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DEPRESSION IS NOT SADNESS
By Monica A. Frank, Ph.D.
A serious problem exists with the public's understanding of depression.
The problem occurs because of the clinical term "Major Depression" and the
general use of the word "depression." One of the definitions in the
Merriam-Webster
dictionary indicates that depression is "a state of feeling sad."
Therefore, the general public typically defines "depression" interchangeably
with "sadness" as in "I'm so depressed today." The tendency, then, is to
assume that clinical depression is just extreme sadness or the inability to
handle normal stress and sadness of life.
This assumption is not only wrong but it is a disservice to all individuals who
experience one of the clinical forms of depression: Major Depressive Disorder,
Dysthymic Disorder, Depression NOS (Not Otherwise Specified), or Adjustment
Disorder with Depression. With each of these disorders, the symptoms
manifest with varying degrees of intensity and cause varying amounts of
dysfunction. However, to simplify this discussion we will focus primarily
on Major Depressive Disorder and Dysthymic Disorder.
The hallmark of Major Depressive Disorder is the amount of daily dysfunction
that it causes. A person with this disorder may be unable to work, go to
school, or socialize. Sometimes they are unable to engage in basic
self-care routines such as showering or taking their medicine. Most
frequently, severe sleep disturbance is present along with eating disturbance
particularly lack of desire to eat. The individual reports extreme
fatigue, dysphoria (low mood), and lack of interest in usual activities.
The most serious symptom of Major Depressive Disorder that is frequently present
is suicidal ideation (wishful thoughts of death) which is sometimes present with
suicidal intention. To diagnose Major Depressive Disorder, the above
symptoms must be present a minimum of two weeks.
Dysthymic Disorder is less well-known among the general public but often more
problematic due to the lack of understanding as a result of the lower intensity
of symptoms. Dysthymic Disorder is a low-grade but chronic depression.
The extreme dysfunction characteristic of Major Depressive Disorder is not
present but the chronic nature indicates that the mild to moderate depressive
symptoms have been present for a minimum of two years.
How do these
depressive disorders differ from a normal state of emotion?
One of the predominate differences from normal emotion
is that depression typically is more of a numbness of emotion rather than an
expression of emotion. In fact, in many cases, if significant active
emotion is present such as frequent crying the individual may be more likely
dealing with the normal emotions of grief or loss. However, this can
become confused due to the accurately perceived loss an individual feels when
suffering from the depressive disorders. In other words, a person
suffering from depressive symptoms may also feel grief because the depression
has imposed limitations and losses upon his/her life. For example, a
woman's husband may leave her because he can no longer tolerate her inability to
take care of herself, her sad and irritable mood, and her lack of interest in
life. As a result, she not only experiences a depressive disorder, but she
also experiences grief due to the losses caused by the disorder.
Another key difference between depressive disorders and normal emotions is that
the core symptoms of depression are physical. The individual's physiology
is in a lowered, or depressed, state. The best way to describe this state
for someone who hasn't experienced it is to imagine when you have had a
low-grade virus that causes general fatigue, a feeling of malaise (bodily
discomfort or unease), slower thought processing, lack of interest in usual
activities, lack of appetite, and excessive sleeping or inability to sleep.
These symptoms are similar to what a depressed person feels continually without
relief. Now imagine that no matter what you do, those symptoms don't
dissipate over time. The inability to change those core symptoms often
lead to the secondary symptoms including frustration, hopelessness, feelings of
failure and behaviors including social isolation, avoidance of many activities,
and lack of motivation.
In addition, sleep disturbance is a central feature of most depressive
disorders, particularly Major Depressive Disorder, whereas normal emotions don't
tend to effect sleep for significant periods of time. Even though intense
grief may disrupt sleep patterns temporarily, it does not tend to be as intense
or chronic as the sleep disturbance with Major Depressive Disorder.
