Depression looks different for everyone

Depression comes in many different forms. While it might be helpful for the medical profession to have one label they can apply to the condition, for those who experience depression and/or work with people experiencing it, the term covers a broad array of symptoms.

Depression can take many forms

There are some common symptoms. For many people, there can be an all-embracing sense of gloom and despair. It can feel as if everything that once gave pleasure now gives either discomfort or produces no feeling at all.

Beyond this, however, symptoms can vary enormously. For some people, there are high levels of anxiety whilst for others it’s lethargy and exhaustion. Sex drive can increase or be non-existent. For some, sleep can become a refuge; for others it is difficult.

Some people eat compulsively, others can’t eat a thing. Some people want to talk about it to everyone; others can’t bear even the thought of being in the company of others, let alone discuss their feelings. For some, there is anger and for others sadness.

In short, depression is not a single experience; rather, it can involve a wide spectrum of complex and sometimes contradictory symptoms.

These symptoms can also change over time. This can be very confusing for those who experience depression and difficult to explain to others, including a therapist.

The self-judgement that can come with depression

Secondly, there is often a sense of ‘I shouldn’t be feeling this’ or ‘Everyone else seems to be managing: why am I so pathetic?’

This kind of self-judgement has been written about for a long time. Over 100 years ago, Freud explored profound feelings of worthlessness and self-reproach in his essay Mourning and Melancholia. While our understanding of depression has developed considerably since Freud's time, the experience of harsh self-judgement may still feel familiar to some people experiencing depression.

This deep sense of worthlessness can be part of depression for some people. In therapy, it is something that can be explored rather than simply opposed or denied. There may be little value in the therapist simply saying something like, “Well, you seem to be a lovely person to me.” Such a response may miss the complexity of how the person genuinely feels about themselves.

Therapy can instead provide a space in which difficult and sometimes despised parts of the self can be explored with greater understanding and compassion.

Reconnecting with others

Psychoanalyst Neville Symington, writing in his 1993 book on narcissism, offered a particular theoretical perspective on depression, describing a retreat into a relationship with the self which excludes others.

Whatever theoretical approach we take, depression can leave some people feeling caught in an aggressive and reproachful battle with themselves and increasingly disconnected from those around them.

For this reason, counselling and psychotherapy may offer valuable support for people experiencing depression. A sensitive and empathic therapist can begin to form a relationship with their client that provides a space for connection, exploration and understanding.

This can take time; it is often messy and rarely straightforward. But therapy may offer some relief from suffering and help people develop ways of recognising and responding to difficulties in the future.