Sat | Nov 28, 2020

Michael Abrahams | The many faces of depression

Published:Monday | October 19, 2020 | 7:24 AM

She has a pretty face. No, make that beautiful, with a curvaceous sexy body to complement it. As for her smile, it can light up a room. Indeed, the occupants of any room she enters will find it an arduous task to ignore her. Women will envy her, and men will want to be with her. Yes, she is that type of woman.

It was about 2 a.m. and my phone rang. I looked at the screen and saw her name and immediately answered. “I can’t do this any more” she said. “I want to die.” Her depression had spiralled out of control, and suicidal thoughts had once again come to the fore. I spent about an hour on the phone with her, listening to her, reasoning with her, reassuring her and successfully convincing her to get help. A history of severe childhood neglect and abuse had left her terribly scarred, affecting her self-confidence and self-worth, ultimately leading to severe, unrelenting, and crippling depression. She had attempted suicide before, and was obviously unsuccessful, and I knew her call was not merely attention-seeking behaviour, but a genuine cry for help.

Depression, like other mental health issues, has many faces. Many of us think people living with depression are these folks walking around teary-eyed with long, sad faces. And many of them do. For example, I recall an incident several years ago, when a woman called my office for an appointment because she had symptoms of a bladder infection. When it was time for me to see her, and she appeared at my door, I took one look at her face and sensed that something was dreadfully wrong, and it was not the urinary tract infection that she was seeking help for. As a matter of fact, her pelvic issue was the least of her problems. Her energy was palpable, and I could sense that memories of decades of pain and hurt were packed densely in her mind, to the point where she was not really living her life, but merely existing in survival mode.

Can of worms

Before even enquiring about her presenting complaint, I simply asked her about her childhood, and in doing so opened a can of worms. Being raped at the age of 8 and experiencing other forms of childhood abuse had led to her being clinically depressed. She had been living with depression for nearly all of her life, even becoming suicidal at times, but the condition had not been diagnosed or addressed until her conversation with me. By the end of the week, she was in therapy.

Depression is way more common than many of us realise. We are surrounded by people living with it and may have it ourselves and not even know. It affects people with different personalities and life circumstances, with varying levels of resilience and coping strategies. People living with depression can paradoxically be quite jovial. Smiles and laughter can easily deceive you. Some of the most loved entertainers, including comedians, actors and musicians, who ironically lift our moods, live with depression. Some even succumb to the sequelae of fighting the disorder, such as drug addiction and overdosing or suicide.

And it is not just about the appearance of being happy or sad. Sometimes when we observe anger, unreliability, slovenly appearance, or asocial behaviour in some of our brothers and sisters, these traits may be manifestations of depression.

From the successful and high achieving to those who have allowed life and opportunities to pass them by because of their inertia and demotivation. From the immaculately dressed to the bedraggled. From the magnetic motivational speaker to the audience member who wishes they had it all together like the person on the stage. Depression has many faces, but people living with it have one thing in common: a mood disorder that can take them careening down a dark and abysmal hole.

You cannot reliably look on someone and know if they have hypertension, diabetes, or many other chronic disorders. Similarly, it is hard to do it with depression also. If you know people living with depression, do not dismiss or trivialise their diagnosis. Do not be misled by smiles or laughter. Many are well controlled and have a good quality of life. But not everyone is that fortunate. Be aware of the signs of worsening depression such as becoming more reclusive and withdrawn, and if you see them, reach out.

Michael Abrahams is an obstetrician and gynaecologist, social commentator, and human-rights advocate. Email feedback to and, or tweet @mikeyabrahams.