Depression, Stigma, and the Soul
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Depression,                                    Resumé
La dépression majeure est une crise sani-
Stigma, and the                                taire mondiale. Elle est complexe et source
de confusion, et la majorité des personnes
Soul                                           qui en souffrent ne reçoivent pas l'aide
dont elles ont besoin. La stigmatisation
liée à la dépression et aux autres mala-
PATRICIA A. MCILVRIDE                          dies mentales constitue le principal frein
à une prise en charge efficace. Cette stig-
matisation, qui est au cœur de l'histoire,
O my Lord, my Beloved, my Desire!              de la culture – voire du modèle médical,
Befriend me in my loneliness and ac-           empoisonne la perception du public envers
company me in my exile. Remove my              les personnes ayant une maladie mentale.
sorrow . . . Verily, Thou art the Gra-         Cette stigmatisation publique amène les
cious, the Generous.                           personnes qui vivent une dépression à
—'Abdu'l-Bahá, Bahá'í Prayers         se stigmatiser elles mêmes, nuit à leurs
rapports avec les autres et entraîne, par-
Abstract                                       fois, un sentiment de désespoir pouvant
Major depression is a global health cri-       conduire à des idées autodestructrices
sis; it is complex and confusing, and the      ou au suicide. De nouvelles approches en
majority of people who need help do not        matière de rétablissement, notamment
receive it. The stigma attached to depres-     celles offertes en neurobiologie interper-
sion and other mental illnesses is one of      sonnelle, remettent en question le modèle
the greatest barriers to effective treat-      médical utilisé pour le traitement de la
ment. Embedded as it is in history, culture,   maladie mentale. En définissant l'esprit
and even in the medical model, stigma has      comme étant transcendant et à la fois in-
poisoned the public's perception of those      carné et relationnel, de nouveaux modes
who suffer from mental illness. Public         de rétablissement deviennent possibles.
stigma also creates "self-stigma," thereby     Les personnes aux prises avec des prob-
causing disconnections in relationships        lèmes de santé mentale parviennent à la
and, sometimes, a despair that can lead to     santé lorsqu'elles créent leur propre plan
self-destructive feelings or suicide. New      de rétablissement et font appel au pouvoir
recovery models including those offered        guérisseur de l'âme et qu'elles bénéficient
by interpersonal neurobiology are chal-        de milieux aimants et éclairés qui les sout-
lenging the medical model in the treat-        iennent en maintenant avec elles des liens
ment of mental illness. By defining the        d'amitié exempts de jugement.
mind as transcendent and both embodied
and relational, new avenues of healing         Resumen
become possible. Health is realized when       La depresión mayor es una crisis glob-
those with mental health challenges create     al de salud; es complejo, crea confusión y
their own recovery plans and draw on the       la mayoría de las personas que necesitan
healing power of the soul within loving        ayuda no la reciben. El estigma atado a la
and educated communities that support          depresión y otras enfermedades mentales
them with friendship, not judgment.            es una de las barreras más grandes para
64                   The Journal of Bahá'í Studies 27.1-2 2017

el tratamiento efectivo. Estando arraigado      this end, he began to carry through
en la historia, la cultura y hasta en el mod-   a plan he had been contemplating
elo médico, el estigma ha envenenado la         for many years—since adolescence,
percepción del público acerca de aquellos       in fact. He bought a large supply of
quienes sufren de enfermedad mental. El         over-the-counter painkillers, sleeping
estigma público también crea "auto-estig-
pills, and other drugs, and he resolved
ma", causando así desconexiones en las
to take them all at once.
relaciones y, a veces, un desespero que
puede llevar a sentimientos auto-destruc-
When he got home, he sat down to
tivos y de suicidio. Nuevos modelos de re-      write a goodbye note to his family, but
cuperación incluyendo aquellos ofrecidos        at that moment, his wife returned ear-
por la neurobiología interpersonal están        ly from work and interrupted his plan.
desafiando el modelo médico en el trata-        She took him to the emergency room.
miento de la enfermedad mental. Al definir      He told the doctor his story, adding
la mente como trascendente y tanto en-          that those negative feelings from a few
carnado como relacional, nuevas avenidas        hours earlier had lessened while he
de sanación se hacen posibles. La salud es      had been sitting in the waiting room.
realizada cuando aquellos con desafíos de       He said that he loved his family and
salud mental crean sus propios planes de        wanted to go home. The doctor took
recuperación y toman del poder sanador
blood tests; did a chest X-ray; exam-
del alma, dentro de comunidades amoro-
ined his heart, lungs, eyes, ears, nose,
sas y educadas que los apoyan con amistad
y no juzgándolos.
and throat; and pronounced, "OK, you
can go home. There is really nothing
INTRODUCTION                       wrong with you. The problem is all in
your head!"
I have been a psychologist for most of             The world is full of people like
my life. A number of years ago, a man           George—men and women, children
I will call George came to see me and           and teens, who suffer from major de-
told me a story that was shocking but           pression. According to the latest infor-
not unusual. George was thirty-two              mation from the World Health Organi-
years old and had a good career, a wife,        zation, depression is the leading cause
and a one-year-old child. He said that          of ill health and disability worldwide.
he had been suffering from major de-            According to their estimates, more than
pression most of his life, but about a          300 million people are now living with
month before our visit he had finally           depression, an increase of more than
lost hope of ever recovering. Although          18 percent between 2005 and 2015. De-
religious, he believed God would un-            spite the fact that depression is treat-
derstand that the world would be bet-           able, nearly half of the people who suf-
ter off without him. He was in such             fer from it do not get the help they need
severe and unbearable emotional pain            and the figure is much lower in poorer,
that he decided to take his own life. To        less developed countries (WHO n.p.).
Depression, Stigma, and the Soul                       65

"Depression: A Global Public               Depression and other major mental
Health Concern" reported results          illnesses affect not only those who suf-
of the World Mental Health Survey,        fer from them, but also their families,
which was conducted in seventeen          friends, coworkers, and community
countries and found that on average,      members. Often both the sufferers
about one in twenty people report         and those who care for them are at
having had an episode of depression       a loss about what to do. Even when
in the previous year (Marcus et al. 6).   urged to get help, many with mental
About one million people take their       health problems seem to resist. Why?
own lives each year. For every person     And what can be done to remedy this
who commits suicide, twenty more          problem?
make an attempt (Marcus et al. 6).            The goal of this discussion is four-
The burden of depression is 50         fold: first, to describe major depres-
percent higher for females worldwide      sion; second, to explain the history
across all income levels. One or two      and dynamics of the stigma attached
new mothers out of every ten will suf-    to major depression and other men-
fer from depression after childbirth.     tal illnesses; third, to show that stig-
Depression limits the mother's ability    matizing others or oneself as being
to care for her child and therefore can   "mentally ill" can be a deterrent to
treatment and implies (contrary to the
seriously impact the child's growth
Bahá'í teachings) that such illnesses
and development (Marcus et al. 6).
impede the progress of the soul; and
According to data compiled by the
fourth, to show how the concept of
Centers for Disease Control (CDC),
"accompaniment" can be a major con-
although more women than men are
tributing factor to healing when it is
depressed, men are less likely to get
informed by a scientifically sound and
help and more likely to commit sui-
empathic understanding of the illness.
cide (1). Suicide was the tenth leading
cause of death in the United States for       CONFUSION ABOUT DEPRESSION
all ages in 2014, and men took their
own lives at nearly four times the rate   The word depression itself is very
of women, representing almost 78          confusing. Webster's Dictionary
percent of all suicides (1).              gives twenty different definitions for
Depression typically starts at a       the word; only three of them refer
young age, and depressed children         to mood issues. Depression, among
and teens often go untreated. Lack of     other things, can be an area of low
treatment has led to increasing sui-      atmospheric pressure, a downturn
cide rates among the young. Suicide       in the economy, or low-lying land
was the second leading cause of death     ("Depression").
in the age groups 10–14, 15–24, and          Even when referring to an emotion-
25–35 in 2014 (CDC 2).                    al state, in English-speaking countries
66                 The Journal of Bahá'í Studies 27.1-2 2017

