Depression is not sadness. It is not feeling blue. It is not a mood that will pass. It is living without hope. Without hope about getting through the day. Without hope that tomorrow will be different. Without hope that we will ever feel better. And then we begin losing hope that we can survive it. Thoughts and feelings about the comfort of letting go of our pain begin to be attractive to us. Suicide becomes an option. Not one we want. But one that seems to be the only choice for ending the pain of living with no hope. Of living with depression. This is depression.
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, sinceshe 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.”