For those with mental illness, happiness is not a choice

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As the stigma surrounding mental illness continues to persist, it remains difficult and frustrating for those who suffer to find the help and treatment that they need. But for others, taking medication is a step towards the right direction, a recognition of importance of treating mental illness as a significant health issue. Illustration by JL JAVIER

Manila, Philippines (CNN Philippines Life) — With the recent approval of the Mental Health Bill in Senate, the future of mental health awareness in the Philippines looks promising. One of the bill’s goals is to integrate mental health into school curricula, led by the Department of Health (DOH) in partnership with the Department of Education (DepEd) and Commission on Higher Education (CHED). The hope is that this encourages a shift in the way we regard mental illness in the Philippines.

In a country where resilience is worn like a badge of honor, the common attitude around depression and anxiety is to simply grin and bear it. An inability to laugh at the hardships of everyday life is seen as a sign of weakness, or worse, a lack of gratitude. If the poorest of the poor manage to crack jokes despite their own situation, it seems almost offensive to wallow in your sadness.

As the stigma continues to persist, it remains difficult and frustrating for those who suffer to find the help and treatment that they need.

Happiness is (not) a choice

It’s not uncommon for those suffering with mental illness to hear their stories being dismissed. “Some people will say, why can't we choose happiness?” says Joy*, who was diagnosed with major depression in January 2017.

But for people with depression and anxiety, the choice to be happy is not something they can just make. “Believe me, I've tried choosing happiness and tried looking at the bright side of things. But when you feel like the light at the end of the tunnel keeps getting further and further, there's a tendency to just give up and be swallowed by the darkness.”

“To be more technical, the meds teach the brain to produce chemicals that they're currently not producing enough of. Or they teach the brain how to process the chemicals that are there but for some reason aren't being used efficiently.”

“People seem to think being happy and healthy is a matter of effort, not biology. But try telling an injured person to not be dependent on their crutches,” says Apple"*, who was diagnosed with depression in December 2016. “I think it's a misunderstanding of the ways that the brain can and does fall short on some of us.”

That’s where psychological therapy and medication step in. Mental illnesses are caused by chemical imbalances in the brain — a lack of neurotransmitters, or brain chemicals, that help stabilize the mood. Antidepressants are given to patients with the hope of correcting these imbalances.

Apple has two analogies for how these meds work. “The first one is from my doctor. He said the meds are simply a crutch to help you walk while your legs learn to heal, she says. “Eventually, you'll be able to walk on your own and we'll take you off the crutches.”

“The second one is from a friend also suffering from depression. Imagine the brain as a movie theater. In order for the movie to start playing, i.e. for the brain to function normally, all the seats have to be filled with certain chemicals. The depressed brain has some empty seats, or seats where the chemicals are blocked from sitting down. What the meds do is teach the brain to fill in those seats and let the chemicals sit down so the movie can start playing,” she explains.

“To be more technical, the meds teach the brain to produce chemicals that they're currently not producing enough of. Or they teach the brain how to process the chemicals that are there but for some reason aren't being used efficiently.”

"People seem to think being happy and healthy is a matter of effort, not biology. But try telling an injured person to not be dependent on their crutches."

For Joy, who is currently taking sertraline, a type of antidepressant, the meds help her become a better version of herself. “Sertraline moderates your moods, which is very helpful. I feel more productive, and I would say it has helped me become a better person. But it hasn't exactly changed anything about me. In fact, I just feel like I'm becoming a better version of myself. I am less likely to burst into a ball of emotions or go into a blackhole of anxious thoughts. It's helped me open up.”

For Christian*, who was diagnosed with depression and anxiety in October 2016 and is currently on escitalopram, another type of antidepressant, the meds help him regain the productivity that depression and anxiety usually take away. “Since I don't have to deal with the extremes of depression and anxiety anymore, it at least makes it easier to do normal things. I don't feel as paralyzed or lacking in the willpower to eat, get up, or walk.”

Not a happy pill

What’s important to note about these medications is that they’re not quick fixes or instant happy pills. Oftentimes during the first few weeks, patients experience undesirable side effects. “It's not instant happiness when you take it,” says Joy. “Admittedly the first few weeks with the meds were horrible. I had no appetite, I constantly got dry mouth, at some point I thought they weren't working.”

For Apple, the meds made her feel drowsy and light all the time. But over time, these side effects wear off and eventually those who take them start to feel a change in their mood. “When my brain and body finally adjusted, I felt like the unknown weight on my shoulder had been lifted,” Joy shares.

Luckily for Joy, Apple, and Christian, their initial prescriptions worked right away. For some, finding the perfect “cocktail” of meds can take months, even years, as each person’s brain chemistry is different.

Unfortunately, there’s still a lot of fear surrounding medication today. “When I was diagnosed and I told my family, they wanted me to stop my medication. They didn't believe I needed it,” Christian shares. “In the Philippines especially, there's the idea that someone seeing a psychologist or taking meds is someone who has something seriously wrong with them.” Because of this, many people suffering with mental illness only turn to medication as a last resort.

"Imagine the brain as a movie theater. In order for the movie to start playing, i.e. for the brain to function normally, all the seats have to be filled with certain chemicals. The depressed brain has some empty seats, or seats where the chemicals are blocked from sitting down."

Yet, there lies a real danger in waiting for things to go bad. People let themselves become vulnerable and expose themselves to the risk of self-harm and suicide.

The stigma surrounding mental illness, rooted in our culture and way of life, makes for a major roadblock in the uphill battle. This is why it is important to keep having these conversations. But beyond this, a more tangible obstacle lies up ahead, one that can’t be fought with awareness and conversation alone, but instead relies on systemic changes.

Therapy and medication comes at a hefty price in this country, and sometimes even those who are financially capable find it hard to fit these into their budgets. How much more difficult would it be then for Filipinos living in poverty to get the help they need?

Hopefully, the Mental Health Bill can eventually help bring education and awareness, along with access to cheaper treatment, to every Filipino in need. In the meantime, as the stigma continues to persist, it’s vital to provide safe spaces for those who may be suffering, be it as a source of much needed information, or as an open, non-judgmental, and well-informed ear.

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*Name changed at the interviewee’s request.

If you need help, or know someone who needs help, the HOPELINE Project provides support for suicide prevention and emotional crises. They can be reached 24 hours a day, seven days a week at (02) 804-HOPE (4673), 0917 558 HOPE (4673) and 2919 (toll-free number for all Globe and TM subscribers).