the word depression is often used in at      depression would do the same. In a
least two ways: (1) to describe things,      sense, it is understandable: the words
events, or circumstances in the present      depressed and depressing are often used
or in the past that cause a generally        in everyday speech to mean "unhappy"
negative emotional state, and (2) to         or "disappointing" or to signify other
denote the presence of a major mental        negative emotional states. For instance,
illness—as in clinical depression (also      a real estate salesman might drive
known as major depression) or unipo-         through a "depressing" neighborhood.
lar mood disorder.1                          Teenagers without a date to the prom
In George's example, the doctor          might say they are "depressed" because
who told him that his problems were          they will miss the event. A woman who
"all in his head" was engaging in this       loses an election to the school board
confusion. George had a major mental         might say she is "depressed" about it.
illness (major depression) and needed        In all these circumstances, a person is
immediate comprehensive treatment.           experiencing a passing state of nega-
Because the doctor could not see it          tive emotion. Such occasional sadness
with his own eyes or measure it by           is a normal aspect of everyday life.
common medical tests, he decided that           When one is experiencing this kind
the problem was not real. In making          of everyday sadness or lowered mood,
this fundamental error, he was blam-         advice to ignore the problem, get busy
ing George for his illness and put-          with other things, or "look on the
ting the onus on him to get over his         bright side" may actually be helpful.
problems by himself. This error could        However, saying the same to a person
have cost George his life, but, luckily,     who is suffering from major depression
George sought treatment elsewhere on         or other major mental illnesses inflicts
his own. The emergency room where            a kind of cruelty upon them. It trivial-
he had been seen was also contacted,         izes the seriousness of the illness and
and this incident was reported. On           adds to it a sense of guilt, shame, iso-
follow-up, it was found that the erring      lation, and hopelessness. It is like say-
physician had been reprimanded and           ing to a person with a broken leg, "You
sent for further education about mental      should be more careful" or "It is noth-
illness.                                     ing. Just hop," or saying to a person
If a trained physician can make such     having a heart attack, "No need to see
a mistake, imagine how much more             a doctor. You are probably just out of
likely it is that friends, family members,   shape. You need to get more exercise."
and associates of those who have major
DIAGNOSING DEPRESSION
1 Bipolar mood disorder also includes
periods of major depression as well as       The definitions of mental illnesses are
periods of extremely elevated or agitated    published by the American Psychiat-
mood.                                        ric Association in various editions of
Depression, Stigma, and the Soul                          67

the Diagnostic and Statistical Manual       and social factors determine the onset
of Mental Disorders. The latest edition     and course of illnesses. Biological fac-
of this volume is DSM-5, published in       tors like genetic predispositions and in-
2013. The first, DSM-I, was published       herited vulnerabilities are key factors.
in 1952. The World Health Organiza-         Psychological contributors include
tion has its own coding system, pub-        developmental experiences, personal-
lished in the International Statistical     ity, intelligence, beliefs, attitudes, and
Classification of Diseases and Related      other variables. Social factors are, for
Health Problems (ICD). ICD-10 is the        example, race, ethnicity, socioeconom-
current version. This system is used        ic status, family relationships, school,
most often for billing purposes.            work-related variables, community re-
DSM-5 is a large book that gives        lationships, and religious affiliation.
detailed explanations of the symptoms           Despite this complex interplay, biol-
of the illnesses and summarizes what        ogy alone can play a determining role.
is known and not known about their          For instance, in our example, George
course. Through the various revisions       reported virtually no problems with
of DSM, different diagnoses have been       his childhood, work, relationships, or
added or removed. For instance, "neu-       family life. He had a pleasing person-
rosis" appears in DSM-I and II but was      ality, low stress, and what appeared to
eliminated from DSM-III and later           others to be a successful life. Yet he had
editions.                                   been chronically depressed all his life.
Psychiatric diagnosis can be chal-      For one whose first-degree relatives
lenging because it relies on self-report    have major depressive disorder, the
and similar symptoms can apply to           lifetime risk of developing the disor-
more than one diagnostic category. Of-      der is two to four times greater than
ten, more than one diagnosis is appro-      for those without this risk factor. In his
priate. For instance, substance abuse       "Overview of the Genetics of Major
disorders are often concurrent with         Depressive Disorder," Falk W. Lohoff
depression, anxiety, or other mental        reports a recent review of twin studies
illnesses.                                  that estimates heritability at 37 per-
While the symptoms of mental ill-       cent, "with a substantial component of
nesses can be grouped together and          unique individual environmental risk
given labels, their causes are often com-   but little shared environmental risk"
plicated or unknown. Only the trau-         (540).
ma-related disorders like post-trau-
matic stress disorder have specific and       HOW EXPERIENCES OF DEPRESSION
identifiable causes—that is, the trauma                  DIFFER
itself.
Scientists now use a "biopsycho-        Given that the word depression can in-
social" model to understand mental          dicate "just a bad day" or a major men-
illness, meaning that complex interac-      tal illness, how can an observer tell the
tions among biological, psychological,      difference? The answer is, you cannot.
68                 The Journal of Bahá'í Studies 27.1-2 2017

There are many reasons for this. De-        move,' and they say, 'Did you put the
pression symptoms differ from person        key in the ignition? Did you check the
to person and may vary from day to          gas? How old is the battery?' And it
day. Those who suffer from it often         makes me mad because the problem is
hide or minimize their symptoms,            none of the normal things you think
or they may not even know they are          about. There isn't a cause that makes
depressed.                                  any sense. There isn't a solution either
Depression is almost impossible to      because nothing in your life explains
describe and even harder to compre-         how unbearable you feel."
hend unless it has been experienced             Cyrus, a young African-American
first-hand. Nevertheless, I asked           man, described depression as a "fun-
friends, family members, and former         damental confusion between pleasure
clients to help me try to describe what     and pain." He said that when he is
it is like to be depressed (names have      depressed, nothing that used to bring
been changed and descriptions edited        pleasure is even remotely of interest.
for confidentiality).                       In addition, he explained, "The feel-
A middle-aged man named Ken            ing of not being like anyone else is
described it this way: "When you are        huge. You feel like you don't deserve
depressed, life is a struggle, a burden,    anything either. You feel so different,
like carrying a one hundred-pound           so apart from everyone, and so unable
weight on your back all day every           to begin to explain it even to yourself.
day. It is hard to get out of bed in the    There is no choice except to be alone
morning. Sometimes, I eat and eat and       and hide."
eat just to try to get some energy, but          Li, an elderly Asian woman who
then, sometimes, I have no appetite at      has had recurring bouts of depression
all. Over the years, I have gained and      all her life, explained that when she
lost weight like crazy. The same with       feels "normal," she can't even remem-
sleep. Sometimes I want to sleep for        ber what it felt like to be depressed: "It
days and can hardly move, then other        feels like that depressed person was
days I'm so agitated, I toss and turn       someone else." But when the cloud of
all night. I can't say I am sad. It feels   depression begins to rise, it beckons to
more like a numb nothingness that           her, calls her, as if to home. Although
makes me feel profoundly ashamed            vaguely recognizable as a state of pain
and guilty. I know I have no reason to      and despair, it also feels familiar and
feel this way, but knowing it doesn't       therefore strangely attractive. As the
change anything. My thoughts seem           condition gets worse, she sinks into it
to have no power over my emotions."         and away from her previously healthy
A teenager named Josiah said it is      life. She becomes lost in the darkness
"like trying to drive your car when         of her low mood and increasingly un-
the engine is dead. I tell someone, 'I      able to function. At her lowest point,
am not going anywhere; I can hardly         she may have only a vague, faint
Depression, Stigma, and the Soul                          69

