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23 Jan 2010

By Emilia Chiscop

John Head, American writer, former journalist, member of the Advisory Board of the Rosalynn Carter Mental Health Journalism Fellowship Program, Atlanta, USA, shares his personal experiences as a survivor of untreated clinical depression for over more than 20 years. On February 5th he will be lecturing in Iasi after being invited by a journalist from "Ziarul de Iasi" newspaper (who was a 2008-2009 Rosalynn Carter Carter fellow) and by the "Socola" University Hospital of Psychiatry.

When did it cross your mind to write a book about your own experience? Did it happen exactly in the moment you were listening to the radio program and heard about The Rosalynn Carter Fellowships for Mental Health Journalism? Had you thought earlier of the possibility of writing a book and you just had been waiting for a good moment for it? Have you had in your mind also the "therapeutic effect" of writing about yourself?

I never thought about any of those things before I decided to write the book. When I first proposed my book as a project in The Carter Center's Fellowship program, it was to be a book about mental health and minorities in general. I was advised that this was too wide an area and I should narrow the focus. I kept narrowing the focus until I reached the point where I realized I was avoiding the thing I should be writing about, which was my own struggle. I felt I could not write an honest book about mental health and pretend the issue didn't affect me personally. I didn't write the book for a therapeutic effect, but I think there has been one. In a way, writing the book was a three-year-long talk therapy session.

In Romania, mental illness is a taboo, a shame, a curse. Therefore, people with mental troubles don't speak about this. What have been the consequences of speaking in public and writing about your illness – the consequences for yourself, for your mental state and for your public image? It is really so dangerous and risky to confess in public that you are mentally ill?

I had an advantage when it came to possible damage to my public image. I didn't have a public image to worry about. I was always a very private person, and the public simply didn't know much about me. I wasn't really on the radar screen, as we say. But I did worry about the consequences of my depression becoming known. I worried that family, friends, coworkers and others would see me differently, see me as a damaged or even dangerous person. As it turned out, just the opposite was true. The people who really knew me and cared about me rallied around and supported me. I can't say what the total impact of my revelation has been. How can I know if someone avoided me or didn't offer me a job or whatever because they knew of my depression? So, I can't say how dangerous or risky it is. And I never pressure people to go public the way I did. I say it would be helpful if more people did, but whether one does or not is a personal decision. I think people are entitled to their privacy.

Your book, "Standing in the Shadows," is an admirable book about depression from cultural, historical and anthropological perspectives. You show that the roots of depression among black people must be found in history of slavery, followed by decades of racial discrimination and attempts by African-Americans to integrate themselves into the culture of white Americans. Do you mean that depression of Whites is different from depression of Blacks and therapy should be also different?

This is the question I've been asked most since I wrote the book. I always start my answer by saying what the experts say. As former U.S. Surgeon General David Satcher said in his Report on Mental Health, there's no racial component to depression. In other words, you're not more prone to depression simply because you're born into a group that we call a race. But racial groups can be exposed to more risk factors for depression for various reasons. For example, poverty increases your risk of depression. That means that if there's a higher poverty rate among African Americans, there will be a higher risk of depression for that reason. And if you go down the lists of risk factors for depression such as exposure to trauma, chronic illness, imprisonment, drug abuse, etc., you'll find African Americans, and especially African American men, face many of these risk factors. I don't think therapy necessarily should be different for African Americans. I do think that there are issues that may have a cultural foundation and can be very important in treatment. It obviously helps if the therapist understands or at least is sensitive to such issues.

When did the first signs of depression appear in your life? You wrote in your book that you had your first suicidal thought at 9 years old, when your mother didn't allow you to go out and play baseball. Was this the first sign? Or maybe it appeared later when your playmates called you a "maniac baseball player."

That incident is the first one I remember. I point to it because, looking back, I don't think my thoughts and behavior were typical for a child that age. I'm sure many children say or think, "I wish I were dead." But they don't mean it. They don't truly understand what it means. I didn't just say it. I planned how to do it. As for my reputation as a maniac baseball player, again, looking back, I would say my mania was relatively mild. In fact, it probably was an advantage. I gave me a passion, drive and energy that allowed me to accomplish more in the sport than my meager talents should have achieved.

