How to explain depression

I often speak to people who don’t understand the nature of depression at all. They are convinced they’ve been depressed — “once after a break-up I cried for three days and listened to Nick Cave a lot, but I just pulled myself together and stopped being depressed”, which kinda suggests you’re just too weak or lazy to un-depress yourself. All it takes is pulling yourself up by the bootstraps, they suggest. Why don’t you stop being depressed? It’s easy!

Except, of course, it isn’t, and they have no clue what they are talking about. Bipolar depression is a chemical imbalance in the brain. (Apparently latest studies suggest it is a sort of inflammation.) You can’t stop being depressed any more than you could stop having cancer. There are ways to improve your mood, but when you’re in the darkest pits, those ways aren’t likely to work. For instance, physical exercise helps, but knowing that doesn’t help much when you can barely get dressed without assistance and taking a shower seems to be the same level of difficulty as climbing Mount Everest without oxygen tanks.

I can’t find the exact quote from Tyler Hamilton that I have read somewhere. This is as close as it gets to the phrasing I recall:

What people don’t understand about depression is how much it hurts. It’s like your brain is convinced that it’s dying and produces an acid that eats away at you from the inside, until all that’s less is a scary hollowness. Your mind fills with dark thoughts; you become convinced that your friends secretly hate you, you’re worthless, and then there’s no hope. I never got so low as to consider ending it all, but I understand how that can happen to some people. Depression simply hurts too much.

When you are depressed, your brain is convinced that you are dying, and those are the signals it sends to the body: full shutdown. The worse the depression, the heavier your limbs feel. My worst episodes reduced my movement abilities to blinking. Speaking was impossible. Scratching my nose required half an hour of gathering all my strength to use it up on this one movement.

The way I understand depression is: imagine you have a certain amount of spoons (read here about the “spoon theory”) and for each decision you make you have to use up a spoon. By “decision” I mean: going to do the groceries, cleaning up the kitchen, cooking dinner, going to a meeting at work, writing a blog post. A “normal” person has, say, 100 spoons per day, and so spending one of them doesn’t seem like a big deal at all. A hypomanic person has a thousand spoons, and feels inclined to use them all.

A depressed person not only has a limited amount of spoons — say, 15 for the whole day — but also the decision making gets more detailed. You no longer spend one spoon on doing the groceries. You spend one spoon on getting up from the sofa. One on walking to the hallway. One on putting on your shoes. One on getting down the stairs. One on walking to the store. You just used up 1/3 of all your spoons, and you haven’t entered the store yet. And there are no refills until the depression stops, whether thanks to medication or just by itself. You have no say on when it stops — you can influence it, but not control. There is no way you can decide to stop being depressed.

This is why “helpful” phrases like “why don’t you just pull yourself together”, “I’ve been depressed too but just stopped” or “you should get a job, it will give your life meaning” hurt so much. When you use 1/3 of your strength for the day to walk to the supermarket, the idea of going to work seems at best laughable, and at worst depresses you further, because your self-esteem plummets and depression whips you with the thoughts: you aren’t doing well enough; you have no value; you are a waste of space; everybody else can do it. Us depressives have enough negative self-talk and doubts about our condition without outside “help”. We are quite literally drowning in pain while wearing a heavy set of armour, while listening, on repeat, to a tape telling us we’re just lazy and should get a grip. But because it all happens in our heads, all that people see is that we’re sitting on the sofa eating chocolate, wearing yesterday’s clothes, and sleep an awful lot. For a person who never really experienced depression, this may seem like an act of extreme laziness. They don’t know we are working two full time jobs in our heads just trying to get to the toilet before our bladders burst.

Another quote: depression is the cancer of the soul. The black acid is eating us up. We didn’t choose to ingest it, and we sure as hell don’t enjoy it — no more than a person with lung cancer does. We’re doing our best — we’ve survived until now, despite fighting an illness that kills up to 20% of the sufferers. We can be helped: give us hugs; try, gently, to help us get through some easy activities (“can’t you bloody clean up” is not gentle, nor is it helpful); help us eat healthy (it affects the mood); take us to our psychiatrist appointments. And, most of all, don’t suggest we’re lazy. We’re working as hard as we can on getting better — being depressed really isn’t all fun and games.

PS. If you haven’t seen it yet, here’s Hyperbole And A Half take on depression. Part two here.

Image: “Depression is a rubber mask of a clown, which suffocates you and – which reeks of the rubber” by Katerina (CC 2.0)

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