Did anyone know that Dwayne Johnson (you know, ‘the Rock’) has suffered with Depression? Yes ok, maybe you didn’t and maybe you don’t really care (in the nicest way I’m sure). My point is the wrestler is one of a string of celebrities and high profile figures who have put aside their fame and fortune to talk about how mental health has brought them to their knees at one or more points in their life. Money can’t buy happiness and all that. If you don’t know who the Rock is, google him (but also, how do you not know who the Rock is?). Yes, money and muscles do not make you immune to the black hole of Depression.

Depression and Anxiety

I’m going to limit my mental health gambit here to Depression and anxiety. They are ofcourse epic topics in themselves, but what I mean is I’m not going into the psychotic stuff. It’ll get too complicated, and I’ll start needing to remember psychiatry terms like folie à deux. That’s French for the eagle-eyed amongst you. It’s when one person in a relationship has some delusion and the other person in the relationship jumps onboard the same delusion wagon. I nearly went into psychiatry training, but decided my brain felt far to pan-fried with all of the thinking that needs to go into therapy. I feel it’s preferable for you to not be sizzling away at 3am for your career to be sustainable.

How we actually feel

So anyway, the Rock. Let’s start by thinking about some wise Rock words – ‘You’ve got to talk about it, and you’re not alone.’ Excellent and on point, Dwayne. I’m a huge believer we are not good at recognising how we feel, and when we do, we aren’t good at really acknowledging it, and even worse at doing something about it if those feelings aren’t terrific.

Think about it. What do you feel right now? You’re automatic reaction is to almost dismiss the question as being far too simple or touchy-feely. We are used to people asking us ‘hi, how are you?’ as a passing comment as we run to our next social function. And more often than not we ask the question in a way that is geared up towards only being receptive to a positive-and-short-response. How many times have you just said ‘good’ without even thinking about it?

So, what do you feel right now? Happy? Peaceful? Helpless? Angry? Worried? Frightened? Pained? Weary? Interested? Bored? Don’t say bored, throw me a bone.

It’s hard isn’t it? Before we even talk about it, we have to recognise it. We should be able to recognise what we are feeling at any time pretty quickly but we can’t because we don’t think about it enough.

Labels – are they healthy?

Let’s take a peak at what happens further on down the line – when people are diagnosed. When it comes to having a ‘diagnosis’ of Depression and Anxiety I feel that many patients fall into one of two groups – those who want to/are happy to have that label, and those who avoid doctor lunners and her sort at all costs because they don’t want that label, thanks very much. I think the former group mostly feels it’s helpful to have a diagnosis so they are able to have a solid explanation as to why they’ve been feeling so bloody awful.

The more experience I have though, the more I think that labeling people with a diagnosis may not be entirely helpful. And I think that’s true of many conditions – I feel like we have become a bit label-happy in medicine. When we write in your records as GPs we have to ‘code’ what you’ve come in with, or what your condition is. There are some great ones. Like ‘struck by macaw, initial encounter.’ Makes you leaving wanting more that one. Did the macaw return?

Whilst I get why coding needs to happen, and there are times where having a diagnosis is helpful, I do wonder whether our need to have a label in society hasn’t been helpful in recognising and treating the depressed or anxious people who really need help. I wonder if my clinics are seeing too many of the people who are finding life tough but who aren’t actually suffering with Depression or Anxiety, and seeing too few of the people who are definitely in need of help. Let me explain before you accuse me of being an unsympathetic sod.

Berny

Berny (not real, patient confidentiality means I can’t blab about anyone. But great name right? Not enough Bernys in the world) comes in because her boss is giving her grief. She’s taken off a bit too much sick leave and they want a note for the last week of absent Berny. She has three kids and struggles with not finding time for herself. Middle child is having problems at school, and her mum who used to help her out a bit can’t at the moment because she’s broken her leg. And it’s November and it’s raining.

I cannot tell you how many times a week I see a Berny in clinic. And before you say it, I pretty much always feel for Berny. But Berny is suffering with life-being-hard syndrome, and not a mental health condition. There is a big and important difference.

The symptoms

Let’s look at the features of major depression. To be diagnosed with this you need to have had persistent low mood or loss of interest in enjoyment in things you used to love. For at least 2 weeks. This needs to be accompanied by at least three other symptoms, like feeling of worthlessness/inappropriate guilt, no energy and thoughts of death. It’s all pretty intense.

