Earning the Right to Be Depressed

(Warning: the following post contains talk about experiencing depression and suicidal thoughts as well as dismissive and/or negative societal reactions to these. There is also mention of terminal illness.)

Last week, I was discussing with a group of healthcare people a hypothetical man. This hypothetical man, Fred, was 92 years old, had lost his wife and daughter, had no other family, and was no longer recognized by his only friend due to Alzheimers. Fred had just been diagnosed with terminal cancer and referred to therapy for quality-of-life and independence work. Fred was refusing both therapy and medical treatment, saying that it didn’t make any difference, he was going to die anyway and didn’t have much to live for in the first place.

It was an ethical discussion, about this Hypothetical Fred. How hard do you try to convince him that therapy is a good decision? Do you try to get antidepressants added to his medicines, knowing that he is unlikely to question an additional pill? Do you try to force him into chemotherapy and radiation despite his objections? It was, overall, a very productive discussion about the ethical ramifications of any potential decision, but what really got me was what one person said: “He’s 92 years old and doesn’t have any family or friends. He has a right to be depressed.”

That implies that some people don’t have the right to be depressed. What is required to earn this right? Is there a minimum age or a maximum number of family and friends you can have before you’re allowed to have depression? And once you’re given this dubious right, how does that change how people treat you? It sounds like, once you’ve earned the right to depression, you’re allowed to make your own treatment decisions. However, if you haven’t earned the right, what then? Medical professionals get to do whatever they want to you?

Even leaving aside that, consider what that statement actually says. You have to earn the right to have a mental illness. No, forget that it’s actually a legitimate illness that you can’t control. You have to endure a certain amount before you’re allowed to experience this illness. If you haven’t gone through enough, you haven’t earned the right to be depressed. But you might still have depression. And this, friends, is where the dangerous idea that you can wish yourself better from depression comes in. After all, you have all these things going for you that Hypothetical Fred doesn’t! Why can’t you just pull yourself up and magically become healthy! After all, if you got the flu or a broken leg but hadn’t earned the right, you could wish yourself better with ease.

I’d like to say that the person who made the statement originally would never tell someone with depression to lift themselves by the bootstraps, but my faith in them is more than a little bit shaken now. They may give lip service to the fact that depression can’t be wished away, but now I’ve heard this underlying idea that depression has to be earned. It feels more than a little bit dangerous to believe that someone with “un-earned” depression would get the best treatment from this person. I’ll hope that it was meant as a joke, but whether you’re in healthcare or not, please consider your words before saying things like this. It hurts people with mental illness; it makes you seem less trustworthy, less honest, and less of a good choice for treatment or for a friend; and it (hopefully) misrepresents your actual beliefs and viewpoint. You don’t have to earn the right to be who you are and experience your life; why should anyone else, good or bad?

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