Depression: Far More than Sadness

Often someone will say “I’m depressed” after a bad day or a major disappointment. If this misconception didn’t affect how we respond to real mental illness, I might be able to hold my tongue.

The Low Bar of “Depression”

Therapists rarely enjoy the luxury of meeting clients at the beginning of their troubles. Often clients arrive at my door bearing diagnoses from other clinicians. I want to believe that all my colleagues use the formal definition of depression with precision when diagnosing their patients. Yet again and again I see clients with diagnoses of Major Depression and its cousins the Bipolar Disorders, who do not report symptoms consistent with these definitions.

While “depression” is often defined as “big sadness” in the popular understanding, helping professionals use a far more refined and scientific understanding of the boundaries between ordinary sadness and clinically significant depressive symptoms.

I emphatically reject the idea that people suffering emotional distress should diagnose themselves. In the U.S., only licensed physicians and psychologists are legally and ethically qualified to render a diagnosis. Yet just as we all need to know the symptoms of stroke or heart attack, I think it appropriate that everyone understand the real differences between healthy and ordinary levels of sadness, grief, and discouragement and mental disorders.

The Diagnostic and Statistical Manual IV-TR contains an extended description and definition of depressive disorders. Recapitulating these definitions is beyond the scope of this article. Instead, I’d like to examine and correct some of the popular misconceptions of the mental illness we call depression.

Depression is neither Minor nor Brief

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Real depression doesn’t come and go over the space of days. It is a near-constant specter in the lives of the afflicted. In order for someone to be diagnosed with depression, the symptoms have to manifest themselves for most of the day, nearly each day. Furthermore, these symptoms must persist for at least two weeks. Thus, a bad day, no matter how bad, can’t be termed depression.

Depression is not just Sadness

The DSM-IV-TR criteria for a Major Depressive Episode lists nine separate symptoms, at least five of which must be present for a diagnosis of Major Depressive Disorder. While depressed mood is one of the nine, mere sadness, no matter how intense, does not by itself define depression.

Working with emotions on a daily basis, I believe that all emotions, both pleasant and unpleasant, serve us at some time and in some capacity. Just as if we didn’t feel pain, we would continue to injure ourselves, sadness often surfaces in response to failure or disappointment, and drives the distraught to rest, recover, and reconsider the behavior that got them to this point. When sadness operates as it’s ‘designed’ to, we emerge from our funk with renewed energy and perspective.

Knowing what adaptive sadness is meant to do makes it easier to spot real depression. When the sadness endures long after the event, when energy fails to re-emerge and when perspective remains distorted and negative, then sadness may have ‘run off the rails’ into real depression.

Depression is not Grief

If you accept the idea that sadness can be good for us, then what about major life traumas, like the loss of a partner, a parent or a child? At moments like these, rest and perspective seem far away and the idea that sadness heals seems absurd. Clearly grief can trigger depression, yet clinically, grief is considered an experience apart from depression. Most cultures make special affordance for the grieving and the deep emotions that are to some degree expected and accepted as part and parcel of life.

Depression is not Pessimism

For those who perpetually see their glass as half-empty, talk of depression can seem like an invalidation of their worldview. Positive psychology has enshrined happiness, optimism and resilience as inherently positive personality traits that can be developed and encouraged. Yet pessimism, like sadness, has its place. Were I to hire a nuclear inspector or a disaster planner, I would probably do well to consider applicants with pessimistic outlooks. Depression’s dual, Mania, is characterized by hyper-optimism and positivity that neglects risks and dangers. While there might or might not be an “ideal” balance between hope and caution, we each draw the line for ourselves and the variety of our answers enriches us all.

To Know Depression is to Know Mental Health

I’ve attempted a definition of depression focusing not on what depression is, but what it is not. Like a sculptor, I’ve attempted to pare away emotions and behaviors mistaken for depression to reveal a more realistic shape of the clinical disorder. In the long view, to understand mental illness requires an understanding of mental health that admits sadness, grief and pessimistic attitude as unpleasant, unwelcome, undesirable, and yet adaptive.

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