“Are you depressed?” I asked him in session.
“Depressed? What…..depression? No, I’m not depressed.” he said to me as if that was a crazy question to ask.
There was some silence between us for what seemed like a few minutes, and then he said.
“Well…I mean, I may have a bad day now and then, or feel down. But I’ve never been depressed.”
I share this short story for you to highlight that sometimes it can be difficult to try and figure out not only what depression is, but to help you understand that sometimes the mere thought of the idea of depression for a lot of people is not something they are ready to acknowledge or grapple with.
According to the Anxiety and Depression Association of American and the National Institute of Mental Health, approximately about 7% of the U.S. population, 18 and over is diagnosed with depression. The World Health Organization estimates that 5% of the world’s population, roughly 350 million people worldwide, struggle with depression. They also report that women are more likely to be diagnosed with depression than men, and by my short story above, my own experience tells me that women are also more likely to acknowledge their own depression, and actually get help with it.
Merriam Webster defines depression as the following:
“b (1) a state of feeling sad: DEJECTION – anger, anxiety and depression (2): a mood disorder marked especially by sadness, inactivity, difficulty in thinking and concentration, a significant increase or decrease in appetite and time spent sleeping, feelings of dejection and hopelessness, and sometimes suicidal tendencies; bouts of depression; suffering from clinical depression.”
If the above definition sounds too clinical, you are probably right, and the reality is that most people who are struggling with depression aren’t using language like that. Rather, you might hear someone struggling with depression say things like:
“I am feeling blue today.”
“I don’t know what the problem is, but I just can’t stop crying. It’s like I’m sad all the time.”
“I just feel like I haven’t been happy in a long time.”
“Nothing really seems to excite me. I just feel sort of flat.”
“I feel nothing. I’m just sort of numb.”
Maybe you have heard some of these things uttered by those you come into contact with. They are in many ways the sound of depression. And it’s important to listen to these key words because people with depression aren’t able to put into their own words what they are feeling, and many feel the burden of a potential stigma and, therefore, never reach out for help out all. Though this is from a book on anxiety, I think the true can be said for depression:
“And the figures don’t tell us how many people live their lives under a cloud of worry or threat of panic but either don’t meet the criteria for diagnosis or never seek treatment at all. They don’t tell us about the people who live in broken, loveless, or silent marriages or the ones who are isolated and lonely. They don’t tell us whether this person finds her work meaningless or if that one can’t talk to his children.” Things Might Go Terribly, Horribly Wrong: A Guide to Life Liberated from Anxiety by Kelly G. Wilson & Troy Dufrene
Many people do live lives where they feel sad and numb, and cutoff not only from their own emotions, but cutoff from the world around them and the most important relationships that they inhabit. When people experience depression some of the most common symptoms are the following:
- Persistent sad, anxious or “empty” mood
- Feelings of hopelessness, pessimism
- Feelings of guilt, worthlessness, helplessness
- Loss of interest or pleasure in hobbies and activities, including sex
- Decreased energy, fatigue, feeling “slowed down”
- Difficulty concentrating, remembering, making decisions
- Insomnia, early-morning awakening, or oversleeping
- Low appetite and weight loss or overeating and weight gain
- Thoughts of death or suicide, suicide attempts
- Restlessness, irritability
- Persistent physical symptoms that do not respond to treatment, such as headaches, digestive disorders and pain for which no other cause can be diagnosed
Not Overlooking Depression
Though depression is no laughing matter I sometimes joke with the audiences when I talk on depression that reading the list above can sound very similar to parenthood. The reason I mention this is because depression can often be overlooked by so many people, even those experiencing it. People will excuse the symptoms, often explaining that the way they feel is normal, or common to their experience. The reality is that perhaps many people are living in a depressed state and don’t even realize it, and many excuse the above symptoms as not that big of a deal. In both cases what you have is people overlooking depression and never really getting the help that they need.
When I was a first time parent I remember going through that season of life with my wife and thinking, well this is just temporary. All the sleepless nights and the colic and the feeling of being on edge at times. And it’s true, it may have been a season of life, but it’s also true that season brought about a certain level of depression, and because I was unable to recognize it, I think it ended up lasting longer than it could have. And I could have navigated the season more successfully if I had gotten help as well.
People excuse symptoms of depression as if that’s just part of living life, and to a degree since we are all human, we all experience varying levels of depression. But being able to recognize depression, acknowledge it, and then get help, is a transformative experience. No one should have to go through that season alone.
Is Depression Situational?