remembrance of her formerly healthy           not knowing how to even answer that
self.                                         question"; "just trying to survive, and
Doris described depression as "a           make it through another day"; "weak-
black cloud invading your mind, over-         ness, black men can't be depressed";
whelming your thoughts and senses,            "wishing that more people would un-
the mental equivalent of being naked          derstand that you're not choosing to
in the cold—no blanket, no warm fire.         be like this, you're not just lazy." The
And at the same time there is a knife         tweets go on and on, reflecting the fact
stuck in you and you can't escape it be-      that depression is a complex, highly
cause it feels like it is you, and the only   individualized experience. Between
escape is to destroy yourself. Your           persons, symptoms can look quite dif-
survival instinct is overridden by the        ferent, and within any individual per-
enormity of the pain and the inescap-         son who is depressed, symptoms can
able nature of it. It feels like oppres-      fluctuate greatly from day to day or
sion coming from an unknown place."           week to week.
She added poignantly, "The worst                 Depression can wear the mask of
form of oppression is when your own           other problems. It can seem like lazi-
mind turns against you."                      ness, lack of motivation, or procrasti-
nation. It can feel like being "burn out"
THE MANY MASKS OF DEPRESSION                or having a "mid-life crisis." Because
depression can cause fatigue, aches,
A recent Twitter conversation                 pains, and a feeling of being slow,
(#mydepressionlookslike) gives a              heavy, and ready to give up on life, it
glimpse into the many faces of depres-        can be misinterpreted as a sign of ag-
sion.2 Many tweets express the painful        ing. Problems with concentration or
loneliness and isolation of depression,       memory may suggest early dementia.
the need to hide the illness, and the         Common physical symptoms like low
feeling that no one really understands.       energy and problems with sleep and
Examples include, "I'm absolutely fine,       appetite could suggest a medical prob-
literally, you wouldn't know anything         lem, while less common symptoms like
was wrong by looking at me & that's           cardiac arrhythmias, loss of libido,
the dangerous part"; "smiles, cookies,        loss of hearing, decrease in body tem-
tears in the bathroom, running, laugh-        perature, sweating, nausea, vomiting,
ter, screaming into a pillow"; "kind-         dizziness, sensations of cold, etc., are
ness to others but not myself "; "being       frequently misdiagnosed as medical,
told 'I'm too bubbly and happy to be          rather than psychiatric, problems.
depressed' which only reminds me of              Depression can masquerade as anx-
the facade I portray every day"; "be-         iety, and because these conditions often
ing always asked 'what's wrong' but           occur together, many people think that
2 See http://twitter.com/hashtag/           their depression is "just stress." Anxi-
mydepressionlookslike/.                       ety can express itself as nervousness,
70                The Journal of Bahá'í Studies 27.1-2 2017

restlessness, tension, feelings of im-        He is not alone. Stigma has been
pending danger, panic, doom, and           identified by experts as the single
worry. It can include physical symp-       leading cause of treatment avoidance.
toms like heart palpitations, sweating,    The following story will illustrate
and rapid breathing. Anxiety attacks,      how prejudices and false ideas work
also known as panic attacks, can mimic     to needlessly prolong the suffering of
the feelings of a heart attack.            those who need professional help.
Chronic feelings of depression and
anxiety sometimes lead to addictive        HOW STIGMA PREVENTS TREATMENT
behaviors meant to mask or reduce
internal distress. Over time, addictive    Juanita came for counseling at the
behaviors become problems in and of        insistence of her parents. She had re-
themselves. Addictions include not         cently become engaged and had asked
only drug and alcohol abuse, but also      her parents for permission to marry as
things like obsessive over-work, eating    Bahá'í law enjoins. They had refused,
disorders, excessive exercise, Internet    insisting that she see a counselor be-
addiction, sex addiction, gambling, and    fore they would agree to discuss it
other obsessive behaviors.
again.
Despite the complexity and over-
Juanita, by now in her mid-thirties,
whelming difficulty of living with
had experienced a lifetime of struggle
major depression and other mental
with depressive symptoms including
illnesses, people manage to do it. In
low mood, crying spells, problems
fact, many famous and successful
people have suffered from major de-        with decision-making, procrastina-
pression including Abraham Lincoln         tion, and feelings of insecurity. How-
and Winston Churchill (Solomon,            ever, she did not believe that she was
367). Writers Ernest Hemmingway,           depressed. She was fine—after all, she
Walt Whitman, Mark Twain, Stephen          was getting married!
King, and J.K. Rowling have openly            After doing some work with me,
admitted to battling low moods, while      Juanita began to realize that she was
entertainers like Billy Joel and Ray       using her relationship with her pro-
Charles expressed their inner strug-       spective husband as an "anti-depres-
gles through music. Prince Harry of        sant." When she was around him, she
Great Britain has recently opened up       felt less sad and more like herself. In
about his chronic depression caused by     her mind, the relationship "proved she
unresolved grief over the death of his     was normal" and not "a crazy woman."
mother, Princess Diana, when he was        Admitting the need for treatment, she
only twelve years old. He now speaks       explained, would lead to a downward
candidly about his difficulties, includ-   spiral that would cause her to "end up
ing delaying treatment because of the      in the loony bin." She believed that
stigma of mental illness, and is urging    "fighting" her illness meant avoiding
open conversations about these topics.     treatment, while admitting her need
Depression, Stigma, and the Soul                         71

