. By broaching a topic very few involved parties in my life have dared broach, my healthcare provider had just unexpectedly offered--daresay—a glimmer of hope. It’s a step in the right direction.
I don't know the context behind that post, because my gut reaction was Well, I won't be reaching out to you next time I'm looking for help with a problem, then, will I?, and I kept scrolling. So I don't know if any clarifying details were expounded in the comment thread.
If you don't want to be available for those kinds of conversations, that’s certainly your line to draw in the sand. To be fair, I do grasp the sentiment: there's enough negativity in the world, and we'd all do well to weigh in far more constructively. I get sick to death of all the complaining, criticism, and unkindness out there, too; it overwhelms my soul at times.
But fixating on any one area of life (good or bad) leaves glaring blind spots in the other areas, where we can miss big redemptive truths. And ignoring problems is a guarantor of more problems.
Consider this oft-cited international suicide research finding: men are less likely to talk about their problems and more likely to kill themselves. No coincidence there. Our preference to ignore, repress, and minimize problem thoughts is a big component of our ongoing societal issues around depression. How many suicide headlines are followed by quotes from bewildered friends and family members who had “no idea” things were this bad?
Well, having lived a lot of years keeping my own struggles with depression in the shadows, I can imagine that those folks who take their lives without warning are people who get awfully tired of just talking about joys to keep other people happy. It’s exhausting, feeling like you have to constantly shelter the people you love. It’s bleak and bone-crushing, trying to play along with whatever mood suits others better. It’s dismally isolating, feeling like there's no one on earth who can just sit with you and allow you to be whatever you are at the moment.
Imagine dealing with a debilitating injury, a chronic illness, or a devastating loss, and all the people in your life are looking at you with exasperation, disgust, and impatience, waiting for you to just “get over it” and “pull yourself together” and “decide to come be a part of life.” It’s kind of like that, except most people can identify with hypothetical injury, illness, or loss scenarios, but people who haven't experienced severe depression have no point of reference to identify with that at all. And people who do deal with depression are typically quite aware and sensitive to feeling like a burden to others, which adds to the burden of shame and guilt we put on ourselves.
On top of difficulties in relatability, there's the commonly held assumption that talking about suicide will cause more suicides. This assumption is, frankly, fundamentally backwards, as most people in recovery will quickly concur. The concern certainly sounds persuasive enough, especially for well-meaning loved ones convinced Johnny or Sally could never be one of the statistics. But, as the mere existence of crisis intervention and suicide prevention hotlines will attest, it's much healthier to speak up than to stay alone.
As one crisis center points out, in its FAQs About Suicide,
There is no research evidence that indicates talking to people about suicide, in the context of care, respect, and prevention, increases their risk of suicidal ideation or suicidal behaviours. Research does indicate that talking openly and responsibly about suicide lets a potentially suicidal person know they do not have to be alone, that there are people who want to listen and who want to help. Most people are relieved to finally be able to talk honestly about their feelings, and this alone can reduce the risk of an attempt.
The point is, no matter where we're at in faith (or lack thereof), instead of hiding, recoiling, or denying, we can recognize self-destructive patterns of thinking and relating for what they are: a mind-body-spirit signal of something in a suffering person that calls for proper care.
Such care may come in the form of attention from a doctor, a pastor, a therapist, a friend, or it may even be self-administered through simple admission of one's physical limitations and spiritual susceptibilities. There are days when the most helpful interpersonal aid really might be to boldly step in and drag a person into unwanted interaction to overcome a bout of social anxiety, but proper care is contextual. Sometimes, the most life-giving thing another person can do is just let a sufferer sit quietly before the Lord, finding rest in His Word or in prayer, journaling, or blessed silence. Sometimes, this soul yearns for someone to show what it means to do those things (or anything) when mere existence seems unbearable. The thing is, we need to be familiar with the underlying condition in order to, together, identify effective next steps for proper care.
That means we need to discuss the problem in order to address the problem. The answer isn't "Don't talk about that—that's bad." The answer is "These thoughts/feelings do happen, and we can work through them together."
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