> Now you can no longer figure out what it is that moves other people to bustle about out there in the world, doing errands, rushing to appointments, picking up a child from school. You have lost the thread that pulled the circumstances of your life together. Nothing adds up and all you can think about is the raw nerve of pain that your mind has become—and, once again, how merciful it would be to yourself and others to extinguish this pain.
We need another word for what is described above. Most people understand ordinary depression, because most people feel down sometimes and they have techniques for getting out of it. They try to get the "clinically depressed" person to try these techniques.
When I was in my cycle of doom I would set as my goal of the day to get up and take a shower and often couldn't accomplish it. Forget doing the dishes. I knew I needed help, but without medical insurance I couldn't afford it and didn't have the energy or will to try to get medical insurance.
Finally, my family intervened and I was locked up as a danger to myself after I verbalized a few dangerous thoughts. I'm on insurance now and taking medication and things are much better. I'm not necessarily happy, but at least the "black dog" is gone.
I have a lot of respect for people that are even able to maintain for a while during that state. My own experience with this (at least from all the descriptions of clinical depression I've heard it sounds the same) was with a bad interaction with medication as far as I know (Mucinex DM, absurdly enough).
It started by me having a pretty droll day at work, but the first indications something was really wrong (looking back), were when I went home, and literally wanted to do nothing. I didn't want to play or deal with with my young children or significant other, didn't want to eat dinner, didn't want to watch TV or read a book, or use the computer for any reason. I literally wanted nothing, and the best way to achieve that seemed to be to go lay in bed, even though I didn't want to sleep either.
The second day was much the same, but I also realized that I didn't like my job, or career, and wasn't sure what I wanted to do with my life either. Needless to say, this didn't improve my outlook compared to the prior day.
The third day, when I woke up, I was scared. I wasn't sure what was going on, but I stopped taking the congestion medication just in case and because it was the only thing I could think of that had changed recently. I was feeling mostly normal within 24 hours or so. I can easily see how in that state of mind things could escalate. Almost a decade later, I still consider it one of the scariest episodes of my life.
Interestingly, 9-10 months later, a friend who I had told about the incident right after it happened told me the same thing had just happened to him from the same medication.
I'm glad you got everything under control. The brain is a crazy organ.
Did you report the possible side-effect? Depression doesn't seem to be recorded for Mucinex DM, so it might be worth flagging that up with your country's drug regulator, especially considering you know you weren't the only case.
It's my impression they really appreciate reports of unlisted side-effects: bug reports are great for software, but they're even more valuable when they can mean life or death - and when the affected systems are as complex & varied as the human body.
I seem to recall I did, and they said that it wasn't a reported side effect they had heard of before. I reported it after my friend reported it, since there was some corroboration at that point, and I mentioned that. I believe this was a number listed on the package, but honestly I don't recall it all that well, as it was quite some time ago.
It's entirely possible I called the pharmaceutical company, and they may not be incentivized to look into every claim...
If the DM stands for dextromethorphan (an expectorant) it would fit. They warn people on SSRIs to avoid it because of interactions - has some affect on serotonin. It's also usually included in things like Dayquil.
Dextromethorphan is a "dissociative anesthetic" that some people use recreationally. It's a bit of a cliche that kids will sometimes abuse cough syrup because it gives them a mild ketamine-like high. I suppose it's not shocking that it could potentially have a negative psychological interaction.
It looks like it has SSRI-like effects itself. So it also shouldn't be taken by people on older anti-depressants (MAOIs) as it could cause 'serotonin-syndrome' (which can be fatal if not treated quickly).
> We need another word for what is described above.
One plausible candidate is the word (and condition) "melancholia," which has the advantage of being identifiable by means of objective clinical indicators[1].
Melancholia was excluded from DSM-5, not because it lacked objective clinical diagnosis indicators, but because it possessed them. By being open to objective, impartial diagnosis, it set itself apart from the other conditions described in the DSM, in a way that would have exposed something about the DSM that its editors preferred to conceal -- the majority of the DSM's content lacks scientific substance[2].
A quote from the second linked reference: "A single disorder that met the scientific demands of the day, in other words, would only make the failure to meet them in the rest of the D.S.M. that much more glaring."
The entire premise of the DSM is a bit of a crock: mental illness simply doesn't fit well into the disease model of illness. Mental dysfunction is not binary, it is measurable on a continuous scale. And although some symptoms do present in certain 'groups' more frequently than others, symptoms of mental illness are more 'mix and match' than the DSM would lead one to believe. This sometimes means that people are either diagnosed with 2-3 'co-morbid' disorders or none at all.
