almost half of us will suffer from
depression at some point in our lives
but the condition remains badly
misunderstood and therefore often poorly
treated at the heart of our collective
difficulty with depression is a
confusion about what it actually is and
in particular how it can be
distinguished from a state that all of
us know very well and with which it has
a distracting number of similarities
namely sadness it's because we
unwittingly tend to apply to cases of
depression a number of assumptions drawn
from and better suited to an
understanding of sadness that we end up
suffering far more than we should but
there are on the surface some notable
similarities between those who are sad
and those who are depressed
both groups cry both withdraw from the
world both complain of listlessness and
a sense of alienation from their normal
lives
but there is one categorical difference
between depression and sadness the sad
person knows what they are sad about the
depressed person doesn't sad people can
without difficulty tell us what is
troubling them I'm sad that my
grandmother has died or that I lost my
job or that my friends are being unkind
to me and though it might sound strange
this is precisely what the depressed
person is not capable of doing they may
be tearful and at a very low ebb but
they can't conclusively put a finger on
what has drained life of meaning for
them they simply say it has no meaning
per se they aren't depressed about X or
Y as one might be sad about X or Y they
are first and foremost simply depressed
the inability of the depressed person to
account concretely for their mood can
lay them open to unwarranted charges of
faking malingering or exaggerating
friends who begin in a well-meaning
search for a soluble problem can end up
frustrated by the lack of
progress when pushed the depressed
person may latch on to rather odd or
minor sounding issues to account for
their state they might complain that
there's no point going to work because
the earth is due to be absorbed by the
Sun in seven and a half billion years or
they might insist that life lacks all
meaning because they've just dropped a
glass on the floor and everything is now
completely hopeless at this stage one
can hear it said that if depression
doesn't have any sensible psychological
causes the problem must be bound up with
some kind of imbalance in brain
chemistry which it would be kinder and
more effective to treat with pills an
idea of great appeal to the
pharmaceutical industry first and
foremost but also to worried families
and schools and employers who crave
rapid and cost-effective solutions but
there is another approach to depression
which those slower and more arduous may
be a great deal more effective in the
long term this stems from insights drawn
from psychotherapy the discipline that
has arguably been able to understand
depression better than any other the
basic premise of psychotherapy is that
the depressed person isn't depressed as
they suggest for no reason there is a
reason they are very distressed about
something but that something is proving
extremely difficult to take on board and
has therefore been pushed into the outer
zones of consciousness from where it
wreaks havoc on the whole person
prompting boundless feelings of nihilism
fir depressives realizing what they are
concretely upset about would be too
devastating so they unconsciously choose
to remain dead to everything as opposed
to very distraught about something
depression is sadness that has forgotten
its true causes forgotten because
remembering may generate overwhelming
untenable feelings of pain and loss what
might these true causes be perhaps that
we've married the very wrong person or
that our sexuality isn't what we once
believed or that with furious with a
parent for their lack of care in our
childhood in order to preserve a fragile
peace of mind one then chooses though
that may sound more willed than it is in
reality
to be depressed rather than to have a
realization we pick unceasing numbness
as protection against dreadful insight
to make things yet more difficult the
depressed person doesn't typically
consciously feel that they are in fact
lacking insight they're not aware of a
gap in their self understanding
furthermore they are nowadays often
taught to assume that they are just
depressed as one might be physically ill
a verdict that can be of appeal as much
to the pharmaceutical industry as to
certain people close to the patient with
an interest in insights remaining buried
there's another key difference to note
between sadness and depression sad
people are grief-stricken about
something out in the world but they
aren't necessarily sad about themselves
their self-esteem is unaffected by their
grief whereas depressed people will
characteristically feel wretched about
themselves and be full of
self-recrimination guilt shame and
self-loathing paranoia that may a tragic
extremes culminate in suicidal thoughts
for psychotherapy the origins of these
violent moods of self-hatred line anger
do fall but unable to be directed
towards someone else in the world that
has then turned against the sufferer
wrathful feelings that should have gone
count words towards a partner whose
relentlessly defensive or denies one sex
or a parent who humiliated one in
childhood these feelings are instead
driven back onto the sufferer and starts
to attack them the feeling X is horribly
let me down turns into a very unpleasant
but in some ways more bearable I'm an
unworthy and unbearable wretch one
becomes self-hating as a defence against
the risks of hating someone else also
worth noting in all this is that in many
cases depression is associated with an
apparently opposite mood a kind of
euphoric state termed mania hence the
term manic depressive the mania in
question looks from a distance a bit
like happiness and just like depression
can look like sadness but in one area in
particular the relationship between
mania and happiness is identical to that
between depression and sadness
the common element is a disavowed
self-knowledge in mania one is euphoric
but cannot go into one's own deep mind
and discover its bitter truths which
explains one of the leading
characteristics of manic people the
habit of being in flight from themselves
talking too much about nothing over
exercising drinking working continuously
or spending too much all as an escape
from a submerged grief rage or loss it
is from this kind of diagnosis that has
suggested cure emerges what people in
depression need above all is a chance to
arrive at insight for this they will
tend to need a hugely supportive and
patient listener
they may also used appropriately benefit
from temporary use of medication to lift
their mood just enough so that they can
endure a conversation but the assumption
isn't that brain chemistry is where the
problem either begins or ends the
despair is caused by an undigested
unknown and unresolved
also far from needing to be taken
through reasons to trust that life is
beautiful depressives must be allowed to
feel and to remember specific damage and
to be granted a fundamental sense of the
legitimacy of their emotions they need
to be allowed to be angry and for the
anger to settle on the right awkward
targets the goal in treating depression
is to move a sufferer from feeling
limitlessly despairing to mourning the
loss of something in particular the last
20 years a marriage a hope one would be
loved by one's father a career however
agonizing the insight and mourning might
be these must always be preferable to
allowing loss to contaminate the
totality of one's perspective there were
plenty of dreadful things in every life
which is why it's wholly normal to feel
sad on a regular basis but there are
also always a sufficient number of
things that remain beautiful and hopeful
so long as one's been allowed to
understand and no one's pain and anger
and adequately mourn ones losses
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