Depression is something I will probably talk about from time-to-time here. It’s a subject that’s been hidden away in society for too long. A recent episode spurred me to write this post.
I have suffered from depression for at least 22 years. I say ‘at least’ because it was 22 years ago when I was first diagnosed with it, although I’d certainly been suffering from it before that, possibly for most of my adult life.
Having been diagnosed with depression, it took another five years or so to get a more specific diagnosis of Endogenous Depression. This basically means I’m not depressed about any specific external event but rather the cause is internal, which is to say it’s cognitive or biological rather than environmental. This explained much because I could never figure out why I was depressed. My life was good and, logically, I could see that.
As it happens I did suffer a hugely traumatic life event a few years ago and that added Reactive Depression (often called Adjustment Disorder) into the mix. That complicated things and was hugely significant for me — indeed, it was the most significant thing to ever happen to me — but it’s immaterial to this article so I will mention it no further.
One of the first problems when it comes to talking about mental health is the term ‘mental health’ itself. I wish that term had never been coined. It implies the problem lies somewhere other than in the body, that there’s this intangible something that’s broken, that it’s separate from the physical. It shouldn’t really be interpreted that way. It should be interpreted in the same way as ‘gastric health’ or ‘renal health’, rooting itself in the physical, but it isn’t. The term ‘mental health’ carries connotations that imply the sufferer only has faulty thinking and can just “pull themselves together” or “snap out of it”.
If you say either of those things to someone with clinical depression you’re likely to get a smack in the teeth. If people with depression could simply “pull themselves together”, they certainly would because it’s a horrible disease.
Depression is often seen as weakness and those suffering from it are likely to have met many ignorant people who express an air of superiority because they are “in control of their thoughts” and the weak, depressed person simply isn’t strong enough to control their own mind. But as far as I’m concerned that’s exactly like saying to a person with a broken leg that they should simply “pull themselves together” rather than seek treatment, fix the broken leg and maybe imbibe some strong painkillers.
The term ‘mental health’ — at least in the way it has been adopted by the majority of society — has the effect of downgrading the disease, portraying it as somewhat secondary to ‘real’ physical problems. This is unhelpful. The tide is beginning to change a little, particularly over the last ten years or so, but many still harbour erroneous misconceptions about the term.
Whether depression is or isn’t caused by a chemical imbalance is the subject of much debate but one thing is for sure: people suffering from depression end up with a chemical imbalance one way or another. The real physical effects of depression on the brain can be observed via brain scans. By the time a depressed person presents to a doctor there are likely to be physical symptoms that could be detected via a PET, SPECT or fMRI scan if the doctor chose to order such a test (which they don’t, habitually, although many have been carried out for the purposes of research).
Picking apart the term ‘mental health’ is just my attempt to straighten out some misconceptions about it, but it doesn’t do much to help a person actually suffering from depression.
Explaining what depression feels like to someone who doesn’t suffer from it is extremely difficult. It may arrive with just a foot in the door, pulling a few emotional strings a little more than they would normally be pulled. But if it barges in completely the effects can quickly become overwhelming, so much so that sometimes the depression is all there is. It controls every aspect of one’s life. It is like being covered with a thick, black blanket. You can attempt to walk around and do ‘normal’ things but, really, the presence of the blanket overrides everything.
It encourages you to become insular, to withdraw from society and to isolate yourself. These are exactly the things you shouldn’t do but when you’re in the throes of depression the temptation to do so is huge. You simply want to be left alone. You don’t want the depression of course — indeed, you’re desperate to be rid of it — but the behaviour it induces is exactly the sort of behaviour that will perpetuate it. You want help but you absolutely don’t want to seek it out.
To the outsider, depression may not be apparent. We develop facades that we present to the outside and they serve to hide the depression from others. At least until it totally overwhelms us, anyway. We don’t wear our underpants on our head and stick pencils up our nose (thanks Blackadder) and, for a while at least, it may be that only those very close to us will notice it.
There is a massive distinction between feeling depressed and suffering from depression. The former is something we all go through from time-to-time (even, as it happens, people with clinical depression — we can tell the difference) but the latter is a much bigger problem, one that feels entirely different in almost every way.
It is a question of scale but that doesn’t entirely cover it, not by a long chalk. It’s like the difference between being bitten on the face by an ant and being bitten on the face by a tiger. Both are bites but there the similarity ends. They are completely different animals. If an ant bites you on the face it can certainly be annoying and even mildly painful, but if a tiger bites you on the face there’s a good chance you’ll have no face left.
Tortured analogies aside, depression is a bit like a tiger bite in that it completely destroys you. It changes virtually every aspect of your personality. Everything you do, see and say is through the lens of depression. It becomes you. And, like a tiger bite, it can kill you.
If you’re lucky you will eventually manage to trust someone with your depression and this is a massive step, particularly if it’s an understanding medical professional. They may not be able to take the depression away but they can often intervene to alleviate the isolating and destructive behaviours that result from the depression and, ultimately, compound it. If I could give one piece of advice to a depressed person it would be to find that person who can help and learn to trust them. Trust doesn’t come easily to the depressed person but it is a huge help and it shares the responsibility, which itself can be overwhelming and a path to even deeper depression.
I spend a long time refusing my GP’s offer of help. She made arrangements for me to book an urgent, same-day appointment, bypassing the officious guard dogs on reception, and she offered her help many times, but for ages I just couldn’t make myself trust her. I’m pleased to say that I often do now and I’m all the better for it. I still don't get it right every time but I'm getting there.
I have undergone much therapy over the years and taken at least a dozen different antidepressants but none of this has completely alleviated my depression. In fact I can say without a doubt that some psychiatrists have made me more depressed. Some of them only know depression from a text book. Of course some of them can only know it that way because they don’t suffer from depression themselves, but if a text book is their only source of information about depression then there should also be a text book that tells them how to deal with a person suffering from depression. The wrong psychiatrist can be unhelpful at best and damaging at worst.
But don’t let any of that stop you searching for someone to trust. You might have to cross off a few duds before you find the right person, but never give up. It may just be the turning point. In fact, that person may save your life.