> We need another word for what is described above. Most people understand ordinary depression, because most people feel down sometimes
No we don't, it's called depression.
What we need is people to realize that depression is not 'people feel down sometimes.' That is feeling down. Depression is not something that you just work through, it is an actual, real thing going on in your brain.
But hell, most people act like armchair psychologists so ya, lets create another term that they'll also misuse.
Any word you try to create for the same thing would be as well because it would be the new word for it.
Also, there is Depression (condition) and Depression (colloquial usage) that's the way language works. The problem is not that the word is used, but that people believe the colloquial usage is the medical usage. They believe that when they feel depressed (colloquial) they just eat a cake or do something they like to get over it so why can't you when you're depressed (actual medical depression).
The way I've often described this to people is that at some point I got off the merry-go-round and I haven't a clue how to get back on. This was (and remains) a turning point in my own depression, which is why it's interesting. Prior to that I felt like I was holding on to something for dear life, then at some point 5-10 years ago it became a feeling much more akin to the above. "Nothing adds up" is a great way of describing it. I also sometimes say I feel like I'm living a in mirror universe where nothing makes any sense.
And I'm speaking as someone who deals with this every day, not as someone who's recovered and is looking back. Recovery isn't possible anymore, unfortunately. I guess my advice to anyone is if you're not as far along as I am... Don't get off the merry-go-round. You really can't get back on.
In my case I didn't choose to get off the merry-go-round. It happened. I choose to get back on with meds because not choosing was too painful possibly leading to unfortunate ends. I am lucky that meds worked for me. My heart goes out to people like David Foster Wallace for which the meds stopped working.
It is, but it's also important not to alienate the person you're trying to help.
I'm not being sarcastic - you're absolutely right - but it's very easy to come across as spouting happy-clappy cliches ("it gets better!"), or claiming to know their life situation better than they do.
Depressed people aren't always right about their prospects, but they aren't always wrong, either.
It is important to realize that other people in this world may have lived longer, gained more experience, and understand more than you do.
It's also important to realize that a huge part of depression therapy is trying to convince people they can be "cured" or can recover, when evidence points to that being highly unlikely - all the actual studies suggest that it causes permanent, irrevocable changes. And the author of the very book we're discussing specifically expresses skepticism about the efficacy of therapy.
It doesn't always get better. In fact, most times it doesn't.
I have 0 experience of your life. What I do know is that if there's a small chance that I'd never have to suffer another major depressive episode again, I'd consider that good information to have. Even when the odds aren't in my favor, I consciously make the choice to focus on the possibility. This isn't Pollyanna, it's practicality -- thoughts impact mood. Part of CBT is learning about your thinking, and one of the things that helped me get into a pattern of recognizing my own thoughts was to separate observations, suspicions and conclusions.
I appreciate your trying to help, and I don't mean that in any kind of a condescending or patronizing way. I shouldn't have been so quick to disregard what you're saying. And it's certainly true that variations of "binary thinking" are a hallmark of depression - although I guess what you're describing isn't quite binary thinking even if I think it comes from the same place, an absolute certainty of negative aspects of something and bottomless doubt of anything positive, or anything else at all about it. I'm glad you found CBT helpful to you and I wish you luck and happiness in your future.
There's a bit of medical jargon to describe this, but it's pretty antiquated: 'psychomotor retardation'. Definition from Wikipedia:
'Psychomotor retardation (also known as "psychomotor impairment" or "motormental retardation") involves a slowing-down of thought and a reduction of physical movements in an individual. Psychomotor retardation can cause a visible slowing of physical and emotional reactions, including speech and affect. This is most-commonly seen in people with major depression and in the depressed phase of bipolar disorder...'
This was/is my most prominent symptom. I once sat in a chair for three days straight (fortunately I had a glass of water within arm's reach), during a two-ish week period where I couldn't summon the motivation to leave my house. It was godawful.
I wonder if it's a vestigial evolutionary trait, particularly in the case of seasonal depression. It would make sense in some contexts: if you're a hunter-gather, resources are scarce during winter. Your chance of survival might therefore be higher if you expended as little energy as possible while waiting out the winter...
I remember reading that and thinking "bingo!" It described what I had felt. Your thought about it being an evolutionary advantage is an interesting one and could explain seasonal affective depression (disorder)
The words we don't have yet are the ones we will need as weapons in the imminent revolution/paradigm shift of mental health.
