Depression from the inside
This first post on depression described its diagnostic criteria. It’s more of an external point of view, very useful to understand quickly if someone suffers from the Black Dog. It’s also very interesting for doctors and clinical psychologists exchanging information about a patient or clinical studies.
But these standardized descriptions do not tell what depression feels like from the inside. And I believe sharing this inner experience is important. It’s easier for us to relate to emotions and thoughts than to a DSM 5 list of symptoms.
Most of us spend a lot of time and energy criticizing what we believe are our character traits (along the lines of : stop being so sensitive, lazy, procrastinating…), not realizing that they are classical symptoms of a disease.
And it is true the distinction is difficult to see especially when we have been living with depression for a long time, sometimes from early childhood.
Depresssion hiding in plain sight
Clinical psychologists and psychiatrists waiting rooms are full of us depressed people. Most of us, however, do not see ourselves as depressed initially: we usually seek professional help for relationship or work problems, addictions, insomnia, self esteem issues, or an array of poorly understood physical problems.
Some of us do not even make it to these waiting rooms, often because we do not realize what we experience is a treatable disease. We just think it is the way things are. Or the way we are.
I tried to do both: first not seek professional help, believing I could find a way to get better on my own. And when I finally reached out, in my mind it was for self esteem problems; all of this, even if I had been diagnosed with a major depressive disorder ten years earlier. The extent of my lack of information was astonishing.
So before talking about our thoughts and emotions when we are depressed, let’s reiterate 3 very obvious symptoms of a major depressive disorder. If these are present, then it’s enough to look for a good mental health specialist.
Recurring thoughts about suicide and death
Sometimes, it is just obvious. If you are considering suicide, and you are not suffering from an incurrable physical disease, no need to perform a quiz: you are clinically depressed.
Please get help immediately: how you feel now is terrible, but it does not have to last forever. There are other ways to leave the pain and the emptiness behind.
Sometimes, though, death thoughts are subtler, and this is when we can misunderstand what is happening. We can, for example, think about death a lot, but not specifically our own, and with no suicidal intention.
We can also have a sudden impulsion to jump under a train or from a balcony, without ever having felt the intention to die. It happened to me once, and I was scared and surprised as hell: I did not have the impression of being sad, disappointed or angry – although deep down I was all of this.
If you witness any of this, within you or someone else, again please get help immediately. It is estimated that 20% of people suffering from an untreated major depressive disorder will end up taking theirs lives. This is not a small percentage. This is not something you only read in novels. Chances are you know someone who died this way. I do.
Changes in sleeping and eating patterns
We don’t all react the same way, of course. Some of us loose all interest in eating. When I was drowning in my troubles, I did not realize I was not eating properly, but I lost a lot of weight. I was already thin before, so it was not a pretty sight.
Some of us, on the contrary, eat too much, or too much of the wrong stuff, and end up gaining a lot of weight. In both instances, we unconsciously try to manage our emotions with food (or absence thereof), and we really don’t care about what happens to our bodies.
On the sleeping front, we can either not sleep well and suffer insomnia, or sleep a lot more than usual. I was in the latter category; I remember feeling so tired all the time, really exhausted, even though I was sleeping close to 12 hours a day.
We can of course suffer from insomnia, or loose weight, without experiencing a depression. The cause can be a physical disease, a very stressful situation, or other mental health problems. But if we see changes both in sleeping and eating patterns, it’s better to look for other symptoms of depression, and if necessary (and possible) to get a proper diagnosis.
A short mention about children and teens: we sometimes believe (even doctors believed it for a long time!), that it was impossible for them to suffer from depression. It’s a mistake: about 3% of children between 3 and 17 years old received a diagnosis of depression. The real percentage is probably much higher: like adults, they are hugely underdiagnosed.
These young people have often no way of expressing clearly what happens within them, especially if they are very young. We should give them special attention if we see changes in their eating and sleeping patterns, and get them to a doctors office. It may be the only signal they send.
Depression’s emotions and thoughts
Now let’s talk about what we feel, and what we think, when we are in the middle of a depressive episode.
Emptyness, hopelessness and the absence of pleasure
Let’s say we experience the death of someone we love dearly. We may have problems with sleeping and eating. We may cry a lot, and feel an unbearable sadness. We may also feel guilty because we did not do enough for our loved one. In itself, all of this is not necessarily a depression: we may be “just” grieving and deep down, we have a sense that it is temporary.
