By Colette Dowling, LMSW
Click here to contact Colette and/or see her GoodTherapy.org Profile
Joann was thirty-eight when she was freed of a depression that had plagued her, off and on, for her entire adult life. Before finally getting help, she felt lower than she’d ever felt before. “I was in agony, caught up in an excruciating, unrelenting mental anguish that worsened with each day. I could see no end to the blackness that engulfed me, and I knew I could not endure much longer.”
Another woman, describing her depression, told me she felt like there was a big black bird hovering over her from the minute she woke up in the morning.
While a particularly stressful event might trigger the blackness of depression, it can appear from nowhere. Or, as in Joann’s case, it can creep up so insidiously that the illness is never fully seen for what it is.
“Nothing had happened to make me feel so terrible,” Joann says. “Yet every drop of color had been slowly drained from my life–so gradually that I didn’t notice it happening. Then, all of a sudden, there was no joy left in my day. There was no pleasure in getting up to a new morning, in being with friends, or in doing any of the million and one things I love to do. All that stretched in front of me was an aching loneliness and emptiness. Nothing had meaning. Nothing brought pleasure. I wanted desperately to laugh and have fun again, but the pain grew worse.
Even with her painful depression, Joann kept working. At first, it was a distraction, a way of keeping her mind off her troubles. But eventually it became a trial in itself as she tried to keep up a pretense of normalcy. At the office, she avoided people. “It was terribly important to me to conceal my pain from everyone, especially since I couldn’t explain it. I struggled to keep control of my emotions. I didn’t understand what was happening to me, and I felt as though no one else would, either.
When depression goes untreated, it gets worse. After a while, Joann had to stop pretending that everything was okay. She was forgetting, avoiding phone calls, growing more and more irritable. “Mail, phone messages, and requests began piling up. I was so confused. I couldn’t seem to clear anything away. I couldn’t concentrate enough to read. Even minor chores began to seem difficult.”
Joann says that dealing with people used to be one of her strong points, but now she was misinterpreting others and blowing small incidents out of proportion. Things would make her cry, right out in the open. Often, this is the point at which people begin to recognize depression. They’re crying over things that would never have made them cry in the past.
Eventually, self-hatred set in. “I began thinking of myself as a terrible worker who had managed to fool people for a long time but who was about to be exposed as stupid and careless, someone who couldn’t do her job.” Life became “one long, confused haze.” At this point Joann was barely managing to get herself out of bed and to the office. At work she spent her days choked with fear and anxiety, and when she got home she felt exhausted. “I stopped cooking, cleaning and even walking the dog. I lost weight. Sleep became my only escape, and I tried to sleep as much as I could. I never woke up really refreshed. At my worst I would snap awake in the early hours of the morning with a terrible knot gripping my stomach.”
A Confusing Experience
The term depression, used in so many ways, can be elusive. In common speech, it describes the “down” or blue state everyone experiences from time to time. But in psychiatry, depression refers to an inability to experience pleasure at all. The inability to feel pleasure is known clinically as “anhedonia”. Those who experience it tend to be able to describe it only in metaphors. “It is like a black cloud,” they will say.
Another symptom of depression is trouble concentrating, which leads to loss of interest in things that were once stimulating. Boredom may be how the patient describes it, but that sensation–or, more accurately, LACK of sensation–is depression. “Objectively, it appears as a steadily increasing disinclination to take part in normal activities,” explains Dr. Max Hamilton, in a psychiatry textbook. Work becomes harder to accomplish, concentration diminishes, decisions are put off, and the great pileup of untended tasks begins: laundry, bill paying, taxes. Interestingly, Hamilton says depressed women keep up with their tasks far longer than depressed men.
When Joann finally sought the help of a therapist, “she put the whole picture together.” A lot of information had to be gathered before that picture could be seen. The therapist found out about Joann’s childhood and adolescent mood symptoms and also about mood, anxiety and addiction problems of her relatives. There were a lot of depressive “threads” in her family history. And there was also a depressive thread in Joann’s own life. Hormone shifts seemed to trigger her depressed moods–at puberty and premenstrually. She might well be at risk for another bout of depression when perimenopause sets in, but if that should happen, Joann will know what to do to intervene and prevent the symptoms from taking over her life. Within a month her leaden symptoms began to lift and it wasn’t too long before she felt in control of her life again. “It seems so weird, in retrospect,” she says. “I’m an intelligent person. Why didn’t I recognize my symptoms and why didn’t I see the connection between this episode of depression and similar if not such serious ones I’d had in the past?” One reason might be that depression actually makes it harder for us to think straight, to remember, to “put the pieces together”, Once the depression is treated, we seem smart again, clear, and it’s hard to imagine those days when everything was so black.
©Copyright 2008 by Colette Dowling, LMSW. All Rights Reserved. Permission to publish granted to GoodTherapy.org. The following article was solely written and edited by the author named above. The views and opinions expressed are not necessarily shared by GoodTherapy.org. Questions or concerns about the following article can be directed to the author or posted as a comment to this blog entry. Click here to contact Colette and/or see her GoodTherapy.org Profile
This entry was posted
on Wednesday, June 18th, 2008 at 7:41 pm and is filed under Psychotherapy: Specific Issues Treated and Changes Made.
You can follow any responses to this entry through the RSS 2.0 feed.