Though I will be the first to admit that I’m not the expert on all things depression, it is an issue that I spend a lot of time working with my clients. And in my experience I often see two different types of depression that I want to make a distinction with. One, there is a type of depression that very much seems to stem from a specific situation in that person’s life. That situation could have happened years ago, or it could be very recent. For example, someone may identify that their divorce three years ago has been a major source of depression for them, or the death of a close friend from childhood is something that is still creating depression. Or they might come in and say, “I’m having a really hard time in my marriage right now because my spouse and I don’t seem to be connecting, and I’m feeling depressed about it.” Both situations are specific and concrete in many ways, and people identify many of the symptoms we know as depression emanating from those experiences. Two, there is a type of depression that people often can’t identify as having a source. They will often describe it as something they have experienced their whole lives. They don’t speak of a specific trauma or event, but might say things like, “I can remember as a child always being sad, and that feeling just hasn’t really ever gone away.” Or I might hear something like “Compared to all my friends I seem to be really sensitive to my emotions and I feel and take on things in a very deep way. I like that about myself, but it often leaves me feeling down for days.”
I think differentiating between these two types of depression (and I’m not saying there aren’t more types of depression, but for this post I want to keep the conversation limited to these two concepts) is really critical because it often helps those in a helping position to know what to focus on. One type of depression might require some specific changes to the person’s current circumstance (for example in the area of self-care), while the other type of depression might require a deeper look at the person’s history and the experiences that started to shape them at a young age. One might require medication for a temporary period of time until the person feels like they have successfully navigated the depression and come out on the other side of it feeling better. While one might require a long term or permanent use of medication to help with some of the chemical imbalances in the person’s brain chemistry.
The point is that depression, like people, is often a complicated matter, and requires an extensive investigation into what is going on with a person.
I want to make clear is that everyone is created uniquely and, therefore, depression will be unique to each person as will their experience. The role of those helping people through depression is to recognize the fact that not one size fits all and, therefore, it will require a level of discernment that helps one know how to best intervene.
So how can you best help someone who is struggling with depression?
First, I think it’s important to create space and give people permission to talk about depression. Like anxiety, depression often carries a social stigma with it, and in many contexts can come with a great deal of shame as particular communities perpetuate myths about depression as being something wrong with a person. So this first step is critical. Whatever environment you are in, and whatever role you play, communicate that it is safe for people to open up about depression. Verbally tell them, “I am giving you permission to talk about it.” And as you do that, begin to create and faster a safe environment that allows for people to share.
Sometimes we live by assumptions that particular people or places are safe places to talk about depression. And that may be true. But I think it is a very powerful move to be able to communicate verbally out loud to those around, “I am giving you permission to talk about your depression and in the process we are going to create a safe environment for this to be talked about.”
Second, begin to explore and identify the roots of depression. Without identifying the roots of depression it can be easy, and even tempting to continually chase after depression itself (which is the symptom, or coping behavior of an underlying emotion), without ever dealing with the core issue. A good question may be to simply start with, “When you notice yourself becoming depressed, what do you think is the deeper feeling that triggers the onset of your depression?” Often I will pass out a list of feeling words (i.e. the Pain Cycle) to people that I work with, and ask them to identify what feelings they experience when depression hits. And looking at a list of words usually has a very powerful affect on helping people begin to identify what may be underlying core emotions for them.
Third, after I have given permission to talk about depression, and worked on creating a safe space for a person to share. And after I begin the exploration of what core emotions are underneath their depression, I then begin to think about tools and resources to help them navigate the depression as they are working on it. In many ways, these three steps are done in conjunction with each other. If you think about a three legged stool, where each leg plays a role in holding up the stool, and without one, the stool can’t stand up. I see this approach as a three legged approach, where each aspect is critical to each other. There are a variety of tools and resources that one can use to help navigate depression, but the key is helping find ones that are realistic in terms of the person using them.
I know that for many people, it can feel overwhelming to be in relationship with, or work with someone who is going through depression. Yet, depression doesn’t have to be scary or overwhelming, and with the right frame of mind, and tools and resources in place, you can help someone navigate through their depression. Begin by listening for key words if the person isn’t coming out and saying they are depressed, and as you listen to their story, begin to follow the steps above.
Last, it’s important that you continue to maintain a relationship with a person struggling with depression, and not to feel that you can’t play a vital role in helping them. But it’s also possible that at some point that person will also need some professional help, whether in the form of pastoral counseling, a licensed professional counselor, psychiatrist, or some type of inpatient or outpatient program. So pay attention to your limits, and acknowledge what you are able to help with, and what you aren’t able to help with. And always know that the human connection is a crucial piece in helping someone navigate what can often be a lonely journey through depression.
Rhett Smith is a Licensed Marriage and Family Therapist in private practice in Plano, TX. He specializes in helping people struggling with anxiety find new opportunities for growth, as well as spending a majority of his week with couples as they navigate relational issues. He is the author of The Anxious Christian: Can God Use Your Anxiety for Good? and What It Means to Be a Man: God’s Design for Us in a World Full of Extremes. Rhett lives in McKinney, TX with his wife Heather and their two children. You can discover more about Rhett’s work through his writing and podcast at rhettsmith.com