I'm a psychologist.

I know depression is a serious mental illness.  Major depression affects over 17% of adults at some point in their lives (NIMH Statistics).  I have family members who have suffered serious recurring depression.

Every semester I work with at least one or two students suffering from depression so serious it forces them out of school.  I have other students who miss weeks of class trying to struggle out of their rooms and function.  I hope - I really think - I treat them fairly, working closely with them, giving them time to complete their works and putting all my lectures on-line so they can keep up with things even if they can't get to class.  I write advocacy letters for them to deans and registrars to allow them to keep working towards their goals

I have worked with the last three colleges where I've fought to get depression treated as a disability so that students get some of the same accommodations as students with other needs.

But that doesn't mean that I am unbiased when it comes to depression.

I learned this recently - and it wasn't one of the most pleasant things I've learned about myself.

Depression and the Peace Corps

Because my son is in the Peace Corps, I know many people who serve and have been following them closely. 

The Peace Corps is a tough job.  You are thrown into another country and completely immersed in the culture.  Most volunteers are young - in their 20's.  After usually two months of very intense language and technical training volunteers are posted - alone - to work for two years on their projects.

Posts vary, but most are in very rough conditions.  In a previous post, I mentioned the bats that live under the seat of the latrine of one volunteer in my son's cohort.  My son has no running water and just experienced a massive hatching of cockroaches in his family's outhouse.  He says you haven't lived until you've been woken up to the nails-on-chalkboard scrape of a rooster trying to claw through your tin roof during a thunderstorm.

The pictures of huge spiders posted by the mom of another volunteer would give many people nightmares - except that would mean you'd be asleep with them crawling over your head.

And then there are the political stresses.  This week, the Peace Corps is pulling the mission from Kazahkstan because of volunteer stress, physical violence, and sexual assault.  (You can read a first person account of that wrenching process here).

Conditions are tough, but mostly, volunteers are just isolated.  Volunteers live with host families, which can be wonderful or can be an added stress.  They are almost always the only American nearby and the only person who speaks English for miles.  Their job is to find a job - in addition to the one they've been assigned (teaching, healthcare, youthwork).   The other two parts of the mission are to share their own culture and to learn about the culture of those they're with.

The Peace Corps orientation manual sent to families say that most volunteers have a low point in mood in their 3-4th month after being posted (5-6 months after arrival).  Long enough for the 'exotic' part of the experience to wear off.  Long enough to get tired of a minimalist diet and for the season to change.  Long enough to be homesick and get tired of taking baths in buckets.

Long enough to experience or observe sexual harassment or blatent bigotry and homophobia, feel overwhelmed by the language and culture, and realize that teaching or providing health care in challenging conditions is hard grinding work.

Depression rates tends to be high and volunteers are encouraged to report the symptoms.  Although medical service varies by country, this is, in part, a response of the Peace Corps to blunt criticism that they have not done a good job dealing with the mental health needs of volunteers.  Especially volunteers who have been assaulted or harrassed - as far too many volunteers are.

The Double Standard of Mental Health Care

But when a volunteer I know recently reported depressive symptoms and was pulled in for evaluation they were livid.  They had called in to say they were worried about some issues and to make sure that the medical officer knew of their symptoms in case they got worse.  They weren't worried about themselves.  It was just a precaution.

But their medical officer was.  They were pulled in the central office (a day by bus) and seen by a counsellor and evaluated.  Still worried, the medical officer sent them back to the United States for evaluation and more counselling - just to make sure. 

After a week in the States, all decided it was not a serious depression - or not more depression than is typical for volunteers in their situation and this time in their post. They were helped to develop a plan for working through it, to develop a coping strategy, and to bolster their support networks.  They were told what to look for as more serious symptoms.

The volunteer felt angry and that the Peace Corps had no faith in them.  It undermined their confidence.  They were worried their village would find out and it would undermine their mission there. 

Then they were 'cleared', put on a plane, and sent back to post.

They were thrilled to go 'home', but hurt and angry.  I was completely sympathetic - it seemed unreasonable and arbitrary.  The evacuation seemed a slap in the face.

It felt like an insult and a slap in the face.

And that's the point of this whole post.

If the volunteer had complained that they had a stomach problem they wouldn't have felt that way.  Lots of volunteers get stomach or gastroenterological problems.  During training they were told they would learn all the nuances of the word 'diarhea' and, from what I've read of their facebook posts, many have.

Several volunteers in my son's cohort have been pulled in for care of these types of illnesses.  Although no one has been sent home to the US for extra treatment, it's not that unusual.  A friend of mine in Burkina Faso lost 20 points off her very thin frame and was almost sent home for that reason.

Some of the volunteers receiving treament felt overly coddled and that the Peace Corps was over-reacting.

But NONE of them felt insulted.  Or angry.  Or undermined.

And when I read about their travails on Facebook and in their blogs, I didn't feel irate.

I felt like that they were getting good health care.

The person who complained of depressive symptoms was getting good health care too

The only difference between volunteers pulled for problems with their guts and for depression was that I was not thinking about depression as an illness.  I was thinking of it as a failure of character.

Not overtly, not at the top of my mind.  But it showed in my emotions and how I - and they - reacted to the care being given.

That mistakes was mine.  It's something I should have known better about.  And it's something we all need to watch out for.

© 2011 Nancy Darling. All Rights Reserved

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