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Page 1 of 5 What is Depression? How Does It Feel To Be Depressed?
Let's be sure that you and I are talking about the same state of mind when we use the word "depression." People sometimes say "I'm depressed" when they refer to a state of mind quite different from the established psychological meaning of the term.
The rock-bottom element in depression is the feeling of sadness. The term "sad" includes without distinction the feelings and moods one might call "melancholy," "blue," "being down," "misery," "grief," "despair," and similar descriptions of negative feeling. The prolonged feeling of sadness, plus the thought "I'm worthless", constitute depression; these two elements are the hallmarks of the depressed person.
A variety of other symptoms are also found in some depressed persons--inability to sleep, disinterest in sex, inability to work, for example. But these other symptoms are by no means universal. If we stick to a definition of depression as sadness plus low self-esteem, we will be clear and unconfused about the subject of this book. And you will find it easy to check yourself against that definition, with the aid of the detailed descriptions of sadness and the sense of worthlessness in the definitions and case histories that follow.
A sense of helplessness, often with a sense of hopelessness, accompanies or is part of the sadness and lack of self-regard in depression. The helpless attitude might be considered part of the core of depression. A rigid set of "ought's" and "musts", and a absence of pleasurable experiences, frequently are important constituents, too.
Prolonged sadness and depression felt to me -- and others have used similar language -- like living in a pool of pain, feeling helpless to escape from it.
Some sadness is inescapable and normal, of course; life without sadness would not be human. But the subject of this book is the state of sadness which does not pass as fast as it "ought" to, and the person who stays sad longer than is "reasonable." The words "ought" and "reasonable" are troublesome, and we'll come to them later. For now let us simply think of depression as a state of sadness sufficiently intense and persistent that the depressed person might consider seeking help to get less sad. And in depression, thoughts of personal worthlessness ("low self- esteem") are more frequent and intense than most people experience.
Similar descriptions of depression--or "melancholia"--have been given from ancient Roman times until now.1
Typical Depressives and Symptoms
Here are some depression cases as seen and described in capsule by psychotherapists: The depressions are mostly much more severe than you are likely to suffer, but they should be instructive nevertheless.
A young housewife:
Margaret ... was young, about twenty- five and married, as she said, to a very fine man. She held a job which she found fairly interesting and about which she voiced no complaints. In fact there was nothing about her life that displeased her, yet she said she suffered from chronic depression. I would not at the outset have said that Margaret was depressed, because when she came into my office, she always smiled and talked about herself very excitedly in a high-pitched voice. No one meeting her for the first time would guess the nature of her problem unless he was astute enough to see that her manner was a mask. If you ob- served her carefully or caught her off guard, you would notice that at times she became very quiet, and as the smile faded, her face grew blank.
Margaret knew she was depressed. It required an effort of will simply to get up in the morning and go to work...There was an inner emptiness and a lack of real pleasure...Her smile, her volubility and her manner were a facade pretending to the world that everything was all right with her. When she was alone, the facade crumbled and she experienced her depressed state.(2)
A 25-year-old engineer, who said:
"I feel as though I'm dragging myself down as well as my family. I have caused my parents no end of aggravation. The best thing would be if I dug a hole and buried myself in it. If I would get rid of myself, everybody would be upset for a time but they would get over it. They would be better off without me."...
After graduating from college, he had had a succession of jobs and had started a small business that failed. He was not doing well in his current position and was certain that he would be fired within a few days. He experienced a gradual loss of self-confidence as his work did not seem to mea- sure up to the expectations of his employer. Two days before his psychiatric consultation he received notice that he would be fired. He became very discouraged and experienced a complete loss of appetite and considerable difficulty in sleeping. He thought of various ways of killing himself, such as taking an overdose of pills or throwing himself from a high building.(3)
A middle-aged single woman:
Anne was an intelligent woman who had been successful alike in her career and her creative pursuits. With the collapse of her morale, work became difficult and her creative urge diminished. Several other factors contributed to her collapse, but all were related to the loss of the feeling of femininity and womanhood.
When I first saw Anne, she looked collapsed. Her body was flabby, her muscles lacked tone, the skin of her face sagged, her color was poor. She lacked the energy to breathe deeply and her constant comment was "It's no use." When a patient utters these words, what he generally means is, "It's no use trying. I can't make it." But I had the impression that Anne was saying, "It's no use living. I simply can't make it."(4)
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