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Updated: Sun, 15 Dec 2013 07:12:32 GMT | By CBC News, cbc.ca

Stigmatizing depression a dangerous trend: Andrew Solomon



In this image released by PBS, novelist Andrew Solomon, a subject of the documentary "Depression: Out of the Shadows," is shown. The documentary airs Wednesday, May 21, at 9:00 p.m. EDT on PBS. PBS/AP

In this image released by PBS, novelist Andrew Solomon, a subject of the documentary "Depression: Out of the Shadows," is shown. The documentary airs Wednesday, May 21, at 9:00 p.m. EDT on PBS. PBS/AP

Andrew Solomon is not your typical depressive, if such a thing exists. Most people struggling with clinical depression do not like to talk about it.

Depression is usually suffered in silence, because of the stigma that still clings to it. Many people still see depression as a sign of weakness, or believe that if you just cheered up or had a better attitude you'd feel so much better.

Solomon has heard the wrong-headed chatter most of his life. But rather than shy away, the journalist and best-selling author wrote a book about it, detailing his own struggles with depression. It’s called The Noonday Demon: An Atlas of Depression.

And he has become a vocal advocate, calling for more progressive attitudes about the disease so that people suffering from it can step out of the shadows and feel comfortable getting the help they need to survive, and to thrive.

So it was with some shock and dismay that Solomon learned about Ellen Richardson, a Canadian woman turned back at the U.S. border last month because she was hospitalized last year for her depression.

Richardson was told she could only enter the U.S. if a doctor — not her own, but one from a shortlist of others whom she had never met — signed a document vouching for her. She would also have to pay a fee of $500. 

Richardson turned around and went home.

U.S. border guards are allowed to bar anyone they deem a threat to themselves, to other Americans, or their property. They have access to police records — including even uneventful encounters with officers — but medical records are supposed to be held in the strictest confidence. 

Richardson's stay in hospital was preceded by a 911 call, placed by her mother, but she says police were never involved, just an ambulance.

In a feature interview with Michael Enright on The Sunday Edition this weekend, Solomon says he was aghast that someone would be turned away at the border because of their mental health condition.

He likened it to the travel ban against people with HIV and AIDS that also once barred people from coming into the United States.

“It had a very stigmatizing effect. It meant that people who had HIV didn’t have the same rights as people who didn’t have HIV, and that led people who had the condition to hide it or disguise it,” he says.

He adds that the same thing should not happen to people with depression. “They’re not going to go into the hospital, because they’re afraid if they do it’ll go on their record. And if it goes on their record, it will affect their ability to live freely.”

Stigmatizing treatment

Solomon says stigmatizing depression is bad, but stigmatizing the treatment of depression is even worse.

“[Richardson] wasn’t picked up because there was a psychiatrist sitting at the border who thought she seemed depressed. She was picked up because she sought treatment," he says.

"So people who seek treatment are going to be denied entry into the country, and the people who don’t seek treatment are going to be able to get in just fine. And that is a very bad situation, because the people who may be a danger to themselves or to others are the people who have gone untreated. People who have sought treatment for mental illness have no higher rates for violence or causing damages than anyone else.”

He says the stigma connected to depression is most acute around the use of anti-depressants.

“People have this notion that these medications change you from who you are into someone else. And people also think that because they’ve had a sad day here and there, that everyone should be able to deal with depression the way they did, by pulling their socks up and getting on with things. People don’t realize that you need certain types of treatment if you have very severe clinical depression.”

Besides the parallels to the HIV travel ban, Solomon was also struck by similarities between Richardson’s ordeal of government-sanctioned prejudice and the treatment of gays in the military in the United States.

He argues that the “Don’t Ask, Don’t Tell” policy not only affected gays in the military; it affected how all homosexuals thought of themselves and their place in the world. And he sees this border policy having the same impact.

“If we say that it’s all right for the government to tell people that they can’t even come to the United States on holiday because they once had a mental health episode that resulted in a hospitalization, then we’re stigmatizing everyone who suffers from depression,” he says. “We’re giving them a sense that they’re worth less, that they’re vulnerable, that they can be easily disregarded.”

Solomon feels the best thing people with depression can do to fight this kind of institutionalized stigma is not to be ashamed of their struggles.

“This is the family secret that everyone has, and I think we will liberate an awful lot of people from a terrible burden if we take away some of that stigma, because dealing with depression is exhausting and overwhelming. And dealing with secrecy is exhausting and overwhelming. And having to deal with depression and be secretive about it makes it five times more difficult than if you could just be open and honest about it.”  

He says people with depression are at a disadvantage because the disease makes it hard for them to be vocal advocates, but those people who have received effective treatment can be the voice for those who are struggling with it in silence. 

[Listen to the full interview with Andrew Solomon on The Sunday Edition starting at 9 a.m. Dec. 15, or on The Sunday Edition's website.]

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