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This article is an excerpt from a commission awarded to Culturissima by a Harley Street psychoanalytic practice.

Further articles in the same series by David Winter include Performance Anxiety, On Being a Stranger in a Strange Land, and The Pursuit of Perfectionism, together with a short introduction to the work of Donald Winnicott.

I'm a Man and Men Don't do Those Things

MARCUS

Marcus Trescothick is an English cricket player, and a world–class one to boot. At his peak Trescothick was, according to the Daily Telegraph, “one of the finest batsmen of his generation”. Between 2000 and 2006, Somerset–born Trescothick represented England on nearly 200 occasions and led the national side as captain a dozen times.

In the early months of 2006, Trescothick was a pivotal member of the England team that was touring India when, according to the BBC, he was obliged to fly back to London “for personal reasons”. The national broadcaster added: "England have refused to expand on Trescothick's sudden departure, other than saying it is for 'a family reason'".

Two or so months later, in April 2006, Trescothick himself expanded on the (apparent) motivation behind his “dramatic departure” from India: "I had to leave India because I picked up a bug and it hit me hard. I could not shrug it off and it left me fatigued."

The very next month, playing at Lord’s – the home of English cricket – Trescothick hit a majestic century for the England eleven against Sri Lanka. It soon became apparent, however, that the batsman’s return to international form was only temporary. A reluctant Trescothick announced in the press that he was no longer able to represent his country due to a "sensitive medical condition”, an ailment that was later to be described as an “acquired gastrointestinal infection" before morphing into an “underlying stress–related illness”.

Needless to say, in reality Marcus Trescothick was suffering from clinical depression. But, in common with so many men and women ensnared in the jaws of the “black dog”, the cricketer initially found it simply too daunting a prospect to come out and say: “I’m down – really down – and I need help”.

Why is it so difficult to acknowledge depression? Why does it feel less uncomfortable to explain that you have been laid low by a virus, a bad stomach, personal problems or a "sensitive medical condition”? What prevents us from turning to family and friends or seeking professional support when we are hemmed in by depression?

The remainder of this article explores the qualms, doubts and fears that act as an obstacle to disclosure. By acknowledging the stigma that routinely attaches itself to depression, we hope that it might feel easier for anyone who is suffering to access support. Or, if you are close to someone who is grappling with severe depression, it could prove useful to have an understanding of some of the emotional obstacles that lie in his or her path. And we will also catch up with what happened to Marcus Trescothick…

DEPRESSION: WHY IS IT SO HARD TO ASK FOR HELP?

Public stigma and self–stigma are two of the greatest barriers to seeking treatment for depression. Whereas the former reflects the general population’s views about depression, self–stigma denotes the prejudice that depressed people turn against themselves.

In spite of the enormous numbers of people who suffer from clinical depression at some point in their lives (see opposite), the illness is in many way a “hidden” ailment that thrives on secrecy and taboo. The empty space of ignorance evokes unspoken, unconscious fears and crooked thinking as the victims of depression are somehow perceived to be to blame for their own suffering (“perceived self–infliction” to use the jargon).

Individuals toiling under the yoke of depression are often acutely sensitive to these stereotypes and prejudices. They have a tendency to internalise and identify with society’s received ideas about depression, convincing themselves that they are somehow socially undesirable or unacceptable; that they do not deserve help; that, if they only tried harder, they would get better… in short, that they are fundamentally bad, weak and unsuccessful people (where this leaves Churchill, Lincoln, Isaac Newton and Beethoven – all of whom suffered from severe depression – is anyone’s guess…). Stigma often feeds into the feelings of shame that are inevitably a major component of depression. Opening up means turning towards others, whereas shame generally compels the depressed individual to shy away from contact and hide him or herself. In addition, sufferers frequently feel unattractive and inferior, thus increasing the fear that they may be rejected if they reveal their turmoil.

