BLOG (2/1) posted on 2018/03/12 – check this blog for the next update in two week’s time
MOVE OUT FROM UNDER THE DARK SHADOW OF DEPRESSION AND ANXIETY
Depression from a psychological perspective
From a subjective to a more objective perspective
If you feel the need to share your personal experience of depression with someone, it is good to initially hold to your own subjective perspective of depression. That way you will experience a greater awareness of this feeling that can paralyse you at times - perhaps you might feel like a tree which is shedding it’s leaves...and you will have your own unique way of describing how you feel. Eventually you will experience catharsis and healing. This will happen because you are able to share these feelings and experiences with someone you can trust. Maybe this person is your partner, a family member, a friend, a psychologist, or members of a therapeutical group you belong to, your doctor or your minister, people you can trust.
However, if it is your desire to know more about what depression really entails, you need to take one step further than the one you already will have taken, by sharing your depression with someone. Then it is necessary for you to look beyond your own perception of depression. Let us get a bit of distance from our subjective views about depression, to enable us to look at it from a more objective perspective.
The nine criteria for Depression
Considering the nine most important criteria or symptoms of depression, brings us closer to a more objective perspective regarding this condition. If five or more of these symptoms persist for two weeks continuously, and they also represent a change in your normal or previous behaviour, you are suffering from depression. It is quite normal for an individual to experience one or two of these symptoms – which doesn’t necessarily mean that you are suffering from depression.
The symptoms mentioned below are signs that should be carefully monitored in yourself, or someone whom you suspect may be suffering from depression. It is important not to disregard symptoms, especially since depression is known to be the ‘illness of our time’. In this blog I will attempt to illustrate the symptoms practically, according to statements made by patients I have treated for the past 24 years.
In the research I did for my doctorate I worked with men experiencing low self-esteem. Each of them had their own opinion about what they understood by low self-esteem and depression. From them I learnt a lot about depression. One hears more often of depression amongst women however, because they are more inclined to talk about it. Most men I know will keep their depression a secret as they tend not to reveal their deepest feelings or problems to someone else. This makes the problem bigger for men – what could have been just a molehill now becomes a mountain.
Just about all the research participants with low self-esteem in my study, also suffered from depression, as will become clear from statements made by them:
· 'I feel very depressed … On a scale of one to ten I will generally evaluate myself between five and six. I fall to minus ten when I feel very depressed.’
· 'I have stopped living.'
· 'I experience intense depression.'
The nine official criteria according to Kaplan and Sadock’s Synopsis of Psychiatry follows. The form that each symptom takes in each individual can naturally vary. It can also differ in intensity.
1 Depressed mood for the largest part of the day, every day. Examples of these are feelings of emptiness and sadness, or observations made by significant others like, ‘She seems to be very tearful.’ In children and adolescents it is often an irritable mood.
One of my patients verbalized it very clearly: ‘I feel empty.’
2 Significantly reduced interest or joy in all or almost all activities for most of the day, everyday, e.g. a hobby or sport that the person used to enjoy. The following statements of patients show the presence of this symptom in their lives:
‘I don’t want to do anything anymore.’
‘I have no interest in the things that I previously enjoyed in life and that gave meaning to it.’
3 Significant weight loss when the person is not on a diet, or weight gain (e.g. a change of 5% of the body weight within a month, or reduced appetite almost every day).
The following words of a depressed lady in therapy who was battling with being overweight, reflect her constant obsession with food: ‘I want to eat all the time because at that moment it makes me feel better.’
An obese woman says in a television interview: ‘I don’t eat because I’m hungry but because I feel so empty inside.’
4 Daily insomnia (inability to sleep) or hypersomnia (the person wants to sleep all the time).
A professional person with underlying depression and a constant high stress level, shared with me as follows: ‘I cannot carry on like this, day by day, night after night. I am depressed. I cannot continue to function without sleep.’
5 Psychomotor agitation – a combination of physical and mental activities related to intense restlessness. This symptom, like fatigue or lack of energy, which is mentioned below, has a strong impact on the social functioning of the depressed person. Depression often leads to social or interpersonal withdrawal.
One of my patients said to me: ‘I hide. I withdraw from society.’
6 Fatigue or lack of energy which is experienced almost every day, is another prominent symptom of depression. However, it is important to remember that it is normal to feel tired from time to time.
One patient said: ‘Recently I have been feeling like an old dishcloth.’
Sometimes people’s statements about their fatigue borders on weariness of life, like the words of this man: ‘Sometimes I feel ill for a week and then I don’t eat. This indicates weariness of life to me. During these times I am very moody. To me, this indicates depression – being tired of living.’
7 Feelings of worthlessness or inappropriate feelings of guilt (which could be related to delusions) almost every day. This relates to the consistent idea or belief that ‘I am not worth anything’, which is in contrast with reality, but is upheld in spite of evidence to the contrary. This is more than just feeling guilty about being indisposed for example, but more like the woman who believes that she can’t do anything of value.
8 A reduced ability to concentrate or think and/or indecisiveness almost every day. It comes down to an inability to focus. Patients will often say of themselves: ‘I am so scatterbrained lately.’
9 Recurrent thoughts of death (not just fear of dying), recurrent suicidal thoughts without a specific plan, an actual suicide attempt or a specific suicide plan.
A very dynamic lady once described her intense feelings of depression to me thus: ‘ I sat on a bench outside on the porch and had the intense desire that God should just take me away at that very moment, because there is nothing left for me. There’s nothing. Everything inside me is dead. I am not up to this nothingness anymore.’
The feelings of the research participants with whom I worked for my doctorate, relate to a wide variety of emotions, amongst which the following were mentioned: suicidal thoughts, suicide attempts (as adults but also as children) as reflected in the words of two of the participants:
‘I tried to commit suicide in primary school.. I tried to electrocute myself. I was totally dissatisfied with life.’
‘In standard five I drank a bottle of paraffin and landed up in hospital. Since then I have lung problems.’
Usually symptoms related to suicides should be a red light to significant others in the depressed person’s life. To threaten suicide can be manipulative, but it must never be taken lightly by significant others.
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ME AND TREE EXERCISE
Perhaps you can let me know what you have heard from a tree of your choice, by sitting under or next to a tree for a while, and allowing yourself to “hear” what the tree wants to tell you. Write it down in your journal or a piece of paper – and just share it with us on this blog!!
(You can share it in English or Afrikaans)
“Be like a tree. Stay grounded. Connect with your roots. Turn over a new leaf. Bend before you break. Enjoy your unique natural beauty. Keep growing.”
(Joanne Rapits)