Depression: A Social Disease

Clinical depression can be thought of as in part a social illness.
Any serious illness affects more than the sick person.
If you have, for example, heart disease,
then withdrawal of your self from the social world
(work, family life, friends and relatives) is a result of
the illness. You may be forced to stay in a hospital for a long
time, or be too sick to leave the house for anything outside
of doctor visits. However, if you have depression, social
withdrawal 'is' the illness and one of the overlapping
consequences of having this disease.

Understanding of what depression really means aids in
the process of acceptance. The deeper the under-
standing, the better able the individual is to cope with what
can often be in irrational disease. It can be an aid to effective
self-management and better coping skills.

'Social withdrawal' is only one of many illness aspects that
overlap with the results or symptoms of having chronic depression.
This article outlines four issues that affect those with depressive
illness. These issues here are social in nature. They affect both
the sick individual, and those in his or her life-world.

(1) Preventing or coping with social isolation.
(2) Dealing with uncertainty.
(3) Normalizing social and interpersonal relationships.
(4) Managing stigma.

* 1. The prevention and coping with social isolation (including
social withdrawal takes an odd twist when you consider that
for this illness, (mostly) voluntary social withdrawal is
the reason for the isolation. The reasons for this are often
related to lack of self-esteem, high levels of anxiety, inability
to concentrate, and general feelings of not belonging.--Of being
out of place, out of touch, and unable to connect to that
internal resource called 'the self'. The person we are--that we
label as 'I' or 'me'-is a resource. A human disconnected from
his or her self can no easier get things done than any individual
could get done without other people. One man in the two-man
bobsled is not going to win the race. He/she can't even play.
"Social withdrawal is both a consequence of the condition
and one of its [depressions] chief defining characteristics."
-David R. Karp, Boston College (1994)

2. Dealing with uncertainty. And with the high anxiety
levels that often accompany this illness, uncertainty can
become quite limiting. Indecision takes over--we are
stuck. We are uncertain of our self and our relationships with
family, friends, and work-mates. If we have not been able to
work, or find it hard to keep a job, finances are always
there in front of us with a big question mark. We are uncertain
of what others are thinking silently to themselves when they see
us. Or what those significant others are saying to others when
we are not around.

Do they think we are crazy? Do they think we are lazy?
Stupid? Selfish? This is an internal negative feedback
loop that can destroy us if we let it. The reassurance of
family and friends and employers can be a great benefit. That
is, if they know about it. If you have managed to hide it well
enough, then you are doing, well, better than some of us are.
That much is for certain.

3. Normalizing social and interpersonal relationships. The
symptoms of depression are mostly to completely invisible to
those outside of the person with the illness, The symptoms,
being internal for the most part, have only external
manifestations associated with other sick roles to use as
"proof" of an illness. Admission of this illness is an
admission to being mentally ill. If we have to take off sick
from work, we have to tell our boss something. If our sex
life with our mate is non-existent, she or he has to know
the reason why. Our friends need to know that we care,
but we do not and can not handle being in groups of people
at social events. Our children need to know that we love
them and support them despite the way we may be acting.
And how we go about acting 'as if' we are normal creates its
own internal problems. If we pretend too much, we may
lose touch with who we are completely. We may hide
the real issues even from ourselves--and doing that can
lead to major problems later on. You know, 'when the rubber
meets the road.' Denial leaves us stuck in place. Lying to
ourselves leaves us without a self we can rely on. Suicide
can result if the spiral downward continues going deep enough
and for long enough.

4. Managing stigma. To be stigmatized is to be labeled as
different from others. We all stereotype to one degree or
another. However stigmatization goes much deeper. To be
stigmatized is to wear a costume that displays who and what
you are so completely, that you are judged as non-person.
You are a 'generalized other'. A sociologist studied stigma.
The title one of his essays (Erving Goffman) on the issue
of stigma: "Stigma: Management of a Spoiled Identity". Now
that kind of sums up definition. So defined your ability to
be treated as a unique individual with wants and needs
and abilities and talents and something to contribute to the
world becomes nullified.

Men in our culture are particularly vulnerable to denial due
to fears of stigmatization because, well, it is not 'manly'
to be emotionally distraught, depressed, unable to
support your family, etc. Instead, to avoid stigma, men
more so than women, often hide their illness through
alcohol or drugs. Even from themselves.

Having depression myself, I can testify to the absolute
'need' to withdraw into ones self. Depression disconnects
you from yourself. It is almost as if the brain is saying,
'back the truck up, we can't deal with the outside world
if we are in pieces. Stay put and get yourself together.'
A biological defense mechanism to protect what is left of
the whole self? The 'ego' knows that it is not whole. It
does not want to risk further damage.

And yet what depression may tell us we need to avoid can be
exactly what it is that we need the most. It is a fact: we
are not human in isolation. We are both a product of
everything that brought us to this point in time and space-
and we are also an ongoing process. We are always in a
state of becoming. This is a very large paradox. To pop
the paradox is to create some freedom from the confines
of a self that cannot get past it.

--
(c) 2002 Rod Cowen
RCowen@...


About the author:
Rod Cowen is a writer, online publisher, and webmaster.
His recently completed electronic book titled, "Depression:
Views on a Fragmented Self," will be released this month at:
http://www.possibilities-are-
us.org/public_html/HomeLevl/wellness.html