What is depression?
Isn't depression a normal part of life?
Sue was seventeen and in high school. She was struggling like everyone else her age to fit in and be accepted. This particular year she was not getting along with her friends and she had not been invited to any of their parties. Sue was feeling hurt and left out. School was the only activity in her life that she enjoyed and her grades were excellent. Sue felt depressed.
Bob was thirty, a successful accountant until the last few years. He was finding it harder to do his usual work. He couldn't keep his mind on anything long enough to complete it. He was always tired. Bob was getting increasingly worried about insignificant things. Every pain he experienced made him wonder about cancer. He would lie awake at night, unable to stop worrying if he had made any errors in his work the previous day. Life was becoming a struggle and he was losing his will to continue the battle each day to survive. He just didn't seem interested in his work or family anymore. Bob felt depressed.
Both Bob and Sue felt depressed but there was a vast difference between their situations. The general public does not correctly differentiate between normal and abnormal "depression." If we are going to help those who need it most, we must be able to tell who is suffering from the illness of depression.
Depression is by far the most common form of mental suffering. It is however, a poorly defined condition which means different things to different people. We must be able to distinguish between the transient "depression" of someone unhappy about a recent disappointment (Sue) and the severe crushing despair of one who has for many years lost all interest in life (Bob). I choose to use the term "discouragement" for temporary mood fluctuations which would be commonly referred to as the "blues" and would never be considered an "illness". "Depression" is reserved for prolonged disorders of mood which require professional help.
It is not always easy to distinguish between these two conditions and it requires considerable training and experience. There is presently no blood test or X ray that will diagnose mental illness. Understanding what a person is thinking and feeling is the only way to separate these conditions. This difficulty in making the diagnosis has caused enormous difficulty in getting the right people into treatment
Someday we might have a test for depression
At this time we have no screening tool to use on the population to find all those that are depressed needing help. It is much easier to find people with vision impairment since the vision screening chart is widely available and well accepted by the public. Our ability to diagnose depression depends on a person's ability to describe what they are thinking to someone who understands illnesses of mood. This requires a significant level of insight, motivation and verbal skill. There are many sufferers who are just unable to communicate their thoughts and so they remain untreated. Since we have no test, we cannot prove that someone has a depressive illness. This allows skeptics to influence a depressed person not to accept treatment or to accept another explanation of their symptoms. The inability to measure mood causes the public to see psychiatric treatment as unreliable, unpredictable, "hocus pocus" and to be avoided. It is a constant struggle for physicians to try to convince sufferers that there is a scientific and reliable treatment for something that can not be measured scientifically.
I will try to describe the differences between true depression and what I call discouragement.
Discouragement is transient with an obvious cause and the person is still able to enjoy other unrelated activities. It resolves with time and supportive counseling. A discouraged person can still be hopeful, with good thought control and concentration. In our example, Sue had recently felt badly about her circumstances but she still did well at school which requires great concentration. She met the criteria for normal discouragement over life events.
Depression is usually very prolonged with unrelenting symptoms. It is often, though not always characterized by sadness. There is an inability to enjoy activities and all interests fade. There is general hopelessness and a lack of ability to control or steer thoughts. This is a much more disabling condition than discouragement. Bob, was truly depressed. He had been suffering for years, his concentration and thought control was worsening. He was losing interest in all of life. Bob needed medical treatment and counseling. Sue likely only needed a friend or at the most, counseling.
The text of this section contains excerpts from "Healthy Moods"
Illustrations by Rev. Jim Keddy
For more information visit Answers to common mental health questions.
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