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“I am a sick man. ... I am a spiteful man. I am an unattractive man. I believe my liver is diseased. However, I know nothing at all about my disease, and do not know for certain what ails me.”
So begins Fyodor Dostoyevsky’s classic novel of alienation, Notes from Underground, in which the anti-hero turns inward, withdrawing into his solitary world of depression.
Depression is a confusing term: it refers to a mood state, a set of symptoms, and a clinical syndrome. The similarities between an everyday depressed mood and what a severely depressed person describes have lead some to conclude that clinical depression is simply an exaggeration of an everyday depressed mood. People sometimes believe that a depressed person can “just pull themselves together,” but often this is not the case. For effective relief, treatment is needed for the severely depressed person.
The theories about the causes of depression fall broadly into two categories: biology and psychology. Biological causes are thought to be:
1. heredity, the inheritance of a depressive condition, as well as the vulnerability towards depression; and
2. physiological conditions, the body’s neuro-chemical system, medical illnesses, and other physical causes such as Seasonal Affective Disorder.
Psychological causes include:
1. family of origin and early experiences, focusing parental and familial problems and personality development; and traumas such as physical, emotional, or sexual abuse; and
2. social and interpersonal factors, broadly covering social, cultural, and relationship influences, including problems such as divorce, grief, or loss of job.
Stress is also considered to be a major contributor to depression, and in this context may be viewed as either biological, psychological, or both. Stress may result from physical illness, significant change or loss, to name a few. Stress can also be the trigger of a depressive episode in someone who is already vulnerable.
The symptoms of depression can include:
• flat emotions;
• loss of pleasure;
• feelings of fatigue;
• slowness of speech, thought, and movement;
• appetite changes;
• irritability or angry outbursts;
• insomnia or hypersomnia (oversleeping);
• physical complaints (aches and pains without cause);
• decreased interest in sex;
• loss of interest in usual activities;
• decreased ability to concentrate, think, or remember;
• feelings of worthlessness, guilt, and shame;
• anxiety;
• low self-esteem;
• feelings of helplessness, hopelessness, and pessimism;
• thoughts of death and/or suicide.
Treatment for depression typically involves psychotherapy, psychiatric drug treatment, or the two combined. Although there are numerous theoretical orientations in psychotherapy, they tend to fall into one of three categories: feelings, actions, or thoughts. Whichever theory is followed, the purpose still remains the resolution of life problems, and how they affect the depressed person.
Suggestions:
• set reasonable goals;
• turn large tasks into small steps;
• set priorities;
• have realistic expectations of yourself and others;
• spend time with friends or family;
• exercise;
• go to a movie or other activity;
• seek consultation for major life decisions;
• give yourself time to get better;
• challenge your negative thoughts—they are part of the depression.
When in doubt, seek help!
Originally published in altered form in “Josselyn Center for Mental Health News”; Spring 1996.
*Important Note: This article is not intended to be, nor taken as, medical advice. If you experience the symptoms described in this article—especially thoughts of suicide, self-injury, or homicide—you must go immediately to your nearest Emergency Room or call 911 for emergency assistance.
Max K Shapey is a Licensed Clinical Social Worker practicing in Evanston, Illinois. His areas of clinical expertise are: mood disorders; relationship problems; personality disorders; and identity, phase of life, and other disorders of the self.
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