Depression is the curse of modernity, affecting more and more of us. It is the black dog that haunts us, the lethargy that makes it impossible to get out of bed. It is the vacuum of meaning which sucks out all our desire, our hope, so we are left in an empty void. Sadness is something we all experience, part of the fluctuations in moods that make up everyday experience. But depression? Depression is something else.
Depression is often as physical as psychological. It saps energy and – evidence increasingly suggests – puts bodies in a state of chronic, dulling inflammation. Gait can change, even the capacity to speak in anything but a monotone. At the same time, it is remarkably difficult to locate a biological cause to depression. The chemical imbalance theories that saturate public understandings just do not fit with the evidence.
Clinical diagnosis is based, therefore, not on any objective tests but on history taking and a patient’s present mental state. Because depression is so difficult to differentiate from everyday sadness, diagnosis is based on the functional impact of experiences such as loss of interest, low energy and lack of confidence, alongside potential risk. Psychiatric diagnosis is a bit like carving up nature by the joints. A diagnosis of depression tells us that something is wrong, but never quite what.
Psychological models often emphasise a person’s negative views of themselves, the future and the world. These often emerge as a result of early experiences – things such as chronic bullying, abuse, being put down, or being expected to be perfect all the time. But depression is also often a result of loss. This may be the loss of someone we love, but it can also be the loss of an ideal. For example, that we can completely fulfil the needs of a partner, or that a dream job will make us happy. One’s sense of self can collapse, implode, leading to a death of meaning and purpose. Health problems can also cause, or at least mimic, depression. For example, people with thyroid disturbance, liver cirrhosis or a dementia process are more likely to become depressed.
Sociologists tend to emphasise the social causes of depression. It is no coincidence that women, people living in poverty, and those who have experienced discrimination are far more likely to experience depression. This is because depression and oppression are inextricably linked. There is also clear evidence – perhaps the most robust in the field – that chronic adversity is deeply damaging to both the body and the psyche. This can become dangerously invisible when depression is viewed as a simple medical problem.
Many people are concerned that the category of depression is being expanded to encompass too wide a range of human experiences, and that this may be damaging. In 1950, depression was only estimated to affect about 0.5% of the population. When antidepressants were developed, drug companies worried that there would not be enough people to prescribe them to.
Since then, depression has been marketed relentlessly despite its fuzzy nature as a diagnostic category. This has shaped how people view and thus experience their internal worlds. People have traditionally viewed the soul as a place of conflict, divided between productive and destructive urges, passion and reason, primal instincts and excessive control. But our inner worlds are now monopolised by market values – the idea that we can and should be able to excise problematic emotions such as sadness, to fashion a more sellable Brand Me.
To trouble the ideas that breed depression, it is vital to try to hear what a symptom is trying to communicate, to unfurl the onion layers around depression and uncover its message. From an evolutionary perspective, depression is often seen as serving the function of forcing a period of reflection. Many people do not regret periods of depression, finding it forced them to leave a problematic job or relationship, or re-evaluate how to live meaningfully in rejection of ideas such as that we must always be digitally “on” and available.
However, the capacity to alter how we live our lives is only possible with adequate access to space for reflection – such as via psychotherapy – and material resources to afford choice. This is why addressing structural inequalities and poverty are as important an antidote to the current epidemic of depression as the prescription pad.
If you are feeling low, conversations are very important, as depression likes to lock us in with our internal persecutors who are not – though they will probably tell you otherwise – the most reliable authorities on your worth. These conversations may be with clinicians, but many people have also found a pathway out of the woods of depression though connecting with activist groups, the local community, nature, animals and religious organisations. If things are not so bad – if you can function OK, and have some hope – viewing your experiences as everyday sadness that will pass can help to ensure you do not start to panic when your inner world throws up its occasional burps. Tagging all our negative experiences as signs of potential mental illness can do more harm than good.
• If you are suffering from depression here are some services that could help: find your local GP to access medication, psychotherapies and social care support here. The gateway service for psychological therapies in the UK is a scheme called Improving Access to Psychological Therapies (IAPT). For details of your local service, click here.
The Samaritans are available 24 hours a day. You do not need to be suicidal to call. Telephone 116 123 in the UK or email firstname.lastname@example.org. Maytree is a free, non-medicalised home from home to stay for a couple of days if suicidal. They can be reached on 0207 263 7070. In the US, the National Suicide Prevention Hotline is 1-800-273-8255. In Australia, the crisis support service Lifeline is on 13 11 14. Hotlines in other countries can be found here.