Globally, 300 million people suffer from depression. It is also the world's leading cause of disability. In other words, it is the No 1 health-related reason that forces people to take time away from school or work. Depression varies in severity, but at the sharp end, it can lead to suicide. Approximately 800,000 people die due to suicide each year, the second leading cause of death among those between the ages of 15 and 29.
Depression, of course, is not a person. But it can be useful to anthropomorphise, that is, attribute human characteristics to illnesses. Anthropomorphising can help us better understand complex problems and empathise with those who face them. One in four of us, at some point, will experience a mental health issue, and understanding these conditions is key to prevention.
Denise Welch, the actress and mental health advocate, announced that she was suffering from clinical depression last week. Taking to social media, she anthropomorphised her condition, suggesting, "I think the visitor made a short visit and is on his way out."
Depression, the visitor, is an unwelcome guest who manages to convince us that we are worthless, unloved and unlovable. His visits are draining, leaving us fatigued, heavy-limbed and de-energised. With the finesse of a sophisticated salesperson, depression convinces us that nothing we do or try will bring us joy or pleasure. So we become inactive, withdrawing from the world. A great artist, depression paints us a picture of a future so bleak we begin to dread each new day, waking up to anxiety and joylessness, hopelessness and despair.
Welch is not the first or last person to give depression a character. Winston Churchill, the former British prime minister, famously referred to his own "terrible and reasonless depressions" as his black dog. Poet, Mia Pratt, describes her depression as "a great white shark who navigates the green sea of my emotions". It is not only depression either. In an essay written for the National Eating Disorders Association, Laura Duckworth, lead singer with Tokyo Taboo, refers to her anorexia nervosa as "Anna". Duckworth, now in recovery, writes: "When she [Anna] tries to whisper nasty things in my ear, I sing loudly to drown her out."
Perhaps ascribing human or animal characteristic to mental health issues help us overcome them? Dogs and sharks can be chased away, and visitors eventually leave.
Anthropomorphising certainly seems to help people who are suffering from psychotic symptoms, specifically those experiencing auditory verbal hallucinations – or hearing voices. A recent study published in the Lancet Psychiatry journal reported the outcomes of an innovative new treatment for psychosis known as avatar therapy. The intervention involves patients creating a computer simulation to represent the voices that they hear in their heads. Patients are essentially turning their auditory hallucinations into CGI characters – talking heads – on computer screens.
Over six sessions of the therapy, patients were encouraged to interact with their avatars, for instance, standing up for themselves when the talking heads became hostile. The study outcomes after three months were incredibly promising. Avatar therapy proved twice as effective as regular counselling in reducing the frequency of hallucinations.
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Beyond potentially helping people overcome mental health issues, the practice of ascribing human characteristics to mental health issues might also be used to raise awareness and de-stigmatise such conditions. Talking about depression as a burglar, for example, might leave us with the idea that everyone is vulnerable, which is the case. It also keeps us away from victim-blaming – we would never stigmatise a person for being burgled. Furthermore, if depression is a burglar, then self-care becomes essential home security.
Promoting a better understanding of mental health issues, and how to keep ourselves and each other well will help us reduce the prevalence of such conditions. Of course, we need to do more than reinvent the way we think and talk about mental health. We must also look at our societies and their institutions, from the family to the school to the workplace. The idea that mental health problems are simply the result of a chance "chemical imbalance" is not the whole story.
We know that adverse childhood experiences can increase the risk of severe mental health issues. We also know that being a member of a disadvantaged minority group dramatically increases risk. Even socio-political upheaval can be associated with increases in mental health issues. For example, a survey reported by the British Association for Counselling and Psychotherapy suggests that Brexit has negatively impacted the mental health of a third of the UK population. Last week, Joan Pons Laplana, the man awarded the title Britain's nurse of the year, blamed his recent breakdown on Brexit.
This Thursday is World Mental Health Day, a time for mental health education, awareness and advocacy against social stigma. We know that the development of mental health issues can be associated with being bullied, victimised or generally treated unkindly. We can all help reduce mental health issues through simple acts of kindness. If depression is a burglar, we are the neighbourhood watch. If we do not do anything else on World Mental Health Day, let us at least be kind. If you cannot be kind, be curious as to why not.