A couple of weeks ago, I was on my way to the gym when my mom called.

She started the conversation by saying she was thinking about me. My response was “why?”

I hadn’t heard the news yet, but she let me know that someone I’m a huge fan of had died. As the news about his death rolled in, it was confirmed that Anthony Bourdain had taken his own life. I’d read some of his books, cooked his food from one of my favourite cookbooks, watched his shows, and basically loved everything he did. I looked up to him.

Strange that someone who you’ve never met, can have an impact on you. Some may even think, strange for a mom to think about their son because of what a famous person did. But, perhaps she was thinking of me because of the way he did it.

I’ve written a little bit about it on this blog before, but have never gotten really personal with it. I debated hard whether I would write this post because it’s so personal. Depression is something I’ve dealt with a lot in my life, (I’m not sure if depression is actually a genetic thing, but it’s something that is certainly prevalent in our family) and was faced with suicide for the first time when I was around 12 years old. My uncle had taken his own life, years later my best friends dad, then one of my mentors at the firehall,  just a few years ago my brother, and a couple of months ago, a childhood friend.

So, any time something like this happens, maybe it hits a bit close to home.

Of course, when it’s a famous person, inevitably there is a lot of media attention. People take to social media to voice their opinions, mourn, share stories, and ask questions.

Most of the time people are left bewildered how someone who has “the ultimate life,” could possibly do something like this, they have it all!?

Then, of course, a barrage of the comments centre around how suicide is a selfish act because the person isn’t thinking about what they left behind, what they’ve done to family and friends, or that they took the easy way out.

Many friends who I’ve talked with since Bourdain’s death, haven’t really dealt with depression in their lives, so they have a difficult time understanding what could lead to this. I’m sure every person who deals with depression has varied experiences and different ranges of severity, so I can’t speak for others, or their experiences, but I will speak of mine.

Now for the personal part.

What Depression Feels Like

I can’t make a blanket statement on this as it’s going to be different for everyone.

Depression isn’t just simply a case of being “down” or feeling “blue” for a little while, it goes far beyond that. We are all meant to have a range of emotions and some days not feel as good as we do others. How could we ever experience how great happiness feels if we’ve never experienced grief or sadness?

Sadness can come and go depending on the experiences we have during the day. When you’re depressed, it’s like there’s a scratch on a record being played that is constantly skipping, playing the same line of a song over and over again. Only the line of the song is negative thoughts and no matter how hard you try, you can’t turn it off.

The longer it goes, the worse the negative thoughts get, and the harder it is to turn it off.

Possibly the worst part, is that you know those thoughts are wrong, you know they’re irrational, but there’s nothing you can do about it, they just keep pounding into your head. Then, you start to believe them.

When you start believing them is when things get really tough. You start to pull away from others because those negative thoughts aren’t just a matter of a feeling of sadness, it’s a feeling of worthlessness. You start to think that no one cares, that you’re not loveable, that maybe, just maybe, you’re as worthless as the thoughts in your head.

You could be laying in bed with someone you’re totally in love with, and when they tell you they love you, you don’t really believe it because, why would they!? When you already believe the negative thoughts in your head, why would anyone else think any differently? You assume everyone else thinks the same thing.

As it persists, things continue on that downward spiral. Sometimes laying in bed just thinking “maybe the world is a better place without me,” “maybe my friends and family would find it so much easier not having me around.” And the thoughts just won’t shut off, they won’t go away.

Then some of the isolation begins. You pull away from everything social because you’re not likeable anyway right?, so why subject your loved ones to HAVING to put up with you being around. It’s such an irrational thought, your loved ones having to PUT UP with you. It makes no sense, but you just can’t help it, it makes sense to you at the moment!

One of the strange things is that it doesn’t matter how good everything else in life is going, you could literally experience the greatest highs, and still have those negative thoughts constantly spinning in your head. One of the greatest experiences of my career was travelling to Russia this year with hockey, it was a major accomplishment, but there was still a night where I had to lock myself in the bathroom to have a good cry…damn those negative thoughts!

According to Mental Health First Aid Canada, some of the outward signs of depression can have both a physical appearance and a shift in attitude. 

Some signs of a change in physical appearance can be:

• Looking sad, dejected, or anxious.
• Speaking slowly in monotones.
• Have a lack of attention to their physical appearance (look unkept).
• Slowed thinking and body movements, agitation, pacing, or unable to sit still.
• Decreased energy, tiredness, and fatigue.

With changes in attitude, a person may say things like:

• I’m a failure.
• I’ve let everyone down.
• It’s all my fault.
• I’m worthless.
• I’m so alone.
• Life is not worth living.
• No one loves me.