Some words we already have include (descriptions from wikipedia):
anomie: a "condition in which society provides little moral guidance to individuals"
acedia: "also accidie or accedie /ˈæksᵻdi/, from Latin acedĭa, and this from Greek ἀκηδία, "negligence") is a state of listlessness or torpor, of not caring or not being concerned with one's position or condition in the world. It can lead to a state of being unable to perform one's duties in life. Its spiritual overtones make it related to but arguably distinct from depression. Acedia was originally noted as a problem among monks and other ascetics who maintained a solitary life."
todestrieb: "the death drive (German: Todestrieb) is the drive towards death and self-destruction [...] This concept has been translated as, "opposition between the ego or death instincts and the sexual or life instincts" [...] The death drive opposes Eros, the tendency toward survival, propagation, sex, and other creative, life-producing drives."
weltschmerz: "(from the German, meaning world-pain or world-weariness, pronounced [ˈvɛltʃmɛɐ̯ts]) is a term coined by the German author Jean Paul and denotes the kind of feeling experienced by someone who believes that physical reality can never satisfy the demands of the mind."
joie de vivre: "a French phrase often used in English to express a cheerful enjoyment of life; an exultation of spirit."
ubuntu: "the belief in a universal bond of sharing that connects all humanity"
From the preface of Foucault's "Madness and Civilization": "...modern man no longer communicates with the madman [...] There is no common language: or rather, it no longer exists; the constitution of madness as mental illness, at the end of the eighteenth century, bears witness to a rupture in a dialogue, gives the separation as already enacted, and expels from the memory all those imperfect words, of no fixed syntax, spoken falteringly, in which the exchange between madness and reason was carried out. The language of psychiatry, which is a monologue by reason about madness, could only have come into existence in such a silence."
Emile Durkheim's "Suicide" is a work that touches upon the co-incidence of depression, existential apathy, and repurposed religion as affected by the industrial revolution. Here's a neat animated video by the School of Life: https://youtu.be/z9W0GQvONKc
The gifted (and, sadly, recently late) Mark Fisher's explanation of capitalist realism: "Capitalist realism as I understand it cannot be confined to art or to the quasi-propagandistic way in which advertising functions. It is more like a pervasive atmosphere, conditioning not only the production of culture but also the regulation of work and education, and acting as a kind of invisible barrier constraining thought and action."
> "Capitalist realism as I understand it cannot be confined to art or to the quasi-propagandistic way in which advertising functions. It is more like a pervasive atmosphere, conditioning not only the production of culture but also the regulation of work and education, and acting as a kind of invisible barrier constraining thought and action."
Can relate to this so hard. Capitalism defines our lives, even the concept of time. It divides our waking hours between consumption, production and rest. I feel it drives people to be unproductive outside of work, because we have conditioned society to respond to payment for labor, when one works for oneself, it is harder to conceptualize the reward.
I'm all for progress, not sure if we are on the best path. Where is the balance, the respect for nature at large and our own human nature?
> Writing about a lack is difficult, and perhaps no one has ever captured exactly what it feels like to be depressed, simply because one can’t describe a negative.
For those who haven't seen it, Allie Brosh's comics on the subject come as close as any other work I've found to "describing the negative" here:
Allie Brosh is wonderful. Her toys analogy in part 2, and "Depression feels almost exactly like that, except about everything" is just so perfectly spot-on.
Depression is a funny thing to write about. If someone is depressed reading about someone else's depression is preaching to the choir, but if they aren't or have never experienced it, it's hard to understand what's going on. But for both groups it's kind of crushing because it reminds you that some people just might not ever be happy and it's not really their fault and that's hard in a culture which says "be happy" or "just do X and you'll be happy".
I saw the article mentions Noonday Demon. I've never read it but a book that cites it and I personally found a depression classic is Lincoln's Melancholy. It is remarkable both how miserable he was and how far he drove himself because of or in spite of it. I don't think you can know Lincoln, the Civil War, or his impact on the US without understanding his depression.
Unfortunately it also makes a lot of modern politicians look very superficial and fake in comparison.
I think David Foster Wallace's description of depression is one of the best I've read.
“The so-called ‘psychotically depressed’ person who tries to kill herself doesn’t do so out of quote ‘hopelessness’ or any abstract conviction that life’s assets and debits do not square. And surely not because death seems suddenly appealing. The person in whom Its invisible agony reaches a certain unendurable level will kill herself the same way a trapped person will eventually jump from the window of a burning high-rise. Make no mistake about people who leap from burning windows. Their terror of falling from a great height is still just as great as it would be for you or me standing speculatively at the same window just checking out the view; i.e. the fear of falling remains a constant. The variable here is the other terror, the fire’s flames: when the flames get close enough, falling to death becomes the slightly less terrible of two terrors. It’s not desiring the fall; it’s terror of the flames. And yet nobody down on the sidewalk, looking up and yelling ‘Don’t!’ and ‘Hang on!’, can understand the jump. Not really. You’d have to have personally been trapped and felt flames to really understand a terror way beyond falling.”
