The Tribune

By ALESHA CADET

Tribune Features Reporter

acadet@tribunemedia.net

Depression is an insidious disease free to strike whoever it likes at any age. Around us today, sitting near you in the office or beside you in the shop or hotel where you work, a colleague, a friend, may be silently battling with this illness which, in its most profound form, can be deadly. Most people who commit suicide are also clinically depressed.

Depression is currently ranked fourth among the ten leading causes of the global burden of disease, but it’s predicted that by 2020, it will have jumped to second place.

A Tribune reader last week wrote to us asking to help us turn the spotlight on the disease, bringing it out into the open where it can be discussed and, for those fighting alone, realise there are people out there ready to help.

Our reader’s plea came after a close friend of his took his own life. The nightmare of that life living with clinical depression was laid bare in a letter the friend wrote four years ago where you can see he literally fought a daily battle to stay alive. In the end, it was a battle he lost.

His letter read:

I have suffered from clinical depression for over three decades. Depression is a disease, a disorder, the manifestation of something fundamentally wrong in the functioning of my brain. I can no more will myself out of depression than a diabetic can will his pancreas to produce more insulin. As I recently told someone critical of Robin Williams’ suicide, judging someone killed by depression makes as much sense as judging someone killed by cancer.

If depression is more insidious - and more misunderstood - than other disorders, it is because its core symptoms are mental and emotional. This can make it difficult to distinguish the person from the disease, as our thoughts and emotions define who we are. This confusing of the person with the disease is not confined to non-sufferers; when the depression is especially bad, I lose the ability to remind myself that this is not me. That is when depression is dangerous; when it swamps the person inside to the extent that they believe the irrational, self-negating thoughts are fully their own, rather than the diseased processes of a dysfunctional brain.

And there is something more to depression, which is hard to put into words adequately: it wants to kill you.

In the lowest lows, the darkest depths it makes you “understand” that you need to be dead. The necessity and inevitability of suicide becomes as self-evident as one plus one equals two. You find yourself wondering why you haven’t done it yet. What’s holding you back? What is this week’s lame excuse for continuing when the future holds only more pain and failure?

The difference between “feeling low” and clinical depression is the difference between a paper cut and a knife in your back. I have a high tolerance for physical pain, but “pain” hardly begins to describe what depression does to your mind. It swallows you and the universe whole, replacing every vaguely good thought or feeling with a rasping oily blackness that wants to blot you out of existence.

You don’t cope with depression so much as you build a repertoire of techniques for escaping from it, and they are all unhealthy: alcohol abuse, disconnecting from friends and loved ones, obsessing over the world’s many evils in an attempt to comfort yourself with the thought that others share your hell. I sleep to escape it. It has cost me jobs and relationships and more opportunities than I can count. Depression leaves wreckage in its wake, hurting more than just the sufferer, wounding innocent bystanders as it carries you along. Depression is a bastard.

I have been through every form of therapy and medication. One pill helps a little. Very little. Anti-depressants are not “happy pills”; they are “painkillers”. Just as an aspirin may hold a headache or toothache at arm’s length for a while, anti-depressants (if you’re lucky) may help dull the edges. At least a little. At least for a while. You take what you can get.

This is not an appeal for sympathy. It is a request to consider depression in a light you may have discounted in the past. I know other people suffer from conditions with a grace and courage few of us can imagine. But please don’t judge someone fighting for their life with this wicked disease. Whether we hide in a corner to try to cover it with a clown face, some small measure of understanding - and patience - couldn’t hurt.”

Dr Sean Knowles, physician at the Bahamas Public Hospitals Authority and registrar of The Sandilands Rehabilitation Centre, told Insight there are no real hard statistics on the numbers of people here affected by depression nor the causes.

“The number one reason is that people are not really seeking the help they need,” he said.

“We can say there are clinically depressed people in The Bahamas, and in all stratospheres of society. The World Health Organisation has also projected that depression is to be the number one illness by 2030, affecting persons all around the world - The Bahamas is no exception.”

He believes people who are depressed are sometimes afraid to speak out on their issues, possibly because of living the “stigma” of how “mental illness” is looked at in society.

“Persons have a mentality that if I go to seek help than I guess I am crazy or something is wrong with me, even though the brain is capable of having trauma or being affected just like the pancreas which leads to diabetes. Persons do not respect mental health or issues with the brain like they would a medical issue,” said Dr Knowles.

Dr Knowles said a second reason he has found is due to confidentiality. On an island as small as New Providence, there are Bahamians who are seriously afraid of their private health information somehow being leaked.

“Persons feel as though their business is going to be discussed because our society is very small and people know people. Once I get persons in, I literally have to assure them the confidentiality aspect of it. I make this clear that whatever they say to me stays within these four walls, they can rest assure it will not be repeated to anyone out there. I stress that because you have persons in high class positions such as politicians, bankers, lawyers and doctors who are battling with depression,” said Dr Knowles.

He said there are a number of safe avenues and options to consider when seeking help, from the private and public sectors. If persons are going through the public avenue for various reasons such as financial, one of the places Dr Knowles recommends is the Community, Council and Assessment Centre on Collins Avenue (CCAC). At The CCAC, the doctors and nursing team there would see the client and may even refer them to see a psychiatrist depending on the level of depression. They may also decide the person needs to be admitted into a facility, perhaps suggesting the client seek inpatient help at the Sandilands Rehabilitation Centre.

Additional places that are for the most part are free in terms of the resources they offer, are: the Bahamas Crisis Centre, and the Christian Counselling Centre. Within the private sector, people should seek local physicians and psychiatrists.

What do you do in a situation where you may have a clinically depressed friend or family member? Dr Knowles said to always be aware help is available for these people before it gets to a point where they may have suicidal thoughts.

“You want to take the person seriously. If someone is saying to you they want to take their own life, listen to them. You may not know what to say but you don’t want to be judgmental or too ‘preachy’ either. That is going to really cause them to not respond in a positive manner. The main thing is to listen, empathise and if you find that you don’t want to leave them alone, you want to get them to a next level of help through a professional; either a physician or in A&E at Princess Margaret Hospital. Get them to one of the places I had mentioned if it is during the day,” said Dr Knowles.