When did you go to a psychiatrist for the first time in your life? How much time had passed since the start of your suffering?

I had suffered untreated depression for more than 20 years before I first got help of any kind. It was 20 years of ignorance and denial on my part, and 20 years of suffering that might have been avoided.

When did you start the treatment? How many psychiatrists did you change until you found the best doctor for your soul and mind?

I started treatment a little over 10 years ago. I've only seen one psychiatrist. I went about choosing a therapist in exactly the wrong way. I simply looked for the one closest to where I lived, whose office would the easiest to get to. I didn't try to find the best person for me, one I could trust and talk to. But I was lucky. The person I chose happened to be a terrific therapist. She began helping me immediately. I could feel her concern for me from the start. This is very important, I think.

I read in your book that depression is called in the black communities "the blues". This reminds me that in our society, in Romania, people confuse depression with sadness. So, there are many people that may think that they are just sad and shouldn't see a doctor about this. In a similar way, you write that for many years you refused to go to a doctor, thinking that there isn't a medical treatment for unhappiness. What do you think now? What is the difference between sadness and depression? Between unhappiness and depression?

There's a song that says everybody has the blues sometimes. That's true. It is part of the human condition. We all have sadness and unhappiness in our lives from time to time. A romance ends, you didn't get the job promotion you thought you deserved, someone close to you dies – there are many things we react to with sadness. But most of us get over it. We do something that makes us happy, or the passage of time heals the emotional wound. But imagine that something that makes most people sad makes you much sadder than it does for others. Or imagine that you get very sad and unhappy for no apparent reason. And what if your sadness lasts for weeks at a time, and as time goes by it lasts longer and longer. Then you reach the point where you think the sadness and unhappiness will never end. The things that used to make you happy no longer do. You don't enjoy them anymore. You think sadness simply is a part of your life and will be forever. You think you deserve to be unhappy. You have no hope of ever feeling happiness again. If you can imagine all that, you can imagine how depression is different from routine sadness and unhappiness.

Depression affected your family life, but didn't affect as dramatically your career. You decided to separate for a while from your wife and sons, but now you are again a family together. On the other hand your career had been going forward uninterrupted. Do you consider that keeping and developing your career helped you to pass over the illness, to recover easily? Or was it just the opposite – the career has been another factor of stress and suffering? What is more important for a mentally ill person: to have a career or a family?

That's a difficult question for me, and it's one that I would never try to answer for other people. I believe a family can be a wonderful support system and motivation to get better from depression. My sons were that for me. I finally realized that I couldn't be the kind of father I wanted to be and the kind of father my sons needed as long as I was struggling with depression. But not everyone wants a family, or what's considered a traditional family of a wife and husband and children. Some people are dedicated to their career or to a cause. For those people, there can be other kinds of support from relatives, friends and even in the workplace. Those people can be motivated to get better also.

And I must say that having a wonderful family or a great career doesn't guarantee that you won't suffer from depression or will recover from it more quickly if you do have it. There are so many factors involved. We deal with our lives as we make them. The thing about depression is that it so often requires help when it becomes a part of your life. Whether people are career oriented or family oriented, we have to have an atmosphere in which they can seek help without feeling afraid or ashamed.

In Romania, persons with mental disorders think of themselves as being blasphemed and are afraid of conceiving children. You have three sons. It is known that the risk of depression is higher among children with parents diagnosed with depression. How have you managed this risk? What would you advise Romanian couples afraid to have kids from these reasons?

I'm not an expert, but from what experts told me during my research for my book, there is strong evidence of a genetic component to depression – that it can be handed down from parents to children – but the strength the connection is unclear. There also is evidence that the home environment that can be created when there's a parent suffering from untreated depression can be a risk factor for the children. I've worried about this with my sons. I've watched them for signs of depression. I've spoken openly to them about my own experience with depression and let them know that they can talk to me if they feel they're having problems. Parents who suffer from depression should talk to their children if they're old enough to understand about the illness. But the most important thing I would tell such parents is to get help for themselves. If they get better, this is the greatest gift they can give their children. And if their children do happen to suffer from depression also, they will have been shown how to get better.

