Depression doesn’t make you sad all the time

Tags

Depression, happy, myths, sad, stigma

Depression doesn’t make you sad all the time

One of the most popular, enduring, and irritating myths about depression is that it means depressed people are sad all the time – and that by extension, people who are happy can’t be experiencing depression, even if they say they are. It is a skewed and horrible version of depression, and it’s one that further stigmatises the condition and isolates people with depression and related mental health conditions. This is because, put bluntly, depression doesn’t make you sad all the time – though the level of sadness a patient experiences can of course vary depending on the individual and the severity of depression.

When I’m having a depressive episode, I’m not walking around in tattered black clothes, weeping and wailing. I go out with friends. I crack jokes (especially sardonic ones). I keep working, and have friendly chats with the people I work with. I often manage to feed and clothe myself, I read books. Above all, I experience moments of happiness: a flash of delight as I’m walking on the beach with a friend and the sun is perfect and the breeze is just right; a surge somewhere deep inside when I’m surrounded by beautiful trees and it’s raining and I feel my heart swelling to encompass the whole world; a warm, friendly, affectionate sensation at the touch of a friend, a hug at the end of an evening or a hand placed over mine as we lean forward to see something better.

Yet I feel a strange conflicting pressure. On the one hand, I feel like I need to engage in a sort of relentless performative sadness to be taken seriously, for people to understand that I really am depressed and that each day – each moment of each day – is a struggle for me, that even when I am happy, I am still fighting the monster. I feel like I need to darken everything around me, to stop communicating with the world, to stop publishing anything, to just stop. Because that way I will appear suitably, certifiably sad, and thus, depressed – and then maybe people will recognise that I’m depressed and perhaps they’ll even offer support and assistance. The jokes die in my throat, the smile never reaches my lips, I don’t share that moment of happiness on the beach by turning to my friend and expressing joy.

I don’t, in other words, do the things that can help ameliorate depression, encourage people to reach out, and help depressed people with functioning, completing daily tasks of life, and finding a reason to live again. I don’t find and build a rich community of people who can offer support (and whom I can support in turn), because I have to be so wrapped up in performing my sadness at all times to prove that I’m depressed enough – even as I want to scream that this is a reinforcement of stereotypes that hurt people, that by doing this I am hurting not just myself but others.

On the other, I feel an extreme pressure to perform just the opposite, because sad depressed people are boring and no fun, as I am continually reminded every time I speak openly about depression or express feelings of sadness and frustration. I’m caught in a trap where if I don’t perform sadness, I’m not really depressed, but if I express sadness at all to any degree, I’m annoying and boring and should stop being so self-centred. Thus I’m effectively pushed into fronting, putting a face on it even when I am depressed and deeply sad – when I feel like I am choking on my own misery, I put up a cheeky Tweet. When I hate myself and I want to die, I post a link to something fun, or I write up something silly to run somewhere – even though as I write it, I am drawn deeper and deeper into my unhappiness.

Depression is an asshole, and it can become your master, but you can slip out from under it occasionally. And many depressed people in the midst of an episode don’t actually spend it fainting dramatically on the couch and talking about how miserable they are. Some are high-functioning (bolstered by the need to put a face on it), others are into morbid jokes, others try to reach out for help (isn’t that what we’re “supposed” to do?) from friends and try to make their depression less scary. Depression isn’t an all-or-nothing deal – seeing a person who identifies with depression cracking a joke or having fun or dancing with a friend isn’t evidence that the person is faking it, whether the person is experiencing a moment of genuine happiness, or fronting. Conversely, jollying up people with depression to demand that they start being more fun is equally revolting, a refusal to acknowledge that people experiencing a rough day, or a rough week, or a rough few hours aren’t going to be your trained monkeys.

Depression manifests differently in everyone and at different times. Various behaviours are not proof positive that someone is or isn’t depressed, and, as with any armchair diagnosis, insisting that someone is not actually depressed just because of a show of something other than deep, entrenched sadness is actively harmful.

Look at the woman above, joyously cycling on a beach, hair fluttering in the breeze. You can’t judge her emotional state or her larger mental health picture, nor should you.

