Introduction

This series of articles (a book in waiting) is an overview of depression, painting its portrait with broad brushstrokes: the who, what, why, and how of the illness. There is more than just mere clinical information, however. Depression affects people in a way that a cold or a broken leg doesn’t: it changes how we think and feel about ourselves, others, and the world in general. So the book also describes how depression feels, through the eyes of someone who’s been there and is on the way back. Me, that is.

If you’re hoping to find out the chemical makeup of monoamine oxidase inhibitors, or how red wine affects the reuptake of serotonin, this isn’t the book you need. But if you want to know what depression is, what to look out for, what causes it, and how you can help — or be helped — then read on.

Chapter 1: Defining depression

‘Unwell’. (Matchbox 20)

All day staring at the ceiling;
making friends with shadows on my wall.
All night hearing voices telling me
that I should get some sleep
because tomorrow might be good for something:
hold on —
feeling like I’m heading for a breakdown
and I don’t know why

Chorus
But I’m not crazy, I’m just a little unwell:
I know right now you can’t tell,
but stay awhile and maybe then you’ll see
a different side of me.
I’m not crazy, I’m just a little impaired:
I know right now you don’t care,
but soon enough you’re going to think of me
and how I used to be

Me — talking to myself in public,
dodging glances on the train;
and I know, I know they’ve all been talking ‘bout me:
I can hear them whisper
and it makes me think
there must be something wrong with me,
after all the hours thinking
somehow I’ve lost my mind.

Chorus

Bridge
I’ve been talking in my sleep:
pretty soon they’ll come to get me;
yeah, they’re taking me away

Chorus (twice)

When we’re looking at a subject for the first time, it’s helpful to define the important words. So the first thing to do is to learn what depression is. The first part of doing this is to correct the mistaken beliefs about depression.

What depression is not.
When most people say, “I’m depressed”, they mean “I feel unhappy.” This is the popular use of the word, but it is only half the truth. This misunderstanding arises because many of us confuse the illness with one of its effects: depression makes people unhappy. But this is not the same as saying depression is being unhappy.

When we don’t realise this difference, a problem arises. We seem unhappy; people ask us what’s wrong. We say “I have depression.” Over weeks and months we don’t get better. Even if we explain that it’s a mental illness, people may still think that depression is just feeling unhappy. So they think that you’re acting like a spoilt child: sulky, self-pitying, wanting everything to be handed to you. They think you’re emotionally weak or immature. This assumption is wrong, for two reasons.

First, it puts the cart before the horse: it makes the effect the cause. If a person breaks their leg, it isn’t because they are physically weak, necessarily. Compare Arnold Schwarzenegger and Stephen Hawking. You could break Arnold Schwarzenegger’s shinbone with about the same force you would use to break Stephen Hawking’s [1]. Both people would be physically limited or weakened, but this would be a result of their broken leg, not the cause of it. Likewise, emotional weakness may be a result of depression, not necessarily the cause of it.

a broken leg causes physical weakness; but
physical weakness does not cause a broken leg

depression causes emotional weakness; but
emotional weakness does not cause depression.

The second reason that depression is not an emotional weakness is that no-one is immune from depression. This means that depression cannot be an emotional weakness. People have heart-attacks, but that doesn’t mean they are caused by a physical weakness. A heart attack makes a person weak; a weak person won’t necessarily have a heart attack. Being who you are is not weakness.

Although no one is immune from depression, there are attitudes that could make us vulnerable to it. This is because every person has attitudes that can become strengths or weaknesses. Which they become depends on whether we recognise those attitudes and control them, or let them control us and say “that’s just the way I am.” For example, a relaxed attitude is a support against depression. But if that attitude isn’t combined with self-discipline, relaxation can become laziness or apathy. When you’re depressed, you want to do nothing, to hide. Laziness and apathy prevent us from becoming active, and so help to keep us in a state of depression.

Religious bit. Christians and depression.
Floating about in some Christian circles is the assumption that Christians shouldn’t get depression — so if you have depression, you aren’t a Christian; or a low-quality one. The problem with this is that the Bible nowhere says that Christians are immune from the difficulties of life. In fact, check out Jesus’ last parable in the Sermon on the Mount (Matthew 7:24-27).

Therefore everyone who hears these words of mine and puts them into practice is like a wise man who built his house on the rock. The rain came down, the streams rose, and the winds blew and beat against that house; yet it did not fall, because it had its foundation on the rock. But everyone who hears these words of mine and does not put them into practice is like a foolish man who built his house on sand. The rain came down, the streams rose, and the winds blew and beat against that house, and it fell with a great crash.

From this, we can infer that people who trust Jesus — that is, Christians — and those who don’t both experience the ups and downs that life can offer. Christians aren’t exempt from suffering. Look at Paul’s experience:

‘I know what it is to be in need, and I know what it is to have plenty. I have learned the secret of being content in any and every situation, whether well fed or hungry, whether living in plenty or in want. I can do everything through him who gives me strength.’ [2]

Whatever Paul’s “thorn in the flesh” was, he didn’t want it. It kept him from perfect health. But God didn’t take it away, in order to keep Paul humble. Paul knew that [3]. Or consider Job: he didn’t know why he suffered. Yet God trusted and was pleased with Job, calling him “blameless and upright” [4]. Usually we don’t know why we suffer either. But that doesn’t mean we aren’t blameless and upright in God’s eyes. Suffering like non-Christians do doesn’t mean we aren’t Christian. It helps us to relate to them, for one thing. It prevents us from believing we’re better than them, for another. Or that we don’t need God.

