Feeling Depressed and 'Depression'.
Feeling sad or depressed is part of what it is to be a human. It’s something that every one of us feels at times and it’s something that none of us can avoid. It’s a sign of maturity that one has developed resilience to misfortune that we don’t expect from children, whom we shield from harsh realities. The degree to which each of us is resilient and what we can take in our stride is an individual matter but very few of us expect to be happy all of the time.
‘Depression’, however, is a diagnostic term used by doctors and some psychological practitioners to refer to a set of symptoms that are often experienced simultaneously. Below is the beginning of the entry on ‘Depressive Episodes’ in the I.C.D.-10, the tenth volume of the International Classification of Diseases published by the World Health Organisation. Along with the D.S.M.-V, produced by the American Psychiatric Association, these two volumes are the manuals used by psychiatrists and psychologists globally to diagnose mental health ‘disorders’.
“In typical depressive episodes... the individual usually suffers from depressed mood, loss of interest and enjoyment, and reduced energy leading to increased fatiguability and diminished activity. Marked tiredness after only slight effort is common. Other common symptoms are: (a) reduced concentration and attention; (b) reduced self-esteem and self-confidence; (c) ideas of guilt and unworthiness (even in a mild type of episode); (d) bleak and pessimistic views of the future; (e) ideas or acts of self-harm or suicide; (f) disturbed sleep (g) diminished appetite.”1
Manuals such as the I.C.D.-10 and D.S.M.V are based on the collection of information from thousands of clinicians - and tens of thousands of their patients - working in the field of medicine and mental health treatment within the medical model. They are developed to take the guesswork out of diagnosis, so that it is reliable and applied uniformly to everyone equally - that having symptoms X + Y= diagnosis Z. The obvious follow on from diagnosis is that particular forms of treatment are prescribed based upon the diagnosis because they have expected outcomes. But is the course of human behaviour so easy to predict?
A little further on from the above entry the authors write that “as with manic episodes, the clinical presentation shows marked individual variations, and atypical presentations are particularly common in adolescence.” So, there’s no one size fits all and teenagers break all the rules. Indeed the preceding quotation speaks about ‘typical’ presentations and what people ‘usually’ suffer from. So things are not so black and white.
As a clinician myself I am concerned about my clients being diagnosed by a doctor as ‘having depression’ before they come to work with me. Certainly, such clients may be feeling depressed, and have many of the symptoms listed in the I.C.D.-10 or D.S.M.V, but having a diagnosis of depression says nothing about what that particular person is experiencing. It says that they went to a doctor looking for help because they were suffering and the doctor assessed them in terms of their symptoms and prescribed a particular treatment. They may be prescribed medication, psychological/psychotherapeutic treatment or both, but the diagnosis itself is only one word that stands in for all the others that make up the experiences of the unique individual in question.
A diagnosis of depression suggests a prognosis - it suggests a typical way that a person will behave based on the previous experience of others and how a ‘typical’ person will ‘usually’ respond to different forms of treatment. In my experience of working with people diagnosed with ‘depression’ there is an expectation that it will end within a predetermined time frame and an expectation that medication will have had a specific and measurable result within a certain time frame. It’s human nature to want things such as suffering to have a definite end point and to look to others’ experience to predict what we can expect but the flipside of this is that there are no guarantees that our own experience will be the same as an other's.
This is particularly relevant if someone has chosen to take prescription medication as part of their treating the depressed feelings that they are experiencing. There is an expectation that they will notice measurable changes within a predetermined time, but everyone responds to medication differently and for many people medication simply is not enough. Medication will treat the symptoms of feeling depressed but it can’t explain why you may be feeling that way in the first place. As a psychoanalyst I believe that all such symptoms are meaningful and can only be understood through speech - that only in analysing why and how the symptoms have developed can we know something about alleviating them permanently.
The main point that I wish to make is this - a diagnosis of ‘depression’ is not necessary to begin doing something about your experience of feeling depressed. Receiving a diagnosis of ‘depression’ does not make your suffering any more legitimate than it was before the diagnosis - because it was always legitimate. If we are truly going to lift the stigma on mental health issues in Ireland and grow as a nation out of the infertile isolationism of shame and silence than part of that is also moving beyond the idea that an other in a position of knowledge can legitimate what is our own unique and individual suffering.
If you are feeling depressed and you want to do something about it you can call 085 1440 272 or make contact via the form on the 'Contact' page.
1 pg.100, ‘The ICD-10 Classification of Mental and Behavioural Disorders: Clinical Descriptions and Diagnostic Guidelines’, World Health Organization; 1 edition (January 1, 1992)