You can leave a response, or trackback from your own site.
By Colette Dowling, LMSW
Click here to contact Colette and/or see her GoodTherapy.org Profile
Joann was thirty-eight when she was freed of a depression that had plagued her, off and on, for her entire adult life. Before finally getting help, she felt lower than she’d ever felt before. “I was in agony, caught up in an excruciating, unrelenting mental anguish that worsened with each day. I could see no end to the blackness that engulfed me, and I knew I could not endure much longer.”
Another woman, describing her depression, told me she felt like there was a big black bird hovering over her from the minute she woke up in the morning.
While a particularly stressful event might trigger the blackness of depression, it can appear from nowhere. Or, as in Joann’s case, it can creep up so insidiously that the illness is never fully seen for what it is.
“Nothing had happened to make me feel so terrible,” Joann says. “Yet every drop of color had been slowly drained from my life–so gradually that I didn’t notice it happening. Then, all of a sudden, there was no joy left in my day. There was no pleasure in getting up to a new morning, in being with friends, or in doing any of the million and one things I love to do. All that stretched in front of me was an aching loneliness and emptiness. Nothing had meaning. Nothing brought pleasure. I wanted desperately to laugh and have fun again, but the pain grew worse.
Even with her painful depression, Joann kept working. At first, it was a distraction, a way of keeping her mind off her troubles. But eventually it became a trial in itself as she tried to keep up a pretense of normalcy. At the office, she avoided people. “It was terribly important to me to conceal my pain from everyone, especially since I couldn’t explain it. I struggled to keep control of my emotions. I didn’t understand what was happening to me, and I felt as though no one else would, either.
When depression goes untreated, it gets worse. After a while, Joann had to stop pretending that everything was okay. She was forgetting, avoiding phone calls, growing more and more irritable. “Mail, phone messages, and requests began piling up. I was so confused. I couldn’t seem to clear anything away. I couldn’t concentrate enough to read. Even minor chores began to seem difficult.”
Joann says that dealing with people used to be one of her strong points, but now she was misinterpreting others and blowing small incidents out of proportion. Things would make her cry, right out in the open. Often, this is the point at which people begin to recognize depression. They’re crying over things that would never have made them cry in the past.
Eventually, self-hatred set in. “I began thinking of myself as a terrible worker who had managed to fool people for a long time but who was about to be exposed as stupid and careless, someone who couldn’t do her job.” Life became “one long, confused haze.” At this point Joann was barely managing to get herself out of bed and to the office. At work she spent her days choked with fear and anxiety, and when she got home she felt exhausted. “I stopped cooking, cleaning and even walking the dog. I lost weight. Sleep became my only escape, and I tried to sleep as much as I could. I never woke up really refreshed. At my worst I would snap awake in the early hours of the morning with a terrible knot gripping my stomach.”
A Confusing Experience
The term depression, used in so many ways, can be elusive. In common speech, it describes the “down” or blue state everyone experiences from time to time. But in psychiatry, depression refers to an inability to experience pleasure at all. The inability to feel pleasure is known clinically as “anhedonia”. Those who experience it tend to be able to describe it only in metaphors. “It is like a black cloud,” they will say.
Another symptom of depression is trouble concentrating, which leads to loss of interest in things that were once stimulating. Boredom may be how the patient describes it, but that sensation–or, more accurately, LACK of sensation–is depression. “Objectively, it appears as a steadily increasing disinclination to take part in normal activities,” explains Dr. Max Hamilton, in a psychiatry textbook. Work becomes harder to accomplish, concentration diminishes, decisions are put off, and the great pileup of untended tasks begins: laundry, bill paying, taxes. Interestingly, Hamilton says depressed women keep up with their tasks far longer than depressed men.
When Joann finally sought the help of a therapist, “she put the whole picture together.” A lot of information had to be gathered before that picture could be seen. The therapist found out about Joann’s childhood and adolescent mood symptoms and also about mood, anxiety and addiction problems of her relatives. There were a lot of depressive “threads” in her family history. And there was also a depressive thread in Joann’s own life. Hormone shifts seemed to trigger her depressed moods–at puberty and premenstrually. She might well be at risk for another bout of depression when perimenopause sets in, but if that should happen, Joann will know what to do to intervene and prevent the symptoms from taking over her life. Within a month her leaden symptoms began to lift and it wasn’t too long before she felt in control of her life again. “It seems so weird, in retrospect,” she says. “I’m an intelligent person. Why didn’t I recognize my symptoms and why didn’t I see the connection between this episode of depression and similar if not such serious ones I’d had in the past?” One reason might be that depression actually makes it harder for us to think straight, to remember, to “put the pieces together”, Once the depression is treated, we seem smart again, clear, and it’s hard to imagine those days when everything was so black.
©Copyright 2008 by Colette Dowling, LMSW. All Rights Reserved. Permission to publish granted to GoodTherapy.org. The following article was solely written and edited by the author named above. The views and opinions expressed are not necessarily shared by GoodTherapy.org. Questions or concerns about the following article can be directed to the author or posted as a comment to this blog entry. Click here to contact Colette and/or see her GoodTherapy.org Profile
This entry was posted on Wednesday, June 18th, 2008 at 7:41 pm and is filed under Psychotherapy: Specific Issues Treated and Changes Made. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.