Do you have “depression”?

What I’d like to write about here is, I think, an intense irritant to most mentally ill people. That is, the way people loosely use the term “depression” to refer to things that are not medical depression and get themselves all twisted up and end up stigmatising us. I am making it sound more simple than it is, because there are depression-like elements which are not the same as clinical, medical depression. For instance I might feel sad because my grandmother died. That to me is grief, not depression, and a totally appropriate response. On the other hand it might persist for months and months and be out of all proportion (this sounds hard, but to mourn the death of an elderly relative to the point where you cannot function is out of proportion) and that could be depression. So I’ve been in search of a definition of depression. (Hint: do not look in the OED, as they waffle on about monetary systems). According to NHS choices:

…as a general rule, if you are depressed, you feel sad, hopeless and lose interest in things you used to enjoy. The symptoms persist for weeks or months and are bad enough to interfere with your work, social life and family life.

They also add that there are specific symptoms such as sadness, hopelessness, guilt, irritability, lack of motivation, difficulty in making decisions, lack of enjoyment from life, suicide, self-harm and anxiety. Obviously you do not need to have all of those things. There are also some physical elements and social elements of depression.

Now we can all become sad, or feel guilty or have the other symptoms to some degree. Where I – and I am assuming medical folk although, as I am not a medical bod I do not know this – make a distinction is that in depression, these symptoms persist, and have an impact on your daily life. In many cases, have a major impact on a person’s life. I would also add that these symptoms may have no cause, or be an inappropriate response to something. For example, a severe episode of depression in me that required hospitalisation and cost me my job was triggered by my anxiety over giving a presentation. This is even though I had done presentations on the same topic before. I just got a thing about it, and my brain’s response was major depression. That is what I mean by an inappropriate response to something.

People loosely use the term “depression” as  sort of shorthand for “I don’t feel 100% good here.” So you will hear people say “I am so depressed, my team lost at football.” They don’t mean they are depressed – they are not going to be crying themselves to sleep or suffering terrible insomnia while thinking they deserve to die, for instance. They are (unfortunately) using it to mean “I am sad” even though it is a temporary and ephemeral sadness. I think most of us who have suffered depression find this infuriating. It trivialises our suffering and means that those who use it in this way are likely to think that we who are diagnosed as depressed are also feeling “just a bit sad”. I would go so far as to say that this loose use of “depression” to mean trivial sadness is at the heart of stigma.

“Pull yourself together,” “smile! it’s not that bad”, “I had depression once and all I needed was some exercise and hard work”. 

These are some of the phrases that I have heard which irritate me the most. (In particular, the “smile!” one. If you say that to me in the street I will be mentally cursing you and wishing I was a violent person so I could punch you!) I wish, really wish, that the medical profession would come  up with another term for depression – something we could use to explain that we have an illness and not have it confused with someone’s momentary sadness. I certainly have experienced low mood which I would not characterise as depression. I get it regularly, I will suddenly feel reflective and a bit down usually because I have read a sad book, been thinking of absent loved ones, feel under the weather (physically – I am a big baby when it comes to physical illness) or similar. This isn’t depression. I may feel sad, I may even have fleeting anxiety, hopelessness or lack of motivation, but it is not depression. It lasts until the next happy thought, until I talk to someone I love, until something funny is on the TV. It does not need medication and yes, I can pull myself together either by myself or with hard work or exercise. But it is not depression and I would not call it that.

I think I am preaching to the choir here – I would say most people who have had medical depression in the past would not mistake it for something you could just pull yourself out of, something easy to tackle and quick to go away. But there are still foolish people misusing the word and sometimes I wish I had the courage to tackle them all the time and make them realise that with every stupid use of the word “depression” they increase the chance of people thinking depression is not a real illness.

I did have a Christian point to make too. It is sadly still common to read Christian books talking about mental illness – particularly depression – and denying that it is indeed an illness. Many Christians around the world still believe that depression is essentially a sin or a response to sin. I have now reached the point where I can see what they are saying, although I think they have got it wrong.

Some Christians say (if I was writing for Wiki someone would have pointed out the weasel words by now!) that people feel depressed because they are sinful. That it is an illness given to those who have unrepentant sin in their life in an effort to make the repent or that it is simply guilt, and nothing else. I think they misunderstand the terms. If you said to someone in the midst of a serious depression, “if you repent of your sin your depression will go away” then I for one would have been delighted to repent of anything you cared to name if it meant that my mood would lift. But the fact is that I could not find such a sin. I searched through my life and I searched through the Bible and I did not find unrepented sin in my life. I found sin, yes, but I also found that I had already confessed all to God and was trying my very best not to sin again. I could not repent of what was not there, and I suspect that the same is true for most/all depressed persons, especially Christians. As I said earlier, to me depression in the medical sense is an inappropriate reaction to something – feeling low because you are a secret adulterer for instance, is not called depression it is called guilt. Yes, you can feel low, sad, miserable because you are guilty – but it is not hard to spot what you are guilty of. And you do not have depression. I don’t believe that most people with depression as diagnosed by a doctor are feeling guilt over some sin – mainly because I know when I first became depressed I got the opportunity to talk with a doctor about my feelings and it would have come out in that conversation that there was something wrong in my life which was making me feel guilty.

I did feel guilty when I was depressed – but I felt guilty because I was such a terrible person that God must have regretted creating me, not for anything specific. I think it is too easy for Christians to realise that guilt can cause depression-like symptoms and that depression can include guilty feelings and to elide them together and say that depression is just our guilt.

Before we make sweeping judgements on a person – or on everyone who has depression we should get to know them. I know many people who have had depression who were good and faithful Christians and it simply is not true to say that all depressed people are just feeling guilty for sin. Just because some people may feel sad because they are guilty does not mean that everyone taking anti-depressants is guilty of some crime. I think it is very foolish to assume things about anyone, particularly someone who is mentally ill and possibly already feeling suicidal. How much worse can we be to one another that we tell someone who is suicidal that God is punishing them for their sin, a sin they neither know of nor can find? If there is one thing I would like to tell Christianity in general it is that we should not assume we know what God is saying to a person, what God doesn’t like about that person, until we at least know that person.

So to conclude, because I have rambled on a bit and I am sorry this is not the best plotted piece of writing, I think that we – Christians and non – loosely use the term depression to describe things which are not medical depression but something else. I believe depression is an inappropriate response to something (or to nothing at all) and that to confuse it with feelings of guilt without knowing a person and their life, is a very foolish and harmful thing to do.