Treating Depression Is Not Making Sadness A Disease
One of the criticisms I often see leveled at therapy and medication is that it’s turning basic human emotion into an illness. There was a huge outcry of this when the DSM V took out the grief clause from the diagnosis of depression (previously one could not be diagnosed with depression 6 months after a major loss), people often remind us that ADD is just having a lot of energy, and in this otherwise lovely article about chronic depression, one psychiatrist remarks that “We’ve reached a point where if you are not actively experiencing ‘happiness’ then you feel you are ill. And if your friends and family think you aren’t happy enough or making them happy enough, they advise a trip to the doctor. “
Many people point towards these sorts of indicators to mean that psychiatrists, psychologists, and the whole edifice of mental illness treatment exist simply to inform us that any “negative” emotions are bad and we should only ever feel happy.
Now don’t get me wrong, I do think there are many ways that our society fetishizes happiness. Many people find ways to run away from any negative emotions, and those who do openly act down or angry or sad are generally encouraged to do whatever they can to change that. Those of us with fairly pessimistic temperaments are accused of self-sabotage, of choosing a bad attitude, of being debbie downers. No one really much wants to be around us and we are informed in no uncertain terms of that fact. Happiness is success apparently.
But where I do want to differ from these criticisms is that they seem to equate the treatment of depression, especially low level depression, with our society’s inability to handle negative emotions. These are two very different things. Depression is not the same thing as being sad or down or unhappy, and providing treatment for those who feel that their emotions are out of control is not the same as telling us we have to be happy.
There’s an odd perception from those who haven’t actually experienced therapy that it’s about getting rid of all the bad feelings and that the end goal is to create someone who is happy clappy skippy doo. At the very least, people who go to therapy are supposed to come out “well adjusted” which for some reason is often associated with a Stepfordish oddness or calmness. We might imagine Chris Traeger bouncing around like a hyperactive puppy when we think of those who have overcome depression (this is probably not helped by shows like Parks and Rec including characters such as Chris Traeger who go to therapy and come out terrifyingly chirpy).
(not me, even though I go to therapy and take meds)
Therapy, and especially meds, supposedly change who you are. They take away your “real” emotions and replace them with scary, socially acceptable ones. In someone’s mind (I’m not sure whose, but it appears to be in many think pieces), this is forced upon you. Somehow you have magically perfect insurance that covers mental health issues and so when your spouse/friend/boss/school demands that you go to therapy you’re suddenly whisked away to a land of pills. You have no choice, and soon this will happen to all of us.
In reality, this is exactly the opposite of the experience that I have had with therapy. In the real world, it’s actually quite difficult to get therapy (and especially appropriate therapy). In reality, therapy spends a lot of time making you think and talk about things that feel miserable. It does in fact encourage feeling miserable, at least for a while. One of the main elements of therapy for me has been learning that negative emotions are necessary, provide information, and can be tolerated. I have learned tools to be able to feel bad and not immediately spring to fix whatever is wrong (which oftentimes is nothing). My therapists have repeatedly told me that they want to find the appropriate place for all of the elements that make me up, including such winners as ennui, existential angst, and an overactive sense of guilt.
Here’s the clear and defining line between depression and normal, healthy sadness: depression affects your ability to function as you would like in your life. Whether that’s because it’s major depressive disorder and you have reached a point where you can’t shower in the mornings or whether that’s because it’s pervasive depressive disorder and you’ve felt low level emptiness your entire life that has been leaving you exhausted and cranky all the time, what makes something a problem is when it starts to interfere with someone’s life in a negative way. Now this isn’t as clear and defining of a line as we would like, but there it is and most individuals would be able to tell you if they feel like their emotions are getting in the way of their life.
Treating depression, whether with medication or with therapy, is about allowing an individual to function again. A functional human being feels painful feelings sometimes. One of the most obvious examples of the ways in which treatment of depression is actually antithetical to happiness obsessions is in mindfulness practices, particularly DBT. These ask an individual to simply notice their feelings without judgment, letting them happen without trying to change them. This is the exact opposite of trying to eradicate sadness.
One of the many reasons that people often end up in therapy or on medication is because they have been too afraid to honestly look at their negative emotions, feel them, and let them go. Of course there are some therapists and clinics that may go too far and end up treating any negative emotions as problematic, but overall the profession’s aim is to help people who are struggling.
