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A time to talk

louiseAOne in four people will suffer from a mental health condition in the course of a year in the UK, and while there’s a lot of talk about mental health in abstract terms, it’s another question entirely whether individual people feel able to talk about their own mental health. In this blog, I want to focus on depression and anxiety, as I don’t claim to know how relevant the following argument might be to any other condition.

Depression and anxiety are the most common mental health conditions but also perhaps the ones that appear more nebulous and easy to dismiss. On the one hand, we don’t want to over-medicalise someone who may just be temporarily feeling a bit sad for quite logical reasons. On the other hand, it’s wrong to label as “self-pitying” or “attention-seeking” someone who may be seeking attention because they are in genuine need of it.

CounsellingYears ago, I used to argue regularly with a friend who took the stance that nobody should need to seek out counselling or other talking therapies if they had good, supportive friends they could talk to. I saw where he was coming from – friends can be a source of comfort and strengthen your psychological defences against the insecurities or anxieties that can accompany isolation. Furthermore, friends who are empathetic, good at listening and validating the person who confides in them can help them to explore their own issues and arrive at a measure of self-awareness that usually brings mental strength.

But I also think my friend’s attitude is unhelpful, because it implies that people who seek professional help for their mental health do so because they are loners, people who didn’t have any friends who were close enough for them to rely upon in a time of need. This prejudice can not only further damage the self-esteem of someone who is already feeling weak, but can also turn into a barrier that discourages them from going and having that difficult conversation with a doctor or other professional.

And here’s why I disagreed with him: you may be the most popular person in the world, with wonderfully kind and empathetic friends who are unable to help you right now because they have other things they need to deal with in their own lives. Even if your friends are highly skilled at exploring and fixing your problems and have time and energy to do so, there may be all sorts of reasons why you prefer not to talk to them. Perhaps your friends are too close to your problem to talk about it objectively, or they may know some of the people you would want to talk about. Friendship is in any case a two-way street, and if you feel like your friend is always listening to you, it might inhibit the freedom you feel to really explore where your issues come from.

Only health professionals will be able to advise you which medical solution will suit your circumstances: perhaps anti-depressants will provide short or long-term relief, or perhaps you would benefit from one talking therapy or another. The advantage of a counsellor is that, unlike talking to friends, you have the freedom to be as self-indulgent as you like. What’s more, they do not have an agenda: they are there to help you find your way to your own answers.

A friend may tell you to try yoga, it helped them, so it will help you, and suddenly you are faced with the burden of reporting back to them on your progress. Another may tell you that “I get depressed, it’s because I was bullied” and appropriating that explanation for yourself may feel easier than delving into your own idiosyncrasies. If you lack confidence, a friend is more likely to try to boost your confidence; a counsellor will explore where that lack of confidence came from in the first place.

If you think are depressed and want to talk about it, a good first step is to take the PHQ-9 (Patient Health Questionnaire). It’s just nine questions, and it’s used routinely throughout the NHS. So your score on that could be one way of starting a conversation with your doctor or another professional.

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