DePrEsSiOn

Almost half of us will suffer from depression at some point in our lives, but the condition remains badly misunderstood and often poorly treated. At the heart of our collective difficulty with depression is a confusion about what it actually is and how it can be distinguished from sadness, a state we all know well and with which it shares many similarities. This confusion leads to applying assumptions about sadness to depression, resulting in unnecessary suffering.

On the surface, there are notable similarities between those who are sad and those who are depressed: both groups cry, withdraw from the world, and experience listlessness and a sense of alienation from their normal lives. However, there is one categorical difference between depression and sadness: the sad person knows what they are sad about, while the depressed person does not.

Sad people can easily identify what is troubling them, such as the death of a loved one, losing a job, or experiencing unkindness from friends. In contrast, the depressed person cannot pinpoint a specific reason for their low mood. They might feel tearful and at a low ebb but can't conclusively say what has drained life of meaning for them; they simply feel that life has no meaning.

This inability to account concretely for their mood can expose depressed individuals to unwarranted accusations of faking, malingering, or exaggerating. Well-meaning friends searching for a solvable problem may become frustrated by the lack of progress. When pressed, the depressed person might latch onto odd or minor issues to explain their state, such as the earth being absorbed by the sun in 7.5 billion years or dropping a glass on the floor and finding everything hopeless.

At this point, some might suggest that if depression lacks sensible psychological causes, the issue must be due to a brain chemistry imbalance, best treated with medication. This idea appeals to the pharmaceutical industry, worried families, schools, and employers seeking rapid, cost-effective solutions.

However, there is another approach to depression, which, though slower and more arduous, may be more effective in the long term. This approach, drawn from psychotherapy, suggests that the depressed person is distressed about something that is difficult to confront and has therefore been pushed into the outer zones of consciousness, causing feelings of nihilism. Realizing what they are concretely upset about would be too devastating, so they unconsciously choose to remain numb rather than face the pain and loss. Depression is sadness that has forgotten its true causes because remembering might generate overwhelming pain and loss.

These true causes could include marrying the wrong person, discovering one's sexuality isn't what was once believed, or being angry with a parent for lack of care in childhood. To preserve fragile peace of mind, one might unconsciously choose to be depressed rather than face these realizations. They pick unceasing numbness as protection against dreadful insight. Depressed individuals typically aren't aware of a gap in their self-understanding and are often taught to assume they are 'just depressed,' as one might be physically ill, which can appeal to the pharmaceutical industry and those close to the patient who prefer insights to remain buried.

Another key difference between sadness and depression is that sad people are grief-stricken about something external, but their self-esteem remains unaffected. In contrast, depressed people typically feel wretched about themselves, full of self-recrimination, guilt, shame, and self-loathing, sometimes leading to suicidal thoughts. According to psychotherapy, these violent moods of self-hatred stem from anger that should be directed outward but instead turns inward. For instance, anger towards a partner or a parent might transform into self-hatred as a defense against the risks of hating someone else.

Depression is often associated with a seemingly opposite mood: a euphoric state called mania, hence the term ‘manic-depressive.’ Mania, like depression, involves disavowed self-knowledge. Manic individuals are euphoric but avoid confronting bitter truths, leading them to engage in behaviors like talking too fast, over-exercising, or overspending to escape submerged grief, rage, and loss.

The suggested cure for depression involves helping individuals arrive at insight. They need a supportive, patient listener and, possibly, temporary medication to lift their mood enough to endure conversation. The goal is not to assume the problem begins or ends with brain chemistry but to address the underlying trauma. Depressives must be allowed to feel and remember specific damage and recognize the legitimacy of their emotions. They need to direct their anger appropriately rather than allowing it to turn inward.

The goal in treating depression is to help the sufferer move from limitless despair to mourning specific losses, such as the last twenty years, a marriage, a hope for parental love, or a career. Although agonizing, insight and mourning are preferable to allowing loss to taint one’s entire perspective. Life contains both dreadful and beautiful elements, and understanding one’s pain and anger while mourning losses can lead to hope and appreciation for the positive aspects of life.

Our Know Yourself Cards can help us understand the deepest and most elusive aspects of ourselves.