Conditions

Depression is a diagnosis that is made clinically ( ie there are no tests) by the presence of a number of signs and symptoms.  Contrary to what is often believed, the presence of these symptoms is depression, whether it was precipitated by a clear trigger or not.  Like anything else, it can vary a lot in severity.  So just because it is not debilitating does not mean that it is not depression.  When there is a relative lack of availability of certain neurotransmitters, this results in the development of the following symptoms.  Not everyone with depression has all of these symptoms, and not everyone with depression presents in exactly the same way.  If someone has quite a few of these symptoms, he or she has depression:

-sleep disturbance:  can be decreased sleep with difficulty falling asleep, interrupted sleep,  or awakening too early, or can be sleeping too much

-decreased interest in things

-decreased enjoyment

-decreased mood:  this can be down, blue, or sad, or often flat or blah

-increased tearfulness

-increased irritability (may be one of the main symptoms in some men)

-increased tendency toward guilt, self-judgement, or self-blame

-decreased self-esteem

-decreased self-confidence

-decreased energy

-decreased motivation

-doing less, eg housework, cooking, socializing, exercise, hobbies, etc.

-isolating self

-decreased concentration

-increased forgetfulness

-mind being less sharp, trouble finding words, etc.

-in school age kids, grades often drop

-may feel slowed down or speeded up

-anxiety:  feeling nervous/tense as opposed to relaxed. Symptoms of anxiety include:  lightheadedness, feeling in a “fog”, dry mouth, racing thoughts, lump or tightness in throat, chest tightness, shortness of breath, chest pain, palpitations, knot in stomach, butterflies in stomach, nausea, pain, discomfort, or a knot in the upper abdomen, pressure over the bladder, frequent urination, cramps, diarrhea, shakiness, getting hot and sweaty, sweaty palms, weakness in the legs, muscle tension, restlessness

-more easily overwhelmed

-less decisive

-more negative thinking

-appetite may be decreased or increased leading to possible  weight loss or weight gain

-there may be feelings of hopelessness or worthlessness

-there may be thoughts of suicide

Again, a person does NOT need to have all of the above.  As long as the symptoms are causing some significant degree of distress, why not have it treated with either medication, therapy or both, so that you can feel as well as possible, and perform as well as possible in all your various roles?  You do not get a medal for suffering along unnecessarily.

DYSTHYMIA is the presence of some of these symptoms in a milder and more longstanding form.  It, too, is treatable. 

There is a hotel in Canada with an unusual elevator.  To go to the second floor from the lobby, you need to press “down”, and to go from the lobby to the second floor, you need to press “up”.  So unless you’ve been there before, or have somehow been warned, you are likely to find yourself not where you had wanted to go.

When we feel tired, we intuitively want to rest in order to help ourselves.  Much of the time, for example, when we’ve walked a long way or have a fever, resting is helpful.  One of the very common symptoms of depression is fatigue, and it feels just like any other fatigue.  However, because it has psychological components that may be subconscious, it is not made better by rest. It, in fact, is worsened by rest, and helped by activity.  So in order to achieve what we are truly after, which is to feel better, we need to go against the intuitive urge to rest, and engage in some type of activity.

Because of the decrease in energy, motivation, and interest that often co-exist in depression, it is very common and understandable for individuals to do less, and to sometimes spend more time in bed. If you find this happening with you or someone you know who is not physically sick, do not be quick to make a wrong judgement of laziness, but instead think about depression, which is very common.  With depression, the mood may be either flat, without much emotion, or sad, or a combination of the two.  People with depression who are doing less are just following the inclinations that the illness is producing, and so deserve compassion, not judgement.  However if they ask themselves whether the extra rest is helping them feel less tired, they will find that the answer is NO.  Alternatively, if they reflect on how they felt with an activity that they undertook, they will notice that it made them feel at least somewhat better.  It doesn’t matter if it’s a pleasant activity or accomplishing something, even simple.  While physical activity is particularly helpful, any kind of activity is better than none.  An excessive amount of screen time is not good, leaving one often listless, lethargic, and more irritable.  While depression often makes people want to isolate themselves, the isolation feeds feelings of depression and aloneness.  Humans have a basic need for connection, and connection is helpful for people with depression, who tend to feel isolated.