for help was tantamount to "giving         that they believed seeking help for de-
in." She also believed that if she took    pression was a sign of a poor charac-
anti-depressant medication she would       ter, weakness, and not relying enough
get "hooked on drugs" and would have       on God. Juanita thought that if she
to take them for the rest of her life.     prayed properly, God would take away
She said she did "not want to get her      her depression. It followed that if He
happiness from a pill." These are com-     didn't, it meant that she wasn't pray-
mon fears and misconceptions that are      ing right or hard enough.
erroneous.                                     Juanita not only believed her own
Getting help decreases the severity     prejudices about getting help; she
of the illness and increases the like-     thought that others did as well: she
lihood that when it passes, it will not    felt that if she told her fiancé about
recur. Often it is not necessary to take   her depression, he would not want her
anti-depressant medications on a con-      because she would be "defective mer-
tinuous basis. Anti-depressant med-        chandise." And being labeled "a nut
ications are not addictive, and taking     case" would ruin her chances of mar-
them allows the body's normal mood         riage. "No one would ever want me,"
to return. Using medication to fight       she said.
depression is only one choice among            As Juanita and I talked more, she
many within a person's individualized      began to realize that she was not being
wellness plan. The "loony bin" is a        honest with herself or with her fiancé.
pejorative term for a mental hospital.     She was racing toward marriage, try-
Most people who need treatment for         ing to outrun her depression before, in
depression do not need to be hospital-     her words, "it took over and ruined my
ized as part of their treatment. Only      chances of living a good and normal
if depression goes untreated and gets      life forever."
so severe that the person becomes a            Juanita's statement is the essence of
danger to himself or herself or oth-       stigma—the prejudiced idea that there
ers (like George in the above example)     are two groups of people in the world,
might it be necessary to go to a hospi-    the "normal" and the "not normal,"
tal for a short time.                      those who have mental illnesses and
Juanita's barriers to treatment in-     those who don't. It is an "us vs. them"
cluded not only misinformation about       way of thinking in which admitting
her illness, but also all the prejudices   mental health problems creates an in-
and false beliefs she had internalized     escapable mark of inferiority that sep-
from her family and culture. She ex-       arates one from mainstream society.
plained that according to her family,          At the beginning of our work to-
people are supposed to "pull them-         gether, Juanita could not associate the
selves up by their own bootstraps"         idea of "a good, normal life" with "a
and "quit whining and complaining          mental illness like depression." It was
and feeling sorry for themselves," and     either one or the other. This is not
72                The Journal of Bahá'í Studies 27.1-2 2017

true, but such beliefs have a long his-    mental health by creating two separate
tory and are deeply rooted in many         insurance systems, one for "medical"
cultures around the world.                 problems and one for "mental" prob-
lems. The separation permits the allo-
THE HISTORICAL ROOTS OF STIGMA            cation of inferior coverage for mental
health treatment and leaves many who
Early Egyptian, Indian, Greek, and         need help unable to obtain it.
Roman writings attribute mental ill-
ness to the displeasure of the gods or             STIGMA—PREVALENT,
possession by evil spirits. The sufferer           POTENT, PERNICIOUS
was blamed for the illness and treated
as a pariah, an outcast deserving ex-      Sociologist Erving Goffman is usually
orcism, torture, or even death. This       credited with the first systematic ex-
view prevailed despite efforts by Hip-     ploration of stigma. In his book Stig-
pocrates around 400 BC to attribute        ma: Notes on the Management of Spoiled
mental illness to brain pathology.         Identity, he describes it as the social
Throughout the 1800s and early          phenomenon of being rejected by a
1900s, the notion that humane treat-       peer group on the basis of an attribute
ment for those with mental health          the group finds unacceptable (6–7).
problems would be curative began to        Goffman lists three categories of stig-
take hold, but fears and misinforma-       matized people: (1) those with "abom-
tion from earlier times remained. Ef-      inations of the body"—now known
fective treatments were lacking, and       as physical disabilities; (2) those with
those with mental health problems          "blemishes of individual character per-
continued to be institutionalized with     ceived as weak will," among which he
criminals, the poor, and those with        included mental disorders, addiction,
other chronic illnesses.                   alcoholism, suicide attempts, impris-
From the mid-1900s to the present       onment, homosexuality, unemploy-
time, medical experts developed more       ment, and radical political behavior;
and better treatments for major de-        and (3) those with the "tribal stigma"
pression—most notably, a whole range       of race, nationality, and religion (6–7).
of psychotropic medications and ev-        The follow-up to Goffman's work over
idence-based psychotherapies. In the       succeeding decades became bogged
United States, some efforts were made      down with controversies about the
to address mental illness through          labeling process itself and whether or
government measures. However, such         not it caused stigma. That issue was
initiatives suffered from poor funding     never resolved, and as interest in the
and lack of follow-through.                topic waned, the notion that stigma
Meanwhile, the American medical         was declining took hold. Meanwhile,
insurance industry has been allowed to     mental health became a human rights
capitalize on the stigma surrounding       issue.
Depression, Stigma, and the Soul                         73

From the 1970s onward, battles          Mental Health reviewed the literature
within the legal system focused on          on mental health treatment and found
fair housing, equal employment op-          that stigma was "the primary barrier
portunities, and adequate medical and       to treatment and recovery" (Office of
psychiatric care for those who need it.     the Surgeon General et al. viii). The
The Bazelon Center for Mental Health        report notes that the general public
Law3 has been working in this area for      still believed Goffman's premise that
many years. An exhaustive treatment         mental disorders are the result of
of this topic is outside the scope of       "moral failings or limited will power"
this paper, but a few landmark cases        (viii) It also over-optimistically pre-
from its website are noteworthy. For        dicts that "[w]hen people understand
instance, in the 1970s, Wyatt v. Stick-     that mental disorders . . are legitimate
ney established the constitutional right    illnesses that are responsive to specific
to treatment for people with mental         treatments, much of the negative ste-
disabilities committed to state institu-    reotyping may dissipate" (viii). It thus
tions, and O'Connor v. Donaldson estab-     calls for mental illness to be defined as
lished the right to freedom from cus-       a physical dysfunction, a "disease like
todial confinement for non-dangerous        any other" (viii).
persons. The Fair Housing Amend-                Following the Surgeon General's
ments Act of 1988 made it illegal to        report, what were supposed to be "an-
deny access to housing based on phys-       ti-stigma" campaigns were launched
ical or mental disability. In 1990, the     to convince people that mental illness
far-reaching Americans with Disabili-       was a brain dysfunction. For instance,
ties Act rendered discrimination based      in the United States, the National Al-
on mental or physical disability illegal,   liance on Mental Illness launched the
just as the Civil Rights Act of 1964        "Campaign to End Discrimination,"
had outlawed discrimination based on        which emphasized the neurobiological
race, color, religion, sex, or national     bases of mental illness and the need
origin ("Our History").                     for pharmaceutical treatments. Within
At the turn of the millennium,          the following decade, in countries in
when serious attention from the so-         North America and around the world,
cial sciences returned to the issue,        similar widespread and expensive
the stigma associated with mental           campaigns emphasized the brain dis-
illness was found to be prevalent, po-      ease model.
tent, and pernicious. In 1999, the first        Research indicates that in many
ever Surgeon General's Report on            ways, rather than reducing stigma,
these campaigns made it worse. A study
3 Based in Washington, DC, the Ba-       compared data from the 2006 National
zelon Center for Mental Health Law is an    Stigma Study-Replication to the 1996
organization that provides legal advocacy   MacArthur Mental Health Study. In
for people with mental disabilities.        both studies, the same vignettes were
74                The Journal of Bahá'í Studies 27.1-2 2017

