Depression

According to the latest Adult Psychiatric Morbidity Survey (McManus, Bebbington, Jenkins, and Brugha, 2016) about one in six people have experienced a common mental disorder (CMD), usually depression or anxiety. While such figures are useful they don’t necessarily help much if you are stuck in the middle of your own mental health disorder.

In this short article, I want to make three points about the most common of these CMDs, depression.

Firstly, depression comes in many different forms and it might be helpful for the medical profession to have one label they can apply to the condition. However, for those that experience depression and/or work with sufferers, the term covers such a broad array of symptoms, that reducing it to just one label becomes almost meaningless.

There are some common symptoms. For most sufferers, there is an all-embracing sense of gloom and despair. It is 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 huge levels of anxiety whilst for others it’s just lethargy and exhaustion. Sex drive can be unmanageably huge or non-existent. For some, sleep can become a refuge, for others it is impossible. 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 company of others, let alone discuss their feelings. For some, there is huge anger and for others just sadness. In short, depression is not a single entity like measles or glandular fever; rather it covers a massive spectrum of complex and sometimes contradictory symptoms. And what is worse is that many of these symptoms can come and go on a daily or even hourly basis. This can be very confusing for those who experience it and difficult to explain it to a therapist.

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 self-judgement seems to have always been the case. Over 100 years ago Freud in his essay Melancholia and Mourning wrote that those suffering from melancholia describe themselves:

…as being worthless, incapable of functioning and morally reprehensible, he (sic) is filled with self-reproach, he levels insults against himself and expects ostracism and punishment. He abases himself before everyone else, he feels sorry for those close to him for being connected to such an unworthy person (Freud, 2006, p. 313).

This deep sense of utter worthlessness seems to be a common trait of depression. In therapy, it is something to be worked with rather than simply opposed or denied. There is no point in the therapist just saying something like, “Well you seem to be a lovely person to me”. Such a response misses the point entirely. For the therapy to work, both the therapist and the client need to understand and eventually accept the despised parts of the self that are being brought to therapy.

Neville Symington in his book on narcissism (1993) suggests that depression is at the root of most mental illnesses. He characterises it as a turning away from what he calls the life giver and a retreat into a relationship with the self which excludes others. This takes me to my third point, those experiencing depression are often stuck in an aggressive and reproachful battle with themselves. They need to find a way to reach out of that battle and reconnect with another human-being. For that reason alone, counselling and psychotherapy can be an effective intervention for depression. The sensitive and empathic therapist can form a tentative relationship with their client to help them rebuild a relationship with the outside world. This can take time; it is often messy and rarely straightforward but can offer both a relief from suffering and help to build resistance towards future depressive episodes.

Bibliography

Freud, S. (2006). Mourning and Melancholia. In A. Phillips (Ed.), The Penguin Freud Reader. London: Penguin.

McManus, S., Bebbington, J., Jenkins, R., & Brugha, T. (2016). Mental health and wellbeing in England: Adult Psychiatric Morbidity Survey 2014. Leeds: NHS Digital. Retrieved from http://content.digital.nhs.uk/catalogue/PUB21748/apms-2014-full-rpt.pd

Symington, N. (1993). Narcissism: A New Theory. Karnac Books.