In my opinion it doesn't have a lot to do with happiness or unhappiness. Unhappiness is an emotion that at least fills the void. I'm unhappy now and I'm happy about that because I have a plan to get happy. Clinical depression is about the void, the nothingness, can't find a reason to live and don't want to live because this emptiness and emotionless existence is dreadful.
Learning about stoicism definitely changed my outlook and attitude towards a lot of things, overall a much calmer and happier person even months into practicing the techniques
My experience with depression is that it does what it can to feed itself. Whatever triggers it (for me I am certain it is brain chemistry) doesn't really matter.
Depressed people detach socially from their support network because that feeds the depression, and any plausible explanation feels as true as any law of physics. All you have to do is pick one: "These people don't care about me/They can never understand/They are better off without me as I will just hurt them."
One way I describe depression is that it's a detachment from reality. Whatever reality you are actually in, depression bends and warps it to such a degree that mentally healthy people could not understand even when described to them.
I can vouch for this. I had a small group of close friends, who all seemed to tolerate the fact that it doesn't naturally occur to me to pick up the phone, invite them over etc. But after 2 years of serious depression, they've all drifted away from me. I don't blame them: I imagine it just becomes untenable to keep trying with someone who doesn't answer their phone, or never replies to your messages...
Not in my case. I have family and friends close by. I'm convinced it's something wrong with the chemical levels and receptors and in the brain, something that pharmaceuticals can help with. It doesn't have to be standard pharma: I'm reading encouraging reports about Kratom, LSD microdoses, Ketamine, and Psilocybin (Mushrooms.) I take Abilify which works wonders for me to keep the Black Dog away. Now that they off-patent (or something, I don't really understand it) it's cheaper. My initial look at it was going to cost around $900 a month so I could not continue even though it worked, so I suffered for another 2 years before I crashed. Now it's cheaper and working fine.
I think it works the other way around, it causes detachment. Which doesn't help, sure, it may become a new source of despair. But getting rid of that one source won't change a thing, there are plenty of others.
I am fortunate in that I don't really suffer anymore; as I was "getting better" one thing I came to embrace was how little sense it made. For awhile I kept a journal, and if I read the entries from the bad times aloud, I'd be constantly apologizing for them and admitting that the feelings didn't make any sense. I intellectually understood the meanings of the words, but the emotions behind them felt foreign. I mean, I remembered feeling that way, but I couldn't understand why. As things improved, I was able to get to a place where I could just resign myself to being hopeless for no real reason, but with the understanding that, in my case, it would fade on its own.
That wasn't the "fix", but just an interesting step along the way.
Depression probably isn't a single illness, and most forms probably don't have a single cause but are a complex mix of "bio psycho social" stuff that reinforce each other.
The void-home is a coping mechanism individuals use to mute their internal disappointment of unfulfilled aspirations embedded in world-view & the vanishing of environmental low-hanging fruit & the consternation brewing according to the matter which makes up their body.
If you are confident in having learned that humanity means kindness, virtue, ubuntu, you may begin to experience symptoms of satisfaction, comfort, optimism, interesting challenges, self-realization and a steady flow of rewards.
The opposite absorbable world lesson the cruelest kind of learned helplessness. Look what fear has done to my body [0]. You might see humanity as fundamentally anti-human, kindness as ironic, nihilism as the stablest philosophy, even if you understand that, logically, the conclusion of nihilism is bound to invalidate the conclusion of nihilism itself.
Folks often invoke "curiosity killed the cat" as a way to communicate "unenriched and empowerment-lacking people are prone to self-annihilation while in their search for harmony". What they don't do is follow the thinking to its conclusion: "But the cat was simply trying to gain root access beyond a seemingly impenetrable social inertia. The cat knew that the subjectivity of contribution to the outcomes of local events was far more rewarding than the dissonance of a depressive hedonism trap.
It's always unexpected - if you could expect you would always appropriately manage your negative expectations, you would call such periods of discontent "vacations."
Like a situation where you're trapped in an action-selection fixed-point of free-energy-dissipation-minimization.
Like a phantom limb, you realize that the psychic model/hierarchical system of values/your world-view ultrafilter/your "rosebud" you placed faith into, you begin to realize that the abstraction might not really have captured every partial ordering/relation/utopia you could have benefited from knowing sooner.
