Wednesday, April 20, 2011

Depression is like. . . asthma?

A roller coaster.
Being thirteen again, but in a bad way.

There are lots and lots of ways people describe depression. Usually we use these similes to explain what feels like a unique experience to people who have just never been there. Most often we use them to explain why the illness we have needs treatment or how the treatment we're using is working for us. Most often the comparison we use is, "Hey if I had diabetes or heart disease I would have to take a pill everyday and people would tell me it's a good thing. Why is it any different for depression?"

Now, this isn't a bad argument to make. But lately I've been mulling this one over and for me it doesn't really do the issue justice. Here's why:

1) There is an element of preventability (I think I just made that word up) with both diabetes and heart disease. Yes, there is Type I diabetes that just strikes, but I think for the average individual when they hear diabetes they equate it with Type II diabetes, which our most often spun as a lifestyle disease by our current media. The same thing goes for heart disease. If people would just eat better and exercise more they wouldn't have those problems. Unfortunately, the same kind of thinking bleeds over into how we think about depression. But depression isn't usually preventable. Life circumstances, some of which we have control over (how much we exercise, if we abuse drugs or alcohol) and some of which we don't (genetic predispositions and postpartum hormone swings). For me, comparing depression to preventable diseases makes accepting the things I can't control that much harder.

2) Depression isn't necessarily a life-threatening disease like diabetes and heart disease are. If you don't treat your diabetes you're going to go blind and lose your feet and die. If you don't treat your heart disease, odds are you are toast. Yes, people with depression are more likely to kill themselves and suicide is horrible, tragic, cruel and everything should be done to prevent it from happening. But I think there are a lot of folks out there with depression who would benefit from treatment that aren't necessarily in danger of killing themselves. Maybe eventually they would be, but ideally we would support these folks in getting treated well before they ever reach that point. I think a lot of the danger of depression is not just that folks might kill themselves, but rather the immediate collateral damage that's done. Damage to family relationships--especially to the children of the depressed, short term health consequences (insomnia, weight gain/loss), and long term health consequences (possible brain degeneration) are all reasons to treat depression now even though it may not threaten the individual's life. Linking depression to two clearly life-threatening illnesses implicitly implies that folks shouldn't get treated if their lives aren't in direct danger. That is wrong.

So what should we compare it to instead? Asthma.

See, recently Mr. J (my third child who is almost four years old!) has been put on a fairly aggressive asthma treatment plan. Those of you who have been reading my blog for years know that Mr. J has never slept through the night and that we've been chasing down a number of health problems with him. Since his doctors at National Jewish Health started treating him as an asthmatic his whole health has improved. His coloring is better, his energy level and appetite are more predictable, and (wonder of wonders!!) he is sleeping through the night. (Okay, to be honest, most nights he still wakes up once and comes and settles himself on my floor but he doesn't scream or have night terrors or multiple wakings anymore. At my house this is as good as sleeping through the night gets. And, in the name of full disclosure, I think it helps that we now have a good eczema plan and allergy plan in place along with the asthma.) In some ways it is like having a whole new child. Before we started treating his asthma things seemed off and he was always struggling. But we didn't know why. It wasn't something we could see (like his eczema) so we didn't think to worry about it until it landed him in urgent care multiple times.

I think this is how a lot of us look at depression. We know something is off. We know we aren't working at full capacity. But because it's something we can't see--or in the cultural at large it isn't a "sexy" illness and can't be dressed up with pink ribbons or little red dresses--we don't think to treat it. Sure Mr. J was surviving without his asthma medicine but he never could keep up with the other kids and never felt healthy. Without my depression meds, I can manage. I can white-knuckle through my days and tough it out. But something is off and I can't keep up with my life; everything is harder than it should have to be. Having emotional stability is like having enough oxygen. Sure you can get by with less, but you'll never be able to thrive.

Now, having written all this, there is still that little voice inside me that says, "If you can manage without your meds then maybe you don't really need them. Maybe you're just trying to do too much. Maybe you're just not meant to be doing all that other stuff. Maybe you just aren't supposed to be that good." This voice is hard for me to quiet. Those doubts are powerful. It takes a lot for me to remind myself that I'm not asking for too much out of life to want to do more than just survive. It's okay to want to feel pulled together. Just like it is all right to treat my son so he can breathe deeply and fully instead of just asking him to get by on limited oxygen, it's okay for me to want to experience life from a place of stability. Thriving is not just something other people should get to do.

Have I sold you yet on my new "Depression is like. . ."? If not, how come? How do you describe your mood disorder or emotional health issues?


Dianna said...

Interesting, yet I would hesitate to rule out the depression/heart disease/diabetes links because you say the last two are "preventable." I have depression and Type 1 diabetes and you would be surprised at how many "healthy" people get diabetes. I have heard about very healthy, athletic people getting heart disease. So I can totally understand the asthma analogy, but when you label diseases as preventable when there is often no rhyme or reason to their occurrence, you risk pointing fingers where they do not belong.

Laura said...

Dianna--Thanks for the comment and for offering correction. I certainly didn't mean to point fingers! I'm sorry if it was offensive.

My thinking was that our culture/media tends to spin heart disease and diabetes as preventable--which does actually stigmatize those diseases a bit. And that's why the analogy falls apart for me. But you are absolutely correct that there are many, many (probably way more than I realize) cases where those diseases strike at random or because of genetic factors that are outside the individual's control.

Johanna said...

I enjoyed reading your thoughts about what depression is and how it is related to quality of life and to other diseases. I live with a Type I diabetic and he actually has a lot of the same feelings you do - "if I only ate better, I could use less insulin or feel better or ...". I think some humans have a hard time with guilt and "look" for places to feel guilty. Depression seems to make this tendency worse. I'm not a big guilt person, but when I was suffering from depression I totally felt guilty about feeling bad. Thanks for sharing your insights.

queensister said...

Hi Laura--haven't visited you in too long. I like the asthma comparison. I like to compare cancer and depression. Cancer is a devastating diagnosis (I have a Cancer-surviving son!) but when a diagnosis is given there is usually an accepted course of care, including length of treatment and indicated drugs. The side effects from the drugs are relatively predictable--nausea, hair loss,low blood count, fatigue--the patient has an idea of what to expect. Cancer is usually socially acceptable--people are anxious to do anything they can to support: hold fundraisers, provide meals, etc.
A Depression diagnosis, on the other hand, does not come with a clear-cut protocol for treatment. Any one antidepressant can affect each person differently. No practitioner can tell you what to expect from your particular med--you just take it and try to figure out what are the side effects and what is still depression. They can't tell you how long it will take to finish treatment--or how long it will take to even start feeling better. Or when to give up on one med and try another!
As to the social acceptability of depression, I hardly need write on that subject. I have found an occasional supportive listener, usually a fellow sufferer, but generally people don't know how to respond if I openly discuss my struggles--it's like they are embarrassed for me that I've touched on the taboo. And, have you ever witnessed a bishop standing in front of the congregation to petition prayers for so-and-so, whose depression has come back?
I'm not looking to have depression named as the condition that tops cancer. But it helps me to look at the realities of what I deal with, to recognize the hurdles I have already and continue to face.

Sorry for using your blog to get my frustrations down in type. It is very theraputic to read your words--they ring so true for me. Thanks.