• This article was originally published on This Ain’t Livin’, part of theGuardian Comment Network

Rape action plan: investigations must ‘focus on accused, not complainant’

Tags

accused, consensual, consent, myths, rape

Rape action plan: investigations must ‘focus on accused, not complainant’

Prosecutors and police investigating rape cases must place greater emphasis on examining whether suspects sought consent for sex from alleged victims, according to an official action plan published on Friday.

In a coordinated attempt to reverse declining conviction rates, the director of public prosecutions, Alison Saunders, and a senior Metropolitan police officer, Assistant Commissioner Martin Hewitt, have agreed to examine how a suspect’s “reasonable belief” that consent had been given is assessed by the courts.

The focus on establishing what steps a defendant took to ensure that sexual activity was consensual and whether the alleged victim was capable of giving consent is aimed at improving procedures.

While the number of prosecutions and convictions has increased following changes to the way rape cases are handled, the conviction rate dropped from a record high of 63.2% in 2012-13 to 60.3% in 2013-14.

CPS figures express the percentage of cases charged as rape and resulting in conviction for rape or another offence. Most rape complaints do not lead to charges being brought while as few as 10% of rapes are estimated to have even been reported to police in the first place.

The Rape action plan, agreed by Saunders and Hewitt, who is the national policing lead on rape offences, is partially a response to a sharp drop in the number of cases being referred by police to the CPS in 2012-13.

The document urges police officers and prosecutors to “focus their cases on the behaviour of the accused, not the complainant”, noting that pervasive myths remain, not only among investigators but society as a whole, which may be a barrier to justice for vulnerable victims.

“Despite efforts to raise awareness, many people still believe a rapist is a man in a balaclava in a dark alley, and a victim is a woman who shows her fear through fight,” the plan adds. “That is very rarely the case – most rapists know their victim, many victims do not physically fight, and the trauma of being raped will effect each victim differently.

“There is an urgent need to change the discourse on rape. Our police officers, our prosecutors, our courts and our communities must reject the out of date myths and acknowledge the realities of rape. We also need to debate and understand the fundamental issue of consent.”

Another proposed change is in the handling of cases that do not result in charges. Officers and prosecutors are to be encouraged to “develop an exit strategy following a police decision to take no further action in order to assess the risk of reoffending by the alleged perpetrator, and to safeguard the victim against future abuse”.

The action plan is the outcome of more than six months of discussions by a rape scrutiny panel convened to investigate the fall in the number of rape-flagged cases referred by police to the CPS. The latest figures show an 8% rise in the volume of police referrals for 2013-14 compared with 2012-13. Seven hundred more defendants have been charged over the same period – an increase of 25% from the previous year.

Saunders, said: “Even though there have been slightly more defendants convicted, the steady increase in conviction rates we have seen in recent years has halted, and this must be addressed immediately.

“The new action plan makes very clear that, as with cases of child sexual abuse, the focus of any investigation and case preparation should not be on the credibility of the victim but on the credibility of the overall allegation, including the actions of the suspect.

“Where cases turn on the issue of consent prosecutors must focus on what steps a suspect has taken to seek consent from the complainant and the extent to which an alleged victim is capable of giving consent.”

Hewitt, said: “All the changes we have made in the way police deal with sexual offences – specialist training of officers, the introduction of early evidence kits, greater access to sexual assault referral centres and working closely with support groups – are changes that have emerged from looking at ourselves and realising that we can do things better.”

Labour’s shadow attorney general, Emily Thornberry MP, welcomed the plan. She said: “We have been pressing for months for action on falls in the numbers of rape cases charged, prosecuted and convicted so it’s good to see some concrete measures.

“However, given that the proportion of rape cases referred by the police for charges fell to a third in 2012-13 and that conviction rates are falling sharply as well, it remains to be seen whether these measures will be strong enough to turn around these worrying trends. If we don’t see the necessary change, ministers will need to consider imposing more stringent obligations on how prosecutors and police handle these cases.”

