By Joseph Scotto, LCSW-R
Vice President, Behavioral Health
I once had a patient who survived the September 11th terrorist attack on the Twin Towers. He was the only one in his office who did. For four hours, his wife couldn’t get in touch with him and believed him to be dead. Both suffered from extreme depression afterward—but both were too ashamed to acknowledge it. How could they be depressed when he, unlike so many they knew, came home? People around them were quick to tell them how they should feel: “You are so lucky,” people would say after hearing of their harrowing experience. Not: “I’m so sorry you went through this.”
I thought of that man and his wife when I heard about the suicide of Kate Spade and then, just a few days later, of Anthony Bourdain. Both appeared to have everything: wealth, professional success, a family. Kate Spade hung herself in a Park Avenue apartment, for crying out loud. What on earth did she have to feel depressed about? And how could Spade and Bourdain, both parents, be so selfish?
That’s the response I hear over and over, even from highly educated people who truly understand that mental illnesses are actual illnesses, on par with physical illness. So why the reaction?
Because we all have a list of things we feel are acceptable to be depressed about—and there is enormous shame and guilt when you are depressed, but your reasons are not on the list. It’s this guilt and shame that, sadly, is behind the stigma of mental health, and why it’s so hard to get it to budge.
The good news is that things certainly have improved since I was seeing the patient who survived September 11. Talking about mental health has become much more acceptable. There have been comprehensive improvements in the mental health plan in New York City. Celebrities have been talking openly about such mental health conditions as depression and anxiety, and it’s been a key theme in other media, most notably the runaway Netflix show 13 Reasons Why. (While some people felt that the show glorified suicide, I thought it opened up a dialogue about it in a very important way, for an important demographic.) And I’m heartened that a lot of the media coverage of Spade’s and Bourdain’s deaths has focused on the need to eliminate the stigma surrounding mental health.
There’s no question that there is less of a stigma surrounding mental health than there used to be.
But, as Spade’s and Bourdain’s suicides make clear, “less” is not enough.
We as a society have been talking more about mental health in general, but I’m not sure that’s translated into individual lives. For example, I think it’s become OK to talk about the issue of mental health, and to voice your opinion that there shouldn’t be a stigma about getting mental health treatment—but I don’t think that it’s become equally acceptable to talk about your own mental health. Still, the mom in the soccer stands would feel comfortable telling another mom she was under a physician’s care for lupus, but not that she was seeing a therapist for depression.
Behind this difference is how we perceive the person with lupus versus the person with depression—and the person with depression knows this. The one with lupus is not judged for having the disease, and no one would expect her to clear up the condition on her own. Not so with depression. People with depression worry that they will be seen as weak, that they should be able to handle the problem themselves. When that doesn’t happen, an incredible sense of guilt follows—especially when they feel they have no “reason” for being depressed. As Anthony Bourdain once said about his depression, “I’m not going to get a lot of sympathy from people, frankly. I mean, I have the best job in the world, let’s face it. I go anywhere I want, I do what I want. That guy over there loading sausages onto the grill, that’s work. This is not so bad. It’s all right.”
Here at The Child Center, we see both parents and children in our outpatient mental health clinics. The parents in the communities we serve haven’t achieved the professional and financial success of Spade or Bourdain, but the guilt of feeling depressed affects them all the same. Balancing multiple jobs and children, often with mental health needs of their own, it seems downright selfish to consider taking the time out of their overbooked schedules (and, they likely imagine, money out of already stretched wallets) to go to weekly therapy sessions. It all comes back to the perception that this is a problem they should be able to fix on their own. When they are unable to, they see themselves as unworthy, may begin to self-medicate with alcohol or other substances, and become much more at-risk for suicide.
That’s why I believe a necessary precursor to erasing the stigma surrounding mental illness is acknowledging that there is no right or wrong “reason” for being depressed, any more than there is a right or wrong reason for getting lupus.
Back to my old patient who survived the Twin Towers, I remember him telling me that if he confessed to feeling depressed to other people, he had to say that he was feeling that way because of the death of his friends. Only then did people think he had a “right” to his depression, because losing friends to death is on the list of acceptable reasons to be depressed. And his wife certainly couldn’t speak of her post-traumatic stress, reliving the feeling of thinking her husband was dead—when so many were dealing with husbands who actually were dead.
I’ve come upon this time and again in my professional career and in my personal life. “He had severe stomach pain for four years and just couldn’t take it anymore,” one person told me of a loved one who had passed away. I later found out it wasn’t true about the stomach pain, but it somehow seemed to the survivor that her loved one would be remembered with more dignity if she ascribed a physical cause to his pain.
If we want to get serious about erasing the stigma of mental illness, we need to start by realizing that happiness and sadness are equal in every way, and we can’t expect to always feel one and not the other. When someone confides in us of their sadness, instead of telling them how they should feel (“You have so much to be happy about.”), let’s make sure they know: You have the right to feel sad, even if what you’re sad about isn’t on a list of acceptable reasons. And if you find your sadness is a problem you can’t “fix” on your own, help really is available.
For anyone who is experiencing suicidal thoughts, please text the Crisis Text line at 741741 or call the National Suicide Prevention Lifeline at 1-800-273-8255. You’re not alone. Confidential help is available for free.
The Child Center of NY provides help for people struggling with depression and other mental health challenges. Please call us to see if we can help.
