Guilt And Depression – “What Do You Have To Be Depressed About?”

When it comes to physical illnesses, it is rare that someone is told that they shouldn’t feel the pain or discomfort they feel. If someone has kidney stones for example, it is unlikely they will be told that they have no reason to complain of the agony (I haven’t had kidney stones myself but from what I have seen on television it doesn’t look like a pleasant experience), but are accepted in their distress and treated accordingly. You would think then that the same would apply to mental illnesses which are after all as legitimate and debilitating as any physical illness out there, but for some reason this is not the case, especially when it comes to things like depression. 

Over the years I have been diagnosed with depression, one of the most common things I hear is that I shouldn’t be depressed.

Indeed, several times after people have heard that I have depression I have been told to imagine I am a person in a concentration camp during the holocaust. Now I am all for using one’s imagination, without people using their creative abilities to imagine scenarios separate to the ones they were experiencing we would never have had Harry Potter (cheers J.K.Rowling. Good work there mate), but I find it hard to understand exactly what benefit using my imagination to pretend I am living in Nazi Germany will have on my mental health. 

I think when people give me this advice the purpose is to illustrate how lucky I am in comparison to other people. They think that people in concentration camps who were unhappy were allowed to feel that way because their circumstances justified the emotions. They didn’t need to feel any shame or guilt for complaining about their situation because their situation was truly horrendous and beyond comprehension. So what is my excuse? What have I got to be depressed about? 

I am not being held captive in disgraceful living conditions, I voluntarily inhabit a light and bright flat with running water, heating and a television with over a hundred channels. I do not have an army of Nazis in my life, I have two loving parents who often go out of their way to make me feel better about myself and demonstrate how much they value me as a human being. I am, compared to many people in this world both past and present, incredibly lucky, so I suppose I understand the confusion someone would feel when they hear how incredibly unhappy I am on a day to day basis. That said, when people tell me to compare myself to someone who has been in a situation as traumatic as the holocaust it doesn’t make me feel better or happier at all. Instead all it does is make me feel guilty for sounding so ungrateful in my privileged existence, ashamed of my emotions and, like many people with depression, likely to bottle my feelings up to avoid stigma attached to them.

It is almost as if people think that people with depression need to carry around a permission slip with them at all times to justify their condition and thus mean they don’t have to feel guilty about it. Who on earth would decide who had permission? I know when I was unwell at school my mum was allowed to write a note to the PE teacher excusing me from playing sport, so does this mean she is the one who needs to write my little “Katie is allowed to be depressed” note. If my mum is the authority does that also mean that she needs to write depression permission slips for everyone out there? Do people realise how many people out there have depression? Where do people expect her to find the time? More importantly where the hell do they expect me to keep this document that must be carried at all times. Most of my clothes don’t have pockets and my rucksack is already full of things I need on a day to day basis. My bag is not a bottomless pit! I AM NOT MARY POPPINS! (Though I am practically perfect in every way and am rather fond of a spoonful of sugar alongside my antidepressants every morning). 

Without a permission slip then, clearly I have no right to be unhappy and should be taken to court for the crime of feeling emotions without just cause. Its odd really because people would never complain about a person who is feeling unexplainably happy. Sometimes a person might wake up in a good mood for no particular reason, they may walk with a spring in their step and a merry tune hummed between their lips, yet if someone asks why they are so cheerful that day and they reply that they simply are, nobody whips out the truncheons to demand they provide a valid list of reasons to justify their emotional state with the threat of shame and judgement were a list not to be provided. 

I really can’t help but wonder how on earth people telling me how to feel expect that to resolve the situation. If someone complains that they were hungry, me telling them that they aren’t hungry isn’t going to take the pain away and magically make a well filled baguette appear in their digestive system. Similarly, when someone hears that I am depressed and then tells me that I am not or that I shouldn’t be, happiness doesn’t suddenly start flowing through my veins. All it does is make me feel invalidated, guilty, ashamed and embarrassed, all of which are emotions that are a large problem in people with depression and are reasons that many don’t speak out to seek treatment. Depression as an illness makes you feel enough guilt and shame as it is without other outside influences supporting those inner voices. To feel the need to keep quiet because of those outside influences is an incredibly dangerous game and unfortunately one that I would argue is a reason many people lose their lives to this illness.