Whatever you believe about healing, I hope you can see that Christians aren’t immune from depression.

What depression is.
To “depress” something means to push it down, by putting a weight on it heavier than it can bear. This is depression — the weight of life is too much to cope with. Winston Churchill called it a “black dog” that constantly hounded him.

Depression is an illness. It is both biological and mental. As a biological illness, the levels of certain chemicals (called neurotransmitters) in the body — particularly in the brain — are out of balance. As a mental illness, depression makes a person think and feel negatively about everything, especially about themselves. These two aspects, the chemical and the mental, feed off each other: our neurotransmitter levels are out of kilter and we feel miserable. For example, we get out of bed feeling very ordinary (otherwise known as bleagh); we go through the day with a negative attitude; this affects our emotions and neurotransmitter levels; we feel miserable … and so on. It’s a vicious cycle.

This description is bland, though; it doesn’t convey the experience. Do you think you know what depression feels like? Maybe this picture will help. The way depression feels is a combination of misery, exhaustion, apathy and despair. Think of Eeyore, the lugubrious donkey friend of Winnie the Pooh [5]. That’s the misery; although Eeyore’s is only quite mild compared to the misery of depression. Have you ever felt so bad you wanted to die? That you almost thirsted for it; prayed for it? Imagine feeling like that every day, for weeks or months on end. And do you know what it’s like when the humidity reaches 100% and the temperature is over 40 degrees? You have no energy; all you want to do is sleep, but you can’t. That’s the exhaustion. Now, imagine a robot like one of Isaac Asimov’s. A robot does what it’s told: without question, without argument, without trying to escape. It acts without joy, without fear, without any emotion at all. That’s the apathy. Now picture that the robot is like Marvin, in Douglas Adams’ ‘The Hitchhiker’s Guide to the Galaxy’. He has no hope that its life will improve. He is so despondent that other robots have been known to shut themselves down rather than listen to him anymore. That’s the despair: both that of Marvin and of the other ‘bots.

This, then, is depression: an illness that destroys thoughts and dreams of anything positive; that drains us of energy; that grinds us into the dirt and holds us there, like a school bully.

Kinds of depression.
There are several kinds of depression. There is Unipolar or Major Depression: sufferers feel emotionally dead, physically exhausted, and mentally drained [6]. There is Bipolar or Manic Depression. People with Bipolar Disorder cycle between times of depression and hyper-activity (mania). The manic cycle is a time of increased activity: the person is constantly on the go and excessively happy. Their thoughts are as irrational as when they are depressed, and just as far from reality. Between normality and Unipolar Depression, we find Chronic Dysthymia: it means you’ve felt miserable for a long time. Between normality and Bipolar Disorder, there’s Cyclothymic Disorder, a low-grade Bipolar Depression.

There are two kinds of depression that are especially affected by our circumstances. Seasonal Affective Disorder (SAD) is caused by too little sunlight. The other kind is Post-Partum Depression (PPD), which up to 13% of newly post-natal mothers experience. 1 in 7 mothers have mild PPD; but the more severe version is only half as frequent [7].

Finally, Psychotic Depression occurs with delusions (false beliefs) and hallucinations (perceiving, through any of the senses, something that isn’t really there) [8].

If you’re interested in learning more about the different kinds of depression, you can find them all in the ‘Diagnostic and Statistical Manual of Mental Disorders’ (DSM-IV-TR), which is the standard for assessing mental illnesses [9]. The DSM takes into account how long the illness lasts, whether it ends by itself, whether it recurs, how severe it is, and what other symptoms occur with it [10].

Statistics about depression. [11]
At any given time, about 1 in 10 people (in western society) experience depression. Females are twice as likely as males to experience depression: 1 in 4 to 1 in 10 females will develop depression at some point during their lives; compared to every 1 in 8 to 1 in 20 males. This higher incidence for females is possibly due, in part at least, to hormonal changes [12].

_____________________
Footnotes

[1] This isn’t including the effect of muscle or abnormal bone development.
[2] Philippians 4:12-13.
[3] 2 Corinthians 12:7-9.
[4] Job 1:1,8.
[5] lugubrious: glum; morose; lachrymose; very, very miserable.
[6] Another finer distinction has been made between Non-melancholic and Melancholic depression. Non-melancholic (Major or Clinical) Depression has an external cause; Melancholic (or Unipolar) Depression has a biological basis and is more severe than Non-melancholic Depression (“Depression – types, causes and symptoms”).
[7] 1 in 15. (“Mental Health Fact Sheet: Depression.”)
[8] (“Depression – types, causes and symptoms.”)
[9] Published in 2000.
[10] Other diseases can have similar symptoms to depression, such as hypothyroidism and lupus.
[11] “What is depression?” These statistics are taken from an American population, but are about the same for any western society, as far as western society carries through Britain and Australia.
[12] “Mental Health Fact Sheet: Depression.”

copyright 2004 Troy Grisgonelle.

Advertisements