How Depression Has — and Hasn’t — Become Normalized

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Daphne Merkin is something of an authority on antidepressants — having relied on them for more than 30 years — but when the subject came up at a dinner party she attended a few years ago, she held her tongue. As the other guests piled on with their critiques of depression medications, she perceived “an unspoken investment in holding depression up to censure, as though it were still, after all these years, a fraudulent bundle of symptoms, an inflated case of malingering that everyone suffers from but that only a select, self-indulgent few choose to make a big deal about.” In her engrossing new memoir This Close to Happy, Merkin describes how she has struggled all her life with clinical depression — and how her suffering has been exacerbated by the stigma attached to mental illness. Depression, she writes, is “a sadness that no one seems to want to talk about in public, not even in this Age of Indiscretion.”

Merkin is in her 60s; she first wrote about her experience with depression and hospitalization for The New Yorker, in 2001, in a piece that also touched on the social fallout of speaking publicly about her struggles. In the years since, activists and doctors have mounted ever more creative and far-reaching campaigns to combat stigma. College students publish their stories of mental illness on widely read, university-sponsored blogs. Survivors of suicide attempts tell their stores in TED Talks and on podcasts. Drug companies pour money into campaigns pushing the idea that depression is a biological problem with a pharmaceutical solution. (Growing up in the 1990s on the Upper West Side, I absorbed that message before I knew what “depression” even meant. I often walked by a building painted with a four-story-tall, all-caps slogan: “Depression is a flaw in chemistry not character.”)

As a millennial, it sometimes seems like depression has been entirely normalized among my peers. My social-media feeds are saturated with young writers liveblogging their breakdowns. Under the handle “So Sad Today,” personal essayist Melissa Broder invites prospective followers to “come for the crippling anxiety, stay for the aftermath of depression,” and offers a minute-by-minute window into her experience: “me and my mental illness are going back to bed,” she tweeted recently, at one in the afternoon. Earlier: “My funeral will be the first party I enjoy.” Journalist Eve Peyser claims to send out her newsletter every time she cries. In real life, too, depression is more of a casual aside than a confession. When the subject of antidepressants came up at a dinner party I attended recently, one guest — an editor in her 20s — mentioned that she took the same one as her dog. It wasn’t intended as a big disclosure or a bid for sympathy; it was just a funny observation. Surveys confirm that young adults are more accepting of mental illness than their parents and grandparents: according to a 2015 Harris poll, 60 percent of American college-aged adults believe that seeing a mental health professional is a “sign of strength” — compared to just 35 percent of older adults.

“You live in New York, right?” was the first thing Bernice Pescosolido, a sociologist at Indiana University whose research focuses on public perception of mental illness, asked, when I floated my theory — that depression has been destigmatized — by her. “Well, there you go.”

Research suggests that stigma is softening in the rest of the country, at least a little. In 1996 and again in 2006, respondents to the nationwide General Social Survey read a vignette about a man named “John,” who meets the criteria for clinical depression: He’s been “feeling really down” for two weeks, waking up every day with a “flat, heavy feeling” and struggling to accomplish simple tasks. In 1996, 35 percent of Americans said they would not want to socialize with John, and 57 percent would not want him to marry into their family. In 2006, those figures were slightly lower: 30 and 53 percent, respectively.

The idea that depression is a disease with a biological basis — rather than a personality defect, or a synonym for self-indulgence — has effectively taken root. In 2006, 67 percent of respondents believed John’s troubles could be attributed to neurobiological causes, up from 54 percent a decade earlier; 32 percent believed that John’s “bad character” was to blame, down from 38 percent in 1996. Ninety-one percent agreed that it would be appropriate for John to seek treatment from a physician, up from 78 percent in 1996. (The next set of data won’t be collected until 2018, but researchers expect these trends to continue.)

But greater acceptance of the medical model of depression — which has been the cornerstone of anti-stigma programming since World War II — isn’t necessarily correlated with lower levels of stigma. “This idea had a backlash effect,” says Pescosolido. “Moving to this medical belief hasn’t had the effect we hoped for.” It can make depression seem intractable — and if it’s inherited, it can be passed down to future generations. “People say, ‘I don’t want that person marrying into the family, because I don’t want my grandchildren to have depression.’”

Newer anti-stigma programs focus on sharing individual stories of mental illness, rather than repeating the message that depression is genetic. Watching a friend or family member go through an episode of depression humanizes the diagnosis: “The most powerful factor affecting stigma is whether or not you’ve had contact with a person who’s had mental-health problems,” Pescosolido says. Could reading a memoir have the same effect as talking to a friend who’s going through a depressive episode? Spending hours reading about Merkin’s struggles felt like a good substitute for personal contact — maybe even better, since she is more adept than almost anyone at conveying her inner life. And though researchers haven’t studied the impact of reading about depression, they have demonstrated “that video contact can be almost as powerful as personal contact,” according to Pescosolido.

Merkin, for her part, sees incremental progress. “I think my book has coincided with a moment in the culture where it is beginning to open up to it,” she told me. “There is more of a sense that depression is fairly prevalent, that it starts early, that it’s not merely moodiness or recalcitrance.”

Even so, she still has to deal with skepticism about the authenticity of her depression. At a recent talk she gave, “People in the audience asked things like, ‘Would it help your depression if you protested against Trump?’ People wouldn’t ask if that would help your schizophrenia.”

And she points out that the most severely depressed people are not going to dinner parties and dishing about their antidepressants. “When I was at my worst, I didn’t do anything,” she said. “I couldn’t read, I couldn’t write. I mostly slept. That kind of depression isn’t in the public eye, because it’s silent.”

How Depression Has — and Hasn’t — Become Normalized