Does depression, that most ubiquitous of modern-day maladies, really need defining?
I have a friend who has seen my movements slowed by sadness over the years, my demeanor frazzled by anxiety. He’s seen me despondent, tearful, hopeless, and suicidal. And he’s refused to accept that what’s wrong with me is depression. If pushed to assent that I suffer from a mood disorder, he insists on calling it “melancholy.”
Others who have commiserated with my suffering at first, insisting they knew exactly how I was feeling, later could not fathom why I went so low. Why I didn’t bounce back. Why I wanted to die. They believed they’d been where I was but they didn’t fall apart or isolate themselves, claw the floors and walls, fantasize about nooses, knives, or car crashes.
What was the hell was wrong with me … really?
No one I know who has been diagnosed with depression (or unipolar depression or major depressive disorder, to get fancy with you) has ever felt satisfied with the word depression. Perhaps the term has become so widespread, so defining of our time, that it has become meaningless. Every person who feels temporarily sad, low, disinterested, or undervalued can call themselves depressed and not be wrong in their assessment. It’s a huge yawning word with a linear scale so wide that it accommodates equally a middleschooler with an unreasonably early curfew and someone who is unable to get out of bed (or off their floor) to feed themselves.
Biologist and author Lewis Wolpert struggled to give the illness its due, by naming his 1999 work Malignant Sadness “to reflect the very serious nature of a depressive illness and also to reflect my conviction that normal sadness is to depression what normal growth is to cancer.”
“Severe depression borders on being beyond description,” he continues, “it is not just feeling much lower than usual. It is a quite different state, a state that bears only a tangential resemblance to normal emotion.”
Where does it come from? The malignancy can be traced back along a thousand rabbit trails inside the body and mind, everything from childhood trauma, abuse, crap food, brain chemistry, allergies, head injuries, environmental poisoning, and on and on.
Symptoms include a scattershot of maladies such as sadness, numbness, dullness, apathy, suicidal thoughts, crying spells, irritability, anger, insomnia, lethargy, fatigue, hallucinations, delusions, difficulty concentrating or making decisions, hopelessness, loss of self-esteem, anxiety, hypochondria, loss of interest, and a general inability to feel pleasure.
Try diagnosing that.
According to the World Health Organization:
- Depression is a common mental disorder. Globally, more than 350 million people of all ages suffer from depression.
- Depression is the leading cause of disability worldwide, and is a major contributor to the global burden of disease.
- More women are affected by depression than men.
- At its worst, depression can lead to suicide.
And, the WHO concludes, “There are effective treatments for depression.”
In the States, affording those treatments, however, is another matter entirely.
The Diagnostic and Statistical Manual of Mental Disorders (pdf), the standard classification of mental disorders used by mental health professionals, attempts to break it down in digestible nuggets, insisting that four of the following nine symptoms be present for a diagnosis of major depressive disorder.
1. Depressed mood most of the day, nearly every day, as indicated either by subjective report (e.g., feels sad or empty) or observation made by others (e.g., appears tearful)
2. Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day (as indicated either by subjective account or observation made by others)
3. Significant weight loss when not dieting or weight gain (e.g., a change of more than 5% of body weight in a month), or decrease or increase in appetite nearly every day
4. Insomnia or hypersomnia nearly every day
5. Psychomotor agitation or retardation nearly every day (observable by others, not merely subjective feelings of restlessness or being slowed down)
6. Fatigue or loss of energy nearly every day
7. Feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day (not merely self-reproach or guilt about being sick)
8. Diminished ability to think or concentrate, or indecisiveness, nearly every day (either by subjective account or as observed by others)
9. Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or specific plan for committing suicide.
Why four? Why not three or five? Because at the end of the day there must be standards of some kind, otherwise we better wrap it up and move on, evolutionarily speaking. (If your shrink has a better explanation, do hit me up.)
Among the various philosophical camps I’ve found those who believe firmly in a genetic explanation, a sort of depressive’s predetermination. The unluck of the draw. Another camp holds it springs from our own beliefs, the accumulation of fetid thoughts. A subsect here gravitates to traumatic injury, victimization, expressed in the psychologist’s “anger turned inward” mantra.
And, per usual, some religious thinkers still root into the muck of broken minds and hearts to find individual or generational “sin” and shadowy monsters lurking. Anyone whose seen or heard rustling from beyond the veil may be liable to accept something from this pot.
One thing all sides agree on is the experience itself.
“A human being can survive almost anything, as long as she sees the end in sight,” the author of Prozac Nation writes. “But depression is so insidious, and it compounds daily, that it’s impossible to ever see the end. The fog is like a cage without a key.”
If you don’t know what depression is because you’re fortunate enough to have never been fully enfolded in that fog, the most important thing for you to know is that it’s far, far worse than you think. Please be gentle.
If you are suffering from depression and need help getting through, I’ve included some resources under the Bikini Atoll beach below.
Jeramman. (That’s Marshallese for “good luck.”)
If you have a mental health emergency dial 911 in the U.S. and Canada. Dial 999 or 112 in the United Kingdom.
The National Alliance on Mental Illness is the largest grassroots mental health organization dedicated to building better lives for the millions of Americans affected by mental illness. NAMI advocates for access to services, treatment, supports and research and is steadfast in its commitment to raise awareness and build a community for hope for all of those in need.
Mental Health America is the leading nonprofit dedicated to helping ALL people live mentally healthier lives in the United States. With 240 affiliates nationwide, we represent a growing movement of Americans who promote mental wellness for the health and well-being of the nation – everyday and in times of crisis.
Finally, the U.S. National Institute of Mental Health has some ideas on locating help in your community.
The Canadian Mental Health Association is one of the oldest voluntary organizations in Canada. Each year, we provide direct service to more than 100,000 Canadians through the combined efforts of more than 10,000 volunteers and staff across Canada in over 120 communities.
Mental Health Foundation is the UK’s leading mental health research, policy, and service improvement charity. MHF is committed to reducing the suffering caused by mental ill health and to help everyone lead mentally healthier lives.