“I think I have depression.”
We’ve all heard this from somebody we know. In fact, we tend to believe that we, ourselves, may have depression at times. But are we, or someone who has confided in us, truly clinically depressed?
The term “depression” is so commonplace today that its implications in reality have lost its gravity. The mood disorder is often misunderstood, misused for the benefit of an individual, or sometimes even misdiagnosed. Brunch spoke to licensed clinical psychologist A. Dewaka Wanigaratne and Shanthi Maargam Head of Counselling and Assistant Centre Manager Ardlay Mohamed about where they feel lines blur.
[caption id="attachment_144285" align="alignright" width="364"]
"We expose ourselves to the risk of being manipulated by assuming the role of caregiver and trying to support an individual without the direction of a professional who is trained in diagnosis and treatment" Licensed clinical psychologist A. Dewaka Wanigaratne [/caption]
Is the term “depression” often loosely used, and misunderstood? Why?
Dewaka: Depression can refer to major depressive disorder (MDD), which is a clinical syndrome. However, in layman’s terms, depression can also be used to describe a feeling of “being low”. These two are differentiated by specific diagnostic criteria, which require that certain symptoms be present for at least two weeks to be diagnosed at mild, moderate, or severe levels. Feeling low and depressive because one is experiencing a difficult time in life does not necessarily mean that one is clinically depressed.
Ardlay: For there to be clinical depression, a thorough analysis of symptoms which have been present for a prolonged period of time need to be present. Even on social media now, people are making it a point to discuss the difference between depression and sadness. A lot of people self-diagnose themselves as being depressed, even before they meet a mental health professional. However, upon assessing, we sometimes have to explain to them that while they are definitely going through something difficult, they are not clinically depressed. The confusion between sadness, going through a rough patch, and depression – which is a mood disorder – is quite common.
Can depression be misdiagnosed?
Dewaka: To diagnose depression, the clinician needs to identify a cluster of symptoms. If the symptoms and signs are not properly identified, a misdiagnosis can occur. This is because the same symptoms and signs are shared by many psychological conditions. Additionally, general medical conditions such as a terminal illness like cancer, or conditions like chronic pain, heart disease, and stroke can lead to depression too.
Ardlay: It depends on the method of assessment. I encourage clients to get a second opinion and I generally have a couple of sessions with any client before I come to a diagnosis that they are depressed. A one-off diagnosis on the first meeting is not advisable. With medication, I advise clients to allow themselves 7-10 days to observe how the medication affects them. If they make you feel worse, go back to your doctor. Additionally, ask your doctor for the possible side effects of any medication, to avoid being alarmed by them when you start the course.
[caption id="attachment_144283" align="alignleft" width="357"]
"I have had a lot of clients come in convinced that they are depressed. It is great that there is so much mental health awareness, but choosing how you apply that information to yourself is critical" Shanthi Maargam Head of Counselling and Assistant Centre Manager Ardlay Mohamed[/caption]
Depression is a topic that has become ubiquitous. Has this led to the misuse of the mental health condition?
Dewaka: In my opinion, any mental health illness can be misused by a person to take advantage of one’s environment.
Ardlay: Any mental health condition can be misused for one’s benefit. But, I want to stress on another aspect of this. Misunderstanding a mental health condition can also greatly depend on the people in your life. Let’s take the stigma surrounding mental health for example. I also want to address the role of family and friends. If you have friends and family who ridicule you when you speak to them about needing mental health assistance, that is harmful too. Parents often misunderstand that medications for mental health issues can be addictive, because that is the general “belief”. They also fail to understand why a child may spend all day in bed, because they don’t understand how depression works. It is really important that, as professionals, we also speak to the family, friends, and immediate people in the life of the client, if we are to help them effectively.
Can you share an example of a situation where either depression was misused or misdiagnosed?
Dewaka: A common example in Sri Lanka is where individuals threaten to resort to desperate measures to prevent romantic relationships from ending. For instance, they use self-harm or suicide threats. I recently spoke to a client whose partner had been sending them images of them cutting themselves after the client decided to end the relationship. Suicide and self-harm should not be taken lightly or dismissed, but using such strategies to force somebody into staying in a relationship, or making statements such as “if you are no longer in my life, I will never see the world the same again”, is manipulative. No individual should feel the need to remain in a situation because they are afraid for the mental/physical health of the other person, and they certainly should not be forced or made to feel guilty about it.
Ardlay: As mental health professionals, we never take suicidal ideation or self-harm lightly if any individual shares such information with us. But, if somebody is misusing a mental health condition, saying: “If you do this, I will take my life, or hurt myself,” it is emotional blackmail and manipulation.
