Ever since starting this blog apart from a deluge of questions on PTSD, the other topic that I receive the most questions and feedback on is Depression. People list their symptoms in their emails and ask do I have depression? I am not a Psychiatrist or a doctor – my field is Sociology but from many of these heartrending emails these people seem deeply unhappy and in search for an answer to their malaise and recurring, well yes I’ll say it for what sounds awfully like depression. Of course, I do not reply like that. I recommend they see a professional. Your GP is always the best first port of call. They can refer you to the correct services. You just have to get up the courage to make that appointment and get yourself there. Easier said than done if you’re depressed.
Depression is the curse of modernity, affecting more and more of us. It is the black dog that haunts us, the lethargy that makes it impossible to get out of bed. It is the vacuum of meaning which sucks out all our desire, our hope, so we are left in an empty void. Sadness is something we all experience, part of the fluctuations in moods that make up everyday experience. But depression? Depression is something else.
Drugs alone won’t cure the epidemic of depression. We need a strategy.
Depression is often as physical as psychological. It saps energy and – evidence increasingly suggests – puts bodies in a state of chronic, dulling inflammation. Gait can change, even the capacity to speak in anything but a monotone. At the same time, it is remarkably difficult to locate a biological cause to depression. The chemical imbalance theories that saturate public understandings just do not fit with the evidence.
Clinical diagnosis is based, therefore, not on any objective tests but on history taking and a patient’s present mental state. Because depression is so difficult to differentiate from everyday sadness, diagnosis is based on the functional impact of experiences such as loss of interest, low energy and lack of confidence, alongside potential risk. Psychiatric diagnosis is a bit like carving up nature by the joints. A diagnosis of depression tells us that something is wrong, but never quite what.
Psychological models often emphasise a person’s negative views of themselves, the future and the world. These often emerge as a result of early experiences – things such as chronic bullying, abuse, being put down, or being expected to be perfect all the time. But depression is also often a result of a loss. This may be the loss of someone we love, but it can also be the loss of an ideal. For example, that we can completely fulfill the needs of a partner, or that a dream job will make us happy. One’s sense of self can collapse, implode, leading to a death of meaning and purpose. Health problems can also cause, or at least mimic, depression. For example, people with thyroid disturbance, liver cirrhosis or a dementia process are more likely to become depressed.
There are many of us who have been at death’s door as a result of mental health problems and yet have found a way back.
Sociologists tend to emphasise the social causes of depression. It is no coincidence that women, people living in poverty, and those who have experienced discrimination are far more likely to experience depression. This is because depression and oppression are inextricably linked. There is also clear evidence – perhaps the most robust in the field – that chronic adversity is deeply damaging to both the body and the psyche. This can become dangerously invisible when depression is viewed as a simple medical problem.
Many people are concerned that the category of depression is being expanded to encompass too wide a range of human experiences, and that this may be damaging. In 1950, depression was only estimated to affect about 0.5% of the population. When antidepressants were developed, drug companies worried that there would not be enough people to prescribe them to.
Since then, depression has been marketed relentlessly despite its fuzzy nature as a diagnostic category. This has shaped how people view and thus experience their internal worlds. People have traditionally viewed the soul as a place of conflict, divided between productive and destructive urges, passion and reason, primal instincts and excessive control. But our inner worlds are now monopolised by market values – the idea that we can and should be able to excise problematic emotions such as sadness, to fashion a more sellable Brand Me.
‘The capacity to alter how we live our lives is only possible with adequate access to space for reflection – such as via psychotherapy – and material resources to afford choice.’ To trouble the ideas that breed depression, it is vital to try to hear what a symptom is trying to communicate, to unfurl the onion layers around depression and uncover its message. From an evolutionary perspective, depression is often seen as serving the function of forcing a period of reflection. Many people do not regret periods of depression, finding it forced them to leave a problematic job or relationship, or re-evaluate how to live meaningfully in rejection of ideas such as that we must always be digitally “on” and available.
However, the capacity to alter how we live our lives is only possible with adequate access to space for reflection – such as via psychotherapy – and material resources to afford choice. This is why addressing structural inequalities and poverty are as important an antidote to the current epidemic of depression as the prescription pad.
It’s good to talk about mental health. But is it enough?
If you are feeling low, conversations are very important, as depression likes to lock us in with our internal persecutors who are not – though they will probably tell you otherwise – the most reliable authorities on your worth. These conversations may be with clinicians, but many people have also found a pathway out of the woods of depression though connecting with activist groups, the local community, nature, animals and religious organisations. If things are not so bad – if you can function OK, and have some hope – viewing your experiences as everyday sadness that will pass can help to ensure you do not start to panic when your inner world throws up its occasional burps. Tagging all our negative experiences as signs of potential mental illness can do more harm than good.
For those of you who are really low, however, I want to say something else. There are many of us who have been at death’s door as a result of mental health problems and yet have found a way back. None of us believed at the time that this could be possible. However bleak life feels right now, however hopeless, things can change. Try not to let depression trick you into believing anything different.