Living with depression

That is, living with someone who has depression. Sharing a life with someone who has depression. Dooce's husband, Jon, writes about it here, and includes discussion of the role that gender differences play in how he deals with his wife's depression. It's great. Everyone should read it. With approximately one quarter1 of the US population reporting having experienced symptoms sufficient for diagnosing a mental disorder during the past 12 months, you know people with mental disorders or you have one yourself. Either way, this is a good read. (Here are Dooce's archives about her own struggles with depression.)

Speaking of that statistic, did you know that it is official Peace Corps policy not to consider anyone for the Peace Corps who has been in therapy anytime during the twelve months before they apply? What do you think of that?

I think it's kind of crazy. I mean what young, idealistic, save-the-world type hasn't been in therapy sometime over the past twelve months? On the other hand, I can sort of understand them wanting to cover their behinds in terms of liability. I don't imagine it's very easy to get an emergency consult with a therapist in the middle-of-nowhere South America or Africa, and they don't want to risk a potential problem. I think a better way to prevent such problems, though, would be to require, in cases where a Peace Corps applicant has been in therapy sometime over the past year, a letter from a therapist certifying that the applicant has not been clinically mentally ill for the past twelve months. I mean, I can't imagine that anyone who is seriously depressed, manic-depressive, obsessive-compulsive, or suffering from any other mental illness would want to do the Peace Corps, but I could be wrong.

In general, I am very wary of blanket policies that discriminate against people on the basis of treatment received. First of all, having had treatment is not necessary equivalent to being ill or unable to handle stress or hard work. Second of all, such policies have the effect of discouraging people from seeking treatment that they might need, which is horrendous.
1. Kessler RC, Chiu WT, Demler O, Walters EE. "Prevalence, severity, and comorbidity of twelve-month DSM-IV disorders in the National Comorbidity Survey Replication (NCS-R)." Archives of General Psychiatry, 2005 Jun;62(6):617-27. [I can't believe how long its been since I've used hyperlinked footnotes, or any footnotes at all, here. It can't be a good sign. I must be slipping!]


David said...

I think the 12-month rule is sensible. The Peace Corps isn't something to join and quit lightly, and saying that someone has to be fully stable for a year really doesn't seem like that high a burden. i.e. if a person wants to go, but was in therapy for a while, just wait a few months. Where's the harm? If anything, learning to wait a bit before getting to do something desireable is probably a good lesson.

Jon's essay is well-written, thank you for pointing it out.

Kate said...

On a similar note, any military personnel taking anti-depressants have limited security clearance. I understand that major depression could lead a person to behave irrationally in a way that might pose a security risk, but I fear that the real impact of this policy is to discourage depressed members of the military from seeking treatment.

ALG said...

Thanks for both of your comments.

David, I agree that requiring someone to be fully stable for a year doesn't seem like that high a burden. However, I'm not sure that's the same thing as requiring someone to not have been in therapy for a year. That is, people can be in therapy and be quite stable, and people can not be in therapy and not be that stable. "Therapy" is being used as shorthand for "mentally unstable," and, while there is quite a bit of logic to it, it's also sort of clumsy as shorthand. In my opinion.

Kate, thank you for bringing the military into this. I don't know how I feel about this particular example. I think that a lot of people have limited security clearance, and I would rather limit security clearance than have to deal with the potential aftermath of not limiting security clearance.

Possibly more trouble is the fact that anyone who has ever taken any psychopharmetceuticals is ineligible for certain roles in the Israeli army, even if they are no longer taking them. They are limited to jobs like...cleaning and organizing weapons. Yes, that's right.

Another thing that I have heard, but not verified, is that admission to the bar in some states is difficult if you have ever been diagnosed with a mental illness (such as, say, major depression). Something about mental illness making someone "unfit to serve." I should look into this some more at some point.

alg's dad said...

It's not true that if someone has ever taken psychopharmaceuticals, they are ineligible for certain roles in the Israeli army. There may be an initial presumption that they are ineligible, but they can overcome that presumption by getting a letter from a psychiatrist, especially a well-connected psychiatrist, such as a former chief psychiatrist of the IDF. The problem here, and probably in the Peace Corps as well, is that no bureaucrat wants to be blamed for problems that might arise later. Having a letter from a prominent psychiatrist, certifying that the person is mentally healthy, makes the lower level bureaucrat less worried about getting blamed for anything later.

Similarly, if the person doesn't say that they ever took psychopharmaceuticals, when enlisting in the IDF, no one is going to get blamed for allowing them into a combat unit. If someone had serious psychological problems growing up, and took medication for them, but didn't say that when entering the IDF, they could easily end up in a combat unit. (I've heard of such stories, and the soldiers in question ended up doing very well.)