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Author: NotMaggie Big gold star, 5000 posts Old School Fool Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: of 14993  
Subject: Re: its your choice.... Date: 8/21/2005 1:30 PM
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sorry, didn't mean to step on toes here....just thought that, to some, it might be helpful...

mea culpa,


Hello Tuni,

I had mixed feelings when I read the subject line, then started to skim the post; I've read this before in other venues. I'm glad others have already responded here about your reply, both pro and con.

The thing is that the "you can do it!" philosophy is good for people who may be suffering from self-esteem and self-confidence issues who presumedly are lacking only in motivation, esteem, and confidence, but it is not conducive to people who suffer with mental health issues, generally speaking. It is a sore issue. It isn't simply a matter of being optimistic versus pessimistic about changing outlook: depression (and other mental health issues) is more insidious than that. It oversimplifies difficult issues.

I hope the following doesn't sound like a lecture; I mean it to be taken as food for thought and explanation and background for why it's a touchy subject.

Being told "it's your choice" is a very touchy issue for people dealing with these types of problems, largely because we were often undiagnosed and blamed repeatedly with terms like, "getting over it already!," "it's all in your head," "you can really get over it, if you really wanted to [make an effort]," "what? you're not over your funk yet?," "just smile, pretend to be happy, and quit whining, and you'll start to feel better automatically," etc.

People who suffer with depression, like many other mental health issues, often seem very functional, intelligent, and capable in general, but simply seem unable (unwilling) to cope. It is the heavy connotation that this is all about "choice" and conscious, deliberate volition, completely within our control.... if we "really" wanted to. Over the years, throughout history, the mentally ill have been judged as bad, evil, weak, or otherwise questionable in character. We have been judged and blamed for what befalls us.

Above are comments addressing general mental health concerns; now, specifically on depression. As far as depression, there are some types of depression that have been shown to respond well to Cognitivie Behavioral Therapy (CBT) modalities. In a nutshell (and I am grossly oversimplifying this), CBT typically includes a combination of talk therapy with a trained therapy provider plus also very specific, directed, and tailored techniques to teach the depressed individual how to manage depression. CBT has been shown to make impressive strides with a depressed person's mental well-being in as brief as a few months, but this depends largely on the individuals (patient and therapist) as well as various issues of the specific depression. This is a best-case scenario.

Even so, being told "it's your choice" as if it was as simple as turning on or off a light switch is still miles away from being given a combination of talk therapy and Cognitive Behavioral Therapy techniques to teach a depressed individual and put into practice ways of coping with depression. I look at it as treating someone who is recovering from a physical (a tangible "real" illness) disorder like knee or back injury, muscular or neurological illness, with physical therapy assistance to help them carefully exercise and use body parts that are weak, fragile, or need to relearn new ways of functioning than before.

I've heard of infrequent cases of people with physical injuries that refused medical treatment and were, eventually, able to compensate or finally become functional again (most recently, a woman with a severe burn to her leg who checked herself out of the hospital after three days, and took nearly 10 years to walk normally again, without a crooked leg/foot). The same may be true for people with depression, or other mental health illnesses. Still, it means the vast majority never learn to return to "normal" functioning, or require too long a period of adjustment before they can be fully functioning again.

People rarely tell someone with a broken leg to just walk on it, it will heal better if you do so. People will rarely tell a diabetic to just ignore insulin levels, it is a matter of mind over matter. People often believe that mental health issues are literally all in one's head and, therefore, it is a matter of conscious control to just "think" or "believe" one is healthy and all else matters. Brain cancers are also in one's head, but I've rarely heard of people believing that it is treatable just by thinking and believing alone (though I personally do believe strong mental and emotional foundation can be conducive towards a holistic approach to medical treatment). Mental illnesses are legitimate concerns and need a multi-pronged tactic and concern to be addressed adequately.

One of the major battles the mentally ill have to deal with is begin accorded with consideration and the respect that they really are ill and require some degree of outside assistance, not something that should be unassisted.
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