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"Man Up"? Why We Need To Talk About Depression
Josh Hall , October 10th, 2012 09:50

Although some parties might be keen to state otherwise - as some disturbing examples this week have demonstrated - now more than ever it's crucial that we learn to talk about mental health, says Josh Hall

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Today is the 20th World Mental Health Day. Orchestrated by the World Federation for Mental Health and supported by the World Health Organisation, the annual event has sought to improve awareness of mental health, and to bring it to parity with physical health as a medical priority worldwide.

Much has been achieved since the event began two decades ago. Investment in mental health care has increased around the world, and there is a growing recognition that mental health demands the same rigorous clinical attention as a broken leg or a dodgy heart.

And yet, as if on cue, two articles published this week have demonstrated quite how much we have yet to achieve.

The first of those articles, published in the Sunday Times (but handily reproduced on Alastair Campbell's blog, since The Times removed itself from public discourse by installing a paywall), has already been the subject of a so-called 'Twitterstorm' – that increasingly common, and increasingly short, social media phenomenon. On Monday, India Knight attracted the ire of mental health charity Mind, following an article in which she derided as narcissistic those who talk about depression. There is, she insists, no longer a taboo surrounding mental health issues. We are free to talk, so why go on about it?

"I can't say it enough," Knight wrote. "There is no stigma."

Knight was quick to insist that she had been misquoted by Mind, that her irritation solely concerns celebrity depression memoirs. She conducted herself startlingly poorly on Twitter, referring to those who took issue with the article as "deranged." Mind twisted her quotes, but as originally published Knight's views are those of someone with no understanding of mental health problems. Stripped of its Christmas bestseller-bashing hook, the crux of her column is twofold: that there is no longer any stigma attached to depression, and that depression is not a potentially fatal illness but rather a minor irritation to which we are all subjected.

She is, of course, wrong on both counts – dangerously, startlingly wrong. "Everybody gets depressed," Knight blithely asserts; a sentence as blisteringly inaccurate as one suggesting that everyone gets the occasional spot of MRSA, or suffers from an annoying recurrence of brain tumour. Despite railing on Twitter about her late father's depression, it is clear that Knight has absolutely no conception of the illness; clear that she lacks the critical faculties to distinguish between a bad day and a mental disorder.

Not everybody gets depressed, just as not everybody gets cancer and not everybody loses a limb. In any given year, around one in four British adults will experience at least one mental disorder. Of those, depression and anxiety are the most common. Depressive episodes can be all consuming. They can render life unfeasible, exploding our capacity to deal with the minutiae of daily existence. They often come hand in hand with psychoses – delusions, hallucinations, an inability to interact with the world at large. Recurrence is common: more than half of those who experience a depressive episode will suffer from at least one more. Depression is chronic for one in five sufferers. It is not the same as feeling a bit mardy.

India Knight's second claim is more insidious, perhaps less obviously incorrect. In the UK, we have become gradually more willing to accept depression as a clinical problem. We talk more about mental illness. GPs are better equipped to identify the signs. Parliament recently moved to end a ban on those with mental health problems serving as company directors, jury members, or MPs – a positive step that is entirely at odds with the government's general tack on health and employment law.

But despite these advances, we remain phenomenally bad at dealing with mental health. Certainly we talk about it. Depression hides in plain sight, sitting beneath a thin veneer of conversation. We are adept at platitudes, but the conversation is always about someone else; someone to whom we can offer sanguine, non-committal moral support. We never talk about ourselves, not really. Knight says "there is no taboo." How wrong she is.

The taboo affects everyone. Campbell points to the case of a nurse who has felt obliged to remove from her CV a six month period during which she was suffering from post-natal depression. That she is employed by the NHS demonstrates how deeply the stigma still runs. Similar stories are everywhere around us. Think about your friends. With how many of them have you had a serious conversation about mental health? About a quarter of them is likely to have endured a depressive episode. Would you ever know?