The way to get someone with depression and decreased activity, whether it’s you or someone else, is not with judgement or a whip, but rather with loving encouragement.  Do NOT use the word SHOULD, as it only tends to induce guilt and resistance.  Nobody wants to be under somebody’s thumb, including their own!  One strategy is to imagine an angel or some other “perfect friend” who is understanding of how you feel, compassionate, gentle, and strong; who can help you up, come up with a good idea of something to do, remind you that it will help you feel better, and accompany you. Or you can be that “perfect friend” for someone. It is much better to encourage and invite, and give the person options, rather than to take charge and force anything.

So remember that wonky elevator, and use the increase in activity to help you get where you want to go instead of trusting your inclination in this instance.  As people with depression increase their activity levels, they feel more alive and engaged in the world, and this in itself can have a significant antidepressant effect. 

Suicidal thoughts are not uncommon when you are feeling very badly, especially if the suffering has gone on for a long time, or sometimes if something very upsetting has happened.  Understandably, a person wants to no longer suffer, and may see suicide as the only option. Many, many people have had the thought cross their mind and never did anything to harm themselves.  Therefore, having such thoughts is

1) understandable and nothing to be ashamed of and

2)in and of itself is not a cause for alarm, but rather a sign that there is serious suffering going that is necessary to address.

When a person is having suicidal thoughts, it is because of feeling hopeless and desperate.  With a significant enough depression will tend to normally come feelings of hopelessness and the feeling that one will never feel better.  Of course, this is just one of the many untrustworthy thoughts and feelings that come along with depression.  The truth is that things are never hopeless, and people get better.  Depression is a treatable illness, with the commonest forms of treatment being medication and therapy, among other things.  Sometimes, it is simple and quick e.g. with the first medication used at the initial dose.  Other times, unfortunately, one has to be patient as various agents and dosages and longer therapy is needed.  But one way or another we can treat it, and people do get better. 

You may recall other times when you have felt hopeless.  Every time, the feeling passed and things got better, right?  And this time is no different. For that matter, think of how all your intensely positive feelings of elation, excitement, and intense love, as well as those of anger or whatever, also passed.  That’s what feelings do:  they come and go; they always pass. Feelings of hope and hopelessness can bounce around like a yoyo, whereas the actual amount of hope there is doesn’t change: you will feel better. You cannot always trust all your feelings, and you want to base your decisions and actions on fact and reality, not on a fluctuating untrustworthy feeling that will pass.  For example, if you own a business and you feel discouraged and hopeless because business is really down lately and the numbers are really bad, it is not wise to sell your business based on those feelings, when taking some corrective action and giving it some time can greatly improve the situation.  Suicide is a drastic and irreversible action that you don’t want to take when things will get better if you give them a chance.  I have frequently had people tell me how good they feel and how much they are enjoying life as they recall having felt so bad and really didn’t believe they were ever going to feel better and thus had not wanted to continue living. Just because a feeling is very strong and real does not mean that it is trustworthy, and when they’re better, people feel entirely different.

Other than the fact that you will feel better, and you don’t want to miss out on enjoyable and meaningful experiences that are waiting for you, such as time spent with family and friends connecting and laughing, hugs, sunsets to watch, adventures, things to accomplish, etc., there are other reasons why you don’t want to kill yourself.  You may have people who need you.  You may have people who you want to see grow up, get married, and have kids.  You definitely have people who would be devastated if you did that, and you definitely don’t want to devastate them.  I have worked with people who were devastated years after a loved one`s suicide. Think about all the reasons that YOU don`t want to kill yourself-not everybody`s list is exactly the same.  Make a list of the reasons, including the ones above.  This list can be pulled out to read in order to remind you whenever you need reminding.

When you`re feeling this way, you are ungrounded and need help to feel better.  This would be a good time to use tools that you have learned in order to feel better.  People tend to feel very alone at these times.  Another helpful thing to do is to talk to someone.

