No, My Depression Is Not Like The Flu

By Julie Kliegman

My depression can and should not be squeezed into a contrived metaphor.

I have depression. At times it’s confusing, exhausting, and painful. But it’s not like having the flu. It certainly doesn’t feel like two broken legs. Nor is it comparable to cancer.

I hear these comparisons all the time, and I know they’re well-intended, but they frustrate me. I’m intimately familiar with the flu and broken bones — I know what they feel like. If depression were truly like the flu, it would come with a vaccine. It’d pass quickly and predictably, though probably not before infecting some of my friends. If it were like a broken bone, I’d be able to safely immobilize my brain until it healed. In either case, everyone would inherently understand and relate to depression, rather than shaming those who seek treatment or call out sick from work. They’d even ask if I needed anything. Advocates’ work would be done.

These conditions, which each have their own misconceptions and hurdles, all deserve support, understanding, and sensitivity. But they are not all equivalent.

If depression were truly like the flu, it would come with a vaccine.

Metaphors like these are intended to reduce the stigma of mental illness by comparing it to common, familiar, often transient and easily-treated physical illnesses. In fact, though, they illuminate the inherent pitfalls of overemphasizing physicality. Since World War II, as researchers learned more about the physical roots of mental illness, advocates have relied more on neurobiological facts to make conditions seem more relatable and less like moral failings. That worked to a point, but by now people get it. Rooting conditions like depression, schizophrenia, and substance abuse in the brain no longer works as planned.

Instead, says Indiana University researcher Bernice Pescosolido, messaging that revolves around the physical nature of mental illness can sometimes increase stigma. In 2010, Pescosolido and her team published a study in the American Journal of Psychiatry showing that people can find it alarming to focus on the genetic component of mental illness. This emphasis might lead people to the conclusion that they don’t want anyone hard-wired for trouble marrying into their families and potentially passing on those illnesses to future generations.

Given that playing up the physical component of mental illness doesn’t reduce stigma, it’s hard to imagine that directly comparing mental illness to unrelated physical illness would work any better. This comparison, too, is probably counterproductive. It implies that the common symptoms of mental illness are so mysterious, or so unpalatable, that they can’t be explained on their own. We don’t expect you to grasp the complexities of fatigue and apathy and delusions and mania and suicidal thoughts, they say, so here, think about the flu instead. The intention is to make people see that those with mental illness are worthy of care, but this strategy has come to have the opposite effect.

Of course, in certain situations, physical comparisons do have their place. Say I’m having trouble leaving my bed one day, and I’m talking to a friend who thinks I should suck it up, stand up, and go enjoy the fresh air. Likening my broken brain to a broken bone might help him understand that I’m genuinely sick and in need of some downtime.

But say that instead, someone’s shaming me for having seen a therapist. In this case, the metaphor is less effective. Broken bones and depression both need care, yes, but they need radically different kinds of care from different specialists, and for different lengths of time. Likening depression to a broken bone, then, risks stripping the former of its complexity and implying that depression can be quickly fixed with a metaphorical cast and some painkillers. That comparison also sends the unintentional message that the more visible and physical an ailment is, the more empathy it warrants.

Choosing whether, when, and how to disclose mental illness to friends, family members, romantic partners, and colleagues is daunting. Deciding to share your vulnerability with the world is a brave move, no matter how many times you may have done it before. So I don’t mean to fault people for grasping onto whatever common ground they can to describe what’s happening in their own brains. But comparing depression to the flu or schizophrenia to cancer feels like letting other people off the hook, saving them from trying to understand an unfamiliar condition, complete with its own quirks.

Choosing whether, when, and how to disclose mental illness to friends, family members, romantic partners, and colleagues is daunting.

Let’s stop sparing people the details. Instead of going out of my way to show the world I’m really not all that different from them, I want to work harder on openly embracing what makes me weird and awkward and — sometimes — convinced my entire life is going to shit. My depression is not like your case of the flu or your brother’s diabetes or your mother-in-law’s best friend’s dog’s asthma. I’d much rather broaden your circle of acceptable humans to include people with mental illness than have to jump through hoops squeezing my depression into a contrived metaphor.

It’s not our job as people with mental illness to educate our peers. We are not responsible for their empathy or their attitudes toward mental illness. There should be no prerequisite — related to mental health or otherwise — for being treated like a normal human worthy of respect.

At the same time, even existing as a person with mental illness can change people’s attitudes. The strongest indicator of whether people can let go of mental health stigma is whether they know people who deal with mental illness, Pescosolido told me. Everyone in my circle is more likely to change their attitudes on mental health simply because I’m around. They interact with me and ask questions of me and can see that there’s more nuance to my personality than “useless and depressed.” I don’t need to contort my illness into something they recognize in order to make a difference.

Not everyone is going to get it, or even wants to try. That’s okay. I know other people’s closed-mindedness isn’t a reflection of my character or my efforts. But I think those of us who feel capable of speaking out about mental illness owe it to ourselves to try, and to try in a way that stays true to the depth of the illnesses we experience, without reaching for an easy comparison. Inclusion is a better goal than assimilation.

Like countless others, I’m ready to discuss the truths of my experiences with mental illness on their own terms, in all of their unglamorous glory. Let’s talk about how hard it is for me to eat when I’m depressed. Or about how getting out of bed can be a daylong project — forget about showering. Let’s talk about all the aspects of depression that can’t be warded off with an annual injection, or treated with chicken soup. People might find it harder to relate to, at first. But when they give up on the easy, flawed metaphor, maybe they’ll actually start to understand.

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