Take a moment and just think about what it would be like having those thoughts repeatedly playing in your head. So, yeah I can see and understand why these famous people with the “ultimate lives” can get to a point where it seems like their only option is to end it all.

Treating Depression

There has been lots of discussion about what works for treating depression, that we need to raise awareness, and we certainly need to talk about it (the main reason for me writing this post).

What I haven’t seen much on, is how does the depressed person feel about all of these things?

This article was being shared around last week about the great effects of resistance exercise in reducing depressive symptoms. While this is great (and is hopefully used as a preventative measure), when you’re going through dark bouts of depression, the last thing you want to do is exercise. Just getting out of bed can be hard enough.

Raising awareness, yes we need to do this and fortunately, mental health, in general, is becoming more recognized and talked about. However, when you’re dealing with it, the last thing you want to do is raise awareness around your mental health. There’s a lot of fear associated with it.

Again, maybe irrational thoughts, but all you can think is:

• No one would want to date someone who deals with this.
• I could get turned down for that job I’m applying for if they find out.
• People are going to look at me differently.
• I’ll get less professional opportunities if people know.
• No one would want to read a blog post I’m writing.

Talking about it, yes let’s get this going! However, it’s important to keep in mind that whether we like it or not, there is still a lot of stigma surrounding mental health (at this point). So, the depressed person may not want to talk to anyone about it, because remember, it’s also possible they think that NO ONE cares anyway.

While exercise and massage therapy are both recommended as lifestyle and alternative treatments for mild to moderate depression, anything more severe, the person should seek medical attention. This can be both medical and psychological treatment. Some of the best scientific evidence points to antidepressants, Electroconvulsive Therapy (ECT), and Cognitive Behaviour Therapy (CBT) as the best approaches for the treatment of depression.

The best thing we can do is start building relationships with medical professionals who provide the above therapies, so we can refer our patients when they need it. 

Assessing Risk Of Harm

This is one of the reasons it drives me bananas when some of our regulatory bodies say the biopsychosocial approach is out of our scope. Not only is massage therapy recommended as a treatment for depression, it’s also our responsibility to recognize and refer out should our patient need it.

How do we handle it if our patient is dealing with a mental health crisis and it gets to be too much for them?

Mental Health First Aid Canada gives four steps as crisis first aid in these situations:

1. Engage the person in a serious conversation
   • Connect in a personal way.
   • Ask if they are feeling hopeless, or engaging in risky behaviour.
   • Show sensitivity and let them describe their feelings.
   • Listen for anything that could be an invitation to talk about suicide.
2. Ask about suicide
   • Are you thinking about killing yourself, or having suicidal thoughts?
   • Asking this will not encourage suicidal thoughts, but rather it shows you care and are willing to talk with them, which can be a great relief for them.
   • Creating this conversation can identify you as a safe person to talk to.
3. Explore and assess risk
   • Ask if they have a plan in place.
     • Have they made arrangements, or have things they could use to do it?
   • Ask about prior suicidal behaviour.
     • If they do, see if they need extra support, or if there are things that helped them in the past.
   • Ask about their supports.
     • See if they have people to turn to (at this point it might be you).
4. Engage them in a plan for safety
   • Try and make sure they don’t have access to the means of killing themselves.
   • Develop a safety plan for a manageable period of time along with emergency or crisis line information.
   • Try to ensure no access to drugs/alcohol.
   • Listen to them.
   • Refer them to appropriate professional help.
   • Connect them with their support resources (and try not to leave them alone).
   • If necessary call 9-1-1.
   • Ensure your own safety.

While I hope this is something you never have to deal with, it’s an important conversation to have, as it could quite literally save one of your patients (or loved ones) lives.

While this is just a blog post, it should not be used as a substitute for more education about mental health, or suicide. I would encourage anyone reading this (healthcare professional or not) to take a mental health first aid course to better equip you to handle these situations should you ever need it. 

Whenever a famous person succumbs to mental health issues and takes their own life, it raises lots of awareness online. Along with that is discussions and opinions about the act of suicide itself. People make statements like: “it’s a selfish act,” and “why couldn’t they think about the ones they left behind?” While those things are all valid statements, as the ones left behind are left with nothing but hurt, and questions about how they didn’t see it coming, or just disbelief that it could ever happen. It may seem like a selfish act, but as we talked about earlier in the post, the person doesn’t believe that anyone cares, loves them, or that there is any other way out. From my own experiences, I’m not concerned about whether the person was selfish, it’s more sadness that whatever was going on in life was so bad, that the only thing they thought would fix it, was to end it all. So please, if you have any concern surrounding this with one of your patients, assist them to get the help they need.