So, make a promise to yourself, to your doctor, your therapist, your family or a close friend, that if you should ever feel very tempted to act on the thought, that you would contact someone INSTEAD OF doing anything to harm yourself.  List who you would contact, together with the phone numbers, in the order that you would like.  Your local distress line is another option. Going to an emergency room is also an option.  Add the promise and the list of people and phone numbers to your paper with the list of reasons why you don’t want to kill yourself.  If you are unsuccessful in trying to reach someone, you are NOT off the hook for your promise.  You must continue to go down your list until you successfully reach someone.

If you have made the promise and know that you will keep it (because otherwise you shouldn’t make it), you should be able to feel a sense of safety or relief-from knowing that you will never attempt suicide, even though the thought may come.

Some people develop the habit of thinking about suicide very often over a long period of time.  This is likely a coping mechanism to make one feel that they are not trapped, but have a way out.  However, it is a very bad habit, and a lousy coping mechanism: it creates distress, is not adaptive or constructive, and is potentially dangerous.  So if you have made the right decision that you will not ruminate about suicide, then it’s time to break that habit.  Make a decision that you will stop that thought pattern, and kick those thoughts out of your head if you notice them rather than entertaining them.  People have reported to me that just making this one change helped them feel much better. Replace the thoughts with helpful adaptive thoughts such as “I wonder what’s the best way to handle this situation”, “How can I help myself feel better?”,”What can I do?”; talk to someone, or distract yourself with an activity.

If you follow the above advice, and prevent yourself from doing anything to hurt yourself, you will be grateful later when you are feeling better. 

When a person has bipolar disorder, they generally spend time in the 3 states of:  hypomania or mania, depression, and even or normal.  Hypomania is a state that is in many ways the opposite of depression.  Hypomania, like depression, is not a personality trait, but rather a state that a person goes in and out of.  When they are neither hypomanic or depressed is who they really are.

Like depression, HYPOMANIA can vary in severity.  Usually a person will have some, and not all, of the following, which is a change from their usual self:

-increased mood: euphoria, elation, or excitement

-may be more outgoing, talkative, funny

-excess energy.  May feel revved up

-restlessness.  May have difficulty sitting still

-speeded up mentally and physically

-speeded up thoughts may lead to faster and sometimes louder speech

-speeded up thoughts may lead to jumping around of ideas, making the person hard to follow

-increased activity level

-decreased concentration, scattered

-may have a number of unfinished projects

-lots of ideas

-impulsivity

-inflated self-esteem eg feeling extra creative, smart, good-looking etc.

-irritability, impatience

-excess spending, alcohol, or sex, or foolish business investments

-less inhibited

-feeling carefree, overly optimistic and less realistic

-may need less sleep, and not be tired after

-may have delayed or skipped meals

MANIA is when the above symptoms are severe enough to cause marked impairment in functioning, or when there are delusions or hallucinations.

For a description of depression, please see “WHAT IS DEPRESSION?” 

Obsessive-compulsive disorder, otherwise known as OCD, is an anxiety disorder characterized by either obsessions or compulsions that feel out of control. The individual experiences anxiety if they do not act on the compulsion or engage in the obsessive thinking. Thus they get caught in a cycle of needing to take part in compulsive acts or obsessive thinking.

Obsessions may be recurrent and persistent thoughts, impulses, or images that are intrusive and unpleasant.  Images may be very disturbing as they can be frightening, gory, violent, or sexual.  A person who doesn’t realize that they have OCD, which is producing these, can judge themselves harshly for having them.  The obsessional thoughts are often of a negative nature eg fearful or guilt or doubt-based.

Compulsions are repetitive behaviors or mental acts.  As mentioned above, they are aimed at preventing or reducing distress, or sometimes they are believed to be necessary to prevent some dreaded event(s) in a superstitious way that doesn’t make sense.  Examples of compulsions include:  excessive handwashing, which can be associated with an exaggerated fear of germs/illness, counting,  repeated checking eg of doors, windows, appliances etc,  keeping things in an unusually ordered or organized way, having specific routines or rituals of how to do things that are often time consuming and need to be rigidly followed, repeating certain words silently, and many others.

