Mental and Physical Disorders: Why They Are Not The Same

After 12 years taking anti-depressants, I decided to approach doctor to ask about withdrawing. She sat back in her chair and put her finger tips together.

“Why?”

I took a deep breath. My motivation had something to do with an earnest, if naïve, desire to take the cushioning off the hard edges of the world. To be able to look at life with cold, unflinching, un-chemically-altered awareness and not sink under the weight of what I saw. But the waiting room was packed with patients, and I decided now wasn’t the time to air my existentialist meanderings. “I just want to see if I can cope,” I told her.

She raised an eyebrow. “Would you tell an epileptic to come off his medication to see if he could cope? Would you tell a diabetic to stop taking insulin? Diabetics don’t produce insulin. You don’t produce serotonin. What you have is no different from a physical illness. It’s that simple.”

I agreed to keep taking them and took my prescription, but our conversation troubled me all day. The idea that depression was in anyway “simple” jarred with my own experience of the condition and the glibness of the statement irritated me. If the past twelve years taught me anything, it’s that with depression, nothing is ever ‘that simple’. It is a complex and contradictory affliction and what is true for one sufferer is not always true for another. For me, the view that mental illness is the equivalent of physical illness will never be satisfactory, no matter how widespread it becomes, and the more I hear it the more I want to push back against the lazy assertion.

Yes, depression and epilepsy both have a biological basis. Yes, they are serious disorders and treatment of both warrants significant public investment. They are comparable in many ways, but there is a big difference between the two and it’s this: depressives, to differing degrees, have an element of choice that epileptics lack. You will never walk into the self-help section of Waterstone’s and find a row of books on ‘overcoming epilepsy’. You will find at least a dozen on freeing yourself from depression. Epileptics are not likely to be prescribed talking therapies which are entirely predicated on the theory that the sufferer has the innate ability to heal himself. Depressives are. Despite all of this, it has become taboo to explicitly state that there is an element of choice in depression, and it’s easy to see why.

On the one hand, choice is empowering. For as long as the depressed person has the power to affect his or her condition, there can be hope for recovery. Choice embodies the inspiring idea of self-determination, of man’s ability to write his own destiny. On the other hand, choice also encapsulates ideas of personal responsibility, self-blame, and guilt, and there are no prizes for guessing which perspective a depressed person prefers. “If I can choose to take steps to leave this horrible place,” one may reason, “I must have chosen to enter it to begin with, and therefore I’m as bad as I thought, and completely responsible.”

Feelings of guilt have long been recognised as core symptoms of the illness, and it is perhaps because of their prevalence that we have become squeamish about mentioning the word ‘choice’ to sufferers. To compare depression to epilepsy is to remove this awkward difference from the picture, and unburden the sufferer from feelings of self-blame. The problem with this is clear: If you whitewash choice, you take a stick from my hand that I could beat myself with, but in doing so, you also take away a tool that I could use to leverage myself to some semblance of wellness.

I did not choose to have depression, but I make thousands of decisions each day and each one has a magnifying or minimising effect on the condition. On a down day, I can choose to cry in a darkened room, or I can choose the harder option: to get up, take a bath and eat breakfast. If I choose the first option, it doesn’t mean I’m bad, or weak, or spineless, or addicted to misery, or wallowing. It doesn’t have to mean anything. But if you come into that room and tell me I’m no more responsible for being bed-ridden than an epileptic would be after having a seizure, you are doing me no favours. You are encouraging an illusion of utter helplessness which could extinguish any sparks of confidence in my ability to make myself well. If, on the other hand, I choose the harder option, this always means something. It means I’m treating my choice as a blessing rather than a curse, and choosing action over inaction is the physical embodiment of hope.

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