A black dog is how Churchill thought of depression. He stole the phrase from Samuel Johnson who in turn drew on older images of black dogs as the harbingers of death or the Devil. The comparison to a black dog, for this reason and others, is not inapt. Dogs loyally follow you everywhere, they occasionally bite and are always underfoot.
Last week I had to get myself going to a three-day conference out of town. I knew I had exactly two hours to drive to the conference, and leave myself enough time to get a bite to eat and get myself settled. The conference was set to begin at 1300. I left at 1055. I really didn’t want to got, though I knew I would meet up with friends I hadn’t seen in a long time, and have an experience that would be both meaningful and engaging. Before I went, I fiddled around nearly up the the last minute before I finished packing, washed and got dressed. As I saw my reflection in the mirror I looked at myself critically. I looked exhausted. My face was puffy and I had large circles under my eyes.
I thought: Okay, now it’s official. I’m depressed. The Black Dog is back and I know it well. Lack of sleep, no motivation, poor appetite, withdrawing from social interaction, and so on.
I’ve been diagnosed with major depression in the past. My history goes back a long way. I know in my case it’s strongly seasonally associated. It will peak in March and April, before magically disappearing in May and in spring sunshine. Some years are better then others. In the past two or three years, I haven’t been depressed at all. In 2003 and 2004 it was so severe I had suicidal ideation. In 1987 I couldn’t, literally, get out of bed for a month. My Grade 5 teacher was so concerned about my sudden silence she sent a note home to my mother. The Black Dog’s been at my heels a long time.
For health care professionals depression is a condition that is doubly damning and isolating. The stigma associated in a normal social context is bad enough. If live the life typical of the middle class, you really think you have absolutely no one you can confide in. You don’t want to be The Clingy Friend With The Issues. Seeking care from your GP is embarrassing. Your employer will accuse you of malingering or worse. And so it goes.
But if you’re a health care professional, forget about it. You are totally alone, and you feel like you’re totally screwed. Professional stigmatization, we all know, is far worse than social. We are much harder on our colleagues with depression than our patients. You don’t want to be known as that “crazy nurse”. Depression, like any mental health issue, becomes tied up with fitness to practice issues, so disclosure to any professional becomes problematic. Professional regulatory bodies are concerned with patient safety, and will take effectively — though in fairness, not officially — a punitive view of any mental illness under the guise of protecting the public. There are, needless to say, very strong disincentives not to seek treatment, in short, to suffer in silence.
The fact that I can only write openly (and safely) about it as an anonymous nurse-blogger says a lot, volumes and volumes broadcast by loudspeaker, in fact, both about our society and how we care for each other.
I know what I need to do and what will help. Exercise, ADLs, diet, so on and so forth. A week puttering in the garden in April will do wonders. I cope. I don’t bother with my GP anymore: I love him dearly, but it’s too embarrassing for the both of us. Talking to him about it is like telling your father about your sex life. At work, I misdirect my colleagues. “You look tired,” they say. I tell them I haven’t been sleeping well: not a lie, exactly. But not the whole truth, either.
It will pass. I know this in my head, but secretly my heart is afraid it won’t, and I will have nowhere to turn.
But I’m thankful there is no suicidal ideation this time.
I wonder sometimes how many other health care professionals are in the same cage of social and professional shame. And I fear for them too, living with their own Black Dogs.