Finally, normal emotion does not cause the severity of disruption to normal
daily activities particularly not for any prolonged period of time. The
individual remains able to engage in normal work or school-related activities.
Even intense grief from uncomplicated bereavement does not tend to cause serious
disruption to necessary activities for longer than a couple weeks. A
person may not desire to engage in most activities but they have the ability to
do so.
Why is it
important to differentiate depressive disorders from sadness?
Most of the clients I treat for depressive
disorders also feel guilty due to the belief that they "should" be able to
handle their emotions better. After all, "other people are able to handle
loss, grief, sadness." They reason that if they are so seriously affected
they most be weak-willed or not trying hard enough. These feelings of
guilt only serve to make the individual worse due to feelings of inadequacy.
To refer again to the above analogy of being sick with a low-grade analogy,
imagine that not only are you suffering due to the illness but you also believe
that you are sick because you didn't take care of yourself well enough, you
didn't exercise enough or eat the proper foods. Now, you might react to
these statements by saying "That's ridiculous! Sometimes you can do all
the right things and you still get sick!" And that is exactly my point.
An individual with a depressive disorder doesn't have any more control over the
illness of depression than someone with a virus; there are health practices that
are beneficial but such practices don't eliminate illness completely.
Another critical reason to differentiate depressive
disorders from normal emotion is that others often blame the individual with
depression. "If only you would look at things more positively" or "If
you'd just get out and do things" or "You can do this, you're just not trying"
are messages the depressive person frequently hears. These messages only
contribute to the negative self-talk, feelings of failure, and hopelessness the
individual already feels. Research with dogs many years ago demonstrated
that if an animal believes that it can't control its circumstances, it gives up
and quits trying. Martin Seligman and Steve Maier (1967) labeled this
behavior "learned helplessness" and hypothesized that the lack of control
contributes to the symptoms in depressed individuals. One way this process
may occur is that if the individual believes he/she should be able to control
the symptoms of depression if they just tried harder, but no amount of effort
reduced the depression, the individual would eventually give up.
Therefore, blaming the individual with depression is only likely to cause the
individual to quit trying.
Finally, if I can help an individual with depression
recognize the symptoms of depression as due to the physical illness of
depression we can often begin improving the depressive symptoms. You may
ask "How can that be? You just said that the person doesn't have control
over depression and isn't to blame." Which is true. However,
cognitive-behavioral therapy can assist with improving perceived control which
leads to improved self-care behaviors. If the individual doesn't feel
guilty and like a failure, they become more able to take steps that can help
reduce the depressive symptoms. I explain to clients that the treatment of
depressive illness is similar to treatment of chronic pain: if a person examines
his or her symptoms without negative self-evaluation he or she may be able to
take reasonable steps towards recovery. For example, we know that exercise
reduces depressive symptoms (Leith, 1994). However, exercise is frequently
difficult for individuals suffering depressive disorders. If the
individual blames him or herself and thinks "If I wasn't so weak and lazy I
could get over this depression" he or she is less likely to try exercise.
However, if he or she thinks "I have a physical illness that makes it difficult
for me to exercise, but if I recognize my limitations and start a little bit at
a time I'll be able to do it" he or she is then more likely to try.
Therefore, a necessary condition for reducing depressive symptoms is to
recognize the depressive disorders as a medical condition and to refrain from
self-recrimination. As with many other medical conditions, depression can
be improved with lifestyle behavioral changes. However, the individual
needs to believe in his or her ability to impact the symptoms.
See also:
Sadness is a State of Happiness
Leith,
L.M. (1994). Foundations of Exercise and Mental Health.
Morgantown, WV: Fitness Information Technology.
Seligman, M.E.P.
and Maier, S.F. (1967). Failure to escape traumatic shock. Journal of
Experimental Psychology, 74, 1–9.
Copyright ©
2010 by www.excelatlife.com.
Permission to reprint this article is granted if it includes this entire
copyright and link.
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