A person with OCD may have only obsessions or only compulsions or both, as long as they are distressing and time consuming, taking up at least one hour a day.

Everyone has some obsessive compulsive traits, some of us more than others, but that does not qualify as obsessive compulsive disorder, when there is not any significant distress or time wasted.

OCD is a fairly common disorder that very often runs in families.  It is treatable with medication and therapy.  Depending on its severity, it can be extremely distressing, and thus treatment can greatly improve an individual’s quality of life (and their family’s). 

ADHD stands for Attention Deficit & Hyperactivity Disorder.  It is not the best name, as there does not actually need to be any hyperactivity present to make the diagnosis.  Also, as will be seen below, there are other important aspects that are not reflected in the name.

ADHD has a very strong tendency to be inherited, and therefore tends to run in families.

ADHD is often diagnosed in childhood.  It is also often diagnosed in adulthood – even though it was present in childhood.  There are many reasons why it may not have been diagnosed in childhood. Here are some examples: people may not fit the stereotype that they think of when they think of ADHD.  For example, the bright quiet girl who daydreams and gets good marks without causing any trouble, unlike the class clown with ADHD.  Some individuals with ADHD can be coping well until circumstances change and there are more demands or stresses. Or, a person may just assume that some of what they notice about themselves is just how they are, and may not be aware that anything could be done.  Also, there   may have been instead a focus on problems such as anxiety, depression, or substance abuse, all of which are often co-morbid (go along with) ADHD.

There are three main areas of one’s life which are commonly affected by ADHD:  attention, emotion regulation, and impulse control.  When these are impaired, there is an impairment of what is called executive function.  One needs good executive function to manage one’s self in order to achieve goals in life ie it is needed in everyday life.

INATTENTION

The problem in ADHD is not actually inattention; it is relative inattention.  The ability to focus is relative to how engaging the activity is for the individual.  For example, a child with ADHD can focus perfectly for hours on an engaging video game, yet have trouble sitting still to do homework for ten minutes.  People with ADHD tend to get easily distracted, have difficulty maintaining focus and therefore staying on task, tend to procrastinate on less engaging tasks, make careless mistakes with those tasks, and can lose track of what someone is saying to them.  They may notice that they are forgetful, disorganized, or frequently misplacing things.  Their mind may tend to focus on several things at once.  They tend to get easily bored, though some keep themselves occupied with their own mind.

EMOTIONAL DYSREGULATION

This means that the person tends to experience intense upset and has difficulty calming his or herself down, so it takes longer to resolve.  Any number of different kinds of upset or arousal can trigger emotional dysregulation, including but not limited to anxiety,  hurt, or anger in response to what is not always a major situational stressor.  Some people report that it is the improvement of this problem that they most appreciate about successful treatment of ADHD.   Some people with ADHD, not all, have a short fuse.

IMPULSIVITY

With impulsivity, a person may find themselves blurting things out or acting on an impulse without adequate thought.  This can cause a lot of trouble. People with ADHD may be fidgety or restless.

Like anything else, ADHD varies in severity and the amount of distress it causes.  It is treatable with medication and strategies, such as structure, lists, reminders and other tried and true approaches.  With treatment, people are typically really pleased with the improvements in their lives and the relief of distress.

If you don’t feel comfortable about the idea of the use of medication as part of managing depression, bipolar disorder, an anxiety disorder, or ADHD, you are not alone.  Many people aren’t too keen on it for various reasons. Most commonly the reasons to avoid medication is more about myth or misperception than reality.

Firstly, of course one prefers no medication.  That is only natural and understandable.  But I’m sure you also prefer not to feel the symptoms of the condition. If there were a third option available of feeling well without taking medication, it would be foolish not to choose it.  But if the two options are: taking medication and feeling better, or not taking medication and continuing to suffer unnecessarily, I would suggest to you that the former is far wiser.

Contrary to what you may have thought or heard, the medications involved, used appropriately and monitored as needed, are safe to use long term.

