Why this photo of Meghan Markle sends a powerful message about what mental health looks like

LONDON, ENGLAND - JANUARY 16: Prince Harry, Duke of Sussex and Meghan, Duchess of Sussex attend the Cirque du Soleil Premiere Of 'TOTEM' at Royal Albert Hall on January 16, 2019 in London, England. (Photo by Paul Grover - WPA Pool/Getty Images)
Prince Harry, Duke of Sussex and Meghan, Duchess of Sussex attend a performance at Royal Albert Hall on January 16, 2019 in London, England. (Photo: Paul Grover - WPA Pool/Getty Images) (WPA Pool via Getty Images)

When Meghan Markle attended a royal event in January 2019, the world gushed over the pregnant Duchess's sequin dress, impeccable makeup and warm smile. But to Markle, the truth of that moment was different than the story photos told.

The morning of the event, Markle told Prince Harry that she was struggling with suicidal ideation, as she revealed to Oprah Winfrey during Sunday's bombshell interview. While her husband persuaded her not to attend the performance at Royal Albert Hall, Markle recalled she told him, "I can't be left alone."

Markle said that if you zoom in on pictures, you can see how tightly the couple's holding hands. "You can see the whites of our knuckles because we are smiling and doing our job, but we're both just trying to hold on," she admitted. "And every time that those lights went down in that royal box, I was just weeping, and he was gripping my hand."

The images are a lesson, Markle said. "You have no idea what's going on for someone behind closed doors," she noted. "Even the people that smile the biggest smiles and shine the brightest lights, it seems, to have compassion for what's actually potentially going on."

To the outside world, Markle didn’t appear to be depressed or suicidal, and yet, her mental health was deteriorating at a dangerous rate behind the scenes. Thus, this begs the question: What does struggling with depression really look like?

For insight on the matter, Yahoo tapped two experts, including New York City-based neurologist, Dr. Sanam Hafeez, and licensed psychologist and executive director of Whole Health Psychological Center, Dr. Rachel Needle to understand how you can tell if someone is struggling with their mental health — plus, how to help them.

Signs that someone is struggling

“Not every person suffering from depression presents their symptoms to the public,” says Dr. Hafeez matter-of-factly. “Some people keep their depression hidden so it’s difficult for others to tell that anything is wrong, such as when Meghan Markle attended a [royal event] a few hours after she told her husband she needed medical treatment for her mental health. No one would have known that Markle was contemplating suicide as she looked beautiful and put together in a blue sequin gown.”

LONDON, ENGLAND - JANUARY 16: Prince Harry, Duke of Sussex and Meghan, Duchess of Sussex attend the Cirque du Soleil Premiere Of 'TOTEM' at Royal Albert Hall on January 16, 2019 in London, England. (Photo by Paul Grover - WPA Pool/Getty Images)
The Duke and Duchess of Sussex holding hands. (Photo: Getty Images) (WPA Pool via Getty Images)

Because depression can be difficult to spot, especially in those that conceal it well, Dr. Needle recommends keeping an eye out for any and all changes in someone’s routine or behavior, as even seemingly small things — like sleep habits — can be indicative of someone’s mental health. “Specifically look for changes in energy, behavior, sleep habits, eating habits, sex drive, thinking, mood and even personality,” says Dr. Needle. “Many can put on a happy face and even be OK while in public, but that doesn’t mean they’re not suffering or struggling internally.”

Dr. Hafeez points out that depression doesn’t discriminate based on financial status, or someone’s occupation, which is relevant in Markle’s case. “It doesn’t matter if a person lives in a castle or makes millions of dollars a year,” she says. “Mental health struggles can present themselves in those with seemingly ‘perfect’ lives, which is why the stigma against mental health is such an issue in today’s society.” She adds that many people believe that those with comfortable lives shouldn’t be battling depression or other mental health issues and that this is why so many folks tend to hide their feelings until it escalates to a perilous level.

“If you believe a loved one may be struggling with mental health, it is advised to keep a close eye on them,” says Dr. Hafeez, who mirrors Dr. Needles’s sentiments above. “Watch their daily life to see if anything seems out of the ordinary, like if your loved one is usually is an early bird, but now sleeps until noon, it may be worthwhile to ask if something is bothering them. If they’re more irritable or have weight fluctuations, those could be signs as well.”

Dr. Hafeez notes that you should never take their first answer as their only answer. “Continue to ask if you can help them and reiterate that you are here as a support system.”

Indicators of suicidal ideation

Depression can certainly be managed through medication and other means of support, but for some people — including those without a family history of depression — it can cause suicidal thoughts. Dr. Needle stresses the importance of recognizing warning signs as this is the main way to get someone the help they need. “Warning signs include someone talking about suicide, social isolation, giving away prized possessions, changes in behavior, appearance, personality, sleep or eating habits, feelings of hopelessness, talk of being trapped and talking about dying or statements like 'It would be better if I wasn't here.’”

It’s also crucial to identify risk factors, which, according to Dr. Needle, are characteristics that can lead a person to engage in suicidal behaviors. “In addition to depression, other risk factors include past suicide attempts, isolation, family history of suicide, chronic illness, depression, prolonged stress, impulsivity, harassment or bullying, stressful life events, or access to lethal means,” she details. “One symptom alone is not indicative of depression or possible suicidality, however, educate yourself and do not ignore the warning signs.”

How to help someone with depression

First and foremost, you can help a loved one with depression simply by not ignoring the aforementioned signs. If you notice any changes in their behavior, ask them about it — more than once! — and make sure they know you support them. As both experts explain, we need to normalize talking about mental health so that more people feel comfortable asking for help.

“We must educate ourselves about mental illness and talk about it openly,” says Dr. Needle. “Being conscious of the language you use can also make a big difference as it is incredibly hurtful and offensive when people use words such as ‘crazy.’ The impact your words can have on those struggling especially.”

Above all, if someone does tell you that they’re struggling, believe them, support them, and help them find a mental health professional or access to appropriate resources. “In more than 95 percent of the country you can dial 211 for resources, or contact the National Suicide Hotline if you are struggling,” says Dr. Needle.

If you or someone you know are experiencing suicidal thoughts, call 911, or call the National Suicide Prevention Lifeline at 1-800-273-8255 or text HOME to the Crisis Text Line at 741741.

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