In terms of misdiagnosis, I have had a lot of clients come in convinced that they are depressed. It is great that there is so much mental health awareness, but choosing how you apply that information to yourself is critical. Call the helplines that are available and speak to a professional. Online self-diagnosis does not give you the big picture, and could potentially make you feel worse.
Individuals can sometimes misuse depression to their benefit, when they do not have the condition in reality. How can one be aware of such manipulation?
Dewaka: Sometimes, individuals with personality disorders may use depression as a mode of controlling one’s environment. They may blame others and life for the difficulties they experience, and fail to take personal responsibility. The reasoning behind such behaviour is complex and cannot be explained in depth here. However, if somebody is complaining of any psychological disturbance, the best course of action is to direct the afflicted individual to a professional. We expose ourselves to the risk of being manipulated by assuming the role of caregiver and trying to support an individual without the direction of a professional who is trained in diagnosis and treatment.
Ardlay: This is tricky territory. If somebody comes and tells you that they have depression, unless you are aware of the nature of the disorder, know the person who is approaching you very well, and can observe a change in their behaviour, you cannot truly know if they are or aren’t depressed. There can be cases where behavioural changes are not obvious, but often, you will notice people isolating themselves, being lethargic, and not interacting as usual.
On the other hand, if you feel gaslighted by somebody who is dear to you and who you trust, telling you that they think you are depressed, listen to your gut. If your intuition says that something is not right, speak to a professional, and don’t allow the words of another to manipulate you about your own mental health.
While access to information about mental health has led to greater awareness on issues and avenues for those in distress to seek help, it has also opened doors for some to use it to manipulate a situation in their favour, sometimes even at the cost of somebody else’s mental health and wellbeing. The onus, then, is on us to identify such instances, draw boundaries, and seek assistance to avoid being manipulated. Professionals are ready to help. But how can we do our part to help?
It is important to remember that depression, or any mental health condition, needs careful attention, treatment, and validation. As responsible citizens, friends, and family, it is up to us to act with prudence when someone we know comes to us for support, regardless of if we feel they are truly depressed or feel that they have convinced themselves that they are. They are coming to us from a place of trust, and we do not know what the people around us, even those we are closest to, are struggling with.
If you feel that you or someone you know may be dealing with mental health issues and/or suicidal thoughts, please seek professional help through:
Shanthi Maargam: 0717 639 898
National Institute of Mental Health: 1926
Sri Lanka Sumithrayo: 0112 682 535
Courage Compassion Commitment (CCC) Foundation: 1333
"We expose ourselves to the risk of being manipulated by assuming the role of caregiver and trying to support an individual without the direction of a professional who is trained in diagnosis and treatment" Licensed clinical psychologist A. Dewaka Wanigaratne [/caption]
Is the term “depression” often loosely used, and misunderstood? Why?
Dewaka: Depression can refer to major depressive disorder (MDD), which is a clinical syndrome. However, in layman’s terms, depression can also be used to describe a feeling of “being low”. These two are differentiated by specific diagnostic criteria, which require that certain symptoms be present for at least two weeks to be diagnosed at mild, moderate, or severe levels. Feeling low and depressive because one is experiencing a difficult time in life does not necessarily mean that one is clinically depressed.
Ardlay: For there to be clinical depression, a thorough analysis of symptoms which have been present for a prolonged period of time need to be present. Even on social media now, people are making it a point to discuss the difference between depression and sadness. A lot of people self-diagnose themselves as being depressed, even before they meet a mental health professional. However, upon assessing, we sometimes have to explain to them that while they are definitely going through something difficult, they are not clinically depressed. The confusion between sadness, going through a rough patch, and depression – which is a mood disorder – is quite common.
Can depression be misdiagnosed?
Dewaka: To diagnose depression, the clinician needs to identify a cluster of symptoms. If the symptoms and signs are not properly identified, a misdiagnosis can occur. This is because the same symptoms and signs are shared by many psychological conditions. Additionally, general medical conditions such as a terminal illness like cancer, or conditions like chronic pain, heart disease, and stroke can lead to depression too.
Ardlay: It depends on the method of assessment. I encourage clients to get a second opinion and I generally have a couple of sessions with any client before I come to a diagnosis that they are depressed. A one-off diagnosis on the first meeting is not advisable. With medication, I advise clients to allow themselves 7-10 days to observe how the medication affects them. If they make you feel worse, go back to your doctor. Additionally, ask your doctor for the possible side effects of any medication, to avoid being alarmed by them when you start the course.