These medications are not at all addictive. Unlike some other medications, they do not have an addictive potential.  Often a person gets recurrent symptoms of their condition after stopping them.  This is NOT because the medication made them dependent on it; it is because they still have an underlying chemical imbalance that is no longer being treated.  It is like a person with pneumonia who stops their antibiotic too soon and starts to have more cough and fever, a person with diabetes who stops their insulin and develops higher blood sugar, or a person with asthma who stops their inhaler and gets short of breath.  When you take away the medication that was working and that is still needed, the symptoms come back because the medication is no longer there doing its job.  It is commonplace for people to stop their medication on their own and then get worse, so this is a decision that should only be made together with your doctor.

There are many myths about medications. These medications do not change your personality or turn you into someone else.  They restore you back to who you really are, even if it’s actually been a long time since you have felt well, so it may not be that familiar.  When people are well on medication, they report “I feel like I am me”.  If a person with no condition takes the medication, they don’t feel the benefit.  For example, antidepressants are not a “happy pills”. They correct a chemical imbalance, thus helping a whole host of symptoms.

All of the above conditions are very common illnesses that tend to run in families.  There is a lack of availability of certain neurotransmitters that results in all the symptoms.  In other words, there is a chemical imbalance, and has a physical basis, just like any other illness. Having any of these conditions and taking medication for it, is nothing to be ashamed of, just like a diabetic taking insulin has nothing to be ashamed of. 

You did not choose your genes nor your past difficulties.  In other words, it is not your fault that you are suffering from this condition and need treatment.  You deserve compassion, not judgment.  It does not make you unacceptable, broken, damaged, or inferior to anybody. People with depression often feel guilty about feeling the way they do.  You need to remember that you can’t help feeling like that; it is the depression causing those thoughts, feelings, and behavior.

You may believe that if you just thought more positively, you would be fine.  But have you noticed that it is very hard to keep thinking positively when you have a significant depression or anxiety disorder going on?  If your efforts are not very successful, you can know that there is a depression causing so much negativity, and that you need some biochemical support.  This does mean that you are weak.  Picture a very strong swimmer trying to swim up towards Niagra Falls.  Despite being very strong, he doesn’t stand a chance against such a strong torrent.  And neither does a strong resilient individual against the torrent of negative thoughts and feelings produced by the chemical imbalance.  When the medication begins working, you will notice that there is less negative thinking, and that it is easier to shift to more positive thinking.  The tools that you learn in therapy become easier to use, and therapy is more effective.  It’s because you are no longer trying to swim upstream against a torrent of negativity produced by the disorder.

Taking medication does NOT mean that you are weak, that you are a failure, or anything else negative about you.  None of these illnesses say anything about your personality.  All sorts of people can have any of these common conditions. There are many people with great qualities such as being strong, resilient, sociable, funny, outgoing, optimistic, intelligent, creative etc. who had depression, anxiety, ADHD, or other conditions, and have benefited from medications.  These illnesses are NOT your identity; they are not who you are.  They are illnesses that are EXTERNAL to you, and hence you can affect it, and it can affect you. With adequate treatment, you are liberated from negative symptoms, allowing you to be more like who you really are, feeling and functioning better.

Many people are concerned about the stigma associated with the diagnosis and treatment.  It is unfortunate that there has been some stigma.  The good news is that it is lessening, and people are more open about talking about these things.  Perhaps you can be part of the process of it lessening even more by being open with those who you feel comfortable to talk to.  There has been more education and widespread awareness, and these problems are just so incredibly common.  If you have an expectation of being judged, it may in part be stemming from lack of acceptance within yourself, making you expect more judgment than there actually is.  If there are those who would judge, it is because they are not informed, and bluntly, they are wrong to judge.  So it is their problem.  Like those who have thought that it was wrong to dance. The main thing is that you know that there is nothing wrong with having an illness or taking medication so that you can feel better.

Another common concern is fear of side effects. For the vast majority of people, we can together find medication that helps you and agrees with you. Some side effects are transient, going away as your body gets used to the medication. Sometimes, there are no side effects.  Sometimes there is a minor side effect that is far outweighed by the benefit.  The best way is to think of trying some medication is as an experiment.  Unless it is a successful experiment i.e. it works and it agrees with you, something else will be tried, and any side effect being experienced will disappear when the unsuccessful medication is stopped.

