A lack of physical symptoms makes depression harder to bear

http://platform.twitter.com/widgets/hub.1326407570.htmlNo high temperature, no flushed cheeks – the guilt that goes with having to justify mental illness can be almost as debilitating as the illness itself

This last week I have been laid low with flu. Proper flu, I mean, not a slightly feverish head-cold. The sort of flu I have only experienced once in my life before. And that was 20 years ago when I flew from Calcutta to Tokyo in the middle of a freezing winter. I had run out of money and was looking for work. For two days I lay in a shivering sweat on a three-tier Gaijin house bunk bed. (A Gaijin house translates literally as a “foreigner” house, a sort of longterm hostel for aliens like me.)
On the third day I forced myself outside, aware that, unless I found a job, I wouldn’t be able to pay for the nights I had already spent there. I remember half crawling around the streets, the slightest gradient leaving me wincing as it drove the cold air deeper into my lungs. It was a stressful situation, in short, and, looking back, a waste of a good dose of flu.
I’m not suggesting that having flu is fun – far from it – but there is a certain luxury to indulging a bout of physical illness, quite absent from my experience of periods of depression, for instance. Lying in bed, with a mug of hot Lemsip, surrounded by tissues – and sleeping dogs – thermometer gratifyingly high, cheeks flushed for additional validation. This time I was teaching when it struck, a workshop on Voice, by the end of which I had lost my voice so impressively I could only make gestures and squeak. “Go home,” they said. “Go to bed, keep warm, make yourself a hot toddy.” And so I did.
There’s something unarguable about physical illness. No need for justification. You’re ill. You need to take it easy. Nobody ever asks why you’ve got flu. Flu exists and you’ve got it. End of.
A serious depression can be far more incapacitating even than a nasty dose of flu. Yet I wonder how many people have claimed physical illness rather than admit to a mental health issue to excuse themselves from work or social commitments, or even a drink with a friend. I know I’ve done it. More than once. It is, let’s face it, so much less hassle to fabricate a tummy bug than to attempt to explain why you can’t get out of bed.
With mental health problems people want to know why. “Why are you depressed?” “What’s brought this on?” “You seemed so upbeat last week.”
There is a palpable sense of disappointment, frustration even; they want to talk you out of it. With physical illness it’s different. You’re ill. It’s not a question of choice. Friends may offer to take the dogs for a walk, bring round a bag of satsumas, but nobody tries to reason you out of flu.
Of course, the loudest and most persistent voice is the one inside your own head. However hard I try to reason with myself, however much I may have read about neurotransmitters, or genetics, or serotonin, the fact remains that I feel responsible for my depression in a way that would make no sense with physical illness. All too often it still feels like a weakness, a self-indulgence, something I should be able to snap out of. In fact, this sense of frustration with myself – of guilt, in short – can be almost as debilitating as the experience of depression itself.
It’s the subjective nature of mental health problems – the lack of obvious physical symptoms, the lack of a measurable temperature – that encourages this sense of self-reproach. A sense that is by no means reduced by the government’s current “So prove it!” approach to assessing sickness benefits, and the shamefully whipped-up hysteria concerning welfare “scroungers”.
But “subjective”‘, however inconvenient, does not mean “imaginary”. How ironic that the very fact that mental health problems do not, generally speaking, cause one to lose one’s voice should make it so hard for mentally ill people to be heard.
• Clare Allan is an author and writer on mental health issues.

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