When it comes to depression I honestly think that the best thing to do is not to deny that it is a problem in the hopes that will make it go away, but to accept that it is the way it is and that that is ok. Obviously it doesn’t feel OK to be so desperately painfully unhappy for no reason at all, but that doesn’t mean you are not valid in your experience. When you actually listen to someone with depression rather than trying to make sense of their inner turmoil, you are far more likely to help them than you would be telling them to picture the bleak and terrible atmosphere of a Nazi concentration camp. When you listen to someone with depression you are allowing them to feel validated and sometimes feeling heard and validated is all people want. When someone speaks out about a mental health condition it doesn’t mean they are demanding you provide an explanation or solution for it. Sometimes they just want people to hear them. If you have depression it is OK to feel whatever you feel and rest assured that you don’t need to come to my house to get a permission slip to justify your emotions (you are more than welcome to come over for a cup of tea of course but as for the permission slip thing there really is no need to bother.) You are allowed to feel and justified in feeling sad, whether you are suffering in a traumatic situation or if you are “lucky” enough to live in Buckingham Palace with a crown on your head, five hundred corgis and are able to pay for your daily newspaper by simply handing over a self portrait printed onto a circular metal disk. Feel whatever the hell you are compelled to feel whether that feeling be positive or negative, even if it makes no sense (especially if it makes no sense), and don’t let anyone tell you that you should do any differently. 

Take care everyone x

Judge1

Why We Need To Stop Rating Pain On A Scale From One To Ten

Whenever you go to A&E or are admitted to a general hospital for a physical illness because of an injury or disease that hurts, you are always asked the same question. 

“On a scale from one to ten, how would you rate your pain?”

They make pain sound like a hotel that you recently stayed in on holiday. You know, those hotels where at the end of your stay you are handed a feedback form to let staff know what you thought of the experience provided (although with the pain thing ten tends to mean “the worst pain you have ever felt” and zero “no pain at all”, rather than the hotel ten to zero equivalents of “I found a dead man in my bed” to “the room service was excellent.”) I always find this question a difficult one to answer, which is silly really because it isn’t exactly a question that requires much revision (unlike GCSE biology. I swear I read those text books so many times that I will never forget the fact that most of the energy released during respiration comes from the mitochondria), and really I am the only person who can answer it. Then again, how can you answer such a subjective question and how can you quantify pain? When you are in pain, that is it, all you know is that you are in pain and the ability to rate it on a scale is somewhat diminished by the agony you are experiencing. 

Were someone to ask you to rate your pain on a scale seconds after you had just stubbed your toe, most if not all people would probably cry out “10” and then perhaps yell some abuse at the person who was asking such a silly question when they were leaping around with a potentially broken toe. In those moments when the injury has just occurred (aka the toe stubbing), you are unable to rationalise that really, the pain is unlikely to be the worst pain you ever felt. You don’t hear the question and really think about it, employing reason to figure that stubbing your toe was probably a lot less painful than the day you had your whole foot bitten off by a shark (suffice it to say you are rather careless with the body parts that exist below your knees). No, in that pain your stubbed toe is a 10, the worst pain ever, and you would say that whether or not that is true. 

The question is then further complicated by the fact that people have different pain thresholds. For example, I use an epilator to remove unwanted hair on my legs (lovely image for you there…enjoy it), and for me the “pain” that causes doesn’t bother me at all because I have been doing it for years and am used to it. My mum on the other hand couldn’t epilate because she finds the process agony, a pain that I have somewhat grown out of fearing through repeated experience. How then can you ask someone to rate their pain when one person’s 10 could be another person’s 4. 

All in all the question of rating pain in medical settings is problematic, yet I would say it is far more problematic in the way it is used when it comes to mental health problems. 

Whenever you are admitted to a psychiatric hospital or sent to see a new therapist, it is likely you will be given a form to fill out with a lot of questions, scales and little boxes to write numbers in. The questions are differently worded each time but overall they are pretty much the same and include things like “On a scale of one to ten how depressed have you been in the last 28 days” or “In the last 28 days how anxious have you been on a scale of one to ten” (Mental health professionals love measuring time in 28 day blocks. Weirdos.)

