Defining Depression on the LGBT Community

                                                                                 

Lesbian, gay and bisexual populations have greater instances of mood and anxiety disorders than their straight counterparts, according to the National Institute of Mental Health.

Results of a recent study that looked at the "lifetime prevalence" of the disorders by sexual identity show that bisexual women have the highest rates of mood and anxiety disorders at 58.7 percent and 57.8 percent, respectively. They're distantly followed by lesbians at 44.4 percent and 40.8 percent, and gay men at 42.3 percent for any mood disorder and 41.2 percent for any anxiety disorder. Straight men have the lowest rates at 19.8 percent for mood disorders and 18.6 percent for anxiety.

Experts attribute the higher rates among LGB (information for transgender men and women wasn't readily available) to society discrimination, in large part.

"A society context of oppression leads to social and family alienation, reduced levels of social support, low self-esteem, and symptoms of psychological distress," a Riverside County LGBT Health and Wellness Profile reports.

                                                           

In terms of support, 75.3 percent of LGB residents in California say they have someone available who loves them and makes them feel wanted, compared to 80.7 percent of straight people who say the same. And the state's gay men and lesbians experience psychological distress at 13.4 percent, which is nearly double the heterosexual experience at 7.6 percent.

That trend is reflected at the local level as well, especially regarding depression.

"The most prevalent mental health issue among LGBT residents in the Coachella Valley is depression," says Dr. Jill Gover.

As director of mental health services at The LGBT Community Center of the Desert in Palm Springs, Gover counsels and works with desert residents dealing with anxiety and mood disorders on a daily basis. In April, she addressed the issue among Riverside County residents in a speech, titled "Defining Depression: Metaphors and Stories," at a Mental Health Summit at CSU San Bernardino in Palm Desert.

Here's an excerpt of Gover's speech:

The symptoms of depression vary considerably, but the first thing to go is happiness. There is no more pleasure gained from what in the past had been pleasurable. And then other emotions follow: pervasive sadness, apathy, sense of humor, capacity for love, and loss of perspective. If your hair was always a bit thin and flat, now you're on the verge of balding. If you were always a bit pudgy, now you're obese. Perspective is gone, negative filtering rules, and everything is worse.

A clear diagnostic signal that you are depressed is when you feel bad most of the time. If it's distracting and uncomfortable, then it's a mild depression. If it's disabling to the point that you can't function, then it's a major depression. The DSM-V defines depression as the presence of five or more on a list of nine symptoms. But this clinical approach doesn't really do justice to the experience of depression. Most people can only describe it in metaphors — the rusting of an iron girder, the strangling of a tree by a vine, the disintegrating, soggy beams of a house foundation. It's a difficult diagnosis because it relies so much on metaphors to define it, and each person resonates with a different metaphor to describe this hellish descent into darkness.

Depression has been part of our human existence since the beginning of conscious thought. And perhaps it existed in animals before human beings were even on the planet. We know for a fact that the symptoms of depression were described by Hippocrates 2,500 years ago. So this is not a uniquely modern, 21st century disease. However, like skin cancer, the prevalence rate has escalated in recent times for identifiable reasons. The climbing rates of depression may be related to the consequences of modern life: a fast pace with constant demands of a technological world, alienation, the breakdown of traditional family structures, increased urban mobility which often leads to pervasive loneliness, the failure to find meaning and direction to life.

Stressors create vulnerability, and our first line of defense is to develop coping mechanisms to manage the stress – the psychological equivalent of sunblock and big hats. We must do two things to address depression: 1) change perspective, and 2) instill hope. No matter what therapeutic orientation, treatment model, psychotropic medication, or lifestyle intervention, the only way to successfully reduce depression is to change perspective and install hope. Not easy, but possible.

I once saw a young adolescent client who worked at a McDonald's in a city in the Bay Area riddled with gang violence. One night on her shift, two men burst in with automatic weapons and opened fire, Al Capone style, killing everyone in the restaurant at the time. My client dropped to the floor and played dead, which is how she was the lone survivor. When I first saw her in therapy she exhibited symptoms of Post-Traumatic Stress Disorder, high levels of anxiety, and depression. Her cognitive schema at that time was that the world was a dangerous place; others would hurt her, and she was a victim.

Little by little, we developed behavioral experiments to test out new beliefs: Was the world always a dangerous place? Were there some people who were safe and trustworthy? Could she see herself as resilient and resourceful, having had the presence of mind in the situation to play dead and thus survive? Long after the PTSD symptoms had subsided, the depression lingered. This young girl had had a crisis of faith in humanity. I encouraged her to write poetry to express her feelings. She wrote the most morose and morbid poems I've ever read. But it was through creative expression, in combination with community support, talk therapy, and anti-depressants, that she was able eventually to conquer the tenacious depression. She had to change her perspective and find hope for the future before she could truly heal from the psychological wounding of her ordeal. ...

No matter which metaphor we choose to define depression, we can all agree that the solution lies in a myriad of different approaches. No one single intervention will work for everyone, and ultimately it's the accumulation of many disparate techniques, strategies and models that synergistically repair the damage wrought by this condition. Medications, lifestyle strategies, alternative medicine, and a variety of different talk therapies combine to forge a formidable defense in the battle for wellness.

Depression today exists as a personal and societal phenomenon. To treat depression, we must understand the biochemistry of the brain, the subjective experience of a breakdown, and the evidenced based treatment that changes perspective and instills hope. We must continue the important epidemiological research that identifies which treatment works best for different populations, and different types of depression. ... Working together, we can find solutions and reduce suffering. Working together, we can extinguish the walking death quality of depression and return people to lives worth living.

Getting help

Counseling is available at The LGBT Community Center of the Desert for anyone struggling with depression and other mood and anxiety disorders. Contact Dr. Jill Gover at (760) 416-7899 or drgover@thecenterps.org.

Will Dean, Desert Outlook