Depression is one of the most painful of human experiences. People who are depressed may actually hurt. When we are depressed, every aspect of our experience is affected. The world tends to look dark, foreboding, or distant. The future seems bleak. Human contact becomes aversive. Depression manages to weaken or destroy our “life force,” along with anything good or enjoyable in our lives. Worst of all, depression evokes painful questioning about ourselves, our worth, and even the value of life, itself.
Depression covers a large spectrum. On the one end, everybody gets the “blues.” This is a normal part of life. On the other end, there is serious “clinical” depression, which can last for many months, involve excruciating and debilitating symptoms, and even cause a loss of contact with reality or be life-threatening because of the potential for suicide. Other depressive conditions of various severity lie in-between these two extremes.
Depression can be time-limited or chronic. Serious clinical depression may occur as a reaction to a trauma or negative situation. Serious depression may also be biological. In this case, there are typically recurrent episodes of intense and disabling symptoms throughout the person’s life. Serious clinical depression is a lot more common than most people think (some estimates are as many as one in four women will have a major depressive episode at some point in their lives). Depression can also be lifelong, but at a lower level of severity. The person is able to function on the outside, but struggles on the inside with unhappiness, pessimism, a sense of futility, and low self-esteem.
No matter what the level of severity, depression causes major shifts in how we experience the world, our body, and ourselves. One could say depression is a negative “altered state” of consciousness because it affects major areas of mental and bodily functioning. This occurs at all levels, but is more intense and lasts longer when the depression becomes serious and is of a clinical degree.
How is depression a negative “altered” state? First, there are marked alterations or shifts in mood. In fact, the word “depressed” is associated with a negative mood state, typically sadness or feeling “down.” This can reach the point of agony, accompanied by tearfulness, even the perception of physical pain in the heart area. However, depression can also be manifest in anger and irritability, and sometimes the person does not feel sad at all. With serious depression, you often see a flatness or emptiness as though there is no feeling. This is frightening to experience or witness. It is almost as though the person has emotionally died inside.
Depression also brings uncomfortable alterations in perception. The world actually looks dark, gray, far away, bleak or empty. Very depressed people speak of being in “a black hole” or “dark tunnel.” Sometimes there is the sense of being weighted-down, trapped, or suffocating. Normal human contact or stimulation becomes aversive and overwhelming. Routine tasks, like going to the grocery store, can feel like “fingernails on a blackboard” because the lights and noise and movement are just too much. Depressed people may become captive to an intrusive flow of internal negative thoughts that interfere with attention and concentration. At the extreme, depression can become psychotic with voices, often abusive or threatening, inside one’s head.
Classic symptoms in depression also involve abnormal alterations in bodily functioning. Normal rhythms of sleep, appetite, and energy become disturbed and are thrown off-kilter. Depressed people are either unable to sleep or sleep too much (but do not feel rested). They lose appetite or eat too much (but do not feel satisfied). Sexual interest is negatively affected, often lost entirely. Depression can result in uncomfortable agitation or the opposite, a lack of energy. This can range from sluggishness and loss of motivation to the point that the person feels physically unable to move from the couch, as though paralyzed. Just getting up can take tremendous effort. This is not voluntary but feels beyond the person’s control. At the extreme end, lack of energy can become life-threatening because the person stops eating and taking care of basic physical needs.
Finally, depression causes distorted alterations in thought. One hallmark symptom of depression is pessimism. This can range from “looking at the glass as half-empty” to severe and pervasive hopelessness. Tragically, this can reach the point that a decision is made that death is the preferred alternative, resulting in suicidal behavior (which seems reasonable to the depressed person because of the bleak outlook). Self-concept becomes derogatory, often punitive. Depressed people begin to think about themselves in harshly negative terms and make judgments that they are worthless, guilty, evil, incompetent, or unlovable. Generally, such thoughts are irrational with clear evidence to the contrary.
Depression can also do tremendous damage to interpersonal relationships. The depressed person tends to withdraw and, without meaning to, is very rejecting of loved ones. Depressed people are hard to be around, as their own unhappiness and negativity spill over, sometimes nastily. It is difficult for the friend or relative to understand what the depressed person is going through, and they often assume that the person has more control over his or her actions (or lack of action) than is actually the case. Depressed people do not “seem” themselves and often say they feel estranged from themselves.
The good news is that there are many treatments for depression, ranging from psychotherapy to lifestyle changes to anti-depressant medication. Because depression covers such a broad spectrum and there are various contributing factors, different treatment strategies are utilized depending on the type or cause. With serious depression, it is particularly important to get treatment because of the severe dysfunction and life-threatening aspects. It is also important to point out that depression can lead to substance abuse because the individual is attempting to self-medicate away the psychological anguish.
Depression is a painful fact of life. It is important that we begin to accept serious depression for what it is—illness, and treat those who are suffering with support, caretaking and understanding.
Dr. Judy Marshall received her doctorate in clinical psychology from the University of North Carolina at Chapel Hill. In thirty years of clinical practice in New York and Los Angeles, she has worked with many different groups, from children to the frail elderly, with particular interests including self-esteem, depression, sensitivity, and creativity.
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