DEPRESSION: A TREATABLE ILLNESS

Counsellors, therapists and doctors are acutely aware that depression is neither a deliberate choice nor a moral failing. They understand that depression is an illness. A treatable illness from which people recover.

In addition, it is important to remember that the ideas outlined in the previous section are value judgements that are based on myths, prejudices and ignorance. Therapy, by contrast, is built on the opposite premise: impartial objectivity. As we explain elsewhere:

In therapy you enter a non–judgemental space where you are not disappointing someone with things you have done or said. You do not need to hide aspects of your true self for fear of negative judgement.

THE BENEFITS OF ASKING FOR HELP

Let’s say you are suffering from depression as you read this, and let’s strip away all the possible impediments to seeking help for a moment or two. What are the potential benefits of visiting your GP, making an appointment to see a therapist or simply talking to family or friends? Here is a handful of potential outcomes:

• You are likely to accelerate the treatment process and shorten the time it takes you to recover.

• Talking to a professional is likely to leave you feeling less isolated and make it easier for you to continue your day–to–day activities.

• You might well sigh a deep sense of relief as you no longer feel obliged to hide the way you are feeling.

• You may find that those around you are now in a position to help and support you, and may even share similar experiences with you… they, too, might feel relief.

• You may discover that your loved ones and your colleagues still love you, accept you and respect you even though you are grappling with depression. Alastair Campbell, Tony Blair’s former “spin doctor”, recounts the following surprisingly touching anecdote about the time he talked to the British prime minister about his depression:

When Tony Blair asked me to work for him in 1994, I said "You do know about my breakdown don't you? You do know I still get depression." He said "I'm not worried if you're not worried." I said "What if I'm worried?" He said "I'm still not worried." I think that's an important signal for us to take on board – if a Prime Minister can take that attitude, we all can.

“IT IS AN ILLNESS, IT'S NOT SOMETHING YOU MAKE UP”

And what happened to the international cricketer, Marcus Trescothick?

Marcus decided to secure professional support to treat his depression: he made an appointment with a doctor and then went into therapy. Two gigantic steps… followed by an equally bold move: Trescothick – who still plays cricket for his county side – opted to “go public” with his depression in a soul–baring biography entitled Coming Back to Me. The cricketer was motivated to talk about his illness because he wanted “to get it [the depression] out in the open”:

There have been so many questions left unanswered and I've not helped that process. But this is the opportunity, and I hope people can understand why I did a few things I did.

Suicidal thoughts, sobbing in the corner of a shop, bursting into tears in the changing–rooms – Trescothick’s account of his depression is striking for its honesty and vividness. But the cricketer’s astute description of why it was initially so intolerable to seek treatment will also strike a chord:

People try and hide depression all the time. I hid it for weeks, months and a couple of years before saying I don't want to run from this any more.

Trescothick further points out that "anxiety problems are seen as a weakness. People tell you to pull yourself together. But it is an illness, it's not something you make up.” He was nervous about talking about his depression – he remembers thinking at the time: “I'm a man and men don't do those things”. And he feared the reaction not only of family and friends but also of the wider public: “I was always expecting the worst. Especially with the condition I was in at the time."

Where he had feared stigma and shame, Trescothick received nothing but support and understanding. He explains that he feels lucky that he made the decision to speak out about “the beast that lives inside” before it was too late.

YOU GOTTA ROLL WITH IT

We hope that, if you are suffering from depression as you read this, you can take heart from Marcus Trescothick’s story – the account of an exceptional cricketer but ordinary human being. We think that it is important to emphasise that Marcus did not eliminate the stigma and shame generated by his depression before he accessed help. You don’t have to. It is more about accepting that prejudices and anxieties exist and slaloming your way around them rather than waiting for the obstacles to go away. You gotta roll with it… You gotta say what you say and don’t let anybody get in your way… Because, when you are in the grip of a deep depression, the benefits of securing help – of being listened to and being understood – are potentially life–changing.