I myself have filled in many forms like this over the years, and the questions stump me every time. Asking me to rate how depressed I am with numbers is like that song in the Sound Of Music when all the nuns are singing about the difficulty of solving a problem like Maria being akin to pinning a wave upon the sand. When I am depressed, it simply feels like I am drowning. How on earth can drowning be rated? You can’t be more drowning or less drowning, you are either drowning or you are not, and if it is the first of those options then the important thing is to send out the life boats rather than asking exactly what percentage of your lungs have filled with water. On the most recent questionnaire I filled out I was asked to write a number from 1 to 10 describing “how suicidal” I had felt in the last 28 days and then there were further enquiries as to how many days I had felt that way and what each of those days looked like when rated and compared. What kind of question is that? Can you rate how suicidal you have felt? Much like with the depression question, when I feel suicidal it is a feeling with a depth and breadth far greater than I can put into words, let alone numbers. Never have I ever turned up in a session saying I feel like “a 4” or indeed “a 10”. Instead I try to capture what is going on using any adjectives to hand, hopeless, guilty, lost, useless, depressed, like a waste of space etc, and even those aren’t good enough. Furthermore, if I have been feeling suicidal for a length of time I am unable to distinguish the levels of the feelings with each day that passes because on the day I am asked, the pain I am CURRENTLY experiencing is all I can think about, much like the person with the stubbed toe can only think about their bruised digit. Even if I could distinguish the difference, how can you measure “how suicidal” you are? What are you supposed to think? Should I reflect on my week and think “well Tuesday was clearly better than Wednesday because I only prepared a noose without planning on a place to hang it and working out how to get to such a height? Isn’t the fact that someone is suicidal enough to ring alarm bells? Professionals should hear that pain exists and take action immediately because to feel suicidal at all is incredibly serious and not something that should be dismissed because the form rated the feelings as “1”. If the number is anything other than a 0 in whatever box, the pain should be addressed rather than swept under the carpet as insignificant. 

Of course I understand the need to rate pain in the physical illness world and to some extent in the mental illness world as well. If you need to tell a doctor where something hurts, telling them how badly it hurts could be a handy indicator as to what is going on. Indeed I think numbering pain has great value and for a brief glimpse into how life is for a certain person, it has a place, but it is still incredibly limited. I am not saying we should stop rating pain by numbers, I am saying that we need to rate it in other ways too. For people who are scientifically minded maybe numbering things is a helpful way to look at distress. I myself however, am not a mathematical person, I instead deal with words and images. When I am distressed I feel my heart racing at such a rapid pace that I feel it will burst from my chest, when I feel hopeless I can see nothing but a bleak black hole, and when I am overwhelmed the world is a screaming canvas of differently coloured paint splattered chaotically like a Jackson Pollock painting. How on earth am I supposed to get all of that into a little box on a form using a secretary’s leaky biro? Mental illness questionnaires need to offer a variety of ways for people to express themselves, maybe some lined paper so that they can write if the number system is unsuitable, hell maybe a watercolour pad and some paint to at least attempt to capture the uncapturable and intricate complications of the human mind. Patients need to be seen as individuals who all feel and express themselves in a certain way, and the questionnaires they are required to fill out should reflect this. 

In my most recent forms, to be honest I found myself writing random numbers in a lot of the boxes (or at least numbers that my head didn’t deem as “dangerous and likely to cause harm to a loved one”), because I couldn’t rank my levels of distress in numerical order and I would be surprised if other people hadn’t had to do similar things just to make the professionals happy when really the idea is that they are trying to help YOU as an individual get better, not YOU helping them fill out their paperwork. Let us explore the diversity of experience in diverse ways, use any method possible to express some of what is going on in the depths of our souls and listen, look, even smell what is really going on rather than capturing it in an insignificant number on a scale of one to ten. We need to focus not on rating the pain but acknowledging that its mere existence is a problem and that if someone is drowning the key is sending out the life boats, not waiting for them to be “more drowning” or to cry out a number that is in double figures. By then who knows? It might be too late. 

Take care everyone x

Pain1