Depression:
Surviving beyond the blues
Timothy Benson was in his third year of medical school and was pretty sure he wanted to become an orthopedic surgeon.
All of that changed one day during his psychiatry rotation when a nurse asked him to come to the emergency room. He thought it a little odd at first. But he went anyway.
Behind the curtains was a young African American man. He had tried to commit suicide by drinking a mixture of Kool-Aid and a household cleaner filled with all sorts of toxic chemicals.
Putting aside the psychiatric checklist he had been trained to use, Benson simply opened with, “Talk to me, man. Things must be really bad for you to have gotten to this point. What’s going on?” The young man tearfully began pouring out what he had bottled up inside for years.
It was a somber scene until Benson intuitively asked about the flavor of the Kool-Aid.
Caught a little off guard, the young man looked up, hesitated, and with a sheepish grin answered, “Red.”
“At that moment, we both smiled in an understanding that went well beyond words,” says Benson.
The young man said, “You get me.”
And with that, a quick bond was established, a breakthrough of sorts, because no one else in the emergency room — or anywhere else, for that matter — was able to connect with the young man.
They talked for 45 minutes or so, and as now Dr. Benson recalls, “The young man gained a whole new perspective on life. He realized that he was not alone.”
Benson said the young man had lost his job and faced the prospect of losing his unemployment benefits. In addition, he was unable to see his son on a regular basis because of his difficult relationship with the son’s mother.
As in many cases, the depression was not simply the result of one incident, but a series of events over a period of time.
“You never know what influence you have in another person’s life,” Benson said. “But after talking with him, he understood that his life didn’t have to get to that point.”
For Benson, his ability to connect was the result of a shared culture. Benson, an African American, saw himself in the young man.
“As I walked into the room, it suddenly became clear why the nurse wanted me to speak to him,” Benson said. “ I thought to myself, ‘This brother could have been me.’ It was one of the most profound moments in my career. All of a sudden, I knew what I wanted to do.”
So much for orthopedics. Psychiatry became Benson’s field of expertise, and, in a field that has only about two percent African Americans, he is sorely needed — particularly when it comes to treating depression, a surprisingly common mental illness.
To a certain extent, depression is depression. It knows no racial or class or gender boundaries and impacts an estimated 19 million people in this country each year.
According to the National Survey on Drug Use and Health, combined data from the years 2004 and 2005 indicate that almost nine percent of youths ages 12 to 17 and roughly 7.5 percent of adults ages 18 and older in this country experienced at least one major depressive episode in the past year.
More troublesome is that only one-third of those with major depression ever seek treatment, according to the National Mental Health Association. And of those least likely to seek medical help, the elderly and African Americans are the highest on the list.
In a recent study published in the Archives of General Psychiatry, the authors found that the incidence of major depressive disorder was comparable among African Americans, Caribbean blacks, and whites, but minorities go untreated at a higher rate and they consider their depression more severe and disabling.
“One of the obstacles that minorities face is the notion that feeling blue is part of life and that we just have to deal with it,” Dr. Benson said. “We have to overcome the stigma associated with mental illness. Seeking help is NOT a sign of weakness.”
Dr. Benson readily conceded that African Americans are less likely to have access to quality mental health care, and while talking with a general physician is a good first step, it shouldn’t be the last.
“There are several studies which detail that a primary care physician’s ability to detect these disorders is very unlikely,” Dr. Benson said. “As a matter of fact, African Americans are half as likely to have mental disorders detected than whites.”
Major depression lasts more than two weeks and is more than just a bout with the blues. Symptoms may include overwhelming feelings of sadness and grief, loss of interest or pleasure in activities usually enjoyed, and feelings of worthlessness or guilt. This type of depression may result in poor sleep, a change in appetite, severe fatigue and difficulty concentrating. Severe depression may increase the risk of suicide.
Major depression takes an economic toll as well. A recent study by Mental Health America found that depression costs U.S. businesses at least $44 billion per year in absenteeism, lost productivity and direct treatment costs.
Other types of depression include: dysthymia — a less severe, but chronic form of depression; seasonal affective disorder, commonly referred to as SAD — which is triggered by changes in seasons and a lack of exposure to daylight or sunshine; and bipolar disorder or manic depression — a condition in which a person’s behavior switches between depression and mania, or excessive energy or activity.
Dr. Benson tells the story of one of his Hampton University football teammates. “His was an extreme case of what could happen if depression goes unaddressed,” Dr. Benson said. “He made it to the NFL but after a while was cut by the team due to an injury. He began working as a truck driver but couldn’t afford to pay his bills. His mood worsened to the extent that he ended up killing his wife and himself. He had two kids. I’m not sure if he ever reached out for help, but with that major of a life transition, I am positive that he would have benefited from professional counseling and/or medication.”
There’s no single known cause for depression. The illness often runs in families. Experts believe that genetics, combined with environmental factors, such as stress or physical illness, may trigger an imbalance in brain chemicals called neurotransmitters. But the relationship between this imbalance and depression is not fully understood. The imbalance in neurotransmitters may cause the depression or be a result of it.
What is known is that twice as many women experience depression as men and those gender differences may be due in part to biological causes, such as hormones and different levels of neurotransmitters.
Contrary to prior belief, mental health providers now believe that clinical depression is common in men. But many men are hesitant to talk about their feelings; thus, symptoms of depression go undetected. Also, men may mask their depression through certain behaviors, such as alcohol and drug abuse, gambling, anger, or by working excessively. In addition, suicides, homicides, and other violent behavior are more common in men, and these aggressive behaviors can be a strong indicator of depression.
Zinah Abukhalil-Quinones works as a clinical social worker at Whittier Street Health Center, and in the Boston Emergency Service Team, or BEST program at Boston Medical Center. At BMC, she works in the emergency room and treats those with homicidal or suicidal urges. She assesses the patients and assigns them to an appropriate level of care.
Detecting depression in blacks, she explains, can be tricky. “Minorities have a harder time putting it together, and don’t always understand that the symptoms they are experiencing are those of depression,” she says. “ The symptoms are the same as those experienced by whites — withdrawal, sleeping too much, lack of energy, loss of concentration — but someone else has to make the connection for them.”
For the most part, she said, minorities don’t seek outside support and are uncomfortable with the concept of medication for mental illnesses.
In fact, the idea of being labeled insane or crazy is, in some cases, enough to make some soldier on without seeking help. Worse, many minorities have a difficult time letting someone in to their personal and private thoughts and behaviors.
“It’s taboo to talk about private things, especially if it involves the family,” Abukhalil-Quinones said. “It’s seen as a betrayal.”
Yet, depression is very treatable, usually with antidepressants, psychotherapy, or both. More than 80 percent of those who seek treatment show improvement.
Abukhalil-Quinones said that people have to realize that depression is a medical disorder, just like diabetes. “You take medicine to treat the diabetes,” she said. “You should take antidepressants and/or psychotherapy to treat the depression.
Like diabetes, depression needs to be controlled.
“Seeking help for depression is not a sign of weakness; it is a sign of strength that can make a difference in your overall health.” |
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Timothy G. Benson, M.D.
Instructor in Psychiatry
Harvard Medical School/
McLean Hospital
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Zinah Abukhalil-Quinonez, M.S.W.
grew up in Mission Hill and “knows the community,” which she says increases
her ability to communicate more effectively with her clients. She is a licensed certified social worker at Whittier Street Health Center. |
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