By Wong Zi Yang (19A01D)
Cover illustration by Alvin Lim Jun Han (19S06B)
I don’t think it comes as a surprise to anyone that we have quite a few students suffering from depression in Singapore. In fact, it’s one of the more common mental illnesses seen in Singaporean youth. What comes as a bit of a surprise to me is how little people actually care about the situation; and by “‘care” I mean take tangible action against it. We may hear the odd rumour here and there: “he’s been missing school a lot lately”, or “someone has been hospitalised”. If an incident does happen, people keep quiet out of confidentiality and respect for those involved. But at the same time, doing so means that there is little to no impetus for uninvolved students, already busy enough as is with the academic rigour of school, to care much about it. The problem is not addressed at its root, and we just don’t talk about it – and so I set out to look deeper into students’ responses to depression in Raffles: Do people care enough about it? What then can we do about it?
Depression is a serious mental ailment characterised by persistent negative thoughts which have immense psychological and occupational ramifications. According to Ms Woo Mei Hui and Ms Chua Kah Hwee, counsellors at the Raffles Guidance Centre (RGC), there is a lot of knowledge, but translating that knowledge into action is an entirely different matter. While the Peer Helpers Programme’s annual Mental Health Awareness Week and other initiatives such as talks during the Raffles Science Symposium Mental Health Strand strive to change this situation by moving “beyond raising awareness to creating actual changes in behaviours and mindsets”, there are some limitations, such as the short opening hours of MyRestSpace (2.30pm-5.30pm) and lack of awareness about support initiatives like the Peer Helpers Programme.
Most of us have at least some knowledge on depression as an illness. Ms Woo and Ms Chua can attest to as much: they share that most students are quite well-informed in being able to identify symptoms of depression in themselves. However, many students do not actually seek out the counsellors for help. At the same time, however, Ms Woo notes that there have been “more students with depression” as well as cases of “more severe depression”: some cases are so severe that it begins to significantly affect students’ lives. Their daily functions are impaired, some cannot attend school or are even put on medication (which may be because they waited too long before seeking help). So bearing this in mind, we move on to the next questions: Why are there more cases of depression – and more severe cases at that?
Why is depression so prevalent?
One key reason is that depression is hard to pin down. Since the causes and symptoms differ from person to person, it is hard to detect depression in someone else and offer help. In the case of sufferers themselves, they fear being treated differently (well-intentioned or otherwise) because of their having depression. On both sides, Ms Woo and Ms Chua attribute this issue to the lack of discourse.
This is exacerbated by the fact that people tend to avoid talking about depression. This lack of discourse is an issue serious enough for the World Health Organisation to not only have dedicated their World Health Day 2017 to depression, but also to theme it “Let’s talk”.
Most of the time, people don’t talk about depression because they don’t see themselves making any significant impact on the situation, or are afraid of touching upon such a sensitive topic. For people with depression, they don’t talk to you about depression because you don’t. Since guilt and shame are now somehow tied to the condition, discussion is halted and progress stopped. But what’s so taboo about depression that not many of us are willing to talk about it, and how does that worsen the situation?
One explanation is that we simply don’t know enough about depression to be able to engage others in conversation about it, especially our peers who may be suffering from depression. Since the symptoms of depression can vary so greatly between individuals, there is a great difference between concept and reality: reading about depression is just not the same as experiencing it. Thus, for fear of making things worse due to lack of professional training, we tend to avoid talking about the topic entirely.
Another reason is the lack of normalisation of discourse regarding depression. The lack of a social script (behaviors that are expected in a particular situation – for example, waiting in line, ordering and paying for food in the canteen) hinders conversation. We aren’t sure how to discuss a condition as nuanced as depression, and there really is no set formula to interacting with sufferers. In short, our hesitation to tread unknown ground and possibly hurt a friend’s feelings often leads to the lack of conversation about depression. But as long as we believe that talking about depression makes things worse, it will make it harder for people with depression to speak up.
Finally, our increasing use of social media diminishes the time we spend with friends which, according to Ms Woo, is worrying since human interaction is so important to our emotional well-being – Whatsapps and DMs just won’t cut it. I’m not saying that conversations don’t happen at all, though — you’ve probably had a few heart-to-hearts with your friends. However, since having a strong support network means that people will be less likely to develop depression, we should try to have as many conversations as we can.
Of course, all this may be easier said than done due to the stigma that is still attached to depression: because there is a lack of conversation about depression, people lack information. The idea that ‘depression sufferers are just weak’ is not born from depression sufferers actually being weak. Rather, it’s due to the lack of actual interaction with depression sufferers; without real-life interactions with depression sufferers, we don’t realise that in truth, depression sufferers lie on a spectrum. “Some can continue to work, study and contribute to society in spite of their mental condition, which this is a testament to their strength and resilience”, Ms Woo notes.
