Popularly, people use all kinds of words that have a precise, technical meaning for professionals, but they use them in imprecise ways, often causing confusion. As an anthropologist I frequently use the word “culture” to mean the totality of behaviors of a particular group. I might say, for example, that I am not comfortable living in England because of the culture, and by that I mean I am not comfortable with the whole system of ideas and behaviors that unites the people into a recognizable whole. However, when I say I don’t care for British “culture,” people who are not professional anthropologists may think I mean that I don’t like art, museums, music etc. in Britain: not what I mean, at all. In this post I want to talk about depression, but first I want to be clear what I mean by the word “depression.”
Most people have experienced some form of depression at some point in their lives, many, without knowing what depression is. There lies the problem with words. What comes under the popular umbrella of “depression” is actually many different things. First of all, depression is not sadness. That can be the first point of confusion. Everyone experiences sadness because of circumstances – loss of a pet or loved one, trouble at work, an accident, bad news, that sort of thing. Sadness comes in many flavors, but in general it does not last, and there are ways to overcome it. It is also possible to be sad and happy at the same time. Depression is not like sadness. While everyone has experienced sadness, not everyone has experienced depression, or, if they have, they may not know what it is.
It is hard to describe depression in a nutshell, but I will try. Depression, like sadness, also comes in many flavors, but the root feeling is one of hopelessness and/or crushing fatigue and indifference to the world around you. You want to do NOTHING: just crawl into bed, pull the covers up, and shut the world out. Meanwhile, your mind churns with inchoate thoughts of blackness and despair. You may sleep a lot because being awake is intolerable. I know depression because I have experienced it and I know what it is, so I recognize it when it comes over me. For me, the good news is that my depression is exceptionally rare. I have experienced it only a handful of times in my entire life, and it has never lasted more than one or two days. That kind of depression is sometimes called “situational depression” because it is often (not always) triggered by a particular situation. Situational depression is still something of a mystery because it is not clear what the mechanism is. The same situation can cause depression in one person, and not in another, (whereas similar situations are likely to produce sadness in just about everyone). Sadness and depression are different animals.
Many people experience situational depression at one time or another in their lives, but some people experience a more permanent state of depression. This is clinically called major depressive disorder (MDD), although there is a whole alphabet soup of potential depressive diagnoses, such as, post-partum depression (PPD), seasonal affective disorder (SAD), and so on. The common denominator in all of these is depression, and – despite the acronym SAD – they are not about sadness. Depression is a whole different thing. For convenience (at the risk of being simplistic), I will just use the term depression here.
You might know someone who is depressed. I’d be surprised if you did not. The thing is that you may not know how to recognize depression, nor what to do about it. You may not recognize it in yourself. When I first met my late wife, she used to tell me about these periods during the day when she felt dismal and hopeless. She described them as being like tumbling down a deep, dark vortex. I had no idea what she was talking about, although I was sympathetic, and she had no idea what was happening to her. Over time, these dark periods got longer and longer until they consumed her whole life. Eventually she sought help, and was diagnosed with chronic depression. Having a label is a start, because then you can do some research to figure out what is going on. Also, once you have a diagnosis you can get treatment. She began on antidepressants coupled with therapy, which is the usual standard of care.
Antidepressant medication is not a cure for depression, nor is therapy. There is no known cure for depression. That’s the first lesson that you need to learn if you are unfamiliar with depression. Medication plus therapy is a way of managing depression: a way of helping people with depression to cope with daily life. It is not a cure. With medication and therapy, depressives may begin to feel less hopeless, less worthless, less dark; but those feelings are still there. However, instead of lying in bed all day with a head churning with horrible thoughts, they may be able to get up, get dressed, get active, and, in general, get on with regular, day-to-day activities. For some depressives that is a huge step. But . . . this management must be in the hands of a professional. There is not much you can do to help.
Even though there is not much you can do to help, you can do something. First thing you can do is learn about depression so that you don’t try to help in ways that are counterproductive. Do not, for example, tell a depressed friend to cheer up, or suggest doing things that will cheer them up. They don’t need cheering up; they are not sad. Furthermore, if you do something you think will cheer them up and it does not work, they may end up feeling worse, either because they feel that they have let you down, or because the attempt just shows them how hopeless their situation is, or both. These are 3 things I did with my wife.
- A Hug. Physical contact made her feel a little better sometimes. Giving a depressive a hug is never wasted as long as you have no agenda along with it. You can give someone a hug (anyone for that matter) simply because you care about them.
- Listen. Once in a while, my wife wanted to talk about how she felt. At first I was not much of a good listener, but I learned over time. Her great mantra to me (and her therapists) was, “I don’t want you to cure me, I just want you to listen.” What she wanted, maybe what all depressives want, is for someone else to understand what it feels like to be depressed. She was not asking for advice or suggestions or anything like that. She was content to know that another person understood what she was going through. That way she did not feel so alone and isolated.
- Change of scene. Sometimes when my wife had been in bed for days on end I would suggest a simple change of scene. I designed a large, beautiful garden around our house with flowers, fish ponds, vegetables, trees, and whatnot. I worked in it most days when the weather was nice. Every so often I would go to my wife’s room and say, “Honey, I’ve just cleaned the fish ponds (or whatever). Would you like to see them?” Quite often she’d refuse, but now and again she would come out with me (if I pushed). Then, if it were a nice day, I’d suggest sitting in the garden for a while. We didn’t need to talk, but the simple change of scene could be energizing, for a while.
I’m not going to make any big claims about how I helped my wife. I probably helped very little. I’m also not going to claim that what I did is universally helpful. But I can say two things. First, what I did helped my wife a little, but it helped me as much. Every tiny step forward she made felt like a step forward for me too. Second, the three actions I advocated with my wife are useful in life for more than dealing with people with depression, especially the first two. Everyone can benefit from a hug, and everyone can benefit from having an uncritical listener.
To be continued . . .