Yes, the taboo affects everyone, but this inability to articulate our disease seems particularly acute in men – and it is compounded by articles like that written by Tony Parsons in this month's GQ.

It is, of course, a match made in a particularly displeasing corner of literary purgatory: a furiously impotent Boy's Own for the metropolitan Tory, commissioning a man whose lad-lit-lite journalism is founded on the sort of greasy misogyny favoured by men in shiny leather jackets leering from the corners of suburban pubs, ruddy cheeked in the mid afternoon. And, surprisingly enough, Parsons' article is illustrative of men's blindness towards depression, and of continuing, dangerous prejudices regarding suicide.

The piece is a response to a suicide note; not so much a eulogy for a dead friend as a 2000-word suggestion of where it all went wrong. Two thousand words about promiscuity in the Philippines, about arguments in Bali, about drugs and alcohol. Two thousand words and not a single mention of mental illness, not a single mention of depression.

"Most men will not kill themselves, no matter how life humiliates us," Parsons says. "Why not? Because the choices we've made in our lifetimes make suicide unthinkable. It is only when you get enough of those choices wrong that suicide becomes an attractive option."

For Parsons, suicide is something that happens when you fuck up. Men who kill themselves do so because they "choose sex instead of love, drink instead of gym, the late night instead of the early morning." Make these choices and you are, Parsons says, in a delightfully dehumanising turn of phrase, "a suicide waiting to happen."

Parsons' outlook belongs in the last century. It is this suggestion of weakness, this insistence that suicide is primarily a result of poor decisions, that renders so many people unwilling to seek help when they need it.

Suicide is the biggest single killer of young men in the UK. Every year, more men take their own lives than die in road traffic accidents, or of drug overdoses, or as a result of accidents at work. Almost twice as many women as men are treated for mental health problems, and yet men are three times more likely to commit suicide. We do not feel comfortable seeking help – and our reticence is killing us.

CALM was established in 2006 with the aim of reducing the rate of suicide amongst men under the age of 35. Its director, Jane Powell, says that Parsons' article "illustrates how difficult [suicide] is to comprehend, understand, vocalise, and empathise with for the non-suicidal."

"The idea that suicide is the recourse of those who've tired of life simply can't be true," Powell says. "There are lots of young men out there who've barely stepped out the house and barely lived, let alone got bored – who don't have the confidence to talk to anyone, who aren't cold-hearted bastards but quite the opposite.

"A large number of callers to our helpline aren't living it up abroad and flying fancy free. They're trying to support a family, trying to get exams, trying to ply their trade as a plumber or carpenter or electrician and see their children on a regular basis, and who are so bloody stressed out and under intolerable pressure that they don't see any other recourse but to leave."

The suicide rate had been gradually declining before 2007. Now though, despite the valuable work of CALM and others, the number of people taking their own lives is back on the rise. The economic collapse looms large. Between 2008 and 2010 there were 1,000 more suicides than expected – and according to recent research published in the British Medical Journal, two fifths of those are associated with job losses. Men accounted for 85 per cent of that 1,000.

"The taboo around suicide pretty much ranks alongside incest as a no-go area," Powell says. "Men don't feel able to talk about emotional or mental health at all, and this is shockingly clear from the suicide data. Last year there were around ten male suicides in the UK a day. We've a very long way to go."

Parliament may have voted to allow mental health sufferers to stand as MPs, but the government is decimating the services on which we rely. Spending on mental health was cut by £150 million this year – the first fall in a decade. Crisis resolution, early intervention, and outreach services saw their budgets slashed by £30 million.

Were it not for the remarkable efficiency of Tower Hamlets mental health services, I might not be writing this article. As the crisis continues, these cuts will kill. They likely already have.

But it is not just money that is needed. We must continue to fight against stigma, must continue to reject the old prejudices and the new blindness of people like Parsons and Knight. Until we learn to talk about depression, until we stop treating suicide as an unspoken weakness or a failing of character, people will continue to suffer and continue to die. It is a tragedy that every day, men and women take their own lives because they do not feel able to seek help – a perception that is only bolstered by people like Parsons and Knight. Now, more than ever, it matters what we say when we talk about mental health.

