Dodgy Mood or Dodgy Tummy

Should the excuse of physical illness be used when depressed?

Posted Dec 02, 2019

In my last blog, I wrote of the difficulties experienced when talking about mental illness, and how I was starting to find this easier. Another interesting issue that should be considered, however, is how others describe our illnesses for us.

A recent example for me came about while on a trip with my husband. It was a work trip for him, pleasure for me. For much of the travel we were accompanied by a colleague of his, a friendly woman whom he knows well. My mood had been low before we set off, and a mixture of long flights and uncomfortable rooms didn’t help. My back, and its annoying sciatic projections, also sprung into action, and I was feeling low and irritable, and certainly not like going out. My husband, unbeknown to me, told our friend that I had a stomach upset, rather than telling her I was depressed. It is probably worth adding that she would have known of my history of psychiatric illness.

Now, there are at least two ways of looking at this, and while it will depend on the circumstances, it leaves me feeling deeply uneasy. I think when talking to someone that you don’t know, it may be easier to offer the stomach upset excuse (although I still don’t like the fact that it is easier). But, in my view, if talking to someone whom you do know, then there is an issue with not telling the truth. It perpetuates the difficulty of talking about mental illness and makes it harder to use as an appropriate excuse when it actually is one.

I discussed this on Twitter, and was surprised by the results (bear in mind I was trying to fit a complicated situation into one Tweet, so it may not have been quite clear). A number of people ‘liked’ it, but quite a few others felt that it was, indeed, better to use the physical excuse. The reasons were varied — for example, that it would be embarrassing, that it wasn’t worth it. One even said it would bore people. Well, I could certainly bore them with some of my physical ailments!

I am easily persuaded, however, and could see the merit of some of these arguments. I suppose what I wonder is whether this is sufficient, and we should expect no change — in thirty years’ time will I still be murmuring about my stomach upset? — or whether we are just not there yet.

To add a touch of humor to the whole proceedings, this left me rather tongue-tied when our friend asked how I was. I had no idea what to say. And then, to add insult to injury, I did indeed develop a rather nasty case of Montezuma’s revenge some days later. Our friend may well be getting rather concerned given this prolonged gut-related illness!

Rebecca Lawrence
Travels with my Tummy
Source: Rebecca Lawrence

So I am left pondering — is there a right answer? I think that in my example I was probably slightly irritated that my husband had taken the executive decision without discussing it with me. He is always incredibly supportive, so my main question is not about his behaviour, but whether this approach can or should be generalised.

As I have said, we may agree that it is better to speak of physical illness when the person to whom we are talking is unknown, or may never meet us again. But, like it or not, that still feels like a drip down of stigma. People are only embarrassed because something is not generally done, this is not innate.

From the perspective of one with serious mental illness, it makes me doubt. How can the medical model of mental illness have any real validity if this is our decision?

Moving up the levels of severity of illness, and, perhaps more importantly, the level of closeness to the other person, I would suggest that we should not deny mental illness. This is, indeed, stigmatising. It is interesting that many people complain of a wide range of stomach upsets; indeed we all know that a mild upset may be something of an excuse, but this is more or less accepted.

One other important issue is the potential embarrassment caused, to both parties. In my view this is a result of years of stigma, and it doesn’t need to be like this. We are feeding this by our excuses. No illness, mental or physical, requires detailed explanation when briefly disclosed, and there are some physical illnesses I would be uncomfortable to discuss. We should be able to state the problem and move on.

Having said all this, I think that one obvious exception is the preference of the individual. We should allow whatever makes it easy for them, although in the longer term this may – or may not – change. We should respect this, but I think it should be what they want, not their family or friends.

Lewis Wolpert, the eminent biologist, wrote some years ago that his wife "said that she was embarrassed about my being depressed and told friends and colleagues that I was exhausted and was suffering from a minor heart condition" (Wolpert, 2001).

I strongly believe things have moved on since then, but perhaps not as much as we sometimes think.

References

Wolpert L. (2001). British Medical Bulletin, Volume 57, Issue 1, Pages 221–224, https://doi.org/10.1093/bmb/57.1.221