Speaking openly about mental health can seem like a minefield of clichés. Those suffering do so “in silence”, which they “break” when they describe what is happening to them. If they speak about it calmly, in a composed way, we’re more likely to applaud them as “brave.” But if their distress is more palpable, and their account lacks coherence, we often stop listening and instead whisper under our breath that they are “unwell” or “in crisis”.
Despite the formulaic codes we often adopt to articulate this process, I remain convinced of its importance. This week Years and Years singer Olly Alexander spoke frankly about his long term struggle with depression and anxiety in an interview with Owen Jones. I admired him greatly for it, particularly his honesty that some of it was connected to growing up as a gay man. For a mainstream star to discuss mental health issues and queerness so openly is still rare.
Alexander’s interview came in the same week that it was announced unexpected deaths in mental health patients has risen by 20 per cent in the last three years and that UK police spend an estimated 20-40 per cent of their time dealing with cases that arise from mental health issues. The impact of Tory austerity cannot be overlooked – talking helps, but if, like me, you were given seven months to wait for an NHS counsellor, a willingness to talk is of little use.
For those who have never known severe depression but are friends or family members of those who live with it, the silence can be confusing – “I want to help” or “why didn’t you say anything?” are, no doubt, natural reactions. People speak of “stigma” but I think we are in danger of not being specific about that that means. Universal pronouncements are impossible, but I offer some reflections on why it remains tough for depressed people to open up.
THEY DON’T KNOW THEY’RE DEPRESSED
In my first depressive episode, I believed the fact I couldn’t get out of bed in the morning because I was just a bit hopeless – I made a cavalier joke out of it, people laughed. I stopped eating regularly – I made another joke, friends laughed again. I laughed with them. Depression doesn’t knock on the door and introduce itself; it isn’t monotonal – people still make jokes, they still function, they still believe they’re happy. In my case, I would have insisted I was having a great university experience. I was also drinking a bottle of wine alone most afternoons and crafting misspelt essays to my tutors full of excuses.
The subsequent times I had depression, I refused to believe I’d become depressed again. To a person who has experienced recovery once, the violence of being dragged back from the world of the living into the lost days of body odour, unshaven skin and the grease of your hair sticking to your forehead is so dreadful you delude yourself it simply isn’t happening. I’d show up for work, but I wouldn’t have showered, or brushed my teeth. After a fortnight people notice. People call you into rooms and ask if you’re ok – you acknowledge their concern and insist you are fine. It’s surprising how long this can last; people hide their depression but depression also hides itself from the human roommate it has selected.
THEY DON’T SPEAK BECAUSE YOU WOULDN’T LIKE WHAT THEY HAD TO SAY
“I wish I had cancer!”, I still remember shouting back at a loved one trying to help me by telling me I was unwell and needed to treat my depression just like a physical illness. There was a stunned, horrified silence from us both. As I recall it now, its monstrosity as a statement still fills me with shame. Now, with the clarity of good mental health I see how it’s both terrible and untrue.
That said, I know I had felt it – another trick played upon me by mental illness. The suicidal ideations and intrusive thoughts that accompany severe depression are not the same as the intent to kill yourself. They are, more often, the latent sense you’d be better off dead and that you are simply lacking the ‘courage’ to end your life. The depressed person will not say this to friends or family, often through a noble sense of not wanting to upset, panic or distress them. In my case, this made me “jealous” of the physically ill: the world seemed to acknowledge them, give them freedom to speak and not blame them for their struggle. For months, I incubated these thoughts, while beating myself up for how evil they seemed.
As soon as they were spoken, the curse was broken. This is why access to therapy is so crucial for many. There are things it’s easier to say in front of someone paid to be neutral, to not judge and to challenge the real origins of your thoughts calmly.
SILENCE ALSO PRESERVES DIGNITY (SOMETIMES)
Depression is ugly, banal and unsexy. It’s lying facedown in a bed with a full bladder for 36 hours, white bed linen turned grey, tobacco stained fingers secretly decanting a premixed gin and tonic into a glass of orange juice.
Depression hampers self-awareness but it doesn’t eradicate it – you still know how terrible you look, smell, feel. You don’t want people to see it. Your own mind has humbled you, this humiliation needs no further audience. On ‘good’ days, when you’re feeling better the last thing you want to do is discuss your illness with friends.
You want to escape it, be your old self, actually enjoy the company of others. Life should be more than a therapy session and your pain shouldn’t become your personality. I believe all depressed people wrestle with this and become so desperate for “time off” they dig themselves further and further into a crater from which it is hard to emerge.
TALKING HELPS BUT IT’S NOT THE BE ALL AND END ALL
I’ve described some of the reasons a depressed person may not open up. It’s hard to generalise the ways in which those around them can help them break this silence. How, against such obstacles, can anyone know when it’s right to push a friend into speaking and when to respect their boundaries?
Much of this is intuitive and specific but I’d suggest one firm, alternative answer. Talking isn’t the only form of care, it isn’t even the greatest. Some of the kindest things friends have done for me have been practical: my housemate cleaned my room when I was out, another friend cooked a meal for me when I hadn’t eaten for days, one ordered me to put on a jumper and shoes with my pyjama bottoms and go out for a ten minute walk, another called the GP for me when I was too distressed to argue with a receptionist for a same-day appointment. A depressed friend can be the hardest person to talk to but in the midst of the silent and ineffable, they will remain forever grateful for the practical and the tangible.
Follow Shon Faye on Twitter here @shonfaye