John Smith
Oct 10, 2012 2:10pm

....men in shiny leather jackets leering from the corners of suburban pubs, ruddy cheeked in the mid afternoon...

Can you tell me a bit more about these men who you seem to despise so much?

I bet they like football and drink lager, the vile PLEBS!!!

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John Doran
Oct 10, 2012 2:25pm

In reply to John Smith:

GQ's readership is middle class.

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Oct 10, 2012 2:36pm

Really superb and necessary piece, Josh, excellent work.

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Emil
Oct 10, 2012 2:37pm

This is a fantastic article. I recently read a book about depression – Living with a Black Dog by Matthew Johnstone which really illustrated to me how depression affects people. It sounds like Knight needs to read it.

I’ve also recently taken the first tentative steps to seek out a counsellor for my mental health problems. I’ve become more open about it to my friends but don't want my employers to find out.

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David Stubbs
Oct 10, 2012 2:37pm

Sorry, forgot to append my name to the above.

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kev the builder
Oct 10, 2012 2:42pm

In reply to :

Is The Quietus readership middle class ? I would have thought so. A music site for avant skronk...it comes none more middle classed than that. Factory Floor ironically are not big on the factory floor. Music isn't working class anyway. Never has been apart from folk music, which by its essence is such. The Rolling Stones, The Clash, LCD Soundsystem etc etc....... Christy Moore however on the other hand....anyways this is not a class debate and class is a dull subject essentially as the lines are blurred now. Vincenco, pass me my Gavi...and skin up

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Emily West
Oct 10, 2012 2:46pm

Brilliant article. I've just read GQ's too, and I have to say that I don't think it's bad. It's evidently written for a wildly different audience to this (perhaps the ....men in shiny leather jackets leering from the corners of suburban pubs, ruddy cheeked in the mid afternoon...), who aren't as comfortable with mental illness and depression talk straight out, but I think that what's important is that it's written. More sources of advice alongside it would be more than a good start, but at least this is something.

Readers of that piece may not wish to read articles in this style but might feel comfortable reading the GQ piece. What's important is that the same points for discussion are getting out to hugely different audiences. Yeah it's be ripped apart in 30seconds if it was published here but... each to their own. On an issue as important and stigmatised as this, let people get to it how they can, I see no benefit in putting down another publication trying to broach the same subject in a different way.

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Oct 10, 2012 3:36pm

My advice to India Knight, if she’d like to avoid narcissists, is to stop reading celebrity memoirs. And perhaps find a less narcissistic line of work.

My advice to Tony Parsons, if he'd like to understand mental illness, is to read something more challenging than a Choose Your Own Adventure book.

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Carpathian
Oct 10, 2012 6:34pm

Brilliant, especially the important differentiation between actual depression & other things. Having had a couple of pretty heavy episodes (inc being on the verge of walking into somewhere and asking for help against myself) I can verify the power of something as simple as actually being able to honestly voice what is going on in your head *without* the fear & stigma of the results of doing so. It never goes away but acknowledgement of it can start things rolling the right way.

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Reggie P
Oct 10, 2012 6:46pm

In reply to John Doran:

No doubt The Quietus' readership is middle class too, John. You wear a leather jacket don't you being a fan of Heavy Metal?

Great article. Who ever said Parsons should stop reading Choose Your Own Adventure books is spot on.

x

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Reggie P
Oct 10, 2012 6:46pm

In reply to John Doran:

No doubt The Quietus' readership is middle class too, John. You wear a leather jacket don't you being a fan of Heavy Metal?

Great article. Who ever said Parsons should stop reading Choose Your Own Adventure books is spot on.

x

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Reggie P
Oct 10, 2012 6:46pm

In reply to John Doran:

No doubt The Quietus' readership is middle class too, John. You wear a leather jacket don't you being a fan of Heavy Metal?

