The Big Taboo: Is Help Around the Corner?
|by Paul Harris|
Surprise! Surprise! Gay men and lesbians are more prone to depression than the rest of the population. Sadly the subject is taboo and one that people prefer not to discuss. Depression is one of the most untreated (or undertreated) illnesses in the Western World. In the U.S., 18 million people suffer from depression of whom two-thirds go undiagnosed and untreated. For some, admitting to suffering from depression seems to be tantamount to acknowledging that they are in some way a failure. THIS IS UNTRUE. Depression is a treatable condition. This month for the ninth year running there will be a National Depression Screening Day on Thursday, October 7th when people can be screened for free.
A couple of years ago I heard Sue, a middle aged lesbian, talking candidly about what it is like to live with depression to an audience of people. She told about how it affected her working and private life. Sue, who has been in a relationship with her partner Cindy for over 20 years, reckons that she has been suffering from a form of low-grade depression all her life. She describes her depression vividly. "I used to come home from work and go straight to bed. I gave up hobbies and didn't want to go out. I started withdrawing from life. It was like being sucked down in quicksand. I always thought I would feel better the next day, but I didn't. It was something over which I felt I had no control."
She started to see a psychiatrist at the urging of a therapist friend and, after at first being resistant to the idea, went on a drug called zoloft. She has noticed an enormous difference. "I have a lot of energy. I have interests back in my life reading, hospital visiting, going places."
Robert is a thirty-eight year old gay man. He related to me how when he suffers one of his deep bouts of depression he finds it difficult to even get out of bed. He doesn't eat properly and sometimes goes a day or two without showering. His home can become so untidy that he dreads anyone ever dropping by unannounced. "I get into a vicious cycle. The place gets untidy. I can't face dealing with it, so it gets even worse. Then I get the feeling that my problems are insurmountable. Just the other day I couldn't get up and start functioning until after four o'clock in the afternoon. So as a result my sleeping pattern gets wrecked and I wind up falling asleep when I should be awake and so on and so on...."
Win, a gay man in his mid-sixties, pulled no punches in describing how depression affects him. "You lose your self-esteem, self-confidence, you feel you don't have any friends, you wish you were dead. It gets to the point where you want to be totally isolated, and not be around people."
Some believe that gay men and lesbians are more prone to depression than the rest of the population. Someone said half-jokingly, "Every gay man is either on antidepressants or should be!" Dr. Lee Works, who is based in Vermont believes it is because of the condemnation of our sexual expression by the institutions of our society from when we are children onwards. "As children the strongest insults hurled at one another refer to our differences in a negative way. When some other child shouts faggot or queer at us, deep down inside we know they are right and fear that we will be found out. Children do not wish to be different from their peers and in trying to fit in have a great internal struggle to overcome. As a result," he argues, "gay men and lesbians grow up with self-loathing and low self-esteem. These internal struggles are sometimes too difficult to overcome on our own, often resulting in teenage suicide, and/or substance abuse as a means of self-medicating."
A study done in 1995 by the Massachusetts Department of education of over 4,000 grade 9-12 students in 59 schools across the whole state found that gay and lesbian students were four times more likely to have attempted suicide, five times more likely to miss school because of feeling unsafe, and nearly five times more likely to have used cocaine. A Chicago-based psychologist, Dr. John Carney, believes that gay rural teens are especially vulnerable to depression and suicidal thoughts due to the lack of visibility of gay adults and the lack of visible and accessible supportive services.
Lee Works does not see an easy solution to this problem while "the codified condemnation of our kind continues. The Gay and Lesbian youth groups are a wonderful way to help ease young people through the pain of self-discovery, but they are not prevalent in smaller cities and towns across America."
Even when people come to terms with their sexuality and enter the gay and lesbian community, all too often, Lee Works points out, the community "is not driven by those good and noble intentions toward the newcomer that I would like to see. Instead we find people driven by their baser urges to have their way with this newcomer." He added that, "As a defense mechanism we have developed insult to a high art, and only serve to further undermine the self-esteem of our brothers and sisters. Too often our community is not based on healthy interactions, but of who might have the sharper tongue."