Did people around you know you were depressed?

Not really. I was very good at hiding it most of the time. There were people who knew me well who thought something was wrong, but they didn't know what it was. To give you an example, my mother, my brothers and my sister told me they didn't know what I was going through until they read my book. It wasn't that they had been uncaring. I just hid things from them.

Ok, maybe they didn't know what you were going through. But did they know that you were depressed? Your colleagues knew that something was wrong with you? You reported in the book an episode: you were at work, you were thinking of committing suicide by throwing yourself through the window, and a colleague noticed that something was wrong.

People knew something was very wrong, but they didn't put the name "depression" to it. This may have been out of ignorance or out of embarrassment for me. By that I mean that there may have been people who thought they would embarrass me if they suggested that I was suffering from depression.

The episode at work took place shortly after I began treatment. I had no idea if I was going to get better. Things still seemed so hopeless. I was looking out of the window in the office high above the street and watching people out on their lunchtime break. I had this overwhelming sense that so many of these people were happy, and that I would never be happy. It really did seem life was not worthwhile and never would be. I felt as if I was completely breaking down. A coworker happened to walk by and knew something was very wrong. She asked what was wrong, and for the first time I told someone what I was feeling. She knew me, but she was not someone I would call a friend. Still, she was very sympathetic and tried to comfort me. She had the presence of mind to ask me if I was seeing a doctor. When I told her I was and gave her the doctor's name she immediately looked up the doctor's telephone number and called her. She handed the phone to me and I spoke with the doctor. I really felt embarrassed about what happened, but I was so grateful to the coworker. I had to include this episode in the book because of the wonderful example of compassion she set.

You wrote in your book that some of your acquaintances and friends advised you to go to the church and pray, but you felt this wasn't the good and proper treatment for you. Yet, you accept later in the book the "recovery effect" of prayers and having faith in God. You've mentioned that there are even research and studies in the U.S. about the recovery effects of the prayers for mental health. What would you think about the role of the spiritual life and faith in the recovery process of the mentally ill?

I think it's a mistake if mental health therapists always disregard the spiritual aspect of their patients' lives. This is very important for some people. In a way, depression is a sickness of the soul as well as an illness of the mind. Depression can cause a loss of faith. For the person for whom faith has been a fundamental and sustaining force in his life, recovery may require a restoration of faith. And faith can be a potent tool for fighting depression. The problem comes when people are told that faith alone can end their depression or that if they don't get better it simply means that they lack faith. This, in fact, is a destructive attitude. People who suffer from depression should be given every available resource to help them, spiritual or otherwise.

Do you think that your depression could have been not only a cause of suffering but also a motivating factor for your life, for your career?

I certainly didn't feel that way about it when I was in the deepest depths of my depression. But, yes, in a way it was a motivating factor, but only when I started to get better. That was when I could appreciate being lifted from that place where I suffered so much. And it made me more open to the possibility and importance of joy in my life. The people and the things that bring true joy into my life remain very rare, and I appreciate them more than ever.

When did you start to report on mental health issues?

I had written occasionally about mental health issues as a member of the editorial board of the newspaper in Atlanta. I didn't start specializing in mental health reporting until I started my Carter Center fellowship. I wanted to write about mental health for the newspaper while I worked on the book.

How good and how often do journalists report on mental health in the US? What is in your opinion the future of mental health journalism? How can journalists in the world be motivated to keep writing on mental health?

The American media generally do a good job on writing about mental health when they focus special attention on it. By that I mean efforts like investigative reports that point out flaws and abuses in the mental health system, or feature articles that tell in-depth stories of people with mental illness. It's in the day-to-day reporting on mental health that I see the media falling short. This tends to be the reporting that focuses on the sensational, associating mental illnesses with crime and violence. And this reporting also often reinforces stereotypes that create the stigma that makes so many people keep quiet about their emotional problems. I see improvements. Definitely programs such as the Rosalynn Carter Mental Health Journalism Fellowship Program that encourages accurate and comprehensive coverage of mental health can help bring about positive change. When journalists understand the impact of mental illness on people and the interest people have in this subject, they will devote more coverage to this subject.

