Armchair diagnostics

Fidelito, Raúl, Fidel

Any suicide is an intensely sorrowful affair, and somehow the search for explanations is accepted as a natural response, but perhaps it’s worth thinking of it as an outdated habit overdue for correction.

For instance, in the case of the untimely death of Fidel Castro’s eldest son, Fidel Angel Castro Diaz-Balart (Fidelito), we might start with some recognition of how depression really functions, rather than banal armchair analysis of the pressures he faced as the son of a larger than life father, or the product of a bitter divorce, or why his death did not make the front page of Granma, the Cuban newspaper of record.

It was openly and calmly reported here that when he took his own life, the much loved Fidelito was undergoing treatment for depression. Whether the depression was clinical or situational, or a combination of the two is something only his doctors could diagnose. Naturally there’s no shortage of loose tongues primed to whisper or offer opinions – partially or totally uniformed – about the method he chose or his reasons, but in the absence of access to Fidelito’s medical chart, a more thoughtful approach would be to consider the consequences of misunderstanding depression and learn to offer better support to those who suffer from it.

Situational depression is a response to difficult or unpleasant circumstances, and usually lifts when the situation improves. Clinical depression is the kind that settles over a person’s life like an acidic grey fog that corrodes a person’s behavior and perspective. It can be set in motion by a difficult situation, or not. It can be hereditary, or not. Its effects are unmistakable though. It murmurs a tale of failure, indecision, worthlessness and mental paralysis, on an endless loop in the depressed person’s mind. Once this is understood, it’s easier to comprehend how an incredibly accomplished nuclear physicist could perceive himself as worthless and expendable.

It might help to see depression the same way we see diabetes, or arthritis. It would be ludicrous to suggest to the diabetic or arthritic that they heal themselves by trying to behave like people who don’t have those illnesses. We would never suggest that insulin or pain relievers are unnecessary for treating those conditions, or that perhaps by considering those in much worse shape, quadriplegics say, or torture victims, the diabetes or arthritis will be seen to be minor and therefore conquerable complaints. Mind over matter.

For the clinically depressed person, these kinds of suggestions are toxic. The last thing a person who is enduring mental anguish and self-recrimination needs to hear is that their situation is self-created and a bit more intellectual analysis and self-control would lift them out of their despair. The depressed person may actually agree, and even have performed the same self-analysis, but because the method has not worked, this advice only confirms the sense of failure and the downward spiral. Understanding depression as the real illness it is, should encourage a different approach: love, concern, or a gentle offer of assistance in finding medical professionals skilled at treating the illness would all be good places to start.

In Cuba of course, there are additional challenges in the treatment of depression. One is that the poor economy, for which the United States bears the lion’s share of responsibility, limits the country’s ability to obtain the raw materials to manufacture affordable generic anti-depressants. So the pharmacological toolbox is limited. Generic Zoloft and Prozac are easy enough to obtain, but after that the list grows somewhat sparse.

As for psychiatrists and psychologists, Cuba’s like any other place – some are better, some worse, but the right to treatment regardless of ability to pay is guaranteed. Self-medication is an issue, and there are ongoing public education efforts to address it, but it’s not coincidental that there’s no such thing in Cuba as an opioid epidemic, despite the abundant triggers here for situational depression.

It is offensive though, to suggest that being Cuban is reason enough. Reporting for the BBC about the tragic event, Will Grant claimed that suicide is still “taboo” here and “more common than generally reported.” Really? How does he know? Based on which statistics? Ann Louise Bardach has also suggested that suicide is embedded in Cuban society, quoting Louis A. Pérez Jr. to say that “long ago, it ‘passed from the unthinkable to the unremarkable.’” So which is it? A shameful subject or a commonplace one?

I can only speak for what I have observed. Cubans who cared about Fidelito were enormously saddened by his loss. His suicide was not covered up, nor was it glorified. It certainly was not sensationalized. This was incomprehensible to those who persist in viewing Cuba through their own lens, seeing the Castros as a dynasty comparable to the Kennedys (Clintons, Bushes, etc.); one that rules Cuba as a personal fiefdom. It’s not like that. Fidelito was never groomed like a young Kennedy in waiting – he had the freedom to decide his own career and it’s laughable to suggest that he was ever expected to follow in his father’s footsteps, or that his depression sourced from the impossibility of doing so.

He was simply not well. If there is any sense to be found in this tragic event, it is there. Period. Not in motives invented or imagined. We can do so much better, and it’s long past time that we try.