A retired psychologist living in Texas compared working with gay men and lesbians to "working with elderly nursing home patients. Both groups know that they live in a world which would rather that they just go away. This lack of social support limits their sense of social value, and hence their self-esteem."
Dr. Michael McGinn, a psychologist based in New York City, described to me in very stark terms the problems that many gay people face that leads many of us to have to deal with depression. "Familial rejection, internalized homophobia, a potential for alcohol and substance abuse, fear of death or dying, together with loss of friends and family to an as yet incurable disease, AIDS, as well as a glaring emphasis on appearance and youth create a perfect list of ingredients for a depression cocktail."
McGinn's comments were confirmed by an article published in The Journal of Health and Social Behavior looking at adult gay men. It found three main stressors at work internalized homophobia; expectations of rejection and discrimination and actual events of anti-gay violence and discrimination. The study, which was conducted by Dr. Ilan Meyer, an assistant professor at Columbia School of Public Health, went on to show that a sense of community cohesiveness served to reduce mental health problems. "Men who felt connected to the gay community were better able to cope and had lower levels of stress."
All this begs the question of what you should do if you realize that you are suffering from depression. Dr. Christopher Mahon, a psychiatrist in practice in Fort Lauderdale, suggests that you should start by getting a good physical examination from your regular physician to rule out problems with either your thyroid gland or anemia. Once these have been ruled out you should seek to see either, or both, a psychologist or psychiatrist.
What is the difference you may ask? Well, a psychiatrist is an M.D. or D.O. who specializes in psychiatry and looks for physiological causes for depression for which he or she may prescribe medications, while a psychologist has a Ph.D. or Psy.D. and will look at the psychology, the thought processes, of the patient. They represent two differing approaches to mental illness, although it is not unusual to find a psychiatrist and a psychologist working together to help a patient. The psychiatrist will emphasize the medical aspects of illnesses like depression while the psychologist will pursue a behavioral model of treatment and will seek to make a psychological assessment. Obviously it is important to see a "gay affirmative" professional as the worlds of psychiatry and psychology are not without their bigots. There are several ways to find the right person to help you. A recommendation from a friend is one way to start. Alternatively, psychologists and psychiatrists who advertise in the gay press are very likely to be supportive. Christopher Mahon pointed out to me that most mood disorders are very treatable.
Mahon suggests that you should "shop around." Just because a therapist or psychiatrist gets on well with one of your friends doesn't necessarily mean he or she will get on well with you! His other suggestion is to ask questions: What is her/his philosophy of treatment? What is their specialty? How do they like to work? Does he or she present various treatment options including biochemical ones?
Some people "in recovery" from alcohol or drug addiction struggle when it comes to seeking medical help to deal with their depression. This is a mistake, as the Alcoholics Anonymous famous Big Book makes clear. Dr. Mahon pointed out to me that none of the antidepressants are addictive while nearly all of the anti-anxiety drugs are! He also pointed out that all sleeping pills are addicting.
Depression knows no boundaries and one can have a genetic predisposition to the illness. Women are twice as likely to suffer from it as men. It can be absolute hell to live with. Robert described it to me "as being like seeing everything in shades of gray." Very often it is not possible to simply "pull yourself together." With all the professionals in the healthcare field who are supportive of our lifestyles, know that help is at hand. As Dr. McGinn says, "Do yourself a favor and don't waste your life being semi-satisfied and marginally unfulfilled. This is not a dress rehearsal. Check around and find a person who can help you define where you want to go, and how to get from here to there."
Do yourself a favor. Make this the opportunity you take to do something important for yourself!
Copyright Paul Harris Inc. 1999
LETTERS From CAMP Rehoboth, Vol. 9, No. 12, Aug. 27, 1999