Understanding depression

Whether you wish to help someone, or be helped, it would be good to understand depression. This page is edited and amalgated from a few of my blog posts.

Understanding the Mechanics

Depression is a strange illness. It’s not serious in the sense that it’s not directly fatal, such as a collapsed lung, or a hole in the heart. It doesn’t have as severe external symptoms as other mental or physical ailments. Yet it is more common than we think, with an estimated 1 in 20 Singaporeans suffering from depression at any time, according to Health Promotion Board statistics.

Depression isn’t just sadness because of something that has happened. It is characterised by sadness over an extended period of time, with other symptoms such as suicidal tendencies, low energy, changes in appetite, changes in moods and so on. Of all these, the suicidal tendencies are the most dangerous, and insiduous. Depressed people can find it hard to make decisions, maintain eye contact, lose control of their emotions more easily, get tired easily, walk or move at noticeably different speeds, or simply find conversation very difficult.

Depression isn’t something that can simply be snapped out of. It may result from mismanagement of emotions, or the incidence of crises such as heartbreak, but once it strikes, the illness itself is a real issue, not simply the management or control of emotions. Put another way, while depression may be triggered by incidents such as major changes, being sick with depression is a real thing, not simply a thing of the mind. This means that it’s no longer as simple as just cheering up, or thinking the right way. If someone can get out of their “funk” by doing something as simple as “not thinking so much”, they probably aren’t really down with major depressive disorder, but may simply be sad for that time.

Depression can have many causes. Sometimes, there is an imbalance of chemicals in the brain, which results in the brain not being able to cope with normal stressors, resulting in a constant sense of sadness and helplessness. Other times, while chemicals may not be the main reason, stressors can result in a temporary imbalance that would worsen the situation, and cause sufferers to enter a depressive state. Chemicals such as cortisol and serotonin are believed to be critical to maintaining a balance in the brain that allows us to deal with emotions properly. Too much cortisol can cause too much negativity, and too little serotonin also prevents positive emotions from being felt in the brain.

This simply means that the brain is no longer able to cope with stress well, and it is even possible to say that only negative emotions can be felt. Ordinarily, this is not the end of the world, but if positive emotions cannot be felt because of an imbalance in chemicals, this means that a sense of helplessness starts to creep in, as everything seems negative. At the same time, the brain no longer processes positive messages, and starts to believe only negative messages, especially those with a grain of truth. Half-truths are particularly insidious because of the grain of truth which is then magnified so that even a lie seems to be true.

In extreme cases, the false message that a depressive is a worthless person who cannot contribute to society becomes a very seductive siren song. Following closely on the heels of that message, is the whisper that death and suicide is the best way out – since the depressive sufferer is worthless anyway.

It is important to note that depression marks a change from won’t to can’t. For example, consider the few statements below:

  1. Think positively.
  2. Trust God.
  3. Pray.
  4. Eat well.
  5. Relax.
  6. Don’t think so much.

A person without depression who is upset, may choose not to do the above, or won’t want to do the above.

A person with depression can’t do any of the above.

This may be the cornerstone of understanding lacking in most mishandling of depression cases. Once this is understood along with a huge dose of empathy, helping someone with depression becomes easier and yet harder. Easier because a proper understanding has been reached, yet harder, because you don’t know what to do.

How Depression Feels Like

If you wish to understand how a depression sufferer feels, picture this:

Put on a beanie, or a skullcap, something that wraps itself around the top of the skull. Attached to the beanie is a chainmail veil, that drops over your eyes and ears. Once you’ve put it on, it’s not something you can take off at any time. At the same time, a steel band is wrapped around your heart, and starts to constrict, just a little, even as a cape of liquid metal drapes itself on your shoulders. It’s not heavy, but the weight is definitely felt.

Now everything that you see and hear is filtered through this gray haze. All positivity is filtered out, whether heard or seen. Pleasure is taken away by the veil, and whatever you see, touch, taste, hear, is now tinged with gray negativity. It’s never totally black, oh no. It’s a drip torture, little by little. You start losing touch with the world. If it was sudden, it might be easier to take since you know for sure you’re sick and need help. But it drips on you, little by little, giving hope that things may improve, even as it takes away hope with every drop.

The band around your heart grows tighter, day by day. The cape drags down, without you noticing it, more and more. Your breath comes harder, and every day grows dimmer, heavier, as you drag your feet, as you try to carry on. Soon, you forget to look up, always looking down instead. You forget how to find pleasure, and everything feels like mud and molasses. Drink tastes like dry water, and food tastes like sand. Occasional bursts of enjoyment gets through, and the laughter is real, but nothing lasts beyond that sparkle of time, which makes it even more painful because you don’t know how to reach back for it.

Despair starts to set in. Your self-worth drops. Hopelessness is your constant companion, as pain wracks your heart. Breathing becomes even more difficult, and now death itself seems like a good way out. It doesn’t matter how positive life is for you anymore. You can’t count your blessings because every breath is difficult, every step is painful, every thing is gray with despair. Every blessing becomes pale, every good thing becomes a shadow of goodness that you desperately wish to taste and enjoy, but can’t.

Words matter at this point. Words that tell you that you’re worth something. The constant reminder that there’re others around who care. If you don’t even have that, then suicide becomes a reality to dance with. In fact, even with care, death becomes delicious, something to savour, because the pain is already so deep that nothing else can fill your heart. The pain could have a source – because something bad has happened. Or it could have no real reason. But the pain is all that you feel, the grayness is all that you see, and ashes are all that you taste.

But even words can’t do much, as the pall continues to grow, as you struggle to breathe, to walk, to think.

Other Aspects of Depression

No matter what, understanding depression is difficult without having gone through it. But I will continue to attempt to give a glimpse of how it looks like from the inside.

To further understand depression, it is vitally important to understand that depression is full of paradoxes, and it is difficult to make sense of them.

Also, it may help to understand how depression affects energy and the way we live.