presented to respondents, who were        decrease stigma around the world.
asked to imagine themselves interact-     Its efforts have been focused on the
ing with a person with a mental health    importance of the media in the fight
diagnosis. The report concluded, "No      against stigma. Research has shown
significant decrease was reported in      that the public perception that people
any indicator of stigma, and levels       with mental illnesses are dangerous
remained high" (Pescosolido et al.        has been fueled by media reports of
1324). A majority of the public con-      hugely dramatic and destructive acts
tinued to express an unwillingness to     of violence committed by a very small
work closely or socialize with persons    number of people who are not getting
diagnosed with mental illness or have     adequate treatment. While such acts
them marry into their family. And         are statistically rare, they powerfully
while believing mental illness to be a    create and sustain negative public at-
neurological problem was correlated       titudes. The Carter Center has been
working to educate the media about
with believing treatment is necessary,
their responsibility to provide bal-
it was also correlated with believing
anced coverage of the issue of mental
the problem to be irremediable. More
health challenges. It provides schol-
alarmingly, many people in the 2006
arships to journalists who work on
survey spontaneously volunteered the
projects that emphasize the success
information that they associated men-
of people with these illnesses: the re-
tal illness with an increased risk of
silience, the significant achievements,
violence.                                 and the everyday happy lives of people
in mental health treatment.
THE PERCEPTION OF VIOLENCE RISK              In terms of violence risk in the
general population, having a mental
Research has shown that the vast          illness can raise the risk of commit-
majority of those with mental illness     ting a violent act if the illness is very
are not dangerous. Having a mental        severe, causing a break with reality,
illness is not a predictor of violence    and if the illness is not being properly
within the general population. In fact,   treated. Even then, the increased risk
mentally ill people are more often the    of someone committing a violent act
victims of crime than its perpetrators    like homicide compared to someone
(Torrey 1–5).                             in the general population is believed
"But," you might ask, "what about     to be "about 2% or less" (Torrey 1).
all the media reports on mass shoot-      However, the criminal justice system
ings? Aren't all these committed by       has amassed a large number of cases
mentally ill people?" The answer is       involving these severely ill individuals
complicated.                              because the lack of available psychiat-
For many years, the Carter Center     ric hospitals has left many homeless
in Atlanta, Georgia, has worked to        and without treatment or sufficient
increase mental health treatment and      resources to survive.
Depression, Stigma, and the Soul                        75

THE DEVELOPMENT OF SELF-STIGMA                the prejudices against those with men-
tal health problems become reflected in
Social psychologist Patrick Corrigan          the government and community infra-
is one of the most well-known experts         structures. The ongoing legal battles
in the field of mental health stigma.4        and biases in the healthcare delivery
He explains that it is important to ac-       system discussed above are examples
knowledge that stigma is not a figment        of structural stigma. Self-stigma oc-
of the imagination of those who suffer        curs when the prejudicial attitudes of
from these illnesses. "The problem of         the public sector are co-opted by indi-
stigma," he and mental health services        viduals with mental health challenges
researcher Nev Jones write, "does             like depression.
not lie within the individual with the           As Corrigan, Jonathan E. Larson,
mark, but rather in the stigmatizing          and Nicolas Rüsch explain, self-stig-
communities in which the individuals          ma develops through three separate
find themselves" (Jones and Corrigan          but related processes: stereotyping,
9). Corrigan's work shows that nega-          prejudice, and discrimination (75). The
tive community attitudes (public stig-        first component, stereotyping, can be
ma) can be internalized by the sufferer       relatively benign. Webster's Dictionary
and become "self-stigma." The story           defines stereotyping as a process of
of Juanita is a good example; her sto-        unfairly believing "that all people or
ry shows how internalized prejudicial         things with a particular characteristic
beliefs distorted her thinking and pre-       are the same" ("Stereotype"). Social
sented a major barrier to her seeking         groups share stereotypes as part of
treatment.                                    their common culture, and these as-
Corrigan, Benjamin G. Druss, and           sumptions are often reinforced in the
Deborah A. Perlick distinguish be-            arts and media. It is easy to think of
tween three main types of stigma:             some of them: "the suit," a conserva-
public, structural, and self-stigma.          tive banker who dresses impeccably;
Public stigma refers to the attitudes         "the class clown," a middle-school boy
of the general public that are outlined       who is disruptive but funny; "the soc-
above. Structural stigma occurs when          cer mom" with her minivan and work-
out gear.
4 Corrigan identifies himself as a            Corrigan, Larson, and Rüsch con-
survivor, researcher, and advocate. His       tend that while stereotyping itself is
website (http://www.stigmaandempow-           somewhat inevitable and not neces-
erment.org/) provides tools and resourc-      sarily damaging, it can be dangerous
es to empower those with mental health        when it opens the door to the second
challenges. Recently, he was appointed ed-    and third aspects of the stigmatization
itor in chief of Stigma and Health, a newly   process, prejudice and discrimination.
created journal of the American Psycho-       When stereotypes become fixed neg-
logical Association.                          ative beliefs about a group, they are
76                The Journal of Bahá'í Studies 27.1-2 2017

called "prejudices." When large seg-      himself it was a just a joke. But the
ments of society begin to share those     label stuck, and as time went on, he
prejudices and act upon them, discrim-    began to adopt it, even introducing
ination is the result (81).               himself to other people as "the new
It is important to understand how      geek in tech support."
this counterintuitive and often uncon-       The day before the party, Carl be-
scious process of self-stigmatization     gan to imagine himself being there.
works because self-stigma can com-        He thought, "I am a bit shy and seri-
bine with the symptoms of depression      ous. I wear T-shirts and a hoodie all
to create a sense of hopelessness and     the time. Sometimes when people tell
treatment avoidance that can lead to      a joke, I don't get it." In his mind's
suicide. Corrigan, Larson, and Rüsch      eye, he imagined himself as "the geek"
call this the "why try" effect (75).      sitting alone at the party, feeling sad
In the following hypothetical ex-      and ashamed because he doesn't fit in,
ample, Carl will self-stereotype him-     so he eventually decided not to go. On
self as a "geek" and stereotype his co-   Monday morning, a coworker said to
workers as "artsy types." Then, based     him, "Hey Carl, we missed you last
on these prejudices, he will imagine a    Saturday night! What were you do-
sequence of events that will lead him     ing?" Carl looked down at the floor
to discriminate against himself.          and mumbled, "I played video games"
Carl, is a gifted programmer who       as he walked away. The coworker, feel-
moved from a San Francisco technical      ing snubbed, thought, "I guess you re-
firm to a New York City advertising       ally are a nerd."
and media firm. Six months into his          Carl's self-stigma blocked his view
new job, the creative arts department     of reality. He didn't know that when
staff invited him to a party. He wanted   his coworkers met him, they immedi-
to go because he felt lonely. He had      ately liked him. They were fans of the
been having difficulty making friends     television show The Big Bang Theory,
in New York. In California, he and        in which a "nerd" hero creates comedy
his friends had hiked together on         out of his extreme intelligence and
weekends and played video games at        lack of social skills. Carl's coworkers
lunch. These New York "urban artsy        were comparing him to their hero
types," as he called his coworkers,       when they used that label. For them
didn't share his interests in computers   it was a benign stereotype. But Carl
and the outdoors. He began to notice      didn't know that. Instead of going to
that they often referred to him as "our   the party and testing his theory of
new geek" or, sometimes, "the nerd."      being an outcast, he stigmatized him-
He had never been called that before      self and stayed home, thereby effec-
and wasn't sure how to react.             tively creating the reality of being an
At first Carl tried to convince        outcast through his own actions.
Depression, Stigma, and the Soul                        77