The other piece of the puzzle is medication, which many people view as a “quick fix” for those who refuse to deal with their problems and just want to be happy all the time. Now I haven’t been on every medication ever so I can’t speak to all experiences, but that really is not how medication works most of the time. I have never had medication actually lift my mood, it simply has held back some of the negative so that I have space to work towards positive for myself. It allows me to go about my daily life in a relatively normal manner so that I can find ways to be effective long term. Again, it’s about keeping depression from drastically impacting my life.
Perhaps the reason that so many people point towards the prevalence of therapy and medication in our society as evidence that we refuse to be happy is because of a basic misunderstanding of what those treatments do. If someone’s emotions are keeping them from achieving their goals in life, from having relationships, from effectively doing their jobs, then the aim of treating those emotions is to help that person live their life. That doesn’t require happiness, but it does require the ability to cope with negative emotions.
I do think that it’s important to address our societal phobia of sadness, grief, and pain. But the way to do that is not to throw the mentally ill under the bus by implying they are running from their negative emotions when they seek out treatment. It also doesn’t mean casting shade on the few tools for treatment of mental illness that we actually have evidence are effective. A diagnosis of depression does not say “this person is too sad”. It says “this person can’t function the way they would like to because their emotions are consistently out of control”. There is a world of difference between those two statements.
Crossposted from Teen Skepchick
As someone who has suffered most of my life with depression, ADHD, and a handful of anxiety disorders, it was that very idea that what I was experiencing was normal and I just sucked at dealing with it that kept me from getting help for the better part of two decades.
My pediatrician suggested that I had some form of anxiety disorder by the time I was 7. When I was 9, I developed OCD, which would grow increasingly worse over the next several years. Then the nightmares started; I was terrified to sleep because it meant hours of dreams where I was tortured and killed, and it felt absolutely real (even including physical pain). By 15, I hated myself so much that physically punished myself just for existing. By the time I was 19, I was suicidal 24/7; there were several attempts over the years.
But I refused to go to therapy or consider the possibility that there was anything medically wrong. Part of it was the depression itself; I had been in it for so long that I was completely convinced these feelings were right. “Of course you feel this way,” I’d sneer at myself, “Someone as terrible as you has every reason to.” But I know that those ideas didn’t come from nowhere. A large part of what I’d internalize were what I’d heard from outside my entire life, that I was just looking for attention, or that everybody has those feelings, or that I just needed to stop overreacting, or that I was entirely capable of pulling myself out of it if I just tried hard enough.
I was 27 when I finally decided I needed to see a therapist. She identified several events in my past that she thought were behind a lot of these symptoms and feelings (and she was right). But from the beginning, she told me that she couldn’t be certain whether there was a chemical component–actual physical depression–going on as well.
The therapy led to rapid progress. Anyone who thinks it’s meant to be happy and ignore bad feelings has never done it. I would leave those appointments exhausted and, often, holding back tears. But week by week, things were improving. I was believing different things about myself and the world around me.
Then, several months in, I woke up one day and it was like that never happened. Literally overnight, I became convinced that it was all lies. I was furious at myself. “How dare you?” I yelled at myself, out loud. “Who the hell do you think you are, acting like you ‘deserve’ something better?” It proved to me that all the self-hatred was right, that I was this selfish, disgusting, terrible excuse for a human being. Every day that I lived was actively hurting everyone else on the planet.
I had a therapy appointment the next day. Saying that my therapist was worried would be an incredible understatement. That’s when she said she believed that this was something I needed to see a doctor for, something I probably would need medication for. It would be a couple months before I could do that, before I’d have any kind of insurance; a substantial portion of those months was spent curled up in a ball on the couch, staring at the wall, silently crying — and I couldn’t articulate why.
When I finally did get put on medication, I was told it could take a couple weeks to see any effect. But on the eighth day, I noticed something. I woke up in the morning – and felt okay about it. I didn’t even notice until several minutes after it happened, but it was huge. I couldn’t remember the last time I had gotten out of bed in the morning without a feeling of dread and regret that I hadn’t died overnight and would have to live through another day.
Things improved at lightning speed after that. I didn’t backslide like before, and even got to the point of “graduating” from therapy. My family was shocked; they said it was like seeing someone who’d disappeared long ago come back. And the progress wasn’t entirely comfortable. I didn’t know what to expect. I knew how to see the world as terrifying and myself as evil and the future as bleak, but I didn’t have anything to replace those views with.
