Health and wellness

Depression, the invisible illness: stigma that makes people hide the condition, and why it needs removing

  • Three in every 100 people in Hong Kong suffers from depression
  • In Asian society, depression is rarely talked about because of the shame associated with it. Admitting you have depression may harm your family’s reputation
PUBLISHED : Monday, 10 December, 2018, 5:30am
UPDATED : Monday, 10 December, 2018, 8:34pm

Depression is a growing problem. Experts believe we can stop it getting bigger – and help sufferers manage their depression – by removing the stigma that surrounds the condition.

Maria England was diagnosed with dysthymia (persistent mild depression), when she was a teenager. Today, at the age of 35, the job recruiter, who works in the Asia-Pacific region, still experiences depressive episodes, but says that because it is an invisible illness, people expect her to act “normal” when she’s feeling anything but.

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“Sometimes I feel like I have to put on a mask when I’m around others, and I’m not alone when I say that. Most people with depression cannot admit their condition to their bosses because they worry about getting fired; we don’t want to tell our friends how we’re feeling because we don’t want to be judged or shunned; so we pretend that everything is OK when in reality we’re falling apart inside.

“There’s definitely prejudice against people with depression. For me, some days are better than others, but people cannot even see my illness, let alone understand it, so I feel like I have to be cheerful and positive all the time, no matter what. It’s exhausting.”

England isn’t wrong about the stigma surrounding depression.

According to Paula Yeung, a psychologist at Chorus Counseling in Hong Kong, the condition is often portrayed negatively, especially in the media, which often links depression with admission to hospital, being confined in an institution, psychiatric symptoms and problematic behaviour.

In Asian cultures, depression is rarely talked about because of the shame and guilt associated with it. To admit that you have depression may negatively affect your family’s reputation.

Mental health is a spectrum. It ranges from healthy to compromised, and one’s mental health condition can range from mild to severe
Angela Watkins, counsellor and psychologist

Angela Watkins, counsellor and psychologist at Red Door Counselling Hong Kong, agrees. “Society perceives mental illness in derogatory terms. It’s seen as a measure of failure, not of success, and most people don’t want to be seen as failures.”

The World Health Organisation reports that depression is now the leading cause of disability worldwide; in Hong Kong about 2.9 per cent of the population is thought to have depression.

Many people are unaware that those with depression can still go to work or school and function normally. Depression also affects people who are popular, successful, have many friends or are in happy relationships, and the condition is definitely not one in which sufferers cry and feel sad or suicidal all the time.

“Mental health is a spectrum,” says Watkins. “It ranges from healthy to compromised, and one’s mental health condition can range from mild to severe. This is crucial for people to understand – that mental health is a continuum and any of us may experience a mental health condition at any point in our lives.”

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Yeung says depression can affect anyone, at any time. “It may be triggered by life-changing events, such as the death of a loved one, a major illness or a personal crisis. Some people are genetically predisposed to the condition, while for others depression may be triggered by environmental factors.

“That said, women have a higher risk of experiencing depression because they go through more biological and hormonal changes than men and are generally less satisfied than men when it comes to their personal lives and careers.

“Women are also more likely to experience trauma – a major cause of depression – because they are more likely than men to have experienced childhood or sexual abuse,” she says.

“One’s risk of depression also increases with age,” Yeung adds. “Older people tend to be more dependent on others, and this can lower their sense of self-worth and increase feelings of hopelessness, which in turn may cause them to feel depressed.”

The stigma surrounding depression doesn’t just affect the way society views the condition or treats people with depression. It may also prevent sufferers from seeking or accepting help.

“They may worry about being discriminated against at work, penalised or socially excluded. As a result, they may keep quiet about their condition,” says Yeung. “When you feel that you cannot talk to anyone or access help, you tend to feel even more helpless and hopeless, and this may drive you to even greater despair.”

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Watkins says: “When there’s shame attached to your condition, you may feel that you’re a burden and that you have to deal with your depression on your own. That’s not good because it’s difficult to get through depression by yourself. You need social support and professional help.”

Removing the stigma that goes with mental illness is key. This means not associating depression with violent or problematic behaviour; it means not shaming, judging or shunning people with depression or making them feel like they’re a burden to society.

It’s also important to understand that you can recover from depression, Yeung adds. “It’s not the end of the world to have depression; with psychotherapy and medication or other therapies, the condition can be treated and managed. It’s up to all us of to spread this message of hope.”

Finally, if someone opens up to you about feeling depressed, listen to them instead of turning them away, and encourage them to get help. If they exhibit common symptoms of depression – for instance, they have isolated themselves socially, have lost interest in their favourite activities or seem increasingly agitated or irritable – reach out to them and let them know that you are there for them.

“When I was younger I didn’t feel supported by my family,” says England. “They’d say things like, ‘I don’t know why you cry all day’. They never asked me what was wrong, but instead made me feel guilty for behaving in a certain way.

“As someone who has depression, I’d like to be able to talk about how I’m feeling without being judged. I’d like to not be expected to ‘snap out of it’ or ‘get over it’ the next day. I’d also like people to know that dealing with depression is a journey, one that can be made easier with the right medication and the right support.

“The only way to remove the stigma of depression is to dispel the myths about it and to remember that it’s OK to not feel OK. By empowering ourselves with knowledge, we also empower people with depression to get the help they need.”