How many times have you heard a friend say, "I feel so depressed," when describing an unfortunate situation? Have you ever used this term to describe yourself? The frequent use of the word "depression" as a feeling or emotion has lead to a misconception of the seriousness of this mental illness. In this part of the "Breaking the Stigma" series, I will focus on clinical depression, and my thoughts on why it can be so difficult to understand why people can't just snap out of it.
Quite often people will say that they feel "depressed" when they are really sad, upset, down in the dumps, etc. What distinguishes depression from these feeling words are clinical symptoms that, when recognized by a professional, leads to a diagnosis and (hopefully) course of treatment. That being said, it is estimated that 10% of Americans are currently suffering from clinical depression. Take a look at how the Diagnostic and Statistical Manual (DSM-IV) outlines the symptoms of clinical depression*:
• Depressed mood or a loss of interest or pleasure in daily activities for more than two weeks.
• Mood represents a change from the person's baseline.
• Impaired function: social, occupational, educational.
• Specific symptoms, at least 5 of these 9, present nearly every day:
1. Depressed mood or irritable most of the day, nearly every day, as indicated by either subjective report (e.g., feels sad or empty) or observation made by others (e.g., appears tearful).
2. Decreased interest or pleasure in most activities, most of each day
3. Significant weight change (5%) or change in appetite
4. Change in sleep: Insomnia or hypersomnia
5. Change in activity: Psychomotor agitation or retardation
6. Fatigue or loss of energy
7. Guilt/worthlessness: Feelings of worthlessness or excessive or inappropriate guilt
8. Concentration: diminished ability to think or concentrate, or more indecisiveness
9. Suicidality: Thoughts of death or suicide, or has suicide plan
*taken from this rating scale
Clinical depression and depressive episodes are much more serious and pervasive than deep sadness. Oftentimes, people suffering from depression need professional help in the form of counseling and/or medication, and in extreme cases, electroconvulsive therapy (ECT). Now, before you get the image of Jack Nicholson in "One Flew Over the Cuckoos Nest," let me assure you that ECT is not at all what it was decades ago. This life saving treatment is painless and can be done on an inpatient or outpatient basis. I tell you this to further indicate how serious depression really is, and why it is so important for us to take it in earnest.
In my work, I have frequently heard clients say that they just don't know how to "snap out of it," and why, despite many blessings in their lives, they still feel hollow and sad. They come in for treatment because their loved ones "don't want to hear it anymore, they just don't understand." Allie, the author/creator of Hyperbole and a Half** writes a strikingly accurate depiction of what an individual with depression goes through. Her illustrations for "Adventures in Depression" parts one and two reflect her own experiences with depression. Part one poignantly shows the self-hatred many people with depression feel, along with amotivation, feeling "sad and hopeless for no reason," and the internal monologue filled with put downs. In part two, her example of growing out of playing with toys is an excellent metaphor for the emptiness that comes with depression, the feeling of nothingness, the absence of feelings. She also shows her loved one's reactions towards her depression, again, hitting the nail right on the head with the frustration one feels when he or she is not understood. Her humorous depiction of how people offered her solutions to a problem she didn't have again is reflective of the things we tell depressed people; "You have so much to be happy about, just focus on that...just force yourself to get out more...why not have a positive mantra to repeat every morning..." While these may be helpful suggestions to some, to someone in the depths of depression, these statements come across as not understanding. She writes, "Hating everything made all the positivity and hope feel even more unpalatable. The syrupy, over-simplified optimism started to feel almost offensive."
So why can't people just snap out of it? It's because often the depression is not related to or goes beyond a sad event; depression isn't about being sad something happened, it is a complete disconnection from the world of the living. There can even be a resistance to getting well: think of quick sand. Once a person is in a depressive episode, there is a strong undercurrent of hopelessness, apathy, and sadness. This makes for a dangerous combination, and a difficult barrier to break. It can lead to suicidality. The topic of suicidality is too indepth to explore in this entry, but suffice it to say that all thoughts of suicide or self harm should always be taken seriously. In Allie's story, her depression is resolved with talk therapy and medication. Anyone who is feeling depressed should seek professional treatment, and not rely on suggestions from non-professionals.
How can we be helpful to those who suffer from depression? Remember the earlier statistic that about 1 in 10 adults in this country are currently struggling with some of these issues. Chances are you know someone who is or who has struggled, or perhaps you have battled depression yourself. It is my belief that having loved ones who are unfamiliar with depression can be a barrier to treatment. In my previous entry in the "Breaking the Stigma" series, I discussed the importance of self-awareness and compassion in those who know someone with a substance abuse problem. The same goes for depression; when everyone is on the same page regarding treatment, everyone does better. It can be very difficult to understand why someone who seems to have everything going for them suddenly is depressed. Maybe it's a genetic predisposition, maybe they are always putting themselves down, maybe it's something else that preceded the depression. Do not focus on that! That is not helpful to the person suffering, and those questions are best left to professionals.
What May be Helpful:
Listening, validating the individual's feelings; indicate that you hear the pain they are going through and acknowledge it as a legitimate struggle.
Encourage the individual to seek professional treatment and maintain treatment once it has started.
Be patient with those who have depression, even with treatment the symptoms may not subside for weeks.
Do not ignore the person because you don't want to hear them. It is understandable that you may feel burnt out or brought down by spending a significant amount of time with someone who is depressed. Remember that this individual has come to you because he or she trusts you. To cut off that person all together can be further stigmatizing.
Do not force your loved one to do anything he or she does not want to do. Treatment planning should always be done with a professional, not done to a person. While medication may be the most popular treatment currently, there are specialized therapies and other treatments that he or she may want to utilize. Allow him or her to explore all options, and be supportive of his or her decision.
Do not ignore any indications of self-harm, harm to others, or thoughts of suicide regardless of your belief of their truthfulness.
Recommended resources:
NAMI.org for more information
The Dawn Room - A wonderful website for anyone feeling sad
National Suicide Prevention Lifeline
**All rights reserved for the creator of "Hyperbole and a Half."
Please remember, as with all posts, this post is not intended to diagnose or treat any mental illness.
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