By Dr. Chua Sook Ning
WHAT IF we treated our physical illnesses the way we treat our mental illnesses?
Let’s imagine you woke up one fine morning in Kuala Lumpur.
1. Your head hurts, you had a fever, your throat was sore and your nose was runny. Your whole body was aching and you felt so tired. What do you do?
A. You decide against going to the doctor. You say to yourself: “I’m sure it’s just because I’m stressed. I know I have a fever, a sore throat and a runny nose, but maybe that’s normal”.
B. You make an appointment to see the doctor.
More than 70% of adults who have been depressed do not seek treatment.
2. Your boss calls you and yells at you to come to work. “What’s the matter with you? Don’t you know that all of us are tired? Stop pretending you have the flu!”
A. You think to yourself, “What a jerk!”. You call up a friend to complain about him.
B. You feel really bad and guilt. Maybe you really don’t have the flu. Maybe you are making the symptoms up. Maybe your boss is right… So you get dress and go to work. Your concentration is low, you are tired and it’s just a bad day overall.
Guilt and self-blame is a symptom of depression. People blame themselves for things that go wrong, including their own symptoms of depression. People with depression are not pretending to be depressed. Depression is not a pleasant state. If they could, they would feel happy. But right now they cannot. Happiness is not a choice they can make or will to happen. Just like you cannot will your sore throat and fever to disappear. With depression, people are more likely to doubt the reality of their own symptoms and internalize the negative comments made towards them.
3. You meet your parents for dinner and your mom tells you, “Yeah, you better work harder ok? You don’t want to lose your job! Don’t rest, there is no time. Nevermind if you have a fever. Take some panadol than ok. Last time, I had also got fever but I never took a day off!”
A. You think to yourself, “She’s right. What’s wrong with me? Why am I so weak?”
B. You think, “But I am sick AND I am allowed 10 days of sick leave AND I haven’t even taken a single day off the whole year!”
People are told to just push through their symptoms. Depression is not just sadness, it is severe sadness that does not get better the next day, or the next, or the next. It does not go away just because you ignore it. Denial does not make the problem less real. In fact it makes the problem worse because you end up doing things that you should not be doing, and you don’t do the things you should be doing.
4. You feel worse after dinner and you crawl into bed. You wake up with your head throbbing, your fever is higher, and your throat feels like sandpaper.
A. So you decide to push yourself even harder. You tell yourself, “I can do this! I don’t have a fever! I don’t have a sore throat!”.
B. You take the day off.
But most people just try to push through it anyway because they feel bad for feeling bad.
5. And let’s say you took option A and pushed yourself. What do you think would happen?
A. A miraculous recovery!
B. Nothing good.
Nothing good happens with untreated depression.
a. You prolonged your suffering
b. You may experience a worsening of symptoms.
c. Important domains of your life such as work and social domains are negatively affected. Untreated depressive illness progressively handicaps an individual’s ability to work, study or carry out their home duties. Depression causes irritability and social withdrawal.
d. Prolonged and severe symptoms increases the risks of relapse in the future.
e. Risk of physical diseases (such as heart disease) and damage to the brain (e.g. hippocampus) increases.
Depression is not just sadness. It is unrelenting severe sadness. It is not your fault, it is not your weakness, it is an illness that can be treated. Treat mental illnesses as you would physical illnesses.
You don’t need to wait till you are severely depressed to deserve help. Just like you don’t need to wait till you have Stage 4 cancer to get help.
Help is not earned or reserved for special individuals. You deserve to get help.
Please seek help by making an appointment with a psychiatrist or a clinical psychologist.
Here are the symptoms of depression according to the DSM-5:
Five (or more) of the following symptoms have been present during the same 2-week period and represent a change from previous functioning; at least one of the symptoms is either (1) depressed mood or (2) loss of interest or pleasure.
Note: Do not include symptoms that are clearly attributable to another medical condition.
1. Depressed mood most of the day, nearly every day, as indicated by either subjective report (e.g., feels sad, empty, hopeless) or observation made by others (e.g., appears tearful). (Note: In children and adolescents, can be irritable mood.)
2. Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day (as indicated by either subjective account or observation.)
3. Significant weight loss when not dieting or weight gain (e.g., a change of more than 5% of body weight in a month), or decrease or increase in appetite nearly every day. (Note: In children, consider failure to make expected weight gain.)
4. Insomnia or hypersomnia nearly every day.
5. Psychomotor agitation or retardation nearly every day (observable by others, not merely subjective feelings of restlessness or being slowed down).
6. Fatigue or loss of energy nearly every day.
7. Feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day (not merely self-reproach or guilt about being sick).
8. Diminished ability to think or concentrate, or indecisiveness, nearly every day (either by subjective account or as observed by others).
9. Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide.
B. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
Dr. Chua Sook Ning is a Clinical Psychologist and a lecturer at the National Institute of Education at Nanyang Technological University, Singapore. She believes in raising public awareness of mental health by encouraging open and public conversations of mental health. She also is also working on early identification of mental health conditions by promoting mental health screenings and. training communities to recognize mental health conditions. Finally, she is working with a team of international researchers to develop accessible and affordable mental health interventions.