LABEL AVOIDANCE AND THE                   This is the reality for people with
"WHY TRY" EFFECT                   major depression. They are squeezed
between the pain of their own illness
The self-stigma that kept Juanita from      and the scourge of public opinion,
getting mental health treatment is in       forced to choose between the rages of
some ways similar to Carl's self-stig-      their own internal suffering and the
ma. Juanita labeled a depressed per-        loss of their sustaining ties. And as a
son like herself "a nut case" and saw       society, we are asking them to face this
herself as "less than" someone who          unsolvable dilemma at the very time
does not need mental health treatment       they feel most vulnerable and least
(prejudice). She then acted on her be-      able to cope, at a time when all the
liefs when she avoided treatment (dis-      symptoms described at the beginning
crimination). Juanita was engaging in       of this article are in full force. Is it
what Jones and Corrigan call "label         any wonder that many find themselves
avoidance," which he defines as "re-        boxed into a no-win, no-way-out co-
fusing to get help for mental illness in    nundrum that leads many to feel death
order to avoid the label of being men-      is the only solution?
tally ill" (19).
However, Juanita's self-stigmati-          MIND, SOUL, AND RELATIONSHIPS
zation is different from Carl's in two
important ways: first, Carl was sim-        The above discussion reflects the com-
ply feeling a bit sad about missing his     plexity of depression and stigma. De-
friends, but Juanita was suffering from     pression and other mental illnesses are
a serious mental illness, major depres-     private, and they are public. They are
sion; second, while Carl's coworkers        widespread throughout the world yet
actually liked him, a large portion of      uniquely expressed within each indi-
the general public holds negative views     vidual. They are embedded in relation-
about people with mental health issues.     ships yet deeply personal and intra-
Juanita had to choose between get-       psychic. Genetics play a roll, but they
ting treatment and potentially losing       only partially explain the complex,
the supportive network of her fiancé,       life-threatening challenges of depres-
friends, and family, and refusing treat-    sion and other major mental illnesses.
ment to keep her social network. Can        Decades of research and public cam-
she be blamed for choosing to main-         paigns have failed to eradicate stigma,
tain her relationships? Is it fair to ask   and the widespread phenomenon of
a person suffering from feelings of         untreated mental illness goes on. In
hopelessness and self-loathing to fight     fact, the problem seems to be getting
public opinion that decades of social       worse. What can be done?
science research, public relations, and         The soul is a timeless concept.
government programs have failed to          Bahá'ís believe in the soul, as do the
impact?                                     followers of most of the world's
78                The Journal of Bahá'í Studies 27.1-2 2017

major religions dating back to ancient     as machines whose separate parts add
times. Aristotle, Socrates, and many       up to the whole. The example of a bro-
other ancient philosophers spoke of        ken clock is often used as an example.
the soul. Indigenous and Native peo-       If the clock isn't working, take apart
ples also affirm the existence of our      the pieces one by one, find the broken
link to the Great Spirit that provides     piece, fix it, then put the clock back to-
guidance during this lifetime and the      gether. According to this logic, if the
next.                                      problem is depression, label the de-
However, introducing the con-           pressed group "not normal," separate
cept of a "soul" into a discussion of      it from the "normal" group, analyze
problems that have variously been          the parts that appear to be "broken"—
defined as the province of medicine,       concrete, physical, measurable things,
psychiatry, sociology, law, and public     such as chemical imbalances—then fix
health may seem incongruous, even          those with equally concrete, physical,
contrived. But consider for a moment:      measurable things like medications.
perhaps the intractability of stigma is       Notice the actions involved in this
related to the framework within which      approach that contribute to stigma: la-
it has been addressed. Perhaps the ap-     beling, separating, defining as broken,
proaches reviewed above contributed        assuming an outside expert is needed
to stigma by labeling and categorizing     to fix the brokenness, and ignoring
human beings rather than seeing them       all the unquantifiable aspects such
as unique, complex, multifaceted, and      as social relationships, inner psychic
transcendent. Perhaps when dimen-          thought processes, spirit, and soul.
sions like wholeness, interconnection,     Although slightly exaggerated for the
soul, and spirit are eliminated and re-    sake of making the point, this is essen-
placed with static categories and nega-    tially the biomedical model of health.
tive labels, stigma is the result.         It prides itself on being hard science
Starting with the Enlightenment,        because it shows cause and effect as
Western research and practice in most      linear, fixed, and measurable. Within
fields of science removed any con-         this model, there is no room for the
siderations of the spiritual nature of     least measurable, least quantifiable,
mankind. As technology and science         most ineffable aspect of a human be-
rapidly advanced, the dominant para-       ing, the soul. Could it be that without a
digm became materialistic and mecha-       framework that includes the transcen-
nistic. From this perspective, the only    dent, the problem of stigma and the
things that exist are those that can be    puzzle of recovery from mental health
observed and measured. That is why         issues cannot be solved?
the doctor in the emergency room told         Daniel Siegel is a clinical professor
George his problems were not real af-      of psychiatry at the UCLA School of
ter his lab tests proved to be negative.   Medicine and the founding co-director
Mechanistic ideologies see humans       of the Mindful Awareness Research
Depression, Stigma, and the Soul                         79

Center at UCLA. In his popular work        the relational aspect of individuals
Mindsight, he tells the story of his       and the theory, skills, and benefits of
own struggle with trying to help peo-      personal growth and changes in states
ple within the boundaries imposed by       of mind. He suggests that through
the medical model. It nearly drove him     self-awareness we can become mindful
out of the field. He took time off from    of our own internal subjective states
his training, and when he returned,        and how these directly shape our phys-
he was determined to take a differ-        iological and psychological health. He
ent stance. The result is his lifework,    explains that through this awareness,
called "interpersonal neurobiology,"       we can change the organization and
which is taught through his books,         structure of our own brains. He calls
lectures, and the Mind Sight Institute     this awareness "mindsight" and de-
(www.mindsightinstitute.com).              scribes it as a process that "enable[s]
Mindsight begins with the question,     us to sense and shape energy and in-
"What is the mind?" A basic question,      formation flow" (55). Higher states of
it would seem, in a field named "men-      consciousness lead to transcendence,
tal health." But, he says, no one really   in which people simultaneously see
knows. He polled over eighty thousand      themselves as unique individuals and
experts about whether or not they          part of the entirety of humanity, the
had ever attended a course or lecture      whole of creation (52). "Mindsight,"
defining the mind or mental health:        Siegel explains, "takes away the su-
"The responses were easy to count. In      perficial boundaries that separate us
numerous countries on four different       and enables us to see that we are each
continents, in lecture halls around our    part of an interconnected flow, a wid-
globe, the same statistic has emerged      er whole. By viewing mind, brain, and
again and again: Only 2 to 5 percent of    relationships as fundamentally three
people in this field had ever been given   dimensions of one reality—of aspects
even a single lecture that defined the     of energy and information flow—we
very foundation of their specialty—        see our human experience with truly
the mind" (51). Siegel set out to do       new eyes" (58).
just that, and his work is noteworthy         He emphasizes that self-reflection is
in many ways.                              at the heart of mindsight. He reports
In Siegel's model, the mind is not a    that when people become more inter-
material thing but rather an integral      nally integrated and insightful about
part of the interplay among three as-      themselves, "[t]heir identity expands;
pects within what he calls the "trian-     they become aware that they are part
gle of well-being"—mind, brain, and        of a much larger whole. In various re-
relationships. "The mind," he says, "is    search explorations of happiness and
a relational and embodied process that     wisdom, this sense of interconnection
regulates the flow of energy and in-       seems to be at the heart of living a life
formation" (11). His model emphasizes      of meaning and purpose" (76).
80                 The Journal of Bahá'í Studies 27.1-2 2017

