This time, I’d like to talk about how we refer to depression.
Before proceeding, please note: I was diagnosed with severe depression three years ago. While I have personal experience with the illness, I possess no medical expertise. My account contains no falsehoods or exaggerations, but it lacks medical basis. Please understand this point. If necessary, I urge you to seek a physician’s opinion.
Depression is viewed as a “mental illness”
Generally referred to as “mental illness”
When people hear the term “depression,” they likely think of it as a “mental illness,” don’t they? Even in major media outlets like television and public relations magazines, as well as official sources, the term “mental illness” is frequently used. In fact, when seeking treatment at a hospital, you would typically visit a “psychosomatic medicine department” or a “mental health clinic.”
I believe the term “mental illness” and the way it’s perceived are fundamentally flawed. From personal experience, depression is a brain disease. A brain disorder. While I’m not sure how it’s classified medically, labeling it as a “mental illness” leads to people saying things like “You can push through it with willpower” or “It’s all in your head.”
Because of the image of “mental illness”
During a regular meeting with my company while on leave, the company representative told me, “Depression is like a cold.” I honestly didn’t understand what they were saying and didn’t know how to react.
Seeing my reaction, they laughed and said,
”If you think you have a cold, you’ll catch a cold. If you don’t think you have one, you won’t. You know how it is, right? Depression is the same thing. Just like a cold, take your medicine, get a good night’s sleep, and you’ll feel better. After that, it’s all about willpower, willpower. It’s all in your head. Illness stems from the mind, you know. First things first, don’t slack off—get up properly in the morning, don’t stay up late, and make sure you get a good night’s sleep.”
And patted my shoulder. I was devastated.
Perhaps this person meant to encourage me. Even though I ended up taking leave due to depression, it’ll be fine because I’ll recover soon. I’ll be back to my old self and able to work again in no time. It’s not like I couldn’t hear it that way. I’m sure he meant well and had no ill will. But fundamentally, his perspective is flawed—not just regarding depression, but even when it comes to the common cold.
The person who said this was the company’s depression liaison. He claimed that since he’d handled numerous employees on leave for depression, he understood exactly how I felt. I wanted to ask, “What exactly do you mean?”
Examples of brain diseases include “cerebral infarction”
The Struggle with Aphasia
When people hear the term “brain disease,” many immediately think of conditions like cerebral infarction or subarachnoid hemorrhage. It’s well known that these can be fatal, and even when patients survive, they may suffer lasting effects such as hemiplegia.
Two years ago, my wife’s father suffered a stroke. He had been working hard as usual the day before, but from that day on, he lost the ability to speak. It seems to be called aphasia.
Fortunately, he suffered no lasting physical damage. However, immediately after collapsing, he could only utter sounds like “Ah…” or “Ugh…” After some time, he regained the ability to speak, but he said that even when words came to mind, different words would come out when he tried to say them. At first, he couldn’t tell time, didn’t know the names of objects, couldn’t say his address, and was in the sad state of being unable to even say his daughter’s name.
A cerebral infarction is a condition where blood vessels in the brain become blocked. This prevents oxygen and nutrients from reaching specific areas of the brain, causing cells to die and leading to lasting effects. In his case, the Broca’s area (the motor speech area) in the left frontal lobe was damaged.
It was a sudden occurrence, but he diligently continued his rehabilitation. Starting with something like elementary school workbooks, he worked steadily every day. Now, while reading numbers still seems difficult and he occasionally stumbles over words, he has overcome nearly everything else. I respect him. Without giving up, day after day. Steadily.
Words for Those Battling Illness
Would you ever say things like
“Speak properly”
“You’re a terrible person for not being able to call your own daughter’s name”
to someone trying so hard to speak again? Of course not. Because it’s an illness. You know they desperately want to speak. You know there’s something wrong with their brain.
I believe the same must hold true for someone whose hands or feet have become difficult to move due to aftereffects.
Causes and Symptoms of Depression (※Hypothesis)
Depression is still under active research, but it is said that various causes lead to the following conditions. (※There appear to be multiple theories. The following is one such hypothesis.※)
One of the most well-known hypotheses regarding depression is the monoamine hypothesis. This theory suggests that a deficiency or imbalance in monoamines—neurotransmitters in the brain such as serotonin, norepinephrine, and dopamine—disrupts proper information transmission within the brain, leading to the emergence of various depressive symptoms.
- Serotonin
It helps stabilize mood and emotions and is also known as the “happiness hormone.” A deficiency of this substance leads to core symptoms such as depressed mood, anxiety, and sleep disorders. - Norepinephrine
It plays a role in enhancing attention, motivation, and activity levels. A deficiency can lead to decreased motivation and lack of concentration. - Dopamine
A substance involved in pleasure, joy, and motivation. When its function declines, it causes anhedonia—a condition where one loses interest in and joy from everything.
Furthermore, in the brains of people with depression, changes may be observed not only in neurotransmitter abnormalities but also in the structure and function of specific regions.
- Hippocampal Atrophy
Long-term stress is thought to cause excessive secretion of the stress hormone cortisol, damaging nerve cells in the hippocampus—a region involved in memory and emotion—and leading to atrophy. - Decreased Prefrontal Cortex Function
Brain imaging studies such as MRI suggest reduced activity in the prefrontal cortex, which is involved in thinking, judgment, and emotional control. This functional decline is thought to be associated with symptoms of depression such as impaired thinking and reduced decision-making ability.
Recent research has also highlighted the theory that neurogenesis—the creation of new nerve cells in the brain—is suppressed in depression. A protein called brain-derived neurotrophic factor (BDNF) is essential for nerve cell growth and maintenance. It is thought that when stress or other factors reduce BDNF levels, neurogenesis becomes impaired, increasing the risk of developing depression.
Isn’t that a brain disorder?
Even if it’s just a hypothesis, looking at this cause and these symptoms, there’s definitely something wrong with the brain, right? It’s a brain disease.
The patient is trying so hard, trying so hard. They want to live their daily life powerfully, sleep soundly at night, and wake up feeling refreshed in the morning. But their emotions won’t cooperate, and they can’t control their body. Because something is wrong with their brain.
Even so, the words directed at patients include things like:
“Aren’t you just being lazy?”
“Isn’t it all in your head?”
“Are you really depressed?”
“You can push through it—just push harder!”
“Stop staying up late and get proper sleep.”
“Stop skipping work, get up in the morning, and fix your reversed schedule.”
“Hang in there. It’s all in your mindset.”
These are all things I’ve actually heard from people at my company.
That’s like telling someone who can’t speak due to a stroke, “You can do it with sheer willpower. Come on, talk!” or telling someone whose hand won’t move, “You say it won’t move, but isn’t that just you being lazy?”
I think it’s because we tend to imagine suffering from something intangible like the mind, which makes it seem like some unknown entity or leads us to wonder if it’s all just in our heads.
If more people understand where and what kind of phenomena are occurring, it might make the battle a little easier for those suffering from depression.
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