The passing of Robin Williams on August 11 moved millions throughout the world whose lives he had lifted with his well-known comic brilliance and well-kept-from-the-public generosity, especially to those with terminal illness. For his private pain, however, he found no relief.
Williams' death was ruled a suicide, an act that comes to mind in times of desperation and deep depression for many but which few would dare share for fear of being judged.
In fact, one person commits suicide every 40 seconds, World Health Organization Director General Margaret Chan said in a report on September 4 in Geneva.
Mental health professionals define depression as a state of low mood and low energy that can affect the individual's thoughts, behavior, feelings and sense of well-being. It may be a normal reaction to life events, a symptom of a medical condition or a side effect of medical treatments. Or it could be symptomatic of clinical depression, a more serious psychiatric syndrome. Unaddressed, the condition could fuel feelings of hopelessness and a desire to end it all by taking one's life.
"Depression can happen to anyone," said Dr. Jei Africa, a licensed clinical psychologist who directs the diversity and equity program of the San Mateo County Behavioral Health and Recovery Services. "Unfortunately, the condition is attached to much stigma that prevents the depressed from talking about it with their friends and family or with a professional. Shame contributes significantly to why people refuse to seek help."
While the world mourned the loss of the comic genius, his act inspired others to share their own experience with the illness.
Only after Williams' death, with months left till the end of her term, did California Secretary of State Debra Bowen on September 7 disclose her struggle with acute depression, to shine a light, she said, on the sickness and the shame that had prevented her from talking about it.
San Francisco Chronicle columnist Jon Carroll reacted to Williams' suicide with a revelation of a dark time when he let life pass him by until he found a therapist he could work with and medication that proved effective.
Africa and his peers know culture can be among the many barriers certain groups face when dealing with depression. Filipinos are no exception.
For this reason, Africa and his colleagues formed the Filipino Mental Health Initiative with funding from his office to bridge the disparities between those who seek help and those who don't. Among FMHI's efforts is teaching Mental Health First Aid, a free eight-hour interactive workshop to train professionals and non-professionals on how to recognize, assess and intervene when someone in their lives is developing an emotional crisis. The Philippine Consulate in San Francisco has hosted the training for its staff.
Through collaborations with community-based organizations, FMHI advocates lift the veil of mystery from the issue. Their most recent event in Daly City drew more than 100 people.
"In this country, therapy is common and is a means to sort out people's lives and not just serious matters," Africa said. "And even then, working with a therapist raises eyebrows among those from a culture unfamiliar with the program.''
Therapy – or talking to a professional with a license earned from education and thousands of hours of training – may not be as accepted in the Philippines, where the mere mention of "mental," "psychological" or "psychiatric" would drive away those who could benefit from the process.
“Depression is a real illness. It can be debilitating and disabling” Africa added. “When you are sick, it makes sense to go to the doctor or get some help, right? It also makes sense to seek help when you have depression or any other mental health issue. But that's not always what happens.”
Recent signs, however, show a shift in Filipinos' attitude toward mental health, with celebrities leading the way.
Philippine film and recording star Sharon Cuneta aired her battle with depression in an August 18 posting on Facebook, apologizing to fans for "letting them down" with her inability to lose weight and not attending to her career. The posting sparked concern from her colleague Judy Ann Santos, who worried that the longtime entertainer might be on the verge of harming herself.
In Manila, popular fashion designer Jeanne Margaret Goulbourn issued a statement on her Natasha Goulbourn Foundation (NGF) website, cautioning the media to be "responsible" in reporting the Williams tragedy. Goulbourn's advice comes from having lost her daughter to depression-led suicide and in whose honor she established the nonprofit.
"Depression is not a sign of weakness," said Goulbourn, whose daughter died in 2002 "from overmedication for depression."
Tragedy inspired Goulbourn to take steps to prevent others from taking her daughter's last resort after the latter found no resources available in her country for her inner turmoil. NGF aims to shed light on depression through education and intervention. It operates a confidential crisis line.
In her presentations, Goulbourn cites myths Filipinos associate with depression that hinder rather than help.
"One of the greatest misconceptions is that people who are depressed are weak or have diminished intellect, which is false," Africa concurred. "We know for a fact that depression can be caused by many things such as life stressors, chemical imbalance, medical problems, or having a genetic predisposition".
Depression is among the mental illnesses or disorders many experience in the course of a lifetime, said Africa, who also has a private practice in San Francisco. Other examples are anxiety or extreme discomfort in any situation; impulse control disorders such as pyromania, kleptomania and addictions to food, gambling and alcohol, even shopping; and severe cases such as schizophrenia.
Obsessive-compulsive disorder and post-traumatic stress disorder are two other examples of common mental illnesses often played up on television and film. While some may chide others about being "OCD" for being fastidious or driven, the actual disorder can be incapacitating and is not at all amusing.
Misinformation and lack of understanding coupled with cultural taboos contribute to stigmatizing of the disorders, mental health experts agree. Unfortunately, Filipinos must grapple with cultural impediments to learning about mental illness.
"Often we are discouraged from discussing news about others taking their lives much less expressing our suicidal thoughts because of the religious connection, that it is a 'sin,' for example,'" Africa said.
But sharing suicidal thoughts is different from actually taking one's life, which is tantamount to "not putting our trust in God," and therefore sinful, said Reverend Leonard Oakes, pastor of Holy Child and St. Martin Episcopalian mission based in Daly City.
At his fellowship, he said he encourages members to share and respond in a "non-judgmental and affirming"' manner. He himself is always ready to provide "inspirations of both Biblical and experiential stories that connote positive thinking."
Oakes confirmed the cultural block Filipinos often face.
"'We inherited a custom where such topic is not openly discussed at our dinner table. We don't want to offend or cause more trouble for the person and we don't want to be blamed in the event tragedy happens."
Oakes points to "lack of listening and lack of empathy" due to "lack of education on how to detect and deal with depression" as a challenge to Filipinos suffering from mental illness.
"We are told to toughen up, instead of being comforted or encouraged to find help," Africa said of reactions that deride the depressed for being "weak" or "self-centered."
Listening is crucial to addressing depression, concurred Paulita Lasola Malay. The marriage and family therapist in private practice in San Bruno and San Mateo said she begins her sessions by "listening closely" to allow clients to "vent their thoughts and feelings."
She follows up with "validation," or expressing understanding of the client's emotional experience. Then she gives "positive reinforcement," commending the client for the decision to speak up and not try to handle their situation on their own.
The former counselor at Maryknoll College finds that repeating clients' thoughts and waiting for them to complete a statement without "pumping them with questions" help them to verbalize their beliefs, religious and otherwise.
Hearing the right words in a supportive tone can make a difference for someone who has lost a sense of purpose, but providing consistent appropriate care comes with an accountability earned by trained clinicians.
"As in most problems, talking about it is the first step," said Africa, who would recommend reaching out to a trusted relative, friend or co-worker, if the individual is uneasy opening up to a licensed professional.
Talking helps for some, but for others appropriate medication, structured activities and skill-building programs are critical elements of treatment, he cautioned.
Perhaps the saying "It takes a village" applies to the depressed more than anyone else. "Each of us knows at least one person who suffers from depression or maybe even one who has committed suicide," said Africa. "What would we lose by learning how we might help them?"
Cherie M. Querol Moreno is a Commissioner with the San Mateo County on Aging, executive director of ALLICE Kumares & Kumpares and executive editor of Philippine News.
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