Siegel's definition of mental health      and effects" (55:5), just as Siegel as-
is "integration." He says, "With in-         serts that "mindsight" allows one to
tegration, we see ourselves with an          monitor and modify the flow of in-
expanded identity. When we embrace           formation internally. Siegel says that
the reality of this interconnection,         the mind cannot be separated from
being considerate and concerned with         relationships with others. The pro-
the larger world becomes a fundamen-         cess of the soul is concerned with
tal shift in our way of living" (260).       relationships too, with "the qualities
Siegel uses brain science to argue that      and properties of beings" (55:5). Both
the "mind" can change the brain and          definitions emphasize growth, discov-
therefore behavior. "The mind uses the       ery, and the acquisition of knowledge.
brain to create itself," he says (261).      Both affirm a human spirit that con-
Compare this description of the in-       nects us all together in an integrative
tegrated mind with 'Abdu'l-Bahá's de-        whole. Both allow for complexity and
scription of the rational soul in Some       connections among seemingly dispa-
Answered Questions:                          rate parts. 'Abdu'l-Bahá states, "Reflect
upon the inner realities of the uni-
The human spirit which distin-             verse, the secret wisdoms involved, the
guishes man from the animal is             enigmas, the inter-relationships, the
the rational soul, and these two           rules that govern all. For every part of
names—the human spirit and                 the universe is connected with every
the rational soul—designate one            other part by ties that are very power-
thing. This spirit, which in the           ful and admit of no imbalance, nor any
terminology of the philosophers            slackening whatever" (Selections 137).
is the rational soul, embraces all         Furthermore, in The Promulgation of
beings, and as far as human ability        Universal Peace, 'Abdu'l-Bahá declares,
permits discovers the realities of         "Religion must conform to science and
things and becomes cognizant of            reason; otherwise, it is superstition.
their peculiarities and effects, and       God has created man in order that he
of the qualities and properties of         may perceive the verity of existence
beings. (55:5)                             and endowed him with mind or reason
to discover truth. Therefore, scientific
While Siegel's definition of the          knowledge and religious belief must
mind and 'Abdu'l-Bahá's definition of        be conformable to the analysis of this
the soul are not completely identical,       divine faculty in man" (96).
they are compatible. The soul as de-            The preceding discussion shows
scribed here is dynamic, a process and       that love is good science and that the
not a static or material "thing." It "dis-   powerful reality of the human soul and
covers the realities of things" (55:5).      spirit defines human beings regardless
The soul includes understanding and          of the barriers that may at times dim
gaining insight about "peculiarities         their lights.
Depression, Stigma, and the Soul                        81

"CONSIDER THE LIGHT OF THE LAMP"             of soul. Let us hope in the mean-
time scientists will find better and
That movement toward the spiritual           permanent cures for the mentally
and transcendent is necessary to ad-         afflicted. But in this world such
dress mental health was also affirmed        illness is truly a heavy burden to
by Shoghi Effendi in a letter to an in-      bear! (qtd. in Selections from Bahá'í
dividual believer dated 12 April 1948.       Writings 948)
He reflects:
In this letter, Shoghi Effendi cele-
It is very hard to be subject to any    brates the power of the soul, empha-
illness, particularly a mental one.     sizes its inherent health, and describes
However, we must always remem-          illness as a "hindrance" between the
ber these illnesses have nothing        soul and the body, a point also under-
to do with our spirit or our inner      scored by Bahá'u'lláh:
relation to God. It is a great pity
that as yet so little is really known      Know thou that the soul of man is
of the mind, its workings and the          exalted above, and is independent
illnesses that afflict it; no doubt,       of all infirmities of body or mind.
as the world becomes more spir-            That a sick person showeth signs
itually minded and scientists un-          of weakness is due to the hin-
derstand the true nature of man,           drances that interpose themselves
more humane and permanent                  between his soul and his body, for
cures for mental diseases will be          the soul itself remaineth unaffect-
found. The Guardian, much as               ed by any bodily ailments. Consid-
his heart goes out to you in your          er the light of the lamp. Though
fear and suffering, cannot tell you        an external object may interfere
whether electric shock treatments          with its radiance, the light itself
should or should not be used, as           continueth to shine with undimin-
this is a purely medical question,         ished power. In like manner, every
and there is no reference to such          malady afflicting the body of man
details in our Scriptures. The best        is an impediment that preventeth
scientists must pass upon such             the soul from manifesting its in-
methods, not laymen. You must              herent might and power. (Glean-
always remember, no matter how             ings 153)
much you or your others may be
afflicted with mental troubles             Siegel's work suggests that when a
and the crushing environment of         person is experiencing maladies that
these state institutions, that your     affect the mind, relationships, or "soul
spirit is healthy, near to our Be-      to soul" connections, can wield a pow-
loved, and will in the next world       erful force. Within loving relation-
enjoy a happy and normal state          ships, the positive energy flow helps
82                The Journal of Bahá'í Studies 27.1-2 2017

buttress those who are experiencing         of detachment may be made man-
mental health challenges. Converse-         ifest. Such is My counsel to you,
ly, stigma and related negativity like      O concourse of light! Heed ye
judgment, criticism, or relationship        this counsel that ye may obtain
"cut-off " can cause irreparable dam-       the fruit of holiness from the tree
age. The Bahá'í community, with its         of wondrous glory. (Bahá'u'lláh,
emphasis on love, community building,       Hidden Words, Persian no. 69)
and reliance on the spirit, is uniquely
suited to respond to the needs of those      The Bahá'í Writings are very ex-
who suffer from mental illness.           plicit in regard to what a relationship
would look like when walking "even as
ACCOMPANIMENT AND RECOVERY           one soul." This beautiful and moving
passage sets a new standard of friend-
Accompaniment is a concept that has       ship for all of us. 'Abdu'l-Bahá says
recently become a lodestone of com-       that
munity building efforts within the
Bahá'í Faith. To accompany someone          the Cause of the Ancient Beauty
is to stand next to that person and "be     is the very essence of love, the
there," supporting him or her with          very channel of oneness, exist-
understanding and empathy. Accom-           ing only that all may become
paniment is neither giving advice nor       the waves of one sea, and bright
abandonment. It is non-judgmental           stars of the same endless sky,
supportive friendship, a soul-to-soul       and pearls within the shell of
relationship in which each learns from      singleness, and gleaming jewels
the other.                                  quarried from the mines of unity;
that they may become servants
O children of men! Know                 one to another, adore one another,
ye not why We created you all             bless one another, praise one an-
from the same dust? That no one           other; that each one may loose his
should exalt himself over the             tongue and extol the rest without
other. Ponder at all times in your        exception, each one voice his grat-
hearts how ye were created. Since         itude to all the rest; that all should
We have created you all from one          lift up their eyes to the horizon of
same substance it is incumbent on         glory, and remember that they are
you to be even as one soul, to walk       linked to the Holy Threshold; that
with the same feet, eat with the          they should see nothing but good
same mouth and dwell in the same          in one another, hear nothing but
land, that from your inmost being,        praise of one another, and speak
by your deeds and actions, the            no word of one another save only
signs of oneness and the essence          to praise. (Selections 193)
Depression, Stigma, and the Soul                         83

