“Depression” as experienced from the other side of the table
We hear the words “depressed”, “unhappy”, and “sad” so often, and these words are habitually used casually to describe one’s low state of mind. But do we really understand what depression essentially is and what the person affected by it truly feels? Sadness is a part of everyday life and most often are usual reactions to disappointments and setbacks we face in our life. Depression although is loosely used to describe it, is much more than feeling sad or low. It’s a much intense and a persistent state of mind. In depression, a person is continuously sad for over 2 weeks. This sadness engulfs whole day and is pervasive, i.e., it is present in all situations, even in situations that are supposed to make one feel happy!
As a counselor, I knew all about depression that I was supposed to know. What are the symptoms? How to identify, rate, measure and plan management? The information was right at the tip of my fingers. But I had no clue how debilitating a condition it is until I experienced a bout of syndromal depression myself. It was a struggle that lasted for weeks and it made me question a lot of things I read in the textbooks that I took for granted, and also the way I began seeing others with depression. It opened an entire new world of experience for me.
In this article, I would not like to focus on depression as how a psychologist would view it. I want to describe depression as an experience and how it actually felt being clinically depressed. The aim is to help others gain an understanding of the suffering from depressed person’s point of view, with a hope that it can promote empathy, acceptance and remove stigma, thereby encouraging help seeking behavior.
Depression is not the fleeting sadness or feeling low when things go wrong. It’s not the disappointment we feel at our losses. Yes, we can feel intensely sad or even agitated when we experience negative life events. But somehow, we manage to recover and bounce right back, and function normally after a few days. But what if each day continues to be the same or even worse? Clinically, as per ICD 10, the core symptoms of depression are characterized by a set of symptoms lasting for a minimum period of two weeks:
Pervasive depressed mood, wherein lowered mood varies little from day to day, and is often unresponsive to circumstances
Loss of interest and pleasure in activities that are normally enjoyable
Reduced energy leading to increased fatigability, marked tiredness only after slight effort, and diminished activity.
Other common symptoms include:
Reduced concentration and attention,
Reduced self esteem and self confidence
Ideas of guilt and unworthiness
Bleak and pessimistic views of the future
Ideas or act of self harm or suicide
Diurnal variations, psychomotor agitation or retardation, irritability, somatic complaints, hypochondriacal preoccupation, anxiety and distress have all been reported in depression. Symptoms of depression may vary from person to person, and at times it may not even be overtly evident and can be hidden in person’s day to day activities. It can be present at any age, even in children, elderly, as well as in pregnant or in post natal women.
That’s how depression is described in clinical terms. It is one thing to read these symptoms in textbooks, identify them in a patient and make a diagnosis of depression; and totally a different thing to have actually experienced these very symptoms myself. It all began with a feeling of sadness, a sort of pain that I just couldn’t get rid of or couldn’t understand. It slowly took over my entire being and refused to go away or reduce even as days passed. The pain expanded so much that it was becoming heavy and unbearable. I couldn’t explain why I was feeling that way or place it on any particular stressful situation or a setback around it. Of course things were stressful in my life, but it had been like that for a while and I was managing fine until now. I felt a deep sense of loss, a void, but I hadn’t lost anything. I would lie awake all night, and even if I did fall asleep, I would awake up at odd hours and couldn’t go back to sleep. I would then fall asleep at 6 or 7 in the morning, and couldn’t wake up on time. I didn’t feel like getting out of bed or even leaving my room for that matter. I didn’t want to go to work and I just didn’t want to do anything. It wasn’t that I didn’t feel like doing things or did not want to do things. Rather, it was an inability. I was unable to do anything. I seemed to have no control or exert my will over my mind or body. Everything was becoming so difficult, and I was so tired all the time. I couldn’t even get myself to bath or change my cloths. My house was becoming a mess, I didn’t do the dishes and I stopped cooking. I wasn’t hungry either. It was too tiring to even move out of bed. It was like a spark of my life was taken away. I was just a live body, something in me had died. Nothing interested me. I had so many hobbies, and now nothing mattered. I used to volunteer, garden, paint, make handicrafts, pen satires, and the list went on to anything that caught my attention. But now, even the music was unbearable. I had simply lost interest in anything and everything, shunned myself away, isolated myself from my friends, and family. Nothing seemed meaningful anymore. All I wanted was to die and put an end to my misery. There seemed no point to my life any longer. I believed that I was good at nothing, no one would care if I lived or not, and I was being a burden on everyone around me. I felt so worthless and there was no hope for me. My life was such a failure.
