As a research scientist, I am asked what The Tell tale Signs of Depression and Suicide are and befuddled, I say the usual, “search the web”! Since, I deal with diverse populations, many of the top search engines, especially health websites, are NOT always people of color’s “BFF’s”. When explaining to diverse groups about the symptoms of depression and suicide, plenty of “yes, buts” or “what ifs” come to mind that countermand adherence to medical directives. These actions still occur even when a Nobel Laureate physician wrote the major symptom section for the DSM-IV revised!
I have personally witnessed on numerous diverse social media websites the grossly inaccurate information posted on them. I myself have been subject to ridicule and harassment. As a result, I am relaying and translating the societal and cultural nuances so that diverse laypeople all understand the key symptoms of depression and suicide. I am translating these symptoms for the African American community because I am African American and many people have come to me wondering if there is a way to identify these symptoms. Disturbingly, they may have lost a loved one to suicide and they wonder if there was anything more they could do to stop it. While reviewing top health websites for depression symptoms, I found there was a lack of cultural competency in explaining these symptoms. While it is clear that not ALL of these symptoms are seen in every case of depression or suicide, the key symptoms outlined in major online health websites do NOT translate with “any culturally nuanced depression symptoms”.
At this time, I will not be listing what to do on how to manage these symptoms. I organized this “Translation Navigator” so that everyone is “on the same page”. I mean no disrespect to those who understand this information, but seriously, looking at the mental health disparities, something MUST be done for the lack of cultural competence described in my symptom review. Anyone using this information is for entertainment purposes only and cannot be used as a diagnostic. Moreover, it can complement a professionally licensed health care provider’s directive, but it does not supplant or supersede any treatment plan by a licensed provider. Nor does it counteract against the written referenced material.
Culturally Competent Telltale Signs for Depression in the African Americans
- The inability to concentrate often resembles forgetfulness This symptom occurs almost everyday and people who are depressed often forget important tasks, like missing due dates for bills, or forgetting to call key people like doctors. It is not the casual forgetfulness of losing keys or dementia like getting lost, or even Alzheimer’s, which is VERY different! This forgetfulness is after a profound conversation/argument with the depressed person, and he or she STILL forgets to pay the cable bill!
- Being fatigued or decreased energy If the depressed person goes to church Sunday at 11:00 AM, and then stops suddenly, to which s/he complains of fatigue or “I’m tired”, when they did nothing physically strenuous, then it is probably a state of depression. It is the dramatic shift in routine over a month.
- Feelings of guilt, worthlessness and/or helplessness These symptoms lack articulation by diverse depressed individuals. Moreover men do not discuss their feelings freely. If men say anything, it resembles blame on any perceivable target-usually the caregiver! Depressed women complain, whine, and then blame. Shortly, I will explain later how that resembles in diverse communities.
- Hopelessness and/or pessimism Depressed individuals often have “sarcastic commentary” that teenagers are more than happy to provide whenever anybody makes comments. For example, when the caregiver says, “Let’s go to the Beach, it is a nice sunny day!”, a depressed individual would retort, “Why? To get burned by the sun!!!”
- Insomnia or excessive sleeping: I have not noticed diverse depressed individuals to be unable to sleep unless they have an anxiety/PTSD or a mania, but I have seen sleeping all day for several days without being sick, or having that dark room, because light hurts. Depressed individuals often choose that darkened room during a sunny day rather than enjoying the outdoors–an active choice that is made.
- Irritability or restlessness: Irritability often looks like whining and snapping at whatever is said. A caregiver could just say “BOO” and the depressed person combined with the feeling of guilt would bite the caregiver’s head off for saying it. The restlessness is often combined with the forgetfulness. Watch when they cook. Request the depressed person to make lemonade from powder and they will get flustered by making a simple recipe. And remember, the behavior is not random; it is consistent over a month or two.
- Lost of interest in activities once pleasurable, includes sex: This symptom is combined with the forgetfulness, fatigue, guilt, pessimism and excessive sleepiness symptoms. It could be any activity that the depressed person enjoys often as a tradition or ritual, and for some unknown reasons it is suddenly dropped! An example is, with the “holidays approaching” the depressed loved one for no reason, refuses to participate in an activity once thoroughly enjoyed. It is not because they have a new life situation, but the excuse is that they do not want to do it and are likely to berate it. Remember, the behavior is consistent over a few weeks and is not completely random!
