CHAPTER 1

The experience of depression

Depression is a very common term that many people can relate to in some way. We have all had our share of losses and felt sad; we have all made mistakes and experienced disappointments and setbacks. These experiences may have left us feeling upset and confused. They may have been quite shattering and taken some time to get over. So we know what it’s like to feel sadness and distress and we may wonder what makes our experience any different from what is referred to as ‘depression’ in a clinical or medical sense.

When someone feels sad, or when they experience a passing, depressed mood, it is generally a normal and healthy response to some misfortune they have experienced. Most of the time, their mood is a reaction to the loss of a person, a social role, a close companion or a place to which they felt attached. A person who feels sad knows they have lost something and they yearn for its return. Generally, they will share their grief with someone and be open to receiving whatever support they get as they come to terms with their loss. For a period of time, they will grieve until they can gradually accept their loss. Their emotional life and their capacity to work and relate to others may be temporarily disrupted. This is a natural part of coming to terms with the new situation they find themselves in and learning to re-engage with life without whomever or whatever they have lost.

Depression is something different. Whereas sadness and grief are focused entirely around an experience of loss, depression refers to an experience where a person becomes convinced that there is something seriously wrong with them. If sadness is a natural response to loss, depression is a very painful experience of believing oneself to be a ‘loser’. In depression, a person’s distress may have been triggered by some loss in their life, but their attention very quickly shifts away from whatever they have lost to a preoccupation with a personal sense of failure, inadequacy and helplessness. Lacking any belief that they are worthwhile, they may turn away from others and become withdrawn and unresponsive to offers of help.

When someone becomes depressed, it is not simply that they feel down. Their capacity to think clearly and make decisions is diminished, their physical health suffers, and the energy they normally have to deal with life drains away. A person who becomes depressed also experiences a complete lack of satisfaction from the activities, relationships and pastimes that had always given their lives a sense of meaning and joy.

Because depression can be so disabling and so intensely painful, it is regarded as being as much of an illness as any other form of physical suffering. It can last for a long time and a person may feel utterly hopeless about whether or not they will ever recover. When depression persists for a long time, a person may begin to feel that they are an intolerable burden to others and convince themselves that everyone might be better off if they were no longer around.

This book is about the experience of feeling down that seems to take hold of us, that doesn’t shift easily and that causes us significant difficulty in getting through our everyday lives.

This experience is commonly referred to as clinical depression and it is as much a physical experience as it is an emotional experience. Clinical depression causes us such difficulty that it becomes extremely hard for us to live our lives in a way that we want for ourselves. People who become clinically depressed may feel confused, terrified and fearful and no longer in charge of their own lives.

In the early stage of her depression, Sarah described her experience in her journal. Her account conveys the sense of confusion and isolation so characteristic of depression.

Signs of depression

Depression is characterised by a particular set of changes in how a person thinks, feels and behaves. As well as being an experience of intense psychological suffering, a person’s sense of physical wellbeing is greatly affected, and sleep, appetite and energy levels are all disturbed. The primary signs or ‘symptoms’ of depression are discussed below and illustrated in the diagram below. The symptoms in this diagram are categorised and grouped according to their impact on our thinking and our feeling, and on our behaviours and our physical health.

Ways of thinking that are characteristic of depression

As Tim describes below, a person who is depressed thinks about their world in a very negative way.

The past, the present and the future are all viewed though a dark lens that distorts everything. Important achievements in the past don’t count. She or he focuses exclusively on every sign of failure or weakness that they can possibly point to in their life. They see the future as a relentless continuation of their current misery where nothing good will ever happen for them. These preoccupations make it hard to concentrate on anything or to believe there is any good in themselves. Making a decision can be an enormous strain because they don’t trust themselves to do the right thing.

Sarah, in her darkest moments of depression, described how her sense of hopelessness was overwhelming.

Other people very often view people who are depressed as being terribly ‘selfish’. While it is true that their thoughts seem to centre exclusively on themselves, and that their behaviour might seem very self-centred, it is not accurate to say they are ‘selfish’. Such pain is generated within the mind when a person is depressed that the person is often unable to consider the needs of others or to contribute to activities where they would normally play an active role.

The physical symptoms of depression

Depression is for many people a very physical experience and the symptoms they describe are often to do with changes in their body. They may describe the sensation of hurting deeply inside or they may have physical symptoms which worry them, but which have no apparent physical cause. Sleep disturbance is probably the most common physical symptom of depression. Sufferers usually report a broken sleep pattern that results in waking without the sense of being rested or refreshed. Their normal appetite may also be affected, resulting in either excessive eating and weight gain, or a complete lack of interest in food, which leads to weight loss. They may also find themselves unable to make love and indeed have very little interest in doing so, and this can be a major worry for them.

Behavioural characteristics of depression

It is not always easy to recognise that someone may be depressed. No matter how intensely distressed they may feel inside, many people hide it very well on the outside. And even when someone behaves out of character, we may not realise that they are depressed, and mistake their behaviour for something else.

This is often the case with children and adolescents who may express their inner turmoil in behaviour that appears destructive and anti-social. For example, an adolescent may begin to act in an uncharacteristic way, participating in shoplifting, fire-setting or disruptive behaviour at school, and never get the support for what is really troubling them. An adult’s sudden lack of interest in sexual intimacy may be interpreted as rejection, or they may start to drink heavily and procrastinate and get into trouble for not delivering on their work responsibilities. All of these behaviours result in life being more difficult for anyone experiencing depression and can reinforce their belief that they are fundamentally bad.

A significant slowing down in activity is a very common feature of depression, although some sufferers can become restless, even hyperactive, as they try to block out the turmoil they experience inside. Excessive ‘busy-ness’ can be a protective mechanism to distract from this turmoil, but it leaves a person feeling constantly on edge and irritable. Sometimes being busy can seem preferable to the prospect of slowing down and acknowledging that something is not right. Susan, who was mentioned in the introduction, put this very succinctly when she said, ‘You make yourself very vulnerable when you stop to think!’

Most commonly, the behaviour that is characteristic of depression is marked by lack of energy and social withdrawal. One man in his mid-thirties, described how his ‘get-up-and-go was all gone’. There is little energy to devote to external demands and concerns when you are depressed. A tendency to take to the bed is all too common. Sometimes it can seem easier just to retreat from the world to avoid having to deal with the criticism, demands, even concerns, of loved ones and friends.

Feelings that are characteristic of depression

If you have never been depressed, it is hard to appreciate just how intensely painful depression can feel. People who are depressed often find it very hard to put their feelings into words. They also fear that if they were to say how badly they were feeling, other people may be shocked and write them off as insane. Sarah described the feeling of being depressed in the following way:

Emotions can be so intense when you’re depressed that you can become frightened of your inner world. You do whatever you can to suppress your feelings and block them out. Your body may become tense with the worry about what you are feeling. Or you may resort to abusing alcohol or other substances to shut down your feelings and make yourself as numb as possible.

Severe and mild depression

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