A great description of the feeling of depression can be found in the Netflix stand-up special of Neal Brennan, 3 Mics. (He's also the co-creator of Chappelle's Show, and quite funny.) It's really difficult to convey the feeling of depression to people who don't have first or second hand experience with it, and I think Neal did a great job with that task.
"I remember being endlessly entertained by the adventures of my toys. Some days they died repeated, violent deaths, other days they traveled to space or discussed my swim lessons and how I absolutely should be allowed in the deep end of the pool, especially since I was such a talented doggy-paddler. I didn't understand why it was fun for me, it just was. But as I grew older, it became harder and harder to access that expansive imaginary space that made my toys fun. I remember looking at them and feeling sort of frustrated and confused that things weren't the same... I could no longer connect to my toys in a way that allowed me to participate in the experience.
Depression feels almost exactly like that, except about everything."
I totally agree. I bought her eBook and binged it in one day. Reading about her initial escape from depression was great, laughing at the absurdity of a kernel of corn under her fridge. I should revisit that book soon.
> “Men,” she writes, “have cannily figured out how to sidestep the implication of moral failing that attaches to mental illness—as well as the specific criticism of self-indulgence that is attributed to more introspective accounts of this condition—by insisting on a force outside themselves, or on a purely genetic susceptibility.”
I didn't, but perhaps I should have. From there it delved into how truly horrible and abusive her childhood was. Which, to me, is much more relatable to outsiders than having depression with no obvious cause. Like apparently men are genetically impervious to.
It sounds like the book in reference is talking more about clinical depression than, well, depression as a phenomenon.
I'm not going to pretend like I don't still have issues to work out, but I've been heavily depressed many times in my life, and I eventually thought of an interesting question that changed my outlook:
Watch some of those old home videos of you from when you were around 7 years old. The age isn't that important, but I think that's a golden number in this case. Look at that boy or girl who is playing in the fountain, popping bubbles, imagining dogfights with toy airplanes, and shouts "YEAH!" when asked if they want to ride the sled down the hill again. Is that child fundamentally who you are? Why not?
Granted, this won't apply to everyone. I've known people personally whose early childhoods were lousy. But there are lots of people out there who, like me, are fundamentally happy, curious, and enthusiastic, but were lied to by society. Society told us big lies, such as that we can't be truly happy unless we have things to demonstrate our status. We're told that, by a certain age, we should have a significant other, cars, gadgets, a "career", and more. If we get the sequence wrong, or it doesn't happen on time, we disappoint ourselves. Even when we get those things, they're rarely as satisfying to have as we thought they'd be. This is largely because we sacrificed our inner child in order to seek the approval of everyone else, only to discover that most people around you don't actually care if you have any of those things. It doesn't matter how many things you have to show off your status -- if you're being a miserable person, you're not going to get the approval or acceptance that you're seeking.
The idea of "loving yourself" first seems cliche and silly, and I thought it was, but there's a lot of truth in it. Taking a look back to childhood, before you were tainted by negative experiences, might give you the best insight into who you are. I began to feel much happier the more I got in touch with that 7 year old boy who only needed the unconditional love from his parents and an unabashed imagination. Getting in touch with your child doesn't mean behaving like a child, but it does mean learning how you could once experience happiness without the need to show status, own the latest fancy toys, have a "respectable" job, have an attractive partner, a backyard, retirement plan, yada yada yada.
The irony of learning who you are through your child, and rejecting the lies of society, is that you can re-learn to be self-amused and radiate those positive emotions, which will get you far more approval and status than you could get with anything else.
It might not be true for everyone, sure. But if that "missing piece" to your life has been inside you the whole time, and you aren't seeking it out, that's tragic.
P.S. I know that clinical depression is not the same. I have first-hand experience with this, and I certainly wouldn't tell someone with serious issues in their life or inexplicable depression to just "be happy".
We need another word for what is described above. Most people understand ordinary depression, because most people feel down sometimes and they have techniques for getting out of it. They try to get the "clinically depressed" person to try these techniques.
When I was in my cycle of doom I would set as my goal of the day to get up and take a shower and often couldn't accomplish it. Forget doing the dishes. I knew I needed help, but without medical insurance I couldn't afford it and didn't have the energy or will to try to get medical insurance.
Finally, my family intervened and I was locked up as a danger to myself after I verbalized a few dangerous thoughts. I'm on insurance now and taking medication and things are much better. I'm not necessarily happy, but at least the "black dog" is gone.