But if we start feeling our life will be empty and hopeless forever, or if we feel sad, empty and hopeless all the time without any identifiable cause, then it may well be a depression. It becomes then difficult to engage in normal activities, such as work, social life, hobbies. We don’t have the energy, besides we don’t see the point. So we stop participating.
For some of us with milder forms of depression, we do have what looks like a “normal” life; we do work, we do have relationships, a social life, hobbies. But all of these activites feel hollow and do not bring us pleasure, really. We do these things because they are expected from us.
For example, there is a difference between inviting people over only because you think you should return an invitation, and inviting friends you are looking forward to share a pleasurable evening with.
We can not always do only things we enjoy, of course. On the other hand, never doing things we enjoy, or not even knowing what we enjoy, is not normal. It may be a sign we are depressed. This is what happened to me for years after I managed to climb out of major depression. I was functionning, but my life felt empty and pleasureless.
A depressed self esteem
One of the reasons we do not seek help with our mental distress, is that we believe it is our fault somehow. Plus, we believe we do not really deserve help to get better. These beliefs are tied to a low self esteem, which is itself a symptom of depression. And on and on it goes, that’s why it is not easy to find a way out.
Often, we do experience an inner critic on steroids. What we are telling ourselves is untrue, cruel, and well, depressing. We would’nt dare saying half of it to our worst ennemy.
You can find information about self esteemissues in previous posts. To take again the example of the death of a loved one, if we are grieving we may show symptoms similar to a depression. But we often do not experience a dramatic drop in self esteem.
Emotions go MIA
A good indication we may be depressed is when we lose all the good stuff: joy, pleasure, desire, enthousiasm, laughter, happiness. Without any of this, life is not much fun.
But we may also loose access to difficult emotions as well. I remember not feeling anything when my grandmother died. I loved her dearly, and I knew I should have been sad. I felt like a monster, and this is not the only time I felt this way (It also did not help my self esteem). I did not have access to anger, fear, or pain. I could not grieve. In fact, I had repressed my entire emotional life.
I learned later that these emotions were there, but I could not consciously access them. I was not in pain, but I was not enjoying life either. In fact I was not living my life.
We confuse depression, sadness, and grief. However, the opposite of depression is not happiness, but vitality – the ability to experience a full range of emotions, including happiness, excitement, sadness and grief.Richard O’Connor, Undoing Depression
Pessimism was not the most difficult of my problems initially. In fact I was not even aware of it. But it is one of the most enduring.
Today, I see myself as having a reasonably good self esteem, and having access to most of my emotions (sometimes with a bit of time and work, but still). But when I start a project, including this one – blogging about healing the effects of sexual violence – the first thing I hear in my own head is “It will not work”.
Still now, I need to gently contradict this very pessimistic view. Since I have a few decades of life behind me, with some successes along the way, It it not too difficult to see that this is not always true. Sometimes, things do work out. Most of the time, better than what we expected.
This pessimism of depression can encompass just about everything that will happen in the future, and even what is happening right now. People won’t like us. In fact, they already do not like us. Or if they do, it’s because they do not see the real us. We will not be able to perform at our new job. We will end up feeling stupid if we try to make a joke. Our best friend will not like our present. The world is hostile, and we do not know how to navigate it.
When we do this, we make ourselves miserable, for no reason apart from depression.
Sometimes, things do not work out. But that’s ok, because if we keep on trying, something else will work out. It is not necessarily what we had planned, but it still counts as a success. We don’t even really know if something is really a failure. My first love story was a disaster, and a few others after that. But when I look at my long term relationship now, and everything we did together, I’m really, really happy these relationships did not work out.
The impact on our lives
All these signs of depression work together to make our experience miserable. But as it was not enough, it impacts our relationships, our jobs, our projects; everything is more difficult, and self reinforcing.
The good news is that getting better has also a kind of circular, self reinforcing benefit. We can start by addressing our self esteem, and it will benefit our relationships. Or we can start by working on our emotions, and we will little by little improve our self esteem. We can address our pessimistic thougts, and it will improve our motivation, and our confidence, at work. Any improvement works, and can start an upwards spiral.