It is said that there is a lesson and a good meaning in all things. What would be the positive thing you learned from experiencing depression?

I'm not one who necessarily believes one has to suffer to really appreciate the good things in life, but this is one of the things my struggles with depression showed me. I embrace the things that bring me joy, and I appreciate them in ways I didn't before. That plus the lesson I learned about my own resilience are the most positive things I take away from the experience.

Do you think of yourself as totally recovered? Do you follow any treatment or psychotherapy now?

I think of myself as recovered, but not in the way most people might use that term. People equate recovery with being cured, and they take "cured" to mean you won't suffer from the illness again. But as a person who has recovered from this illness, I'm no more cured of depression than a person who has never had depression is immune to it. That person might one day suffer from depression, and I might one day suffer again. I had a last meeting with my psychiatrist about four years ago. She said she was very happy to tell me she thought I didn't need to see her or any other therapist regularly. She thought I had recovered and was self-aware enough to recognize when I needed help. And she was confident that if I needed help, I would get it this time. This is the most important thing. I think of myself as a very positive person who enjoys life now. But if I start sinking back into that place where I was before, I'll know it and do something about it.

What are the three most important pieces of advice that you would give to somebody struggling with depression?

These are the things I would say:

-Don't think you're alone. You're not. There are many people who suffer as you do, and many who care about your suffering.
-Don't be ashamed. You're not to blame for what is happening to you.
-Don't be afraid. There is hope. There are many ways to get better, and, with help, you'll find your way.

"Leaving mental health problems untreated is more expensive than treating mental health problems"

In Europe, prevention of depression is a priority for European Union health policies. I recently attended a European conference on this issue. The American mental health system has been given as a good practice example. What do you think about the American Mental Health System?

America has great resources to offer mental health treatment. The problem is that the care is available to only a fraction of the people who need it, and only a fraction of the people to whom it is available take advantage of it.

It has been said that the only people in the United States who are guaranteed health care are people who are in our jails and prisons, because our courts have ruled that once the government takes someone into custody, the government becomes responsible for their wellbeing. Many of the rest of us are on our own, especially when it comes to mental health care. I hope this will change. But anyone who has watched the turmoil that has surrounded our recent debates over health care reform knows that fundamental change will not come easily.

You are very critical with the American mental health care system and I don't doubt that you still have many problems. But I want you to be a little more specific because our readers may think that the American System is even worse than the Romanian one. And this is not true. The American mental health care system is considered as a good practice in Europe, even in the developed countries. Of course there are many differences from a state to another in the US. How is the mental health system in California?

First, let me be clear about my criticism of mental health care in America. Again, I don't say we have a bad system. We have a very good system with resources that would be the envy of any other country. My criticism is that we haven't made this high-quality mental health care available to enough people There are a number of reasons for this, but the main one, I think, is a lack of political will to provide more access to mental health care. And this is in part because of the American attitude toward health care. We don't see health care, in general, as a right. And when it comes to mental health care, it is treated almost as a luxury. We have this attitude in spite of what our own experts are telling us: leaving mental health problems untreated is more expensive than treating mental health problems.

You asked about California's mental health care system. It once was known as among the best in our country. But, like many states, California is struggling with a budget crisis. Some of the deep cuts in funding have been to mental health services. Still, California's system probably is better than in many other states.

Where is the best mental health care system? Could you describe it briefly?

What the states do varies so much that it's hard to compare them. It tends to be that states make the biggest improvements in their mental health care systems after the media have exposed mistreatment or neglect in facilities or after legal action has been brought against the state and the courts have ordered improvements. For example, in the last few years a newspaper in Oregon did articles and editorials on the horrible conditions in the state's mental health facilities, including deaths of patients that could have been avoided. The state responded to his exposure with reforms that quickly improved the system, including more funding for community-based mental health care that helps patients live more normal lives.

How many hospitals do you have, for example, in San Francisco, and how many community mental health centers and psychiatry hospitals you have there? How many associations of the beneficiaries do you have in San Francisco?

