The word ‘depression’ can mean a whole bunch of different things – too many, in my view.
The Oxford English Dictionary defines depression as “feelings of severe despondency and dejection” and clinical depression as “a mental condition characterized by feelings of severe despondency and dejection, typically also with feelings of inadequacy and guilt, often accompanied by lack of energy and disturbance of appetite and sleep”. Both sound like a day at Disneyland, obviously, but notice that both are also very much umbrella terms: we could be talking anything from the deep sadness that follows, say, a relationship break-up, to years spent semi-catatonic, hardly able to get out of bed. The definitions say nothing about causes, triggers, duration, treatment or numerous other factors that distinguish the multifarious experiences we bundle together under this one big woolly word.
I think we need several words instead of the word depression not just because I’m a stickler for semantic orderliness (though I do totally get hot for some of that) but also because I think the breadth and vagueness of the word can often make being depressed, in whatever sense, even harder and more lonely.
It might help to consider a physical analogy – which, in itself, says quite a bit about where we are on understanding mental health, but hey. Imagine that, instead of the terms ‘asthma’, ‘chronic bronchitis’ and ‘lung cancer’ we had just one overarching term, let’s say ‘chest trouble’. Now imagine you had one of these three conditions – asthma, chronic bronchitis or lung cancer. A doctor could do the appropriate tests, discuss your symptoms in detail with you, identify the precise nature of your ‘chest trouble’, and treat you accordingly. But in normal, everyday conversation, there’d be no easy way, no quick label you could use, to tell someone precisely what you had. That might feel quite disabling, right? It could make it hard to communicate, and lead to misunderstandings and false equivalencies. It might even, by compounding your physical symptoms with feelings of frustration, isolation and confusion, make you feel materially worse. It might actually change the way you experienced your condition.
I’ve been getting treatment for what, in this sad state of lexical paucity, can best be described as ‘episodic depression’ since I was 20, though I’m pretty sure I remember the black dog – or, as a dear and sometimes-depressed friend has coined it, TOLGOD (“The One-Legged Goblin Of Doom”) – lurking around the edges of my peripheral vision back into my teens, perhaps even before. My relationship with SSRI (Prozac family) anti-depressants has been on-off and somewhat uneasy over the past 18 years. I’ve never liked the idea of being dependent on medication, it’s never sat easily with my self-image or control-freakish tendencies, and these drugs are still relatively new and we still don’t really know what the implications of their long-term use might be. Every so often, I’ve come off them just to check on my baseline state. The last time I did this was towards the end of 2013. I’d ended up on an unusually high dose, having experienced additional anxiety when my son was a baby, and started to pick up on some physical signs that caused me concern, including my periods grinding to a halt, so I wanted to clean things out, give my body a chance to reset and see how the land lay. My doctor warned me it wouldn’t be easy, and she wasn’t joking: the first day I reduced my dose was followed by a grim sleepless night of palpitations, hot flushes and lurching nausea, which only confirmed my suspicions about the strength of the stuff. Determined to persevere, I phased them out incrementally, finally stopping altogether by the end of November that year. What followed was a blighted Christmas, and three more bad, exhausting depressive episodes in the space of about ten weeks. In February, I went to my doctor and cried a lot and agreed to go back on the meds.
My doctor – a blessedly calm, pragmatic, Indian-American woman who happens to be just two months older than me – listened patiently and said some wise, illuminating things that, amazingly, after all those years, I’d never heard before. “You’ve got depression. It’s not you, it’s a condition, like high blood pressure – some people just have it and we don’t really know why. You’re unlucky, but there are things that can help”. I explained that I felt profoundly disappointed in myself; that I couldn’t escape the thought that I should be stronger and somehow capable of controlling it. Her very slight smile said: Oh, you Type As, you make me crazy. “You can’t fix a broken mind with a broken mind”, she said.
A depressive episode for me is different from sadness, and it doesn’t stop me getting out of bed. It’s not a matter of magnitude – or not primarily, anyway: while we might say some of the conditions we refer to as ‘depression’ are, in certain ways, worse than others, the main point is that they are just qualitatively different. That’s why, I think, we need different words – at least three, and probably many more.
Here’s my best attempt at describing what a depressive episode feels like for me. (Incidentally, I’ve never been able to pinpoint any triggers, and these days I‘m 99 per cent sure none exist, perhaps apart from shifts in my body chemistry). It starts with a portentously familiar feeling, like that ephemeral sense you sometimes get that you’re coming down with a cold. Sometimes I feel fatigued, like everything is harder work than usual, but it’s subtle, and often I will only realize later, when things have built up, that the feeling was there at all. Over the course of a few days or a couple of weeks, that quiet hum gradually crescendos to a roar, a cacophonic blast of rough, overwhelming emotion. The feelings are panic, fear, despair – and it’s feelings that define it, rather than thoughts, but one of its most insidious features is that it will hook on to certain negative thoughts and insecurities, and inflate them beyond any reasonable size. For example, work is a sensitive issue for me having let my career slide since having a child, but what are normally fairly calm, measured thoughts, mild worries at worst, transform during a depressive episode into Oh my god it’s all gone wrong, I’ve made a terrible mistake that’s completely unfixable, I’m a fundamentally incapable person… It’s very undermining. And there’s this kind of double consciousness that goes with it, too: on one level, I know I’m in the grip of a depressive episode and therefore that I probably shouldn’t pay too much attention to the thoughts running through my head, but at the same time the depression whispers in my ear: This bit is the truth. It’s actually now that you’re seeing clearly. After all, when you think about it, don’t you always end up here?
Once things reach their peak, it typically takes no more than a day or two for me to wear myself out with all the invisible battling – oh, and the weeping, so much weeping, endless and unstoppable, more tears than one pair of eyes ought to be able to produce. Then I enter a recovery phase, when I coddle myself like I’m frail or sick, reducing living to a series of very small, simple components, taking each slowly in turn. One. Foot. In front. Of the other. That’ll last for a week or two. It’s a fair chunk of lost time.
To me, depression feels like whatever it is that anchors me to some kind of equilibrium, some general, fundamental sense that life is under control and things are going to be basically okay, suddenly gets cast adrift, and it’s only by flailing about in the water that I’m able, somehow, eventually, to get it back in the sand.
Inevitably, that account feels inadequate, and I have no idea how much it might resonate with anyone else, but what I do know is that since my doctor helped me gain some clarity about exactly what it is – this thing I’ve got, that I’ve been dragging around with me for most of my life – I’ve taken a leap in learning to accept it and finally found some sort of peace. I’m now on a low dose of Lexapro and it’s been over a year since my last depressive episode. Maybe there’ll come a day when I don’t need the drugs, and maybe there won’t, but for now I’m glad to have stopped resisting what, for now, can help me. A better understanding has been key to that, but a more precise word – one that differentiated my experience from all those other things we call ‘depression’; one that sounded less dull and more violent; one that captured the relative brevity and painful repetition of my episodes, as well as the propensity of my particular condition to be controlled by medication – a word like that might, I think, have got me here more quickly. Crucially, a clearer label would have made it easier to communicate my experience to others, and helped me avoid some of the understandable misunderstandings that at times compounded my pain by making me feel silenced and alone. We use language to connect with one another and interpret our own experience. Better words may help us get better.
Photo: ‘Abstrato’ by Guilherme Yagui https://www.flickr.com/photos/yagui7/