Depression Stigma Sometimes Deadly

Aug. 9, 2007 — -- Last month a young Baltimore woman, merely 19 years old, was found dangling lifeless from a tree in a quiet wooded area. She had suffered from depression and had hanged herself.

Sadly, she was not receiving psychiatric treatment. Friends and family were devastated.

As tragic as this story is, the circumstances behind it are far too common. A 2003 report found that only about one half of people with depression in the United States received medical treatment for the illness.

While this represents an increase of about one-third over the treatment rates from the early 1980s, there clearly remains enormous room for improvement.

A major obstacle to closing the treatment gap is the stigma that exists in the minds of many people, despite much more openness about these disorders than existed previously.

The word "stigma" derives from Latin for a tattoo indicating slave or criminal status. Now it refers to a mark of infamy, disgrace or reproach. Throughout history depression has been misconstrued as resulting from demonic possession, moral failings, distorted sexual feelings and bad parenting.

Diseases Are No One's Fault

Major depression, or clinical depression, is a disease of the brain, much like asthma is a disease of the lungs. And, as with asthma, it is no one's fault that the disease occurs -- not the fault of the person suffering, and not the fault of parents or others.

Diseases happen for a complex set of reasons that primarily involve biology. In the case of depression it is the biology of the brain. The treatment typically involves antidepressant medications as well as psychotherapy, which is "talk" therapy.

One reason that many people do not get the treatment that they need is that they fail to understand that they have an illness. A second reason is that while they may know they have an illness, they are afraid to acknowledge it because of the stigma they perceive is attached to it.

Enter the stigma busters. Dr. Karen Swartz is co-director of the Johns Hopkins Mood Disorders Program. Eight years ago, in response to the death by suicide of three high school students in Baltimore, she started the Adolescent Depression Awareness Program (ADAP). Along with a team of psychiatrists and psychiatric nurses, Swartz began impressing upon high school students, their parents, and their teachers, the message that depression is a common and treatable medical illness.

Health Education Wizards

Among the clever ways Swartz educates teens is to invoke an image from the wildly popular Harry Potter book series. She uses J. K. Rowling's description of the Dementors, black-hooded creatures who create a cold, empty feeling, and leech happiness from their victims, eventually sucking the soul out of them. Rowling has said that she drew on her own experience of depression in creating these terrifying beings.

The ADAP program also draws on ordinary humans, teens who have faced mood disorders, to help students see that these illnesses can happen to people like themselves, and that they can be overcome. A series of such teens were filmed for a 26-minute DVD called "Day for Night: Recognizing Teenage Depression".

In a paper e-published last week in the journal Health Education and Behavior, the ADAP team reported that among 3,538 students surveyed on their knowledge about depression before and after exposure to the ADAP curriculum, the number scoring 80 percent or higher on the assessment tool more than tripled from pretest to post-test.

ADAP is now spreading its wings, expanding from a focus on the Baltimore-Washington area, to include a program in a Tulsa, Okla., high school system, and a program focused on college students, with Princeton University as the pilot.

Running With 'The Heard'

Another program that is fighting to decrease stigma is the National Mental Health Awareness Campaign (NMHAC). The Campaign was launched by Tipper Gore in 1999 as part of the White House Conference on Mental Health, after a surgeon general's report on mental health cited stigma as the main reason people with illness don't seek help.

Last fall the NMHAC expanded its Youth Outreach Program by recruiting and training a handful of articulate young advocates to take part in a mental health speakers' bureau, which they named "The Heard." Presentations are often given at schools, to provide positive examples of people who have dealt with mental disorders, in order to help students understand that they too can talk about their troubles.

More help in the fight against stigma comes from the Depression Is Real Coalition, a group of nonprofit organizations that have come together to combat popular notions that depression is "just the blues" or a "made-up" disease. The coalition has a highly informative website, which includes audio of Nobel Prize winner Paul Greengard, talking about the nature of depression. It also includes 15 episodes of "The Down and Up Show," available as podcasts, on aspects of the illness, with this month's topic being late-life depression.

Efforts such as those of ADAP, the NMHAC, and the Depression Is Real Coalition are critical to rolling back the tide of misunderstanding, misinformation and stigma still attached to depression.

When people understand that they are dealing with a treatable medical illness, they feel more free to talk openly about it, and to seek out the potentially lifesaving help they need.

Dr. James Potash is an associate professor of psychiatry and co-director of the mood disorders program at the Johns Hopkins School of Medicine in Baltimore, Md. If you have questions or comments, please e-mail at moods@jhu.edu. To participate in our studies, call 1-877-MOODS-JH.