Everyone feels low or sad sometimes. Often those feelings
are in response to a negative event or life problem. Those feelings are
perfectly normal. Indeed the ability to experience these emotions may be an
essential part of what it means to be human.
These feelings will frequently lead to changes in our behaviour. That is, they help us adapt to our environment
– often by enhancing our use of social supports. That is why we feel
better when a friend, parent or family member gives us a hug or spends quality
time with us. These feelings can also be helped by us seeking out and
participating in activities that we usually enjoy.
Sometimes we feel low or sad for no reason. This is
also normal. Our moods fluctuate over the course of a day, monthly and
yearly. Spontaneous mood changes may be more pronounced over the teen
years but everyone has them. These changes are short-lived, do not lead to
pronounced social, interpersonal or job problems and usually go away as
mysteriously as they came. When these feelings are there you can help them
leave by hanging around with people you care about, exercising, listening to
music or doing things you like to do.
Unfortunately, we often refer to these normal feelings as depression. This
is a shorthand for a whole host of different emotions, including the following:
despondent, distressed, despairing, demoralized, disturbed, frustrated, blue,
sad, low, etc. Not only does the use of the shorthand “depression” to mean
all of the above detract from our ability to communicate the rich nuances of our
feelings, but the word depression used as a substitute for these normal
feelings can be confused with the concept of clinical depression – which the word depression could be
reserved for.
A clinical depression represents a failure of brain
adaptation. Unlike feelings of sadness, distress, despondency, etc. which
signal brain adaptation, a clinical depression describes a state of being in
which a person’s functioning is impaired – that is, they cannot do what they
usually do because of how they are feeling. Fundamental to understanding a
clinical depression is the decline in functioning that it causes; such as, poor
performance at school or at work, problems in interpersonal interactions,
social withdrawal, etc.
Unlike the usual and common feelings of sadness,
despondency, distress, etc. which are often alleviated by increased positive
social interaction or usual enjoyable activities, a clinical depression will
usually require a more specific and sustained intervention – usually a
psychological or biological treatment. That does not mean that doing
things that usually make you feel better (for example: talking with friends,
exercising, etc) are not helpful – on the contrary, they may well be. What
this means is that for clinical depression these interventions are unlikely to
be helpful by themselves. If someone is living with a clinical depression
they usually require professional help – from a therapist or physician. These
professional helpers will provide additional specific treatments that have
undergone rigorous empirical scientific evaluation and have been generally
shown to be effective in promoting recovery from the clinical depression.
In addition to the functional impairment, a clinical
depression differs from usual low moods in many ways. The low feelings
must be persistent and sustained; there is a marked loss of interest or
pleasure; there are substantive and persistent feelings of worthlessness or
hopelessness; there is often fatigue, lack of appetite and sleep difficulty and
there frequently are persistent ideas about suicide or even suicide attempts. Clearly,
this state is not a brief response to environmental adversity or a temporary
blip in mood.
So, depression is not the blues. Personally, I would
really like to see us get away from using the word depression as a shorthand
term. So instead of saying “I feel depressed because my boyfriend broke up with
me” say instead “I feel distressed (or unhappy, or pissed off, or hurt, or
despondent, or whatever) that my boyfriend broke up with me”.
Let's start using the rich lexicon of our language to
identify the varied and nuanced expressions of our moods.
~ Dr. Stan Kutcher
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