Great article. Who ever said Parsons should stop reading Choose Your Own Adventure books is spot on.

x

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Reggie P
Oct 10, 2012 6:50pm

In reply to Reggie P:

So true I said it thrice by the looks of things!

A very good piece of writing

Apologies x

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Apop
Oct 10, 2012 7:27pm

A fine article, and a conversation which needs to be had. Paul Robertson via Facebook hits hard a sensitive nail for me "a great many sufferers of mild depression who wear it like a fucking badge and try to one-up one another in the 'look how depressed I am' stakes". Thank you. Being melancholy 'cos your girlfriend of boyfriend left you (see any number of rather good bands covering the topic) is one thing - drinking to excess 4-5 nights a week 'cos at least that puts you in control of how sh*tty you'll feel the next day is on a completely different level. Those who are "always depressed" also always talk about how depressed they are. The latter group (which I described) doesn't talk about it, they just do it.

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Nick Hunt
Oct 10, 2012 7:37pm

In reply to Emily West:

It's only important for an article to be written if it contains anything valuable. Parson's article simply has nothing to say, and only supports the attitude that suicide happens to people other than the wise reader - people more fucked up, or libertine, who haven't grown up, who aren't responsible...his sympathy for the "minimum wage worker" who discovers a suicide is more explicit than any reference to the victim (in this case Cobain), all he mentions about him is a lack of responsibility, a lack of vision. It's not an article to educate, it's to make the writer and reader feel superior.

Don't take the force of this reply personally, as someone who has struggled with mental health issues articles like this make me angry. I also lost a friend to suicide - a man with many close friends, with a lot to give, who was felled by an illness he couldn't cope with. Our cultural attitudes to depression are not working, they are not good enough, and it seems likely that they will get worse out of economic "necessity", as services and benefits are cut for an illness too few respect.

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Alaister
Oct 10, 2012 9:09pm

Great article. On the postive side of things in New Zealand where depression is a huge issue, former All Black John Kirwan's campaign has been brillant. Kirwan's book "All Black's Don't Cry" is a really honest dipection of his struggle with the illness and the prejudices faced. He recalls being told by team mates to "harden up" and of the incredible relief he felt when we finally opened up after years of keeping his illness secret. Kirwan's awareness campagin has been a great inative in NZ, especially coming from a figure of his stature. It's a remarkably bold move - especially considering the All Black is the paradigm of NZ men's "harden up" mentality.

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Emily West
Oct 10, 2012 10:36pm

Nah you make good points. I to have lost people to this, exceptionally close people. I also work in End of Life Care. In my experience, men of this type/class/character/whatever you want to call it are some of the least likely people to have come into contact with death. This is why I think the GQ piece has merit. I'm not denying for a minute that it also has a million faults; the tone of the writing leaves a lot to be desired, and it barely scratches the surface on feelings or wider meanings amongst other sins. Still, an article in a glossy magazine, aimed towards this audience and addressing death and the possibility that it even happens to men like it's readership, even in this thoroughly imperfect way, is a rare thing indeed and I'm of the opinion that these baby steps should be applauded and not derided. That's where I'm coming from, just so you know.

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Secret_Saint
Oct 10, 2012 10:38pm

Have you ever bled and tried to hide wounds
So no one could see your pain

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Katie
Oct 10, 2012 10:41pm

Really loved this article. Inspired me to post my own thoughts/experiences: http://francophonyblog.wordpress.com/2012/10/10/a-few-thoughts-on-world-mental-health-day/

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Nick Hunt
Oct 11, 2012 12:34am

In reply to Emily West:

Fair enough, I see what you mean. I suppose I'm just surprised how imperfect common ideas of depression still are.

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John Doran
Oct 11, 2012 6:41am

In reply to kev the builder:

Our readership is pretty varied Kev and while we doubtless have a lot of middle class readers, in my experience class and lack of further education opportunities are no bar to appreciation of supposedly 'difficult' music. Rather, end of the pier and landfill indie find their heartland in student unions and in various locations (Liverpool and Manchester being prime examples) in the UK you're more likely to find people in traditional working class jobs into psychedelic rock, dub reggae, prog etc.