Many people feel that it is not appropriate to take medication because their depression or anxiety is clearly situational.  Whether medications are warranted or not depends more on the severity of symptoms and the degree of distress experienced, not on whether or not it is situational.  A situational depression is still depression.  How do environment and chemistry interact, you may wonder?  Every feeling, thought, or action has a chemical and electrical counterpart.  If you reach to pick up a pen, certain neurons are firing together to make that happen.  If you’re crying as you’re watching a sad scene in a movie, certain neurons are firing together to go with that feeling, and then later in the movie when you’re laughing at a funny scene, different neurons are firing together.  That is why having a lot of scary experiences in the past sets one’s system up with the habit of feeling nervous, and why a traumatic event can trigger an episode of depression.  This is also why therapy can “reprogram” the brain, also correcting chemistry.  PET scans show significant functional changes in the brain before and after a therapy session in which a trauma was cleared.

Sometimes people equate depression with severe symptoms such as inability to function or being suicidal, and therefore conclude that they don’t have depression because they don’t have those symptoms.  Like anything else, all these conditions can be mild, moderate, or severe.  Just because a condition is not as severe as it can be does not mean that it doesn’t warrant treating.  As long as the symptoms are causing significant distress/problems, it is appropriate to treat.  

Sometimes symptoms of depression can be very longstanding, being there for years, and in a milder form. This is called dysthymia, and it responds well to medication as well, with people commonly reporting feeling much better than they have in years.  ADHD starts in childhood, and so people can feel that what they’re experiencing is normal, as that’s all they have ever known.  However, when treated, they find life much easier.

In the decision of whether to take medication or not, consider that you deserve to feel better, and that your mental health plays a key role in your quality of life and your ability to enjoy your life.  As well, you owe it to the significant others in your life:  children spouse, friends etc., as these conditions are hard on those around you, and on the relationships.  Irritability is one of the symptoms that stings those around.  And often these conditions affect people’s employment or schoolwork. It is not fair to you or to those around you to not take medication if you have significant symptoms. 

The most serious potential consequence of untreated depression is, of course, suicide.  Because it generally takes several weeks for medication to start working, it is better not to wait too long to start it in order to start feeling better sooner, and prevent symptoms from getting worse.

Often I have encountered individuals who have been very reluctant to take medication for various reasons. Once they decided to try it and felt so much better, they were so glad that they decided to try it. 

 A dictionary definition of stigma is: mark of disgrace; stain on character. So it’s an

inherently shameful thing . Also, it goes right to the core of a person, implying a basic

character flaw. Character comes close to a person’s core identity. So one can see just

how damaging stigma is!

Stigma is based on prejudice, or in other words, pre-judging. The dictionary defines

prejudice as an opinion formed without fair examination of facts; bias. It is obviously

wrong, dangerous, and harmful to form an opinion about someone or a group of people

without knowing the facts about them or their condition.

Stigma is steeped in ignorance and judgement, and has a tangled system of longstanding

historical roots. Unfortunately it is prevalent worldwide. The toll that it takes on

individuals is enormous, from causing denial and not seeking help or not accepting

treatment, to the suffering from a psychiatric problem being multiplied by shame and

isolation. The good news is that through increased awareness, programs, and increased

openness, stigma regarding psychiatric problems has lessened, and is continuing to

lessen. Anyone can be part of the solution to the problem when they are ready to be.

IGNORANCE

We say that stigma is steeped in ignorance because it is based on false ideas such as: that

someone with a psychiatric problem is weak, different, abnormal, crazy, is to blame for

his problem, or is somehow less acceptable or should be looked down upon/judged.

These ideas are often held at unconscious levels to varying extents, even if people know

them to be false at a comscious level. Because stigma is so prevalent, it usually affects

the individual himself, those around him, and society in general.

