This is going to be so embarrassing, I thought, and braced myself as I walked toward my doctor’s reception desk. I imagined the expression I’d get from the nurse at the desk once I opened my mouth — a mixture of disbelief and annoyance. But I had to know the answer to a question that hadn’t left me alone since my last visit: Am I depressed at work?
When I arrived for my previous visit, a routine physical, the nurse at the reception desk handed me a clipboard with a questionnaire attached. “Fill this out, please,” she said. “You can go ahead and take a seat. We’ll call you when we’re ready.”
The instructions for the questionnaire read, ‘Over the last two weeks, mark how often you have been bothered by the following,’ and the first scenario read, ‘Little interest or pleasure in doing things,’ followed by ‘Feeling down, depressed, or hopeless’. I looked up at the nurses behind the desk, and glanced around the waiting room at the other patients. I don’t appear depressed, I thought, and I haven’t said anything to anyone about how I’ve been feeling. Why is my doctor giving me this questionnaire now? Is the universe that much of a well-meaning busybody?
I read the title at the top of the questionnaire: ‘PHQ-9 Scoring Tally Sheet’, which meant nothing to me at the time. I read through the nine scenarios and marked “0, Not at all,” as my answer for each. The final instruction read, ‘Mark how difficult these problems have made it for you to do your work’ to which I wondered, how am I supposed to react when terrible things, like a divorce or a mom with breast cancer, happen? Aren’t I supposed to have a ‘poor appetite,’ or ‘trouble concentrating’? Where’s the line between reacting to awful situations, and depression?
Have the Courage to Be Curious
I handed my row of “0, Not at all” answers and the clipboard to the nurse who showed me to the exam room. Even if I was depressed, I didn’t want to join the ranks of the 17.3 million U.S. adults who, in 2017, experienced depression, and I didn’t want my doctor to recommend that I become another of the one in nine Americans who took antidepressant medication. For me, a depression diagnosis was too scary, and medication presented too much risk to my wellbeing.
The questionnaire’s scenarios wouldn’t leave me alone though, like the one that read, ‘speaking so slowly that other people could have noticed,’ or ‘being restless, or moving around more than usual’. The questionnaire intended for me to evaluate my behavior in a two-week timeframe, on a 0-to-5 scale of frequency. The prior week had been a good one, but if I considered my behavior two weeks or more in the past, my “Not at all” answers appeared less than truthful.
In the previous two years, there were times at work when I stammered, or couldn’t find the right words to express my thoughts (odd happenings for me), or my words emerged too fast or too low to be understood. Some days I didn’t want to talk or interact with my co-workers at all, and every interaction drained what little energy I felt I had to spare. There were times when I couldn’t sit still, and though I was tired at the end of a workday, I didn’t want to stop checking things off my to-do list and take the time to get a good night’s sleep. As a result, getting out of bed on workday-mornings was a challenge. The more I thought about the questionnaire in the weeks after I left my doctor’s office, the more I felt I needed to get my hands on it again.
At my next visit, I saved my request until after my appointment and just before I left. The nurse raised and then furrowed her eyebrows, and said in an incredulous tone, “You want to see that questionnaire… again?” I nodded and smiled, while thinking, I guess I’m the first to ever ask this question. The nurse leaned across the reception desk, pulled a paper from a tray, and handed it over. “This one?” I nodded again, said thank you, and hurried out.
Where Honest Introspection Can Lead
This time when I looked at the questionnaire I noticed that Pfizer, the pharmaceutical giant, owned the copyright. I then discovered, in my research, that the doctors who developed the questionnaire were enabled by a grant from Pfizer. That being said, when I found the questionnaire paired with clinicians’ instructions for its use on stanford.edu, I felt better about its validity. This time, I filled out the questionnaire with a more self-aware and honest approach. On completion, I thought, Okay… I may be experiencing mild depression likely caused by ‘normal bereavement’. Now what?
If there is anything good about the prevalence of depression and antidepressant use in America, it is the growing number of people who are comfortable with talking about their experiences. Thanks to those who are brave enough to step forward and start conversations about depression, I know I’m not alone. However, I still find it difficult to admit to anyone that I may be depressed. When the familiar tidal wave of hopelessness approaches, I lean on my newfound self-awareness — I now know what the wave is, where it comes from, and that it will pass.
To combat the feeling further, I concentrate on what helps, like exercise, sunlight on my skin, and quality time with my family. Also, I benefit from practicing (and believe me, it takes a lot of practice), self-acceptance. When I feel overwhelmed, I also concentrate on the present moment — what’s real about what I see and hear around me. Often, untrue thoughts about the past and future fuel my dark mood. I’m learning to let those thoughts go, and just be.
Now when I experience the signs of depression at work, I know I need a break — to get outside, to breathe, and to walk. I accept the experience, but I reject that it defines me. I am better today than I was yesterday, and much better than a year ago. There will be bad days, but those days will become less common.
Unforeseen Benefits and Lessons Learned
An unforeseen benefit of my self-compassion is my new ability to recognize when others are having a bad day, and to avoid drawing conclusions about someone based on their temporary behavior. I now realize that we all struggle with our personal reactions to life’s terrible things, and that it is impossible to keep our struggles outside of work. For those of us who are affected more than others, I believe that we shouldn’t be embarrassed to admit it, especially to ourselves.
The hardest part about stepping up to my doctor’s reception desk was the decision to do so. After that, it was just a matter of putting one foot in front of the other. After all, to be left suffering from depression and unaware of the signs at home and at work, is itself a terrible thing. What I learned is that though I may not be able to completely control my reactions, I can nurture my curiosity about them, and benefit from practicing self-acceptance. I suspect that’s what the well-meaning busybody universe intended.