Besides the personal struggle, people with depression also have to deal with other people’s perceptions of depression — many of which are not true. Amy, a 55-year-old New York City executive, has cycled in and out of depression since her late teens. Some of her episodes have been severe and debilitating, but she hasn’t let her depression — or the threat of social stigma — stand in her way. “I’m not ashamed about having depression, and if a stigma still exists, I think it’s much less pervasive,” she says.
Amy may be one of the lucky ones. Although the social stigma surrounding depression has softened from what it was decades ago, it still exists and affects millions of people with the condition.
“Our culture has a fairly rigid definition of what constitutes appropriate behavior, and there is definitely a social stigma associated with depression,” says Joseph Hullett, MD, senior medical director of clinical strategy for OptumHealth Behavioral Solutions in Golden Valley, Minn. “A social stigma, in general, is like the mark of Cain, a label used to identify groups in a society in terms of behavioral traits.”
According to Dr. Hullett, social stigmas about depression often translate to inaccurate stereotypes, such as:
- People with depression lack willpower.
- Depressed people’s emotions are out of control.
- Depressed people are a danger to others.
- People with depression are “defective,” like broken machines.
- Depressed people are just whiney and make excuses.
- People with depression are antisocial.
“Stigma surrounding depression is particularly prevalent in families of over-achievers and in companies where there is a high level of success,” says Gabriela Cora, MD, MBA, a psychiatrist in Miami. “Men tend to struggle more with depression-related stigma because they’re afraid others will see depression as a sign of weakness. They may try to fight depression on their own instead of seeking help.”
Depression stigmas are also dangerous because they can become self-perpetuating. “There is a phenomenon called ‘The Looking Glass Theory,’ which says you become what you see in the mirror,” Hullett explains. Essentially, it’s the idea of a self-fulfilling prophecy. “If society is your mirror and society looks at you with these stigmas, you may begin to adopt some of those traits and view yourself in a negative light.”
Fighting Depression Stigmas
One of the biggest struggles a person with depression might face is whether to reveal the condition to others, and if so, whom to reveal it to.
“What you choose to share in a setting like the workplace is controversial with regard to depression,” Hullett says. Disclosing depression in your social circle can be equally as intimidating, depending on the openness of your friends and family.
“If you tell people you suffer from depression, you’re likely to encounter social stigma — some people may immediately assume that you’re out of control or that you’re a danger and start to avoid you,” Hullett says. “You may also experience discrimination on the job and get passed over for a promotion — these are real and genuine effects of depression-related stigma.” On the other hand, Hullett says that hiding signs of depression can be stressful, too. “So the decision of whether or not to reveal depression is tough, and very personal,” he says.
If you do decide to share what you’re going through, there are some steps you can take to prevent or decrease social stigma and help people around you better understand depression:
- Pick your moment. The circumstances under which you reveal your depression may help determine the degree of social stigma you face. “The middle of a deadline crunch at work, when your team is supposed to perform, is not the best time to reveal your depression,” Hullett says. A more appropriate time might be when people are talking about something they saw on TV about depression. “You could say, ‘I’ve experienced that,’ and open yourself up to questions,” he suggests.
- Choose your words carefully. “It’s best to say something like, ‘I have a problem with depression,’ not ‘I’m depressed’ or ‘I am a depressive,’ because people are more likely to apply a social stigma if you label yourself,” Hullett says.
- Face your own stereotypes. One of the reasons Amy says she doesn’t feel the burden of social stigma is because she doesn’t place a depression stigma on herself. “If you come from a high-achieving family where mental illness isn’t discussed and everyone just shakes things off, you may have a bias against your depression,” Dr. Cora says. She adds that judging yourself not only perpetuates a negative social stigma, but also gets in the way of successful depression treatment.
- Stop blaming yourself. “If you do have an internal stigma about depression, figure out what drives it,” Hullett says. “It might be something you tell yourself, like ‘I’m a failure,’ ‘I should be able to handle this,’ or ‘this is all my fault.’ Try to change your internal dialogue by reminding yourself that depression is a matter of genes and chemistry — it’s not your fault.”
- Take some ownership of your condition. On the flip side, if you play the victim and solely blame the world, your genes, or your family for your depression, that’s not healthy either. “Take control, and instead of focusing on your condition and feeling sorry for yourself, focus on resiliency, recovery, and positive ways of fighting the social stigma surrounding depression,” says Hullett. Give yourself credit for the steps you’re taking to treat depression.
- Help others with understanding depression. “Explain your depression in the spectrum of normal behavior," Hullett suggests. "Say something like, ‘I get sad more than I would like, and sometimes I don’t know why.’”
- Conduct yourself with poise. “A perceived lack of control is part of the social stigma surrounding depression, so in your interactions with other people, exhibit control and responsibility,” Hullett says. “If you’re struggling with an episode of depression, say something like, ‘I really need to focus more on my energy and motivation because of the problem I’m having.’” By being honest and composed at the same time, he adds, you can help others better understand depression as well as raise your own consciousness about how you’re feeling.
- Don’t isolate yourself. “People with depression become stigmatized partially because they may move away from people and avoid social activities,” Hullett says. “Challenge this social stigma by making sure you’re doing everything you can to get out there and stay in contact with others.”
Combat Depression Stigma With Social Support
If you have depression, it’s often unavoidable that some people will approach you with a stigma. “But there will also be people who don’t apply a stigma and who have some special knowledge that can help you,” Hullett says. “Surround yourself with positive people who understand what you’re going through and are helpful and supportive.” He recommends looking for the following traits in members of your support network:
- People who are trustworthy
- Individuals with a clear understanding of depression
- Those who’ve had similar experiences with depression, either themselves or a close friend or family member
Hullett notes that support groups can be either helpful or harmful, so finding the right one is important. When joining an online support group, he favors groups that are monitored. For example, Hullet recommends Ecouch, which offers an educational and cognitive therapy component for understanding depression as well as a monitored online support group. For good in-person depression support groups, ask your doctor for recommendations.
Overall, one of the best ways to prevent depression-related stigma is to stay positive and vigilant about your condition. Amy, who’s risen above the stigmas of depression, says: “It’s absolutely possible to function well and succeed — and to enjoy life — despite depression.”