The point of the article, which I think is expressed excellently, is that this 'man up' attitude is expressed in lad culture which is not, as far as I'm aware, class affiliated. Unilad after all is Unilad and not Builderlad.

Also, many folk musicians are salt of the earth as you say but this does not, by and large, relate to the fans.

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John Doran
Oct 11, 2012 6:44am

In reply to Reggie P:

I didn't say I'm not middle class. Please see my comments above. Depression is not a class issue and it's damaging to suggest that it is.

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J Decorte
Oct 11, 2012 7:41am

Thank you for this.

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Reggie P
Oct 11, 2012 8:16am

In reply to John Doran:

It certainly isn't, gent, I know that x

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Carpathian
Oct 11, 2012 11:00am

The most frustrating thing about an article like this is seeing comments about class, dress code, music styles and even political leanings etc mixed into it and the the conversation that follows. In the same way as music passing over a national border unhindered, true depression really doesn't stop to think about any of those things. Holding these things up as reasons, excuses or causes just clouds the fact that the stigma is still here and simply shouldn't be.
Still, though, the fact that we are here talking about it at all is a big plus so props to Josh/Quietus for doing so.

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St. Paul
Oct 11, 2012 1:09pm

Thanks for a thoughtful and empathetic/sympathetic article. Still much needed these days...

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Bruce
Oct 11, 2012 7:36pm

I admit, that sentence about leather wearing jackets men is a bit of a generalization and stereotype. I myself love a good beer at local puvs and do wear leather jackets, yet I am aware of mental illness and talk to people about it. Anyhow, the article is still right, it is still taboo and especially for men, believed to be a weakness of the mind.

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whatever
Oct 14, 2012 1:35am

i enjoyed this article and it make some wonderful points but the leather jacket sentence,word for work it was in an article in vice this week,who copied who,if anyone,i dont care.what i do care about is the total cultural snobbery involved in such a comment,considering these lesser mortals as you seem to think of them are the exact men most at risk of suicide,even suicide seems to make class distintions,check the statisics.i come from a shitty little town in the highlands thats been plagued by suicide since the day i was born,statistically the highlands have the worst suicide rates in europe and amongst the worst on earth,and it always seems to be the shiny leather jacket type taking that option,just 3 weeks ago my friend barry paton took that option,six years before that his brother fraser,did the same.so next time you write a sympathetic article on suicide/depression dont ruin the whole thing by attacking the very people most likely at risk of the stigma of mental illness.

regards

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sylvia hebben
Nov 18, 2012 4:26pm

I feel that I have to defend the NHS and other public sector providers (Newcastle City Council, in my case).
Having had 2 major depressive episodes and also worked as a Mental Health Nurse and in other therapeutic settings, the treatment and support received across the UK , by employers and health care providers seems to be a massive postcode lottery, like any other illness.
Without the help of my GP and her team and the support I received from Occupational Health, the last episode would have been 'the last'. To help employers understand, I am very open about my experiences and feel that being a rational, competent individual and employee, who can talk about mental illness using factual and non emotive language, is more effective in removing stigma and ignorance than any amount of literature on coffee tables.
If you want to be understood, have the conviction to talk and educate. There is a life and career after/despite depression and honesty and bravery is the best public health strategy. Lead from the front and employers and the public will become more supportive and educated about the topic. Just make sure you don't sound like Morrissey, or Robert Smith when you do. Even though I am actually very fond of the latter...

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andy mahal
Sep 7, 2013 9:49am

Gabor mate's excellent book 'in the realm of hungry ghosts' is mainly about homeless addicts but more often than not, these people are afflicted with other mental issues including depression. found it to be a very ideologically clarifying read, as it deals with how our society deals with illness and addiction. this -"The taboo around suicide pretty much ranks alongside incest as a no-go area,' just reminded me of it. highly recommended!

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