John Folk-Williams has lived with major depressive disorder since boyhood and finally achieved full recovery just a few years ago. As a survivor of ...Read More
Getting a depression diagnosis is a big step in dealing with the illness. Up to that point you may have tried to ignore the symptoms or hoped they’d go away. By trying to find out more, you’ve taken action and broken the paralysis that often keeps people from getting effective treatment.
The diagnosis itself is simply a name given to a set of symptoms, but you’ll likely receive several messages along with the bare definition of what’s been happening to you. Some of those messages are hopeful, but some may be discouraging. What you hear depends on the attitudes and beliefs of the diagnosing physician. It’s easy to confuse the diagnosis with the message.
Some physicians, whether in primary care or psychiatry, are compassionate by nature and convey messages of hope and encouragement. Others express support by emphasizing their medical expertise and the importance of following their guidance for treatment. Still others reflect indifference to your emotional state and see you only as an example of a mental disorder, not as an individual.
The messages I found most hopeful were the most basic of all.
- You have a well-defined illness. The moods and negative beliefs about yourself, and the rest of the problems you’re living with, are all symptoms of depression.
- You’re not alone. Millions of people around the world also have the illness.
- Depression is treatable.
These are crucial messages of hope and support. You may be feeling quite hopeless when you hear them, but at least they give you something to hold onto. You know there’s a reason you’ve been falling apart, and it’s not that you’re a bad or worthless person. You also know there is a way to get better.
But you need to hear more than these basics. What is the treatment? What about the future? What can I expect?
If you have a recurrent form of the illness, you might hear messages like these:
- Depression is a brain disease with biological causes and is best treated with medication. (This is a hotly contested idea, but you probably wouldn’t know that while listening to your first diagnosis.)
- You will probably have depression for the rest of your life. The best you’ll achieve is remission of symptoms, not full recovery.
- Even after the symptoms go away, you’ll need to be monitored for signs of relapse.
- Medication is the best defense against recurrence, so you’ll probably need to take it indefinitely, perhaps for the rest of your life.
These messages are double-edged. You might take comfort from the idea that depression is a brain disease. This explanation takes the problem completely out of the realm of personality and willpower. It’s a strong defense against those who think depression is simply a weakness of character, a belief that even you may have shared.
The availability of medication is also reassuring. The promise of drugs is that they will take the symptoms away and give you back your life. Even the prospect of taking them forever can be acceptable. If meds work, you’ll gladly take them for as long as you need to.
The problem for me was that these ideas took me out of the process of getting well. They made me dependent on the effectiveness of medication or some other medical treatment, like electro-convulsive therapy. I realized much later that as long as I put all my hope in a medical answer I was limiting my ability to recover.
I went from a belief that I was worthless and couldn’t change to the belief that I had a disease that could only be treated by medical professionals. Either way, I was missing from the effort to get better.
The disease idea failed to help strengthen my own resilience. The answer, I was told, was not inside me but somewhere out there in the world of medicine, and for me that world was like a black box.
Pinning your hopes on purely medical treatments can set you up for severe disappointment if it turns out that those treatments don’t work for you. That’s what happened to me, and I felt hopeless and scared that I would never get better because no medication seemed able to help.
Diagnosis can be the beginning of your partnership with physicians for the work of recovery, or it can be the beginning of a passive relationship in which you wait for the right treatment to come along. It depends on how you respond and the messages conveyed to you by your PCP or psychiatrist.
Do they encourage you to be part of your healing or do they expect you to leave everything in their hands? Do they help you build confidence in your resilience in the face of illness, or do they encourage you to look primarily outside yourself to the latest in medical treatment?
No one can get the better of recurring depression without a lot of help. Primary care physicians, psychiatrists and therapists all play critical roles, but I believe that treatment has to be a collaborative process in order to be effective. Just as depression has many causes, treatment should have many dimensions. If you begin treatment with a diagnosis that puts you in a passive role, I think you’ll have a much harder time making progress.
What has your experience with diagnosis been like?