In our house we have a simple rule: if you don't have a fever and you have not vomited in the past twelve hours, then you go to school. Or work – except that my husband and I have both gone to work with a fever and I did once work with the Norovirus, carefully not eating or drinking anything and obsessively washing my hands: nobody else got it – phew!
This has meant my children have sometimes gone to school when maybe they shouldn't, but at least it means nobody thinks they can pretend to be ill just to get out of a test.
It's never quite as simple as that, of course, and sometimes you can be ill without a fever and without vomiting. We here know that, because we know our depression does not register on the thermometer and any vomiting is usually related to accompanying anxiety rather than infection.
So, we have another house rule: you get up, you shower, you dress, and you walk to the bus-stop. If you are halfway to the bus stop and you realise you just can't go any further, then you can come home and go back to bed, but you must at least try.
I think we'd all agree that we feel better when we're clean. A shower revives and invigorates. Getting dressed gives us more sense of purpose than staying in pyjamas and dressing gown – although I do have great respect for Arthur Dent – of Hitchhikers' Guide to the Galaxy - who travelled the whole universe in his very English checked dressing gown! Stepping out into the fresh air is more energising than staying inside.
I do know that this is not always possible. One of the measures health professionals use is a patient's physical presentation. Has that person washed? Have they shaved? Are their clothes clean, appropriate and put together? If female, are they wearing makeup? If you're severely depressed it may not be possible to achieve those markers.
Even in my darkest times, I think I managed to shower. There were days, however, when I did not get out of my pyjamas: there didn't seem much point as I was sleeping for seventeen hours a day. There have been weeks when I have not left the house. As for walking to the bus stop – it was as much as I could do to walk from the sofa to the bathroom!
One of the receptionists at my local GP surgery once commented that the whole team knew when I was ill with depression, as my clothes were less colourful. I had not thought of that before, but I realised she was right: when depressed, I could not bear bright colours.
I do know however, that, if I can shower, dress in cheerful colours, put on my makeup and step outside, I feel physically better and mentally stronger.
Keeping up appearances can be more for our own benefit than for the opinion of others.
A Moodscope member.