it's okay to not be okay

When Depression Is Not All In Your Head

Dealing with physical illness often comes at the cost of our mental health, but an honest conversation about pain may help avert it.

When Depression Is Not All In Your Head
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When I was first diagnosed with major depressive disorder (MDD), I had no idea that I was depressed.

I had lost a sister to cancer over a year before, so I was feeling sad. It was 2007; nobody talked about mental wellness and nobody I knew had depression. But my family doctor had spotted the signs and urged me to seek treatment.

The fact that depression is known as the common cold of mental illness shows how prevalent it is. According to a nationwide study by the Institute of Mental Health (IMH), one in 16 people has battled MDD at some point but more than three quarters of people with such mental disorders did not seek professional help. They cited two common reasons for this — fear of stigma and the inability to recognise symptoms.

Depression can be hard to detect. It is not about crying your eyes out every day. It can be as innocuous as having trouble concentrating or remembering details, feeling fatigued and sleeping too little or too much — sounds like what distracted or busy Singaporeans face daily.

Other common traits range from a deepening sense of hopelessness and pessimism, to digestive problems and physical pains. But the most dangerous of all is suicidal thoughts.

Illness or chronic pain can cause patients to become depressed. For me, however, depression lasted longer than the common cold. In 2015, I had a terrible fall that left my smile severely lopsided, my face droopy and one side of my body numb. My injuries included nerve damage, a tear in my rotator cuff tendon and a sprained wrist so severe I couldn’t hold a pen.

Over the next few months, I sought treatment by specialists and attended physiotherapy, acupuncture and chiropractic sessions faithfully. But not only did the pain worsen, I also struggled with drowsiness in the day from my meds and nightmares at night.

For the second time, I wondered if life was indeed worth living. It didn’t occur to me that I might be suffering from depression again. I was merely grappling with a physical ailment, yes?

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I was shuttled from specialist to specialist, who prescribed painkillers but failed to diagnose my worsening pain. One young doc even dismissed my symptoms, saying they didn’t seem serious. He lifted my right arm high — and hit an invisible barrier. That sharp pain made me double over and I started bawling in his office!

That outburst led to a fresh diagnosis of frozen shoulder — the pain turned out to be real and not just in my head — and a referral to a psychiatrist, who eventually diagnosed me with post-traumatic stress disorder (PTSD) and MDD, due to chronic pain.

The world has never felt as mentally stressed as it does now, in the battle against Covid-19. At press time, more than 37,000 people in Singapore have contracted it. Globally, over 6.58 million people are sick, with a death toll exceeding 389,000. The global economy is headed for a deep recession, and there is no vaccine in sight yet.

If your heart started beating a little faster reading that last paragraph, you are not alone. Calls to Samaritans of Singapore’s 24-hour hotline jumped by over 22 percent in March, compared to the same period in 2019. The Singapore Association for Mental Health reported a 50 percent increase in helpline calls in February and March 2020, compared to the average number of calls between April 2019 and January 2020. Callers cited health and economic woes as their main worries.

If the physically healthy are struggling with uncertainty and fear, imagine how much tougher it must be for Covid-19 patients, some of whom spend weeks in the intensive care unit. Even those who only suffer mild symptoms report feeling worry and grief (even guilt if they had spread the disease to others) as they are quarantined and treated in isolation.

Our mental health matters. Covid-19 affects everyone, even the rich, powerful and famous like American singer Pink (and her three-year-old son Jameson), Tom Hanks, Rita Wilson and Idris Elba, as well as Britain’s Prince Charles and Prime Minister Boris Johnson.

In an interview with Ellen DeGeneres, Pink said: “Having access to healthcare matters, and loving ourselves and each other, and taking care of our mental health matters.”

She is right. Studies reveal that physical illness increases a patient’s risk of developing severe depressive illness. Medical journals like Scientific American warn of increasing suicide rates due to Covid-19 as figures continue climbing. Even healthcare professionals are not spared. French doctor Bernard Gonzalez committed suicide after contracting the virus, while New York emergency room doctor Lorna Breen, overwhelmed by the stress and exhaustion of fighting the pandemic, took her own life.

Fighting Covid-19 doesn’t end with a negative diagnosis. While the earlier focus was on fighting the fires in hospitals, governments have begun setting up dedicated support resources to help their populations cope with mental wellness issues. Singapore’s National Care hotline is one such initiative.

Covid-19 has unceremoniously thrusted the importance and urgency of mental wellness into the limelight. It’s a painful lesson, but the world is learning that mental resilience is as important as physical healing. If this opens up honest conversations, improves our mental wellness preparedness and empowers more to seek help, we will at least learn how to build a stronger world for future generations.

Feel Good To Feel Better: Tried-and-tested tips to help you manage mental wellness

1. Stick to your routine

A routine helps you prepare for the day ahead. So get out of bed at your usual time and have your favourite coffee. By setting you mentally on track for a “normal” day, it prevents you from giving in to any gnawing sense of helplessness.

2. Exercise

While the reason you used to exercise was to lose weight, that’s not the goal now. Don’t feel up to taking group classes? Start with simple 20-minute walks. The endorphins your body releases during exercise will help reduce your brain’s perception of pain.

3. Stay grateful

Looking for the silver lining can improve your mood. Write about it in your journal or take photos. Or document your finds on social media. Seeing physical proof of things that make you happy or grateful can be that paradigm shift you need.

4. Be kind to yourself

Can’t deal with things or people right now? Take time off for self-care. Don’t feel obliged
to make your day “count”.

I have watched a movie and eaten a meal alone, because
I needed a time out. If you’re feeling a little better today than yesterday, it’s already a win!

For other mental health-related support, call the National Care hotline at 1800 202 6868.

This story first appeared in the June/July 2020 issue of A Magazine.

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