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While mental health challenges affect people from every demographic, cultural factors, economic factors, and access to mental health care often play a large role in the burden these challenges put on individuals and communities.

Rural places in particular, face significant mental health care shortages, even in spite of efforts like the recent expansion of the U.S. mental health hotline. These shortages only exacerbate problems like the increased risk of suicide among aging farmers, and the greater instance of rural LGBTQ adults dealing with depression, anxiety, and fewer treatment options.

Against this backdrop, rural West Virginia author Kathleen M. Jacobs shares about her own struggle with depression.


My earliest memory of deep depression was an episode that came without warning, without any specific incident, and with a sense that something was happening to me. Something that I could not define, but was certain that if I simply talked to myself and found a way to reason with, it would move along, much like a very dark cloud after a storm. 

I, of course, was wrong. And once I found the courage to tell to my physician about the episode, he explained: “This is not something you can simply talk yourself out of, Kathy.” His tone was not condescending. It was a declaration without a shred of doubt. And I believed him. As time passed and more episodes found me (although I tried very hard to hide from their clutches) that declaration made all the difference.

Sometimes I still wonder at my naiveté at the time, and at the naiveté of my community. In my experience, statements that serve no purpose in restoring one’s health, while well-meaning, can do just the opposite. “Mind over matter.” “Just shrug it off and move on.” “Don’t think about it.” “Reading a good book will help.” “Remind yourself that it could be much worse.” “Oh, it’s just a moment; it will pass.” “Do something to take your mind off of your problems.” After these words are repeated, they often become yet another hurdle that we, those who suffer from depression, must jump.  And this additional jumping becomes so effortful that we find ourselves withdrawing to an even greater degree in order to avoid hearing these sorts of, likely, well-meant words. 

Whenever I found myself listening to these phrases and wondering if there might be something to them, I would think of my doctor’s advice, “This is not something you can simply talk yourself out of, Kathy.” Those words became powerful ones; the ones that returned me to a center that was not often easy to find.

A few years ago, my parish priest (who was well aware of my depression) asked me to join him in presenting a program on depression, offered by members of the medical profession, throughout our rural, Appalachian area. 

He, of course, knew of so many who were grappling with depression. And I knew that the only way to gather folks together would be for one of us to come forth with our story. I took a deep breath and agreed to help in any way that would enable others to share their stories, too. I was saddened then and remain saddened still that not a single person attended the event. No one even spoke of the event, sporting only the smiles they were so used to wearing through the pain.

One of the first books I recall reading about depression was by a writer whose work I very much admired — one I had met at a presentation at the Cultural Center in my hometown of Charleston, West Virginia — a man named William Styron. 

The most revealing part of the evening was when he talked about a period in his life when the clutches of depression held him so tight that he wasn’t sure he would survive the intensity. He wrote about this experience in his powerful work, Darkness Visible: A Memoir of Madness (1989). As he explained his experiences, one sentence resounded, referencing that moment when we find ourselves breaking through the depression: “. . . whoever has been restored to health has almost always been restored to the capacity for serenity and joy, and this may be indemnity enough for having endured the despair beyond despair.” 

While that evening was undoubtedly memorable for each of us in attendance in different ways, what we shared was an open invitation to talk about depression. And talking about it became the welcome mat to take it one step further and find a way — any way — to make certain that we were each heard loud and clear, knowing that, in fact, depression wasn’t something we could simply talk our way out of.

It’s worth noting that of all of Styron’s literary masterpieces; it is this memoir of his descent into depression and the gift of recovery that is considered one of his most influential writings. That should bring some measure of hope that we can all enjoy the invitation to openly discuss our mental health without fear of condescension and shame. Depression and its cycles are more than enough to deal with and recover from without anything else getting in the way. 

Instead, let’s forge a new path with words like, “What can I do to help you,” instead of the tired clichés that do not deserve one more mention. And if we can do that, Styron’s ending words might just ring a little clearer: “And so we came forth, and once again beheld the stars.”


Kathleen M. Jacobs lives in Charleston, West Virginia, and writes books for young readers.  She can be reached at www.kathleenmjacobs.com.

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