THE TRUTH

The truth, which is an antidote to stigma, is that psychiatric illnesses are legitimate

illnesses like any other illness. Like other illnesses, the sufferer does not choose the

illness, and deserves compassion not judgement. These illnesses are very common, and

can affect all kinds of people with all sorts of strenghs, including high levels of

intelligence, creativity, strong wills, highly empathetic and so on. In other words, they

can affect anybody. The causes of psychiatric illnesses are multifactorial. To a greater or

lesser degree, genetic predisposition is a factor. Another factor is past unresolved trauma,

which just refers to upsetting events or, circumstances that never got resolved and thus

affect one’s view of themselves, others, and the world. And then, of course, present

stressful circumstances are also a factor.

The other important truth to keep in mind is that NOBODY is perfiect, physically or

psychologically. Everyone is prone to catching a cold, developing an illness, and

everyone has psychological issues causing them to get ungrounded and upset, and take

things personally, or develop a psychiatric illness. There is a continuum from only rarely

and briefly getting upset, as is apparently the case with the Dalai Lama, to those with

severe psychiatric illness, where for example, fears can become so magnified that the

become beliefs, and the person loses touch with reality. Everyone lies somewhere along

the continuum at any one time.

Everyone has their own unique set of strengths and weaknesses, and nobody is superior

or inferior to anyone else, or has more inherant worth as a human being than another.

Nobody out of complete freedom would choose to suffer from a physical or psychiatric

illness, and those who do suffer deserve compassion, not judgement.

Because we all have “egos” as humans, we all have a tendency to judge, both ourselves

and others. Judgement is a product of the ego, which in its insecurity, seeks to elevate

itself above others in order to feel better about itself in comparison. The lierating truth is

that everyone is acceptable and loveable witzh all their imperfections. Truly believing

this gives us security and takes away the need to judge. Judgement is also fed by

ignorance (not understanding or knowing) and fear. Of course judgement can be easily

learned from a judgmental family, community, or culture.

A TRAGEDY

Living in a culture that stigmatizes psychiatric illnesses, it is particularly poignant and

tragic when, for example, a person with depression, is affected by the stigma, and mostly

sees himself as an unacceptable depressed person, losing sight his identity and the rest of

all that he is. Unfortunately, this is a scenario that I encounter all too often. The illnesses

themselves often cause more negative feelings such as fear, worry, guilt, shame, self-

judgement, feeling inferior, and not good enough. So people already immersed in these

feelings are especially prone to fall prey to stigma, thus judging and rejecting themselves,

and losing sight of who they really are. A condition that already causes so much

suffering thus results in the suffering being compounded further by the stigma.

Certain cultures or subgroups within a culture have stronger stigma about psychiatric

illnesses, making it even harder for the individual who is suffering. For example, just

yesterday I met a young physician from Jordan who was telling me that even in the

present, psychiatric illnesses are generally perceived as shameful and unacceptable. So

when a young woman was referred to a psychiatrist, it was a devastating thing for

everyone in the family, despite her parents being physicians . It would have been easier

if she had had advanced cancer, which is seen as a legitimate illness! So something is

very wrong there.

WHAT CAN BE DONE

With each person truly believing the truth: that psychiatric illnesses are legitimate

illnesses with a biological basis and that they can affect anybody, that the sufferer is not

to blame and deserves compassion, not judgement, that they are not signs of weakness

nor cause for shame, stigma is weakened. The truth is important for everyone, whether

they are a sufferer, or know someone who is, or not. The greater the lack of

understanding, the greater the magnitude of the stigma, Likewise the greater the

understanding, the less the stigma. As people come to believe the truth, they will become

more open about discussing the topic in a matter-of- fact way. Less shame leads to less

secrecy, and less secrecy leads to less shame. When I see clients who are struggling with

stigma, I routinely tell them about my family history and personal history of depression,

which they find reassuring. Openness and grounded communication about the topic

helps people feel less alone, and more compassion rather than judgement for sufferers.

There are subgroups within society where there isn’t a stigma, and where people safely

share their experiences with each other.

Educational programs and campaigns, both in schools and outside of them, including ads,

can be helpful to educate, raise awareness, and promote dialogue.