'Abdu'l-Bahá has given a clear answer       (SAMHSA) is a large government
to the question, "How do you accom-         organization in the United States that
pany a person with mental health            oversees a variety of mental health
challenges?" Extol without exception.       programs, research efforts, and poli-
Serve, bless, praise; see the good only.    cy recommendations. Recently, it re-
Express gratitude and love, even to         leased a new set of policy guidelines
the point of "adoring" one another.         regarding mental health treatment
If you are the one who is depressed      that rejects the old medical model and
or suffering from another mental            embraces an individualized, self-deter-
health challenge, you may find it help-     mined, holistic approach. Recovery is
ful to substitute "one another" in the      defined as a process that encompasses
passage above with the word "your-
an individual's whole life "including
self " as you progress toward achiev-
mind, body, spirit, and community"
ing recovery. In spite of the veil you
("Recovery"). The guidelines state
may feel between your conscious self
that "there are many different path-
and your spirit, strive to love yourself,
ways to recovery and each individual
praise yourself, see the good in your-
self, and be grateful to yourself for       determines his or her own way" (del
bearing up under your heavy burden.         Vecchio).
Try not to put yourself down, even             Recovery is defined as "a process
though depression may be twisting           of change through which individuals
your thoughts to the negative. Be kind      improve their health and wellness, live
to yourself. And at the same time, real-    a self-directed life, and strive to reach
ize that it is no one's problem to solve    their full potential" ("Recovery"). The
but yours. That means recovery from         guidelines emphasize that recovery is
major depression and other mental ill-      real. No matter how severe and long-
nesses may be more or less a full-time      standing a mental illness may be, it is
job, and it may be one you will do for      possible to create a plan that allows
the rest of your life.                      for a full and meaningful life. By tak-
Taking responsibility for the ill-       ing charge of one's own illness and
ness is step number one. This does          assembling medical help, counseling,
not mean believing that you caused          skill training, nutrition, exercise,
the problem or that it is your fault.       mind-body practices like yoga and
It means understanding and valuing          meditation, and other curative prac-
your uniqueness while realizing that        tices, individuals become healthy and
only you can create the recovery plan       empowered.
that will be right for you.                    Of course, various situations can
make recovery more complex. A his-
RECOVERY                     tory of physical and/or psychological
trauma requires specialized trauma-fo-
The Substance Abuse and Men-                cused services by persons with train-
tal Health Services Administration          ing in these areas. A trauma history
84                The Journal of Bahá'í Studies 27.1-2 2017

can greatly complicate the already         mid-thirties whom I met at a Bahá'í
complex issue of recovery. Likewise,       conference on healing. She was a
when addictive behaviors are part of       speaker who shared her recovery plan
the picture, they too require special-     with the group. Despite having been
ized treatment. Self-help groups aid       diagnosed with major depression,
recovery and emphasize that personal       anxiety with panic attacks, eating
change is a life-long process of discov-   disorders, and borderline personality
ery that benefits from group support.      disorder, she reported that she is liv-
The recovery process is ever chang-    ing a full and meaningful life. Samila
ing and may include setbacks and           has created a comprehensive array of
learning experiences that are painful.     resources and practices that she calls
This is normal and should not be asso-     her "wellness plan." It includes regular
ciated with failure or lack of effort or   visits with a psychiatrist, psychother-
willpower. Setbacks are opportunities      apist, and registered dietitian; physical
for growth. Small initial steps are of-    exercise; interpersonal skill training
ten the most difficult, and when they      using Dialectical Behavior Therapy;
do not result in the immediate allevi-     an active spiritual life; and participa-
ation of symptoms, many individuals        tion in Bahá'í community activities.
lose hope and stop the process. It is      Samila created the plan herself. She
important not to give up but to con-       explained, "We have to find the way
tinue forward, adding more pieces to       ourselves because no one else is going
the recovery plan until the symptoms       to do it for us."
are under control and life is livable.        Samila agreed to share her story
The new guidelines highlight that     during a telephone conversation in
recovery is a way of life and the "ex-     August 2016:
perts" are those with the "lived experi-
ence" of healing. In the following sto-         You are already fighting a bat-
ry, Samila suffers from major mental         tle every single day against your
illnesses and stigma. When her inter-        own brain, but it's worse to fight
nal distress becomes too much to bear,       the stigma that you have put on
she is faced with a choice. Her story        yourself and that other people
shows how the supportive respons-            have put on you. I just remember
es of others in her life enabled her         the years and years I went with-
to survive and begin her journey of          out help because I was so afraid
healing while discovering the spiritual      of being seen as damaged. I hid
purpose of her life.                         it. I didn't get the help I needed.
I beat myself up for decades and
WAVES OF ACCEPTANCE                   just hurt myself so much mental-
ly and emotionally. Those were
Samila (whose name has been changed          circumstances that were largely
for anonymity) is a woman in her             set up for me by my parents, but
Depression, Stigma, and the Soul                        85

that was the only attitude they had       terrifying. My mom sat by me and
ever known. You didn't talk about         hugged me and cried and was just
it. You certainly didn't acknowl-         there for me.
edge it. You moved forward. You              It is three years now that I have
distracted yourself. You just con-        been talking about my mental
tinued on as if nothing is really         health. I am owning my mental
wrong. You can't say, "Something          illness and talking openly about
is wrong" because it's not your           it. I still get scared, but now it's
foot that hurts. It's your brain          my way of saving myself.
that hurts. People can't fathom              I used to say, "Why did I get this
that. It is a scary unknown beast.        as my lot in life?" And the answer
Everybody goes silent when you            I got back from God was, "This is
talk about it.                            your purpose. You have been giv-
For over thirty years I lived          en this challenge so you could use
with shame and fear and felt an-          it for some good." If I talk about
gry and bitter because these were         this, maybe it will at least reduce
the circumstances I was given. I          some of the stigma, at least in my
thought, 'Why did I have to get           corner of the world.
this kind of life?'                          Now I go toward the love—
When I had my breakdown a              those who reach out to me and
few years ago, it was the first time      say either, "I struggle too," or
I contemplated suicide. I realized        they say, "I think you are so great
the things I was doing in my life         and courageous," and others say,
made it impossible to live. I could       "I want to be there for people like
not continue playing this game I          you too." Whatever makes me feel
had not signed up for. There were         seen and heard gives me hope, as
rules that had been imposed upon          the waves of acceptance flow out.
me, and I had no choice in them. I
realized hey, if these are the rules
and they mean I can't live any-                      CONCLUSION
more, I can't survive. I was never
hospitalized. I was in my office at    The goal of the preceding discussion
work when I had this realization.      has been to show that the application
Later that day I was able to see       of the Bahá'í teaching of the unity
my therapist. She made me sign         of mankind is urgently needed in the
a contract that I would not take       field of mental health.
my own life. I promised I'd go            Depression is now the leading cause
and stay with my parents and tell      of disability worldwide and despite
them the truth. That was the first     the fact that highly effective treat-
time I ever told my parents I had      ments are available, the majority of
these kinds of thoughts. It was        those who suffer do not get the help
86                The Journal of Bahá'í Studies 27.1-2 2017

they need. The stigma of mental ill-           As the many stories and examples
ness is the greatest barrier to treat-     illustrated, depression expresses itself
ment. Stigma is a societal problem; a      uniquely within individuals and each
problem of attitude, of ignorance, and     healing journey is different. But all hu-
denial. It labels and blames those who     man beings benefit when the reality of
suffer and greatly enhances their dis-     the soul and the potency of supportive
tress at the time when they most need      relationships are acknowledged. In-
love and support. It creates societal      terpersonal neurobiology shows how
barriers that go unchallenged despite      the mind depends on relationships for
their glaring inequities and negative      health and how transcendence itself is
consequences.                              linked to the reality of love as it un-
Conversely, when communities rec-       folds within each of our lives. Healthy
ognize and welcome those who have          individuals have a responsibility to
mental health challenges like depres-      examine their attitudes about mental
sion, they begin to create the frame-      health challenges, educate themselves,
work within which the sufferers can        and take an active role in combating
heal while the community benefits          stigma through loving compassion to-
from their presence.                       wards those who suffer.

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-- Depression, Stigma, and the Soul (Used by permission of the curator)