“I think it’s this idea that people don’t really have a lot of information, very few people actually step forward to say ‘I have depression but I can still function, I can still do the job’. People don’t realise that there are these possibilities… if we don’t have people coming forward, [everyone] will continue to have this negative impression of mental illness.” (Ms Woo)
The impact of this stigma also goes beyond simple gossip: the pervasive negative impressions of depression make it harder for depression sufferers to work up the courage to seek help for their condition. They fear being judged or even treated differently just because they have a mental illness, and thus decide to keep quiet about it. This means that most of the time, their condition worsens before they seek help. Furthermore, the experience of social rejection and isolation that comes from stigma has the potential to harm depression sufferers, and it is also associated with poor mental and physical health outcomes, even early mortality. In short, the stigma surrounding depression is a pertinent issue that we need to address.
So now what?
You may think that you need to be a professional in order to engage a person with depression. That’s true, but only to a certain extent. What a professional can do is offer therapy and psychoeducation (the process of providing information to those suffering from mental illness to help them better understand, and become accustomed to living with, mental health conditions), which is where the specialist training comes in. A friend, on the other hand, provides a personal touch; a listening ear who can better relate to one’s problems. You don’t need to provide solutions to your friends’ problems, but just providing a sounding board for them to voice out their problems will help greatly. Of course, some tact is needed to talk to depression sufferers; but, as put by Ms Woo, “just because they have depression doesn’t mean they are completely defined by depression”: so don’t hesitate to reach out to your friend.
For example, you could just ask a friend how his day is going and talk to him as you normally would. He is, after all, first and foremost a friend before “someone with depression”. The support that a friend can offer is thus quite different from that of a professional, which is why Ms Woo considers friends the “first line of defence” in maintaining one’s mental health. Invite your friend out for a meal or just go out somewhere. Don’t be put off by a deadpan rejection; a common trait of depression is that sufferers tend to isolate themselves since they lose interest in pleasurable activities. Keep that hand extended: this effort at connection can help them see that someone does care about them, and that they are not as worthless as they believe themselves to be.
Talking about depression itself isn’t as daunting a task as you may think either. In fact, simply avoiding touchy topics by sweeping them under the rug and hoping they don’t start to stink does not and will not help anyone. I’m not suggesting that you to go up to random people and say “Would you like to have a conversation about depression?” Rather, don’t dodge the issue if the topic of depression — or any mental illness, in fact — comes up, and keep an open mind. Responsible discussion of depression can and will help the situation by dispelling common myths and making it easier for sufferers to seek help when they need it — that’s why we need to discuss depression (in, I have to emphasise again, an informed and responsible manner).
People suffering from depression don’t need to sit on the sidelines and just wait for ‘something’ to happen, either. Your words can have a profound impact in emphasising the human nature of the condition. Helping others to understand what you’re going through better raises awareness about it and contributes to discourse. It was precisely with this rationale that TOUCH Community Services launched a series of themed MRT trains in collaboration with Nanyang Polytechnic featuring snippets from people with mental conditions on how they are affected. Conversations need at least two sides, and you can be one of those sides. It’s easier said than done, but you can consider approaching a close, trusted friend as a first step to opening up about what you’re facing.
“People don’t really want to talk about it or share about it, they prefer to not let people know that they have suffered from such mental illnesses so I think the stigma can only be defeated if people who have suffered from depression come forward and share their experiences” (Ms Woo)
If reading this is going to encourage you to take action, that’s good. While attempting to help your friends, though, Ms Woo and Ms Chua have some advice for you.
Firstly, be aware of their boundaries and limitations while reaching out to your peers. Be tactful and advise them to seek professional help if the issue is beyond your abilities. You could also offer to accompany them to seek that help.
Secondly, while helping your friend, ensure that you yourself have adequate emotional support to be able to support someone else. Keep an eye on your own mental health and ensure that you’re not burdening yourself with too much emotional stress; emotional support is just as important for you as it is for your friends.
Finally, while confidentiality should be protected, counsellors urge students to break confidentiality should their friend be considering self-harm or suicide, and seek the help of professionals.
There can be any number of reasons people develop depression and/or avoid the topic. You might not think that your voice will make any difference. You might think that you’ll make things worse. You might think that you’ll just be a burden to others. But you won’t. In a school where studies are king, we have to remember not to forsake our mental health for grades (and vice versa). Keeping that in mind, keep that hand outreached and take the hands that reach out to you.