- Changes in eating behavior: What a depressed individual does is over eat a lot of carbohydrates (pasta, sugars, etc.): breads, cakes, chocolates, candies and soda pops! Apparently, the medical aspects of depression feeds off of glucose in the brain, the full mechanism is unknown. Moreover, the meal is one time of day–all day and does not stop until sleep! Alternatively, what a depressed person looks like when his/her appetite is lost, they have failed to shop for grocery and basically all that is left is something indistinguishable, often the depressed person is living off of something bizarre like gum or rationalizes vitamin supplements as nutrition. Most of the symptoms mesh with each other, so this one is combined with forgetfulness, inability to make decisions, helplessness and hopelessness. Moreover starvation through dieting can cause the insomnia…
- Persistent malaise: A depressed person complains all the time about physical issues and when he or she chooses to see a primary care physician, only the immediate aches and pains are treated with drugs rather than the psychotropic medications due to health treatment limitations and standards of care. Meaning, if there is no adherence to these drugs, why force the patient to take them? Laboratory tests and manifestations cannot convince the depressed person of his/her ailment is depression. Remember this is another symptom that meshes itself with other symptoms, so if this one symptom is seen, then it is likely that others will be seen…
- Persistent negative thoughts: A depressed person says as a complaint or whine that “nobody likes them” or any absolute statements: NEVER, ALWAYS, and NOBODY. Often seen as a judgment with accusations: i.e. “You should’s” and “You must’s” and “everybody’s”. The empty feelings look like a comatose person-especially when asked a simple question like “How are you doing today”? The depressed person will respond with a shrug or say “I don’t know” on a consistent basis. Remember, this type of symptom is meshed with the other ones. This symptom is a “trigger” symptom or a “red flag” symptom, meaning when you start hearing them frequently, more than 3 times overall, this is the time when the caregiver’s antenna needs to be raised and attempt to get professional, licensed help!!!
- Thoughts of suicide: I cannot emphasize this statement any stronger: when this comment is made, it needs to be taken seriously! Whether or not there is a plan: DO NOT TAKE THIS COMMENT LIGHTLY! DO NOT DISCOUNT IT! By the time, the depressed person vocalizes it, they have actually intensely rationalized it and have given serious thoughts about it, and now they are beginning to venture out on how to get help with it! PLEASE DO NOT TRY TO UNDERSTAND THIS SYMPTOM OR TALK THEM OUT OF IT! PLEASE GET THEM TO PSYCHIATRIC CARE!!! This key symptom is the neurophysiological course of the depression disease. Literally, the brain is damaging itself due to the aforementioned symptoms. It is thought that all the symptoms meshed together overload the system and crashes the “logic centers” of the brain–somewhat like a computer hard drive crashing. In this case, the other organs actually attempt to save the body at the same time: such as the heart, the muscles, the stomach, the liver and the kidneys, plus many more. The organs try to override this “cerebral self-destruct” button. Remember, this behavior is not always night and day, or random, but it does not lessen the impact, therefore this behavior should be observed closely.
So please permit me to use some creative license and combine some of the warning signs to suicide that I have translated into a culturally competent text from major online health websites:
There are some key symptoms that caregivers MUST watch and be vigilant with for someone suffering from depression, especially as it relates to suicide! I cannot stress enough the fact that a depressed individual is NOT about him/her being crazy or funny, but about him/her suffering from a major medical neurophysiological disease like any other illness where professionally licensed care and treatment is required. Moreover, these are the telltale signs: These are the signs used when one does NOT want to say “if I could have done anything differently…” The way to think about this is the splinter in the tiger. The tiger by itself is a man eating animal, but when there is a splinter in the paw, the tiger writhes in pain and while you might think “it is not a big deal”, because it is a man-eating tiger and usually it will kill itself or gnaw off its paw to minimize the pain. If someone removes the splinter, it is believed that the tiger is grateful and remembers that person always. Loving a depressed individual, like that splintered tiger, is perilous and as a caregiver it takes a team to support that individual, and a licensed provider must be consulted. Unfortunately, hospitalization cannot be enforced upon any unwilling mentally ill person who has not committed a crime or threat. However, a caregiver can learn about the basic suicide symptoms described below:
- Suddenly switching from very sad (depressed) to calm/appearing happy or tranquil: While obviously stated, this symptom often presents a look as if the depressed person has found “resolution” to his/her problem. Unfortunately it is committing suicide… Like a wrong answer game show buzzer–EHHHN–this inaccurate conclusion erroneously looks calm in the suicidal ideation depressed individual. One way to confirm one’s thoughts are to ASK what his/her wants are. This is a question of autonomy, because it determines if a definitive decision has been made. If they have a formal plan with times and dates, get professionally licensed help immediately or call 9-1-1!
- Always talking and writing about death: Listed as dressing in “Gothic paraphernalia”, like always wearing black (somewhat like a vampire)… seriously, this is probably the most egregious example of culturally incompetence I have seen in regards to understanding suicidal ideation and symptoms. To make this symptom culturally competent for African Americans, this often resembles when young people attempt to look like or live like “gangsters” or “thugs”, with the guns, paraphernalia, and listening to “profane gangster rap” or “thuggish” music and actually believing the lyrics are real. The discussion looks like dark and dreary kinds of lifestyle, such as robbing people, misogyny, prostitution, and prison life, etc. This symptom meshes with another symptom as described later.