Professor Liz Kelly, co-chair of End Violence Against Women Coalition, said: “Everyone reporting sexual violence deserves the highest standards from the criminal justice system and the national scrutiny panel has identified actions, which, if implemented consistently across England and Wales, provide an opportunity to achieve this.”

What health professionals should know about eating disorders

Tags

consequences, contact, counsellors, diagnosis, early intervention, Eating Disorders, family, friends, GPs, health professionals, health service, help, myths, nurses, psychiatrists, psychologists, recovery, sensitivity, social workers, support, symptoms, treatment, weight, young people

What health professionals should know about eating disorders

Over the course of two years, I have met with 40 young women and men who have shared on film honest details about their experiences of eating disorders. Their hope is that sharing their stories will help other people who are similarly affected to feel less alone and encourage them to seek help.

The research shows that common myths about the illness have prevented many young people from getting the treatment and support they needed, from family, friends and even the health service.

During the course of their eating disorder, young people came into contact with many different types of health professionals including GPs, nurses, counsellors, psychologists, psychiatrists, dieticians, social workers and other support workers.

There are some things that health professionals should know when dealing with a young person living with and recovering from an eating disorder.

Anyone can have an eating disorder

Anyone can become ill with an eating disorder. Eating disorders affect people of all ages, backgrounds, sexualities, both men and women. You can’t tell if a person has an eating disorder by just looking at them.

First point of contact is often critical

This first contact with services was often a huge step for a young person. People often found it very difficult to talk about what was going on, trying to hide their problems and it could take months, even years, to seek help. The way they were treated at this point could have a lasting, positive or negative, impact.

Young people hoped that the health professionals would realise just how hard asking for help was and to help nurture and support their confidence to stay in contact with services.

Early intervention is key

Young people often felt that people struggled to recognise the psychological symptoms of eating disorders as well as the range of different eating disorders.

If those who haven’t yet developed a full-blown eating disorder could be recognised, they can also be helped earlier. This is critical, as the longer eating disorders are left undiagnosed and untreated, the more serious and harder to treat they can become.

Effective, early intervention could be achieved when health practitioners were knowledgeable, well trained, sensitive and proactive.

Eating disorders are about emotions and behaviours, not just about weight

A common myth that many of the young people had come across was the thought that people with eating disorders were always very underweight. This idea had made it harder for some to get treatment and support or even to be taken seriously by their doctor.

In some cases, young people felt that the only way for them to be taken seriously and be able to access eating disorder services was to lose more weight. This could have serious consequences; the more weight they lost, the harder it was for them to be able to seek or accept help.

See the whole person, not just the eating disorder

Once in contact with health services, above all else, young people wanted not just to be seen “as an eating disorder” but to be treated as a whole person. It was important that they felt treated as individuals and for health professionals to realise that everyone responded differently.

A good health professional also tried to engage young people on other things than just the eating disorder, hobbies or interests.

Respect the young person

Feeling respected, listened to and being given the space to explain things from their perspective was important for young people during treatment and recovery.

Professionals should take their time and find out what was going on for that particular person, not act on assumptions. Health professionals shouldn’t patronise or dismiss issues that were important to the person in front of them.

This research, funded by Comic Relief, has now been published on online at Youthhealthtalk.org.

Ulla Räisänen is a senior researcher with the health experiences research group at University of Oxford, and was responsible for conducting the study published on Youthhealthtalk.org

Mentally ill people nearly five times more likely to be victims of murder than general population

Tags

mental health issues, murder, myths, risk

Mentally ill people nearly five times more likely to be victims of murder than general population

People suffering from mental illness are almost five times more likely to be victims of murder than the general population, researchers have found .

The popular myth of the “mad axeman” on the loose has created an impression that mentally ill people are dangerous which may expose them to greater risk, they say.

Although murders committed by mentally ill people have been widely studied, much less attention has been given to murders of them.

Swedish and American researchers examined 615 murders in Sweden between 2001 and 2008 and found in more than one in five (22 per cent) the victim had been mentally ill.

It is well known that people with mental illness are more at risk of suicide and accidental death. But this is the first time they have been shown to be at increased risk of murder.

