Depression 101
Although it really isn't up to the depressed person to educate the general public about depression, and although it is incredibly exhausting to try to explain depression to the uninformed, I'm going to try anyhow.
Some of us have a better grasp of and the wherewithal to articulate the ins and outs of depression. I hope to explain a bit more about what depression is and isn't and how it differentiates from some of the more commonly held beliefs and stereotypes.
I happen to not only have the vocabulary to help ease this lesson, I also studied psychology in College. I never got my degree. I have, however been involved in psychology as a patient for 47 years. I do have a firm grasp on my diagnosis.
A recent, well-meaning comment on one of my articles is the impetus for this piece.
The comment, paraphrased, was basically asking if I was sad again, and advising me to not let depression into my personality.
I know the comment was well intended. I also know the commenter obviously dies not suffer from or really understand depression.
I'll go over some commonly held misconceptions and stereotypes and explain how they miss the mark.
Misconception #1
Depression = Sadness
Sometimes, yes, a person suffering from depression will feel sad.
More often, however, sadness and crying aren't the first signals to psychiatrists and psychologists that a diagnosis of depression is appropriate.
A person suffering from depression may not seem sad at all, ever. When asked how the depressed person feels, the most common answer is, "I'm ok."
Other signs and symptoms include
lethargy
sleeping too much
sleeping too little
cessation of activities one normally enjoys
withdrawing from friends and loved ones
Misconception #2
Depression is a choice
This misconception is on fact incredibly damaging to people suffering from depression. Especially when it is followed up by advice such as
Think positive thoughts
Just smile
You just have to shake it off
Decide to be happy
These statements to a depressed person most often have the result of heaping shame on top of an already depressed state.
Shame is toxic under the best circumstances. Shaming a depressed person results in self-hatred, self-blame, and even self-harm.
See, the thing about depression is that it's not an emotion or an attitude. It's not a choice. It is an illness. A physical disease.
Science had determined that people with this disease either have brain chemical imbalances or do not have access to the chemicals a healthy brain produces naturally.
No amount of willpower, attitude, determination, or positive thinking can change brain chemistry.
People living with depression have no control over their bodies over-manufacture or under-manufacture of chemicals like serotonin, dopamine, endorphins. We have no control over whether or not we can access the serotonin our brains do produce.
This is why medical doctors will prescribe medications. Which will take 4 to 6 weeks to begin working. It can take years of adjusting dosage and medication before the right balance can be found.
Meanwhile, the depressed person is still depressed. Still can't get out of bed. Still can't go to work. Still can't care for their children. Still do not have the ability to fulfill tasks of daily living.
This is why it is so damaging to believe it is a personality trait, a decision, a controllable situation.
This is why it's so damaging to give advice such as just be happy or think positive thoughts.
There are, of course, some activities a person who is living with depression can do in order to mitigate and of the worst symptoms.
Exercise releases endorphins and dopamine. Waking, running, and cardio can be very beneficial and help prescribed medications with their efficacy.
But the person living with depression must first have the energy to even think about doing these things.
Self harm behaviors such as cutting, burning, or punching will also release dopamine. It takes far less energy to run a razorblade across your skin than to
a) get out of bed
b) get dressed
c) leave the house
d) go for a run
In my deepest depression, I can't even get out of bed. I can't even think about getting out of bed let alone doing it. And I feel ashamed. Which only makes things worse.
Research has relatively recently drawn a connection between gut bacteria and brain chemistry. Research is ongoing in this area.
My medical team insists I take probiotics for this very reason. I do. I also take a host of other medications for depression and anxiety. I've found a good balance of drugs that enable me to get out of bed, get dressed, do chores, write, paint, exercise, cook health food, bathe, and brush my teeth. (I still dislike brushing my hair, but I have the energy to do it when I need to).
Misconception #3
It is easy to get treatment
All over the world there's a stigma attached to mental illness. So even if a person suspects they have problems, they are too often reluctant to seek help. And when help is offered they are reluctant to accept it until in desperate, dire straights.
I am not familiar with healthcare systems around the world, but in the U.S. you can buy an assault rifle faster than you can get mental health treatment.
Unless a person attempts suicide, in which case they are put on a 72 hour hospital hold and given medication and referrals to psychiatric services, the quest for a diagnosis is a long one.
First the person must recognize there is a medical issue. Many people believe (because they are told) they are just lazy or unmotivated.
Once the person decides there's more going on than meets the eye, they have to find a psychiatrist. People with healthcare insurance can do this fairly quickly.
But people without health insurance or boatloads of money will have to find county services.
In 2020 it is estimated that 31 million Americans were without health insurance.
Once a depressed person acknowledges they have a mental illness, and they find county services, they'll have to go through a battery of tests to get an appointment to see a psychiatrist. Who will then make their best guess at a diagnosis.
For most of psychiatry, the diagnosis is based on what medication works.
Talk about backward.
Each of these steps is incredibly overwhelming. Either for the patient or the patient's caregivers.
At each step there's the very strong temptation to just give up. And many depressed people do just that. Treatment is neither easy to come by nor necessarily precise. It's never immediate.
Mental health is not like appendicitis or a broken bone. You don't take an x-ray and say ah-hah! and go fix whatever is wrong by splinting the bone and throwing on a cast or doing surgery to remove the infected organ.
Depression, especially, is diagnosed based on the patient's self-reported behaviors, thoughts, and feelings.
Treatment is NOT easy to come by, not is it cheap, not is it desired much of the time. Because seeking treatment and accepting help means admitting there's something wrong. Which is hard because social stigma.
I'm going to close now because this article is turning into a book.
I hope I have helped someone to understand a bit better what depression is and isn't.
Depression IS a disease.
Depression IS a physical ailment
Depression IS a chemical imbalances.
Depression IS debilitating.
Depression IS NOT just feeling sad.
Depression IS NOT a choice.
Depression IS NOT a personality trait.
Depression IS NOT a moral failing.
As always, I'm open to comment and question.
I do want to stress how very grateful I am to my read.cash family. I feel supported at every turn. I appreciate each and every one of you.
Til next time!
Lead and first image license free from Unsplash
I have always grappled with the "idea" of depression. But you are right. My confusion is probably due to my not fully understanding it. This article does help me to understand it better. I guess when most of us think of depression, that's what we tend to think of. Sadness or despair or just being down in the doldrums—due to whatever reason.
But of course, that is depression of a different sort I suppose. CLINICAL depression seems quite different, and so while I can sit here without a clinical case and say, "Just pull yourself up and suck it up buttercup," it is probably said without fully understanding what I am asking you to do and why it is much more difficult for you to do that than it is for me.
I also can relate to having a situation or circumstance that is beyond your control, and having people around me constantly wanting to diagnose me or offer suggestions as to what I need to do to make things better. As the old saying goes, "When you are sick, everyone around you suddenly becomes a doctor."
It can be frustrating to say the least.