- Having a “death wish”–taking unnecessary risks: such as running red lights… This symptom is another egregious example of missing the social determinants of health and the mental health disparity in diverse communities. In the African American community, especially for young men, running red lights is deadly in the United States, so that would not be something we would see often. The risk factors taken would probably be carrying a gun into a club as to protect oneself as an “unnecessary risk”. The death wishes we have is getting involved in very dangerous activities known to ruin one’s life and are self-destructive–which leads us to our next symptom
- Substance abuse: Alcohol is a depressant, and some illegal substances, like marijuana and methamphetamine make irrational thoughts worse. Many people in our community abuse substances to self-medicate for their depression. It is a self-destructive habit. This is probably one of the single elements that is seen more in the African American community than others. The symptom looks over and beyond the normal consumption of these substances–a functional alcoholic or smoker, etc. Substance abuse treatment differs from depression treatment, while the two are intertwined inexplicably, first the addiction is treated than the mental health issue. More often than not, most substance abusers RARELY get treated for their mental health issues.
- Acting impulsively: Acting impulsively is doing something without thinking about it and letting the chips fall where they land–meaning if the depressed person dies, that will be where the chips land… The depression symptoms are meshed with this suicide warning sign, such as guilt and hopelessness. It is reckless. One possibility is once they get that gun, what more will they do–such as robbery, going along with the violent crowd, rioting, killing people. The mentality is the suicidal person possessing this erroneously thing that they have to see the end of this bad course of action.
- Poor performance in school and work: Young people often have failing grades and it is known that they can perform the work. For adults, it accounts for massive sick days and absenteeism from work, a lack of follow through on projects and missed deadlines. There may be some hostilities between the depressed loved one and co-workers. The depression symptoms seem meshed with this suicide warning sign and a lack of concentration, fatigue and excessive sleeping. There may be others.
- Putting affairs in order, tying up loose ends, writing/changing a will, giving away prized possessions: So many depressed African Americans feel they do not have anything, so changing wills is an infrequent occurrence. This suicide warning sign resembles vandalism or destruction of property. The depressed person’s thinking is “Since I have nothing to lose (hopelessness) and everyone thinks I am worthless (guilt, worthlessness), I will vandalize this property by graffiti or I will destroy this property by stealing/thievery of key items”. What makes this illogical thinking occur in a depressed person is putting the affairs in order or tying up loose ends. This suicidal warning sign shows the welcomed risk of arrest! As usual, this symptom travels with other depression symptoms as well as other suicidal warning signs like substance abuse or a death wish.
- Feeling strong anger or rage: It has been told to me that depression is anger turned in on one’s self. The anger people have is due to unresolved hurts and pains or experiencing what is perceived as a traumatic event. Some people casually say, “This is what is called life, deal with it”! Saying this statement to a depressed person is an abusive, insensitive, destructive and harmful comment, because it will tip them over from thinking about suicide to actually committing suicide. The heartless comment often is misconstrued by a depressed person who is already having inaccurate absolute conclusions and this comment causes the person who cannot articulate in his/her feelings to verify his/her self-worth through the “depression and suicidal lenses”. What is seen is either the first suicidal warning sign of “listlessness” or “empty” feelings or an anger/rage unloading, often with crying. What causes this anger? I have a blog on anger as it is written from my bipolar POV at Crazy Black Woman
Remember, it should be noted that some people who commit suicide do not show ANY warning signs. So, loved ones may still feel, “I knew he or she was crazy, but…” And if caregiver’s actively see these symptoms and want to help him/her, judgment does not help them either! What is optimal is professionally licensed care and treatment! A few pastors have qualifications for mental health care treatment. If a pastor says that ONLY prayer or telling one to just be saved cures mental health, that is HOLY UNETHICAL!
Many professionally licensed providers lack cultural sensitivity and could look “crazy” to you! Finding what works for you is a personal choice. The key is to ask MANY DIRECT QUESTIONS, learn to navigate the mental health care system, and implement mental health and wellness goals!
Dr. Gina L. Moore-Sanders holds a PhD in molecular genetics and has published 5 papers in cardiovascular, diabetes and aging disorders. She is an African American woman who has had the plight of unconscionable culturally incompetent mental health care system, and through a series of graded steps, found her recovery, survived and thrived! Dr. Moore-Sanders loves her new life and now wants to share it with you through her training as a Health and Wellness Coach. She resides in the Pacific Northwest with her husband; who is a veterinarian.