It’s still an ongoing process. I still have to challenge myself to allow things to happen, to take risks, and to be okay with imperfect or negative outcomes.
But the reason I think all those details are important, the reason I’m not sticking a TL;DR on this, is that those experiences were not “sadness.” They were not normal. This thing, this depression, that controlled my entire existence and the way I lived in the world for the majority of my life, was not just me being maladjusted or whiny or weak. It was my reality being different from everyone else’s, while we all assumed we saw things the same way. And if that wasn’t the message I’d heard from the beginning, I could have been spared a lot of suffering. It was my belief in what many people still assume is true–that depression is just sadness that you’re too weak to handle like everybody else–that kept me from getting what I needed.
To be fair, Chris Traeger went *into* therapy terrifyingly chirpy. He’s a ridiculously upbeat character with or without a shrink in his ear.
Part of the problem, at least in my experience, is that the DSM seems to be working toward classifying things as “disorders” that don’t seem to be in any way remotely a disorder. Take, for example, ICD9 313.83: Academic underachievement disorder of childhood or adolescence. Doing poorly in school could well be a symptom of some underlying medical problem, like ADHD, or a need for glasses. But it could also be the result of bullying, or boredom, or going to an underfunded school. Doing poorly in school doesn’t seem to be a disorder by any reasonable meaning of the term.
It’s easy for people to dismiss the entire DSM and everything in it because of things like this. Especially those folks who have never experienced a mood disorder, and think that the people who have mood disorders are just overdramatic about typical human emotions. It’s easy for someone to say that “depression” is just sadness and not pathological, just like “academic underachievement” is not a pathological condition.
Confusing ‘depression’ and ‘sadness’ is a vast category error. I was depressed 20 years back when I went on SSRIs. I’m a lot sadder now, for reasons outside of my head, but I’m not close the the depression I had then. So, at present, I’m off meds, apparently successfully, but still needing some help adapting to outside circumstances that would bum out anyone.
I don’t know if everyone would agree, but I once heard it said that: ‘depression isn’t feeling bad, its not feeling anything.’ That almost agrees with my experience, but it was a long time ago…
I think a lot of the concern about turning normal emotions into an illness stems from the fact that the definition of depression is obviously the product of a committee (not that it’s unique — diabetes and hypertension have the same problem) and doesn’t satisfy. Throw in twenty five years of public awareness campaigns to convince the public that depression is a brain disease akin to brain diabetes, despite a shortage of replicable evidence for it being a disease of the brain. You’re going to have to go to Thomas Szazland or a scientology meeting to find someone who doesn’t believe that the more severe types of depression are real diseases that are at least partly a result of some biological perturbation. A lot of people separate those severe diseases from having the requisite 5 symptoms and an impairment in life as a result of really bad circumstances, a death in the family, or a terrible life event. If you’re the sole breadwinner for your family and you have a horrible boss who yells at you because they’re in a bad mood, humiliates you in front of your colleagues, and threatens to fire you and the symptoms started with the boss, most people will say your low mood and changes in sleep are probably not a result of your brain being broken.
I think one of the concerns is that social problems (the stress of living in poverty, long-term unemployment or underemployment, being a victim of domestic violence) are being reclassified as mental health problems. I recently read something about Betty Friedan’s problem with no name, realized that by today’s standards, those women were just depressed. The fact that adult women were treated as junior adults and expected not to complain would be considered irrelevant when making the diagnosis.
One of the problems with separating depression from non-depression by whether it’s interfering with living your life is that those symptoms could just be the result of a bad situation you need to get out of. I’m not comfortable classifying that person as “mentally ill” and putting them in the same category as someone with schizophrenia or an incapacitating depression that came out of nowhere. Adjustment disorders are supposed to cover people with symptoms resulting from serious stress, but they haven’t caught on, which is unfortunate.
This may be in response to the title more than the post (which was great and does a fantastic job dismissing a common misconception about therapy, which keeps people from seeking the help they could use), but it could be relevant.
