- Mood: Melancholy, Warm
- Theme: Smiles, Looking to the Future, Dealing with Difficulties
- Tempo: Moderate
- Genre: Ballad
May is Mental Health Month, and today people all over the country are blogging about mental health issues today. (You can read more and see a list of other posts on the topic here.) For my part, I am focusing on mental health issues among older adults.
First, a few statistics. According to the CDC, approximately 20% of people age 55 and older experience some type of mental health concern. Depression is the most common mental health problem among older adults. Depression causes emotional distress, of course, but it can also lead to impairments in physical, mental and social functioning, and it complicates the treatment of other chronic conditions. Older adults with depression use more medication, visit the doctor and ER more often, have longer hospital stays, and generally incur higher medical expenses than their peers. Depression can also lead to suicide, and in fact, older men have the highest suicide rate of any age group, more than four times the overall rate for all ages.
Now, here’s the kicker. Depression is NOT a normal part of growing older, even though the rate of older adults with depression tends to increase with age. In fact, in 80% of cases, it’s treatable. Depressive disorders are widely under-recognized, and untreated or under-treated among older adults. (You can read the full CDC report here.)
Why is depression pervasive among older adults? And why the common misconception that depression is a normal part of aging?
I’m not a physician and I can’t claim to know the ins and outs of the physiological changes that contribute to depression among the elderly. What I have seen, though, is probably what you’ve seen and experienced: older adults experience many losses, sometimes without adequate social support to deal with them. The passing of spouses and friends, retirement from a meaningful career, declines in physical or cognitive abilities, children and grandchildren living far away, fewer financial resources – the pressures and stress of all of these circumstances can contribute to depression. Add to that the fact that American society doesn’t really value elders the way other societies do – no wonder depression can become such a problem.
That brings us to our song spotlight: “Smile.”
This song was written by Charlie Chaplin for his 1936 film “Modern Times,” with the title and lyrics added in 1954 by John Turner and Geoffrey Parsons. The original version of the song was recorded by Nat King Cole in 1954, and Michael Jackson released a well-known cover version on a 1995 album. Many other artists have performed and recorded this song since then, including Judy Garland, Chick Correa, Lyle Lovett, and, most recently, the cast of the TV show “Glee.”
I have a bit of a love-hate relationship with this song, and that is because its meaning is a bit ambiguous. The words are especially confusing. If you just take the lyrics at face value, without hearing the rest of the music, you might imagine this to be a rather chipper song about keeping your chin up when the going is tough. (Think “Tomorrow” from Annie.) Here are a few lines from the end of the song:
Light up your face with gladness, hide every trace of sadness
Although a tear may be ever so near.
That’s the time you must keep on trying.
Smile, what’s the use of crying?
You’ll find that life is still worthwhile, if you’ll just smile.
Those lines echo the advice that people with depression often get from people who’ve never had clinical depression: just be positive, keep your chin up, focus on the good parts of life. Why waste your time being sad? Just focus on the good stuff – just smile! – and you’ll be fine.
If only it were that easy…
Examining and changing your automatic negative thoughts is one valid tool in the treatment of depression. (If your therapist has ever talked about a “cognitive-behavioral” model, this is one technique they could use.) This tool alone is not adequate, though, and hearing advice like that in the lyrics above can just add to your depression if you’re trying your hardest to change your thinking and yet are still feeling rotten.
That’s where the rest of the music in this song becomes helpful. You can imagine the singer giving a pep talk to someone – maybe himself – but feeling unsure about whether “just smiling” would actually work. The melody is in a major (“happy”) key but with minor (“sad”) notes and harmonies throughout. The notes move along in a stepwise motion at a repetitive, perhaps plodding pace. The tempo varies from artist to artist, but no version I’ve heard is especially upbeat – they all tend toward melancholy and wistfulness. Even a second look at the lyrics shows that the words acknowledge the stark reality of some difficult emotions – fear, sorrow, sadness, a broken heart – not really mincing words. I don’t think this song is papering over the difficult feelings entirely.
So, maybe this song can just encourage the first step towards seeking help for depression. Maybe it says, look, I know things are really awful, but maybe – just maybe – there is a reason to keep going, if you try to find it. Maybe this song is just trying to help you see the light at the end of the tunnel – even if it’s just a glimmer, it’s still there. Dealing with depression does start with one step.
What do you think of the song “Smile?” How do you feel about the song’s tone and message? I have to say, even after writing this post, I still have mixed feelings. I’d love to hear your thoughts! Just leave a comment below.
And, I’ll say it again: It is not uncommon for older adults to experience depression, but depression is not a normal part of aging and it can be treated. Music therapy is one medium for helping with depression, along with traditional psychotherapy and medication options.
If you or a loved one are experiencing depression, please get some help. You can talk to your family physician, or you can contact me, and I would be glad to assist you in finding the help you need.