By Anthony Mayatt, Apr 25 2017 12:01PM
There’s quite a bit of publicity around depression currently, with Prince Harry “coming out” as having sought counselling. But what exactly is depression?
Medically speaking, the criteria for what constitutes depression are in the DSM-V, where somebody is meant to have had at least five out of nine specific symptoms, nearly every day for a minimum of two weeks. The symptoms are quite varied, with some very clear cut, such as wanting to kill oneself or more than 5% weight change, whilst others are more subjective such as change in concentration, being irritable or decreased interest in most activities. That’s the sort of thing a GP or psychiatrist is assessing against as to whether somebody has depression, and whether to prescribe medication.
Which is all very clear cut…. But I think it needs a bit more exploration.
For me depression isn’t a point in time, it is something that is present and enveloping for a sustained period of time. This basically separates disappointment and depression… the former is the emotional reaction to a bad or annoying event. I’ve been asked a number of times, why have I gotten depressed? The shortest answer is, I’ve no idea, and it’s not necessarily something that can be worked out.
Depression can be the result of an event, such as a bereavement or a relationship breakdown, which causes a re-evaluation of life, or brings into focus the fact we will die, and out time is limited. It can also be a response to a number of events that cause a build up, or it can actually be just a realization that things haven’t worked out. Finally, and this isn’t exhaustive at all, but depression can be an expression of a lack of emotions; there is a theory that depression is just anger internalized rather than externalized at the perceived cause.
To a large extent, the label of “depression” is what the labelled person makes of it. For some people, the label is crippling and just reinforces the feelings of depression as being overwhelming and unsustainable. For others, being given a label gives a route to fix the problem, and an acknowledgement that actually there is something wrong, which can be reassuring.
Where does therapy sit within all of this? It’s a space to try and make sense. If you see a doctor, you’ll potentially get medication which either corrects a chemical imbalance (so presumes there is something physically causing depressive feelings) or causes one so you feel less. For me, the cause is more likely to be something(s) going on in life, which need to be processed and that’s where therapy comes in, as you can burden and take out the very worst and most confused sides of yourself, without worrying about the others.
One of the most surprising things about the peak of disclosure from celebrities about their mental health struggles is that there is such a stigma associated with it.
Traditionally mental health difficulties were very gendered; women who didn’t subscribe to traditional gender roles, or societal norms, were labelled crazy and sent to the mad house where they were detained. In modern society social media really reinforces the idea that everything has to be perfect, and that perfection generates likes which can contribute to our feeling good and satisfied.
Part of the issue is the medicalization of depression and mental health. Let me explain… if you break your leg, the chances are you could have done something different to have prevented it, i.e. not run across a wet floor, or lept into a tackle playing football. Within a medical situation, there is an element of preventability. So the same underlying tones apply to mental health; that it’s something wrong with you that could have been dealt with better.
The way language is used is part of this. When somebody cuts you up on the motorway, and you’re relating the story to your partner, likely you’ll use the phrase “I was mad”, which makes the idea of madness jarring against the idea that “madness” is something painful and discombobulating for the sufferer (I could write an essay on the term mad, but for the sake of this, going with a common idea works).
So… what can be done? Being honest, if it feels manageable, is important, to demonstrate that depression, or any mental struggle, isn’t totally abnormal. So much of the discourse around mental health is trying to reinforce that it happens to so many of us. There’s a gap between the statistical knowledge that 1 in 4 people will experience mental health issues, and the lack of people within ones life.
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