The risk of dying by murder was highest among those whose mental illness was complicated by drug abuse. But it was also increased in those with personality disorders, depression, anxiety and schizophrenia.

The researchers blame, in part,  the common perception that people with mental disorders are “unpredictable” or “dangerous”. This, they say, creates “feelings of uneasiness, fear and a desire for social  distance and may increase the risk of victimisation.”

Mentally ill people are also more likely to live in deprived neighbourhoods and may be less aware of risks to their safety owing to their illness.

The researchers based their findings on the entire adult Swedish population of more than 7 million and adjusted their results for sex, age, education, marital status, employment and income.

The findings, published in The Lancet, have implications for the assessment of mentally ill people, say  Roger Webb and colleagues from the University of Manchester in an accompanying editorial.

Doctors should asses their risk of being victims of violence, abuse and bullying, as well as  their risk of committing it. “Anti-stigma campaigns among the public should aim to counter fear of mentally ill people with sympathy for the risks they face.”

Rape is not a dirty secret, it is a violent crime

Tags

blame, crime, culture, myths, secret, sexual assault, shame

Rape is not a dirty secret, it is a violent crime

It is troubling enough that such a small proportion of reported rapes make it to court, worse still that so few victims come forward in the first place. But most disturbing of all is the reason why so many people keep their suffering to themselves: because they do not think they will be believed. That rape is still a dirty secret, hedged about with so much blame and shame that victims feel they cannot come forward, is testament to how far we still have to go.

There are, of course, great legal difficulties in rape trials. Sexual assault is one of the few crimes where proof lies not in the physical facts of the matter, but in the subjective intentions of those involved. One person’s word against another’s, with no corroborating witnesses, is highly problematic for a legal system predicated on the concepts of innocent until proven guilty and proof beyond reasonable doubt.

This is no call for the wholesale abandonment of basic tenets of justice. But simply to shrug our collective shoulders, blame intractable issues of principle, and thereby leave a swathe of victims of violent assault with insufficient legal protection cannot be acceptable in what purports to be a civilised society.

The latest statistics make gruelling reading. More than a third of British women have been subjected to some kind of sexual assault, and one in 10 has been raped, according to the Mumsnet social networking site. Barely a third of victims go to the police, and another third tell no one at all, not even close friends.

In fairness, there has been significant progress in terms of institutional procedures. In many areas of the country, for example, there are now specially trained police officers and court prosecutors for cases of sexual assault. But uneven regional conviction rates only underline the extent to which such practices remain an optional extra rather than standard.

Equally, although victims no longer face the prospect of being cross-questioned by their attacker in court, pursuing a case to trial remains a horrifying ordeal. As a witness for the prosecution, the victim has no legal support, and faces intensely personal questioning from defence lawyers, often while face-to-face with their rapist for the first time since the assault. Even within the framework of innocent until proven guilty, there is more that can be done to ease the burden on victims, not least allowing them legal representation in court.

But the shortcomings of our institutions are merely part and parcel of a wider cultural understanding of rape that still militates against justice. It is that culture that must change if victims are to be encouraged to speak up. Comments from the Justice Secretary last year that appeared to imply that some rapes are more “serious” than others have hardly helped, adding to the persistent fallacy – often stoked by the media – that a person being either drunk or dressed in a certain way must take some responsibility for the actions of their attacker.

Part of the problem is the myth that rape is primarily a threat on the streets at night. Far from it. In fact, rape rarely occurs in the proverbial dark alley. The truth is both more banal, and more appalling: two-thirds of victims know their attacker, and assaults commonly take place in the home of either the victim or the rapist. Perpetrators rely on shame to keep their crime secret. Too often they are proved right. And if the conspiracy of silence is a problem for women who are raped, it is even worse for men.

Mumsnet is, therefore, to be applauded for its efforts to create a climate where victims feel they can come forward. The current Survivors UK ad campaign encouraging male victims to seek help is also welcome. But each is just one small step. Rape is one of the more appalling things that one human being can do to another, and yet there is no other crime about which our society is so ambivalent. That must change.