Despite considerable efforts to de-stigmatize bipolar illness and depression, many people continue to be ashamed and reluctant to acknowledge, accept, and discuss with others the reality of their symptoms or their illness. I believe this is one of a number of reasons why many people with depression avoid treatment and/or may not fully recover despite receiving excellent medical care.
Sadly many people with bipolar illness and depression continue to feel shame and often blame themselves for their condition. They feel embarrassed to discuss their situation which leaves them feeling stigmatized and alone. The reality is simply this: Their illness is a fact. It’s not their fault. Their challenge is to accept this reality without feeling shame. For many this is very difficult. For others it seems to be almost impossible. The pain of any illness including depression is real, but one does not have compound that pain by also feeling shame.
Anyone with major depression or bipolar illness has to try to cope with painful and debilitating symptoms, but that does not mean that he or she should, in any way, be embarrassed to have the symptoms of the illness. Indeed, I have observed that one of the most important psychological steps towards recovery is ownership and the ability to gradually be open about one’s condition without shame. I believe it is also important for their spouses and parents to acknowledge this reality.
Having facilitated our Greenwich DBSA support group for over a decade I have discovered that this process is best conducted in a safe setting of peers all of whom are coping with the same issues including shame and stigma. In our support group we regularly have talked in depth, with both pain and passion, about our personal struggles with shame and stigma, our fears and feelings of rejection, our fears of never recovering, and our embarrassment about sharing our experiences or diagnosis with other people. Everyone in the support group understands these emotions and has experienced them.
It has become increasingly apparent to me that as people talk about these fears in group, their shame diminishes, their burden becomes lighter and their depression decreases. As they share these vulnerable emotions members feel less isolated and less alone.
Members have been encouraged and supported by the group to gradually take the risk of talking about their condition outside of the group. This is a very complex and controversial matter given the stigma that sadly still exists. People are often terrified that they will be rejected and negatively stereotyped if they reveal they have depression or bipolar illness. Tragically, sometimes this does happen both in personal and vocational settings.
On the other hand, it has frequently been observed in our group that as some of our members have found the courage to be open about their condition, they realize that their fears of rejection were exaggerated. In most instances they discover they then feel closer to the people with whom they have shared their “secret.” The irony of exposing this “shameful secret” is that, contrary to their fear of being rejected, our members have discovered because of their greater openness they are now making closer friends.
As members of our group find the courage to gradually share their vulnerabilities, they feel a heavy burden has been lifted and they discover that gradually a unique human bond has often been formed. Indeed, they now feel closer than they ever had previously to those people with whom they have opened up. This newly discovered emotional intimacy derived from shared vulnerability has become the “silver lining” of their illness!
Our members have found this is a totally different type of emotional and interpersonal experience than they might have previously had in sharing achievements, accomplishments, information or work issues, recreational activities or hobbies. This type of interpersonal sharing is sharing from the heart and from the soul. This experience, as it is increasingly repeated, can become a source and a wellspring of love of self and of others.
This may well be the paradox of mental illness. It can be and often is a source of shame, humiliation, and isolation. On the other hand, it can open up the possibility for the deepest kind of human relationship which can ultimately result in truly accepting oneself in all aspects of one’s humanity.
Themes of initial shame and denial followed by men and women eventually opening up and sharing the truth about their illness en route to recovery show up in virtually every issue of BP magazine. I agree with the editors of the magazine and firmly believe that this is a crucial matter and a major step in recovery. I also believe this essential transformative process is insufficiently appreciated and/or addressed by my medical and psychiatric colleagues. If they really believed that this was a central issue in recovery they would refer many more of their patients to DBSA support groups.
I realize this may be a highly provocative proposal and that self-revelation is perhaps not for everyone and, when it is done, must be done thoughtfully, carefully and certainly not when one is in a manic state.
One final proviso, no one who reads this paper should reach the conclusion that simply “coming out” and talking about one’s depression will cure it. It won’t. Many people need to be stabilized and maintained on appropriate medication for their entire lives.
Please feel free to contact me at Jtamerin@optonline.net
Dr. Tamerin, a psychiatrist with over 40 years of clinical experience, has served for many years as Clinical Associate Professor at Weill/Cornell School of Medicine teaching residents and medical students. He has consistently been voted one of the Top Doctors in America by Castle Connelly.
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