I checked the online listings for hospital in the Bay Area. There are more than 200 hospitals and clinics. There are more than 140 within 33 kilometers of my home in Berkeley. There are more than 30 within 16 kilometers. And there are about 20 within 8 kilometers. So, there are an abundance of health care facilities. If you look at mental health care hospitals and other providers, there also are more than 200 of those in the Bay Area. It's difficult to say how many of those are community-based, but the number definitely would be substantial.

There are numerous nongovernmental institutions and organizations dedicated to mental health care and working on behalf of people with mental illness. There are groups such as Mental Health America and the National Alliance on Mental Illness which have chapters of their organization in communities across the country. There are also countless independent groups which are organized on a state or local community level. People with mental illness have their own groups that fight to their rights. Mental health is an area in which there is a great deal of activism and advocacy in the United States.

How has the American Mental Health System changed since 1973, when you had your first depression episode?

There have been many changes, most of them for the better. There is wider access to treatment. Medications have gotten better with fewer side effects. We know a lot more about depression than we did back then. But some changes have not been good. When in 1970s we began closing down mental health institutions to prevent mistreatment of patients and when they trend really gained speed in the 1980s, there was supposed to be funding for community-based treatment that would be more humane and effective. But the funding for such community-based treatment didn't come, so people who needed care the most simply didn't get it. We're seeing the results of that with our problems with homelessness in the U.S.

However, I'm optimistic about the American mental health system. I believe we're headed in the right direction. The mental health parity law that Congress passed goes into effect this year. This is something former First Lady Rosalynn Carter has worked to enact for years. It means employers who offer health insurance for their workers must include equal coverage for mental health care. It is a very good and significant step forward. And I believe President Obama will be progressive on mental health care and move us forward. One of the ideas behind his health care reform effort is that investing in health care for as many Americans as possible can actually save money in over time. This idea will apply to mental health care also.

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John Head Bio

John Head is a writer living in Berkeley, California. His first book, We Were the Land's: Biography of a Homeplace, chronicles his efforts to restore his grandparents' house and keep their farmland in the family. We Were the Land's was selected by the Georgia Writers' Association as the best memoir published by a Georgian in 1999.

He was one of six journalists selected for 1999-2000 Rosalynn Carter Mental Health Journalism fellowships. During his year in the program, he wrote about mental health for the Atlanta Journal-Constitution. His articles won awards from the Georgia National Mental Health Association and the Georgia Psychiatric Physicians Association. His book, Standing in the Shadows: Understanding and Overcoming Depression in Black Men, brings together more than two years of research that began with his Carter Center fellowship and his personal experiences during more than 20 years as a survivor of untreated clinical depression. In naming John Head a recipient of its 9th Annual Erasing the Stigma Leadership Award in 2005, the Didi Hirsch Community Mental Health Center in Los Angeles said "Standing in the Shadows is a call to action to help those who are suffering and refusing to seek help because of the stigma and shame" society attaches to mental illness. Other recipients of this award include former U.S. Surgeon General Dr. David Satcher, former First Lady Rosalynn Carter and Steve Lopez, author of The Soloist.

He is a member the Advisory Board of the Rosalynn Carter Mental Health Journalism Fellowship Program and the Board of Trustees for the American Psychiatric Foundation, for which he has been elected secretary. He also served as chairman of the board of trustees of the Penn Center, which was founded as the first school to offer an academic education to freed slaves and now is a nonprofit organization working to preserve the history and culture of the Gullah people who inhabit the Sea Islands off the South Carolina and Georgia coast.

John Head was born in the small town of Jackson, Georgia. After being educated in the public schools of his hometown, he became the first member of his family to earn a university degree, graduating with honors with a degree in journalism from Georgia State University in Atlanta, Ga.

His professional experience includes more than 20 years as a journalist for the Detroit Free Press, USA TODAY and the Atlanta Journal-Constitution. He started his newspaper career as a general assignment reporter and rose to the position of editorial board member and columnist for the Atlanta Constitution. He has written short fiction and nonfiction articles for magazines. He worked as press secretary to Maynard Jackson, Atlanta's first African-American mayor, and as a lecturer in the Communications Department at Georgia State University. Currently, he is a senior writer and editor for MHN, a behavioral health company in San Rafael, California.

Copyright 2010. Used with permission by Emilia Chiscop and Ziarul de Iasi.