[caption id="attachment_144283" align="alignleft" width="357"] "I have had a lot of clients come in convinced that they are depressed. It is great that there is so much mental health awareness, but choosing how you apply that information to yourself is critical" Shanthi Maargam Head of Counselling and Assistant Centre Manager Ardlay Mohamed[/caption]
Depression is a topic that has become ubiquitous. Has this led to the misuse of the mental health condition?
Dewaka: In my opinion, any mental health illness can be misused by a person to take advantage of one’s environment.
Ardlay: Any mental health condition can be misused for one’s benefit. But, I want to stress on another aspect of this. Misunderstanding a mental health condition can also greatly depend on the people in your life. Let’s take the stigma surrounding mental health for example. I also want to address the role of family and friends. If you have friends and family who ridicule you when you speak to them about needing mental health assistance, that is harmful too. Parents often misunderstand that medications for mental health issues can be addictive, because that is the general “belief”. They also fail to understand why a child may spend all day in bed, because they don’t understand how depression works. It is really important that, as professionals, we also speak to the family, friends, and immediate people in the life of the client, if we are to help them effectively.
Can you share an example of a situation where either depression was misused or misdiagnosed?
Dewaka: A common example in Sri Lanka is where individuals threaten to resort to desperate measures to prevent romantic relationships from ending. For instance, they use self-harm or suicide threats. I recently spoke to a client whose partner had been sending them images of them cutting themselves after the client decided to end the relationship. Suicide and self-harm should not be taken lightly or dismissed, but using such strategies to force somebody into staying in a relationship, or making statements such as “if you are no longer in my life, I will never see the world the same again”, is manipulative. No individual should feel the need to remain in a situation because they are afraid for the mental/physical health of the other person, and they certainly should not be forced or made to feel guilty about it.
Ardlay: As mental health professionals, we never take suicidal ideation or self-harm lightly if any individual shares such information with us. But, if somebody is misusing a mental health condition, saying: “If you do this, I will take my life, or hurt myself,” it is emotional blackmail and manipulation.
In terms of misdiagnosis, I have had a lot of clients come in convinced that they are depressed. It is great that there is so much mental health awareness, but choosing how you apply that information to yourself is critical. Call the helplines that are available and speak to a professional. Online self-diagnosis does not give you the big picture, and could potentially make you feel worse.
Individuals can sometimes misuse depression to their benefit, when they do not have the condition in reality. How can one be aware of such manipulation?
Dewaka: Sometimes, individuals with personality disorders may use depression as a mode of controlling one’s environment. They may blame others and life for the difficulties they experience, and fail to take personal responsibility. The reasoning behind such behaviour is complex and cannot be explained in depth here. However, if somebody is complaining of any psychological disturbance, the best course of action is to direct the afflicted individual to a professional. We expose ourselves to the risk of being manipulated by assuming the role of caregiver and trying to support an individual without the direction of a professional who is trained in diagnosis and treatment.
Ardlay: This is tricky territory. If somebody comes and tells you that they have depression, unless you are aware of the nature of the disorder, know the person who is approaching you very well, and can observe a change in their behaviour, you cannot truly know if they are or aren’t depressed. There can be cases where behavioural changes are not obvious, but often, you will notice people isolating themselves, being lethargic, and not interacting as usual.
On the other hand, if you feel gaslighted by somebody who is dear to you and who you trust, telling you that they think you are depressed, listen to your gut. If your intuition says that something is not right, speak to a professional, and don’t allow the words of another to manipulate you about your own mental health.
While access to information about mental health has led to greater awareness on issues and avenues for those in distress to seek help, it has also opened doors for some to use it to manipulate a situation in their favour, sometimes even at the cost of somebody else’s mental health and wellbeing. The onus, then, is on us to identify such instances, draw boundaries, and seek assistance to avoid being manipulated. Professionals are ready to help. But how can we do our part to help?
It is important to remember that depression, or any mental health condition, needs careful attention, treatment, and validation. As responsible citizens, friends, and family, it is up to us to act with prudence when someone we know comes to us for support, regardless of if we feel they are truly depressed or feel that they have convinced themselves that they are. They are coming to us from a place of trust, and we do not know what the people around us, even those we are closest to, are struggling with.
If you feel that you or someone you know may be dealing with mental health issues and/or suicidal thoughts, please seek professional help through:
Shanthi Maargam: 0717 639 898
National Institute of Mental Health: 1926
Sri Lanka Sumithrayo: 0112 682 535
Courage Compassion Commitment (CCC) Foundation: 1333