"The last great stigma of the twentieth century
is the stigma of mental illness."
Tipper Gore

      One of the major challenges of coping with a depressive disorder is dealing with the guilt and shame that one often feels about being depressed. Despite the fact that such celebrities as Mike Wallace, William Styron, Patty Duke, Tipper Gore and Ted Turner have publicly shared their battles with depression or manic depression, the stigma of mental illness remains. After my first hospitalization, I remember the dilemma I faced in trying to explain my three-day absence to my employer. If I told the truth-that I was being treated for anxiety and depression-I stood a good chance of losing my job. Instead, I reported that I had been treated for insomnia at a sleep clinic.

      "Clinical depression is a medical condition, similar to diabetes or heart disease," my psychiatrist responded when I confessed how I had concealed my hospitalization. "We need to stop making depression a moral issue. Is the person with a disorder of the pancreas or the circulatory system weak-willed, lazy or defective? Of course not. And neither is the individual who suffers from depression."

      Unfortunately, a recent survey taken by the National Mental Health Association revealed that 43 percent of Americans still believe that depression is the result of a weak will or a deficit in one's character. Many doctors also subscribe to the "defect in character" theory. Consider the observations of physician A. John Rush:

Doctors are still reluctant to make the diagnosis [of depression] because they, too, feel like, "Oh you must have done something wrong. How did you get yourself into this pickle?" which sort of means the patient is to blame. It's okay if you have a neurological disease-Parkinson's, Huntington's, urinary incontinence, a busted spine because you got into an auto accident-but once you move up to the higher cortical areas, now you don't have a disease anymore; now you have "trouble coping"; now you have a "bad attitude."

      I have often wondered why it is so scary to be open about our frailties. With the revelation that depression and other forms of mental illness have a biological component, people should no longer feel that their symptoms are caused by personal inadequacies or a lack of willpower. On the contrary, only a strong and courageous person could bear and ultimately transform so much pain.

      I believe that the stigma surrounding mental illness arises from living in a culture where feelings of vulnerability are considered weak and unacceptable. This is especially true for men who are raised with the injunction that "big boys don't cry"-i.e., it is not okay for men to be vulnerable and show their feelings. This fear of being seen (by themselves and others) as vulnerable and weak, leads many men to lose touch with their own feelings and to avoid being in situations where strong emotion may be present. For example, the observant reader will note that thus far my entire support system has consisted of women. A good male friend who avoided me during my illness later confided, "When you were depressed, I was afraid to be around you for fear that I might 'catch' your depression." What he meant was that being in my presence might cause him to tap into his own latent depression, a proposition that was so uncomfortable, he had to split.

      Women also suffer from this bias against feeling. If a woman works in a male-dominated field such as construction, policing, or law, she is forced into the same mold as men. Women attorneys or construction workers who cry are criticized or passed over for promotions, just as men in these professions would be. A woman working in a non-traditional field who feels and expresses her emotions is labeled as unstable, unreliable and weak. One woman police sergeant tells a story of being sent by the men on the force into a domestic violence situation on her first day at work, to see if she was "tough enough to be one of the guys." It was made absolutely clear that she should show no fear or sadness about the attack the batterer had made upon his wife and children.

      Politics is another field, traditionally the province of men (now being entered by women), where vulnerability is unacceptable. In 1972, presidential candidate Edmund Muskie was considered unfit to hold office after he allegedly cried in public. Similarly, Thomas Eagleton, the Democratic vice presidential candidate in the 1972 election, was forced to exit the race when it became known that he had received ECT for the treatment of depression. I find it incredible that this bias still exists, given the fact that many great political leaders-Abraham Lincoln, Teddy Roosevelt, Eleanor Roosevelt, Joan of Arc, and Winston Churchill (who called his malady "the black dog")-suffered from depression.

      Abraham Lincoln is a particularly intriguing example of someone who achieved greatness in spite of the fact that he experienced bleak, despairing periods of depression throughout his life-no doubt brought on by the early death of his mother and cold treatment at the hands of his father. A typical depressive episode is described by Karl Menninger in his book The Vital Balance:

On his wedding day, all preparations were in order and the guests assembled, but Lincoln didn't appear. He was found in his room in deep dejection, obsessed with ideas of unworthiness, hopelessness and guilt. Prior to his illness Lincoln was an honest but undistinguished lawyer whose failures were more conspicuous than his successes. This was when he was considered well-before his mental illness made its appearance. What he became and achieved after his illness is part of our great national heritage.

      In today's political climate, where image, style and sound bites are more important than substance, one wonders if someone like Lincoln, or other introverted American presidents such as Thomas Jefferson, could be elected. Clearly it is time to reassess our evaluation of what makes a leader.

      For many people, the stigma of being depressed is compounded by shame and guilt about not being a "productive member of society." The depressed person may become a "nobody" when his disability makes him unable to work or to earn a living. How, then, does an individual measure his self-worth when he or she is not working or producing?

      The key is to realize that your individual worth and goodness is a function of who you are, not what you do. Here is a set of affirmations that I have found extremely useful in helping me to realize this truth.

      "________ (put in your name) Who I am is not a function of how much money I make." "Who I am is not a function of how my vocational identity or occupational title." "Who I am is a spiritual being who is on this earth to grow in love and wisdom."

      Repeating this affirmation will help you to redefine your identity in non-achievement terms. You can release the toxic feelings of blame, guilt or shame that so often accompany the stigma of mental illness. Rather than judging yourself as "weak" or "defective," you can learn to love yourself and to affirm your essential goodness.

      Feel free to have your therapist or a good friend assist you in making this shift in perspective. It's okay to ask for help. The roots of shame-based conditioning and society's prejudice against the mentally ill run strong and deep, and have been internalized by many of us. But progress can be made. Remember, the fact that you are facing the challenges of a clinical depression means that you have courage. Or as one counselor put it, "The best students get the hardest problems."