“Frankly, [therapy] is hard work. It’s hard work to really be exploring a lot of these matters…it’s effort,” explains McIntyre.
When it comes to prescribing medication, his philosophy is much the same as that of Zemans: “There’s no one single factor; there’s no one-size-fits-all… People have their own preferences… The decision is a personal decision, made on a case-by-case basis,” he says.
The speed provided by use of medical treatments also helps with the province-wide issue of the poor accessibility of psychotherapy. “One of the biggest issues in Ontario is that there are often big wait times for therapy,” says Zemans. “If the family has good means or good insurance, their child can get therapy… If the depression is very bad, and they can’t wait, that would be an indication for an antidepressant.”
Limited resources on campus
The difficulty of acquiring mental health resources is also experienced at the university level; many of the students interviewed feel that the university does not provide sufficient formal mental health resources for the ever-growing student population that needs them. The University of Toronto’s official program for formal mental health assistance is Counselling and Psychological Services (CAPS).
According to Janine Robb, the executive director of Health & Wellness Services, “The total number of students CAPS has seen in a month range from a low of 729 (July) to 1,508 (October).”
With regard to scheduling times, Robb says, “Students can schedule an intake appointment in person or by phone. They will usually be scheduled within three days, with a course of action being determined on the basis of the clinical presentation. There may be a wait to start ongoing treatment, depending on severity; however, in many cases students may begin treatment immediately by attending our evidence-based, skills-building workshops.”
She adds: “The provision of mental health services occurs within a broader mental health context… [O]ur wait times are significantly shorter when compared to mental health resources in the community, where waiting times for community resources often range from six months to a year… [W]e hope that students will take advantage of our new programs, such as the workshops, groups, and embedded sites.”
Coletta is currently undergoing CBT through CAPS, and reports largely positive experiences with the university’s available resources.
“This year, the only reason why I ended up at CAPS was because I almost dropped out of school because of what I was going through, and I spoke to one my program advisors, and she said, ‘The decision is yours, but if you’re feeling really unhappy, you should speak to someone’[…]and she was actually the one who sent me all the information [for CAPS]. I don’t know that I would have gone and seen someone on my own.”
Coletta’s first appointment took place three months after her initial call. Sarah, however, says that her experience at CAPS was “wildly unhelpful.” She did not feel that she could wait the estimated three months for her appointment. She says that the fact that the interviewing clinician suggested that she take group therapy in the interim period for her appointment suggested that her comorbid social anxiety was not being adequately considered.
Many students find fault with the limited number of CAPS therapy sessions. Explaining the reason for this system, Robb says, “There are extensive research findings that support the notion that increasing numbers of sessions does not result in better treatment outcomes. Unlimited treatment is not feasible, practical, nor recommended. For these reasons, CAPS is a short-term treatment program, but it does provide a referral service, linking students who may require longer-term or specialized care into the community. CAPS aims to balance the demand for our services with best practice treatment guidelines while making services accessible to as many students as possible.”
The burden of misconceptions
The stigmas and common misattributions of mood disorders affect patients in various ways.
For some, the stigmas have little effect on their personal experiences. Aaron, for example, reported having a supportive base of friends and family with which he has shared his experiences with bipolar disorder.
There remain many erroneous, publicly held beliefs about mood disorders, such as the particularly common misbelief that the symptoms of the disorders are within an individual’s control — that the depressive symptoms of both unipolar depression and bipolar disorder can be simply be willed away. Consequently, those unaffected by these disorders often fail to consider them with the seriousness that they should.
When she was 18, Angelo spent two weeks in the hospital after a failed suicide attempt. The night she was released from the hospital, she met friends for dinner. “The waiter came and dropped off food, and one [friend] said: ‘Oh, you might want to take her knife with you,’” she said. It would seem that the fundamental misunderstanding that many have about the nature of depressive disorders and bipolar disorder concerns this key discrepancy between clinical depression versus common, typical depressed mood.
“Depression [as it is commonly known] is something every human being experiences, from the most superficial — your favourite musician didn’t win a Grammy — to a loss of opportunity. That’s human beings; these are the blows of life. That’s not depression in terms of a medical diagnosis. When we’re talking about depression as a medical diagnosis, we’re talking about the major depressive episodes [which are] the defining feature[s] of what’s called major depressive disorder…and are [also] part of bipolar disorder,” says McIntyre.
“I think it’s sort of a general insensitivity that comes out of ignorance,” says Aaron. “The people who don’t take it seriously are often the people who don’t understand it or don’t give people the benefit of the doubt. It’s very difficult to understand — it’s something I don’t even understand.”
“Depression is a very painful experience. It’s not just a cold – it’s a state of mind, it’s an abnormality of brain metabolism, and it’s not to be ignored.”
The failure to understand on the part of loved ones can evidently be harmful to patients’ social relationships, as they cannot effectively convey the reasons for their sadness.
“My family didn’t deal with it particularly well,” says Sarah, “just because there was a fundamental lack of understanding; I couldn’t explain to them why I was upset. At first it was support, but I think that anger and confusion came from that place. [They didn’t] understand that it wasn’t something I could help.”
“I’m me, and I’m happy”
However, despite the stigmas and continued lack of sufficient accessibility of mental health services, discussions of mental health have increased as of late, and various initiatives — such as Bell’s recent “Let’s Talk” campaign — have helped maintain their prominence in the public eye.
McIntyre is hopeful that the public perception of mental health is gradually improving.
“We don’t have sufficient access to services. I think [the problem] is at the government level, the university — we need to get more about this — I think that psychiatry has to campaign more about it…but I think things are changing…Overall, things are going in the right direction. I’ve seen a lot of improvements,” he says.
The flaw in both mental health administration and the general public’s perception of mood disorders is a failure to accurately identify the needs and nature of those with mood disorders and provide sufficient resources to help them.
The fundamental task to be undertaken in reducing the stigmas surrounding these disorders — and indeed, those surrounding any other mental illness — is to ensure a universal understanding that mental illnesses are every bit as legitimate and can be no less serious and deserving of care than physical illnesses, and they therefore should be administered to with attention to the same degree of quality, accessibility, and sympathy on the part of those around them.
Angelo adds, “I think it’s important that students know that they’re not alone…I wish that someone had come up to me and said, ‘Hey, this is okay. Other people have this, other people are on meds, this is totally normal, and you’re gonna get better. It’s not always that you have to be depressed or suicidal’…I look at where I’ve come in a year, and I’m so grateful…I’m such a happy person; I’m so happy to be here. […] I still have [bipolar disorder]…and yes, I will go through it again, but it’s not me; it’s not who I am. I’m me, and I’m happy. And I just wish people could see that it gets easier, and it gets better, and there’s an end to it.”
*Names changed.