To be diagnosed with a generalised anxiety disorder (there are lots of specific other anxiety disorders, but let’s not get our complicated pants on), you need to have been excessively worrying, and finding it difficult to control that worry for at least 6 months. And other lovely stuff needs to go with this – like persistently feeling on edge, real difficulty concentrating, being irritable or easily fatigued. And there needs to be at least 4 other physical symptoms – like trembling, palpitations, feeling sick or dizzy. Again, it’s all weighty stuff.

Back to Berny

My point is Depression and Anxiety are not life-is-tough syndrome. After a particularly delightful clinic one day I had a chat with a colleague who had a standard Berny consult. When she got round to trotting out the requested sick note, she’d hit a blank. Since writing ‘Life’ down in the reason for work absence is generally frowned upon, she scribbled down a bit of low mood.

I get it, life is tough. And tougher for some more than others I’m sure. I honestly have sympathy for that. And there are definitely times where life-being-tough does tip over into Depression or Anxiety. But in my experience the vast majority of Bernys who rock up in clinic are just needing a good vent, some helpful chats on coping mechanisms, and a standard doctor rant to pass onto their employer who should not be bumping them to their doctors for a sick note for less than 7 days off work.

Unfortunately what actually happens is Berny has a tendency to end up with an inappropriate label of Depression or Anxiety, or both if she’s really lucky. Usually because her symptoms are flirting with possibly ticking off a few diagnosis boxes (some of the criteria like not sleeping has so much grey area they’re a murky winters day), she’s in clinic with same presentation for the 4^th time, and her mate Bazza was put on Citalopram so please could she give those bad boys a whirl.

It is my honest opinion that this is all not helpful for Berny. She’s ended up on a drug that isn’t going to fix her social problems.

And this widespread attitude is not helpful for any of us. It is fantastic we are all talking about mental health more, that we are getting better at booting out the I’m-so-weak-for-being-human stigma. But we do not need Depression or Anxiety to be used willy nilly. It devalues using the diagnoses at all. If everyone is labelled with it, when does it all become normal? And on that note, let’s talk about how common these things are.

1 in 4 people

Dwayne said it, you are not alone. 1 in 4 people will have some sort of mental health problem every year. That is a lot of people. Whilst I do wonder if too many Bernys are included in that stat, there are also too many people still not getting the help they desperately need. I can guarantee you now that there is someone you know who you think has life sorted that is suffering from an episode of Depression or Anxiety who hasn’t cashed in on any help yet. After you’ve probably given some thought to who that lucky gem could be, let’s think about why this is.

British stiff upper lip. The old stigma chestnut. The I’m-better-than depression or anxiety. It’s odd, we apparently spend a lot of our time trying to prove our worth or prove to ourselves and others we are ‘better’ is some or all of the ways. It’s exhausting. Why do we do it to ourselves and those people we supposedly call our friends? No-one ever comes out of those conversations feeling good.

Ignoring something that is adversely affecting your daily life is not healthy, and will never end happily. Yes sure it may seem super easy to just ignore this elephant in your head rather than try to deal with it, but Nellie isn’t going anywhere. Despite having some awareness of how awful they feel, some people can’t truly admit that they may have a mental health problem. If Depression was a broken leg, we wouldn’t ignore it and crack on with the hobbling. We’d accept we need to get help. And a bit of plastering.

But Depression and Anxiety are much harder. They don’t have a bone poking out of the leg to convince you something is wrong. They involve having to recognise and admit your feelings. And then talk about them. Yes, I said it boys, you need to talk to about it. Medication can quite literally be a lifesaver in some circumstances, but I see the pills more as a life raft in stormy waters. I know, so much cheese, but it’s the best I’ve got and you’re still reading so pipe down.

The real crux of long-term help with depression and anxiety is in the talking therapies. Medication can get you to the point where you are able to face life, to feel that you’re not so consumed with low mood or worry that you cannot function day to day. But to really address the problems you need to talk it out.

Final thoughts

We all have issues. We all have beliefs that aren’t helpful. And the truth is many, many of us will suffer with a bout of depression or anxiety in our life time. And that is OK. Just like breaking your leg doesn’t make you less of a person, neither does feeling debilitated by worry. What is not ok is ignoring how you are feeling. That and asking Berny to see her GP for a sick note.

The next time you see a friend ask them how they are. In a way that is genuine and ready for a real response. You may be the help they need to figure out better coping mechanisms in our frantic lives, or you may be the person to help them get help for a debilitating mental health problem.