I’m currently in a counseling psychology program, and some of my professors have addressed the issue of the DSM V pathologizing average human experience. As mentioned in the post, finding treatment is difficult in many areas of the country, and even when people have access to insurance, many companies require an official diagnosis before covering the cost of therapy. While there are drawbacks to ambiguous/interpretable definitions of what constitutes a specific disorder (e.g. stigma associated with being labelled mentally ill, cultural inconsistencies in diagnosing which lead to the over-diagnosis of psychoses in marginalized populations, to name a few), a practical benefit is that having broad definitions and specific disorders which can address common experiences (e.g. Adjustment Disorder – in which someone is struggling with a new stressor in their life) allows for clinicians to offer support to people who are struggling but might not fit the arbitrarily rigorous criteria of a “real” disorder.
Having dealt with depression, OCD, and self-injury for much of my life, I’m aware how multifaceted, disorienting, and nuanced mental illness can be, as well as how frightening it is to be convinced that seeking treatment and getting better means losing so much of what you’ve used to define yourself. I also remember, in my initial sessions with my previous therapist, feeling terrified that I wasn’t sick enough, or the right kind of sick, to “qualify” for therapy. I don’t mean to step on any of the points made in the post (which was, again, great), but I wanted to add that there are benefits to increasing what’s diagnosable and, as is mentioned near the end of the piece, a criteria for most disorders is that the symptoms are causing significant distress to the client, and that therapy is not necessarily about correcting the client so that they better conform to our expectations of what’s healthy and well, so much as it is about helping the client deal with their experiences in a way that is satisfying and meaningful for them.
Depression is a real thing, and is very different from sadness or feeling sad, or the blues. If you don’t appreciate that, then you don’t know anything about depression. You (very likely) have the privilege of never having been depressed, or the misfortune of never having been not depressed (as in Laura Tee’s comment).
Much of the problem with how society deals with depression is that it is easy for non-depressed people to marginalize and exploit people who are depressed. People of good will don’t want to do that, but can easily fall into that trap if they don’t know any better. People of good will who do understand need to educate the people of good will who do not yet understand. People of bad will won’t try to understand and even if they did understand they would use that understanding to make their bullying even more effective.
This is why I believe we HAVE to start pushing the scientists and physicians who write the Diagnostic and Statistical Manual of Mental Disorders to start defining and treating Depression and Anxiety disorders as being something other than depression and anxiety…The ignorance that Depression and Anxiety disorder patients face just to get treatment is quite literally deadly. People’s lives are depending on this.
Depression and Anxiety are absolutely NOT depression and anxiety. Those emotions may or may not be part of it. For me, they are not. I’m the happiest Depressed person and the most content Anxiety patient you’ll ever meet.
I know that sounds very strange. You would think being chronically happy and content would cancel out Depression and Anxiety, right? Nope. Clinical Depression and Anxiety disorders have been documented in my family for several generations now. Like many of my parents, siblings, aunts, uncles, cousins, and grandparents before me, I lost the genetic lottery and started manifesting symptoms at around age 6.
If you’re wondering if it must be mild in my case, I don’t think so. I am totally unable to work a normal job like other people now. I had to turn disability into a different-ability. I have no choice but to work for myself (and I LOVE my job as a hobby farmer…it’s been my dream since I was little!). I have three suicide attempts in my past; the first one was when I was just 8 years old. My mother succeeded in committing suicide in 2008.
I’m very well aware that I need to make managing this my priority. This disease is DEADLY, and it’s not a joke to get passed off with trite, “Just choose to be happy!” patronization.
I HAVE chosen to be happy. I AM happy. You can imagine my surprise when I realized that was the literal truth. I realized I really was a master over my emotions (20 years now of daily meditation and cognitive behavioral therapy), I take regular medication, and I STILL have Depression and Anxiety.
This isn’t depression or anxiety. Those normal emotions may or may not be a part of it and for me, they really aren’t anymore (they used to be, but not really anymore). My brain doesn’t transmit signals correctly. Just as an amputee can’t grow back a limb by a choice, I can’t just make my brain chemistry work right by choice. If I could, I wouldn’t be writing this. The condition is creating my emotional troubles, not my emotional troubles creating the condition, and it’s been HELL trying to get care over the years sometimes because nobody believes me that this is totally out of my control.
And I am DONE with justifying myself to others. Either you get it or you don’t. If you insist on being ignorant and consider your opinion more important than me, then I don’t want you around me. You’re bad for my health.
You must log in to post a comment.