Around this time, my mother arrived to stay with me for a couple of days with me and she was surprised to see me in such a deteriorated condition. Here I was, a happy go lucky person, who was so cheerful, positive and energetic, in such a pitiable state. She was very annoyed to see the mess. At first she thought I was ill, but soon she thought I was just being plain lazy and disorganized. I tried to explain at first, “Mom, something is wrong with my life, I am so sad”, I said, tears rolling down my eyes for no reason. “What’s wrong with you?” she demanded to know. I didn’t respond. ”Your life is perfect! Now get out of it!” she rebuked. She couldn’t understand why I was so dull and withdrawn, or why I was so slow when I moved or why I didn’t feel like doing anything. “You’ve become so lazy!” she would scold me often, “why can’t you do your things and be quick at that!” she would snap with irritation. I felt so lonely and helpless. She didn’t understand, and I had no way to make her understand what was happening to me. I would go to my room, lie on the bed and cry.
Back at work, my career was suffering. I wasn’t able to concentrate on my work and made so many glaring mistakes. Moreover, I didn’t want to go to work and the very thought of going to work was becoming such an obnoxious idea day by day. I had neither the energy nor the motivation. But I had to go. What excuse did I have? That I was depressed? Since when does any organization accept “depression” as a valid sick leave without lifting a brow? When you have cold or fever, people see your discomfort, empathize with your suffering and often tell you to take a day off and rest. Back home, parents will ensure that they supply you with soup in the bed and that you sleep well. But depression is another entity altogether. There’s nothing visible that can get people to sympathize with you. People only think that you are plain lazy or even weird. I went off social media as well. I couldn’t update my facebook status as “down with depression”. There have been many times I have added my status as “down with viral flu” and had such encouraging responses to it. But posting about depression takes a lot of courage, which I didn’t have at that time. I felt that it’s a sure shot way to lose friends. “After all”, I thought “who would want to hang out with a sad person, filled with negativity? Nobody will understand, will they?” I avoided people, preferring to be by myself. I couldn’t bring myself to look at anyone in the face or smile at anyone, and even when I did force myself, it was such an effort, that there simply was no twinkle in my eyes and the smile came out to be so fake. Even breathing became a strenuous task, and I noticed that I frequently let out deep sighs as I exhaled, which would irritate the people around me. The worst was the pain. I repeat this point again, because that’s the worst experience of depression. The deep pain in your chest for no reason at times becomes so unbearable that you simply want to die and put an end to it.
Another awful facet of depression that I suffered from was the negative thoughts because everything in life was getting colored by depression. I could feel others getting turned off by my negativity. People begin to avoid your company because you are unpleasant to hang out with. I wouldn’t care less at that point of time, but being isolated from others simply makes things worse, because all we need at that point of time is the social support from friends and family.
This particular experience was unlike anything I have ever experienced in my entire life so far. I have had my fair share of unpleasant life events and I have responded quite well to them. Even when I had lost my father, in between the grief, there have been lighter moments, when I could smile, crack a joke about dad, laugh and carry out a lot of responsible tasks. But now I was, totally incapacitated continuously for days together for no good obvious reason, other than the fact that it was a major depressive disorder.
Thankfully, I was able to recognize what was happened to me. It was a mild to major depression and I realized that I was on the same side of the table as so many patients of mine had been before me. What followed next was a struggle for weeks as I tried to heal and overcome depression. But it was an eye opener for me. This is what so many of my patients who complained of depression were experiencing. I knew the symptoms, but now I had felt them. It saddened me of course. Here, I was working in a counseling firm and I couldn’t approach for help because I feared stigma. If I, a counselor could have so much self stigma, how would the general population feel about mental health problems? I didn’t apply for sick leave simply because I wasn’t sure if depression as an illness would be accepted. Moreover, whom could I ask for medical certificate? My colleagues or seniors? What would they think about me? Wouldn’t they think that I was weak? As a psychologist, was I supposed to be immune to mental health problems? No one seemed to notice or even ask. A few colleagues did comment saying something like, ”you look tired”, “too much work load eh? It shows!”, “hey, you lost weight?” and I simply nodded my head. This is the sad status of mental health problems right now. We have overcome the stigma of leprosy, tuberculosis, and many other diseases, but we are yet to overcome the stigma and self stigma associated with mental health problems. It isn’t visible to anyone and hence assumed to not exist. We don’t seek help because we fear people will judge us. We don’t think that others will understand us or accept us. Society accepts the positive, cheerful and confident people and rejects anyone who doesn’t fit into this model. That’s what acts as a barrier to seeking help. It did for me.
According to WHO, depression is the leading cause of disability in the world. 350 million people suffer from depression and 1 million commit suicide as a result of this illness globally. Which means, worldwide, so many people right now are experiencing the same pain as I had experienced, and so many of them are not seeking help because of stigma. So many of them are contemplating suicide or even attempting even as I write this now. Let’s just begin to understand the intense pain that a depressed person suffers from. Let’s empathize, listen, encourage them to talk and be supportive. The least we can do is acceptance. Depression isn’t who we are, rather it’s a condition we are suffering from. We need to immediately spread this awareness and remove the stigma, the greatest barrier to seeking help. Let’s begin by recognizing mental health problem as serious health issue, just like any other physical ailment, which needs immediate attention and care. Let’s make the world a better place, a less depressed place.
By: Anjali .S.
Note: Identifying pieces of information have been changed to protect confidentiality