Today is Mental Illness Monday! Okay, it’s just Normal Update Monday but I am going to be talking about a mental illness. Why? Because I want my bachelor’s in Psych to be useful for something! Just kidding – think how oft writers give their characters, especially their villains, mental illnesses. All the time, that’s why we’re talking about it. Although, even if you’re not going to give your character a mental illness, or you’re not even a writer, you might consider giving this a read-through anyway. You might learn something about someone dear to you.
Deviant, disabling, and distressing are the three criteria that psychologists use to define a disorder. If it’s significantly deviant from what’s “normal”, if it causes problems for every day life, and if it is distressing, either to the afflicted or the afflicted’s close associates (y’know, like family), it’s a disorder.
I’m choosing to do depression first because it’s one of the most common illnesses of today. It may not be the first choice for a villain’s illness, but it is a little more common for other characters. While remembering that insanity is not a motive and neither are mental disorders, depression, as I’ll explain, is often a blockade to action and an eraser to motive, so it might be acceptable to explain a character’s [lack of] action by saying, “She’s depressed”.
There’s already a lot of media out there about depression so I hope this is not the first thing you’ve encountered concerning it. There are a lot of people out there with depression; you probably know someone with it, or suffer from it yourself. Sometimes people have a hard time accepting depression as a real disease, and have trouble dealing with someone suffering from it. People don’t understand why “cheer up!” doesn’t work. That’s because depression isn’t extreme sadness.
People view depression as extreme, lingering sadness anyway. Sadness, however, is not a disorder. It’s good to feel sad sometimes. It means your emotions, your ability to attach to things and people, your ability to mourn are all working properly. It’s unpleasant to feel sad, but it’s a good thing to be able to. People who view depression as a disease and extreme sadness appear to be people who think sadness is bad and therefore extreme sadness is a disease. Extreme sadness for a huge loss is part of the healing process; it is good, even if unpleasant. People who don’t see depression as a disease appear to do so because they realize sadness is not a disease, or even really bad.
One symptom of depression – one, you typically need many more than that (I think it’s seven? I can’t quite remember) to be diagnosed with depression – is lingering sadness. Other symptoms include insomnia or hypersomnia (sleeping too little or too much), ahedonia (not taking pleasure in pleasurable activities – this includes things like hobbies), exhaustion and weakness.
Compare those other symptoms with sadness. Usually, doing something you like combats sadness. It distracts you and helps you to be happy again. You might not feel like performing fun activities, but that’s usually because you don’t feel like being happy. Sadness may make it hard to perform activities the way a wound would, in that it hurts, but ordinarily, you’re still able to perform those activities. The phrase “Cheer up!” is annoying, “Go outside, you’ll feel better” may be annoying, but still good advice. You might have trouble sleeping for your sadness, but you’ll probably feel better when you wake up. Or perhaps your sadness makes you want to nap – and you’ll probably feel better when you wake up.
The world seems pointless as is everything in it with depression. Doing things you usually enjoy do not cheer you up; those things don’t bring you joy any more. They just remind you how pointless everything is. It’s not about not feeling happy because those things can’t make you happy. It’s difficult to perform every day activities not because you hurt, but because you have no energy, mental or physical, to do them. You’re running on empty and have nothing to give and demands are still made of you. They also remind you of how pointless everything is. The phrase “Cheer up!” is like saying “Stop throwing up!” to someone with a stomach virus. It’s pointless, even kind of rude. “Go outside, you’ll feel better” is only true if it’s sunny out and you have SAD – seasonal affective disorder. Otherwise, it’s moot advice. You go outside and see everyone whose lives aren’t pointless like yours. Your lack of energy makes you exhausted and you wish you were home where you can keep your pointless life on the couch where it’s easier to be pointless. The trouble sleeping may have to do with sadness, or the pressure of the void weighing down on you, or hormones, etc. The excessive sleeping may have to do with sadness, or boredom, or escape from the pressure of the void. When you wake up, you do not feel better. You feel just as terrible as you did when you laid down. Maybe worse.
Depression isn’t sadness. It’s all of the life and energy sucked out of you, living in a void. Sadness is involved, if anything, as a reaction to having the life and energy drained away all day every day.
What causes depression, then? Sadness comes from loss, typically. Doesn’t depression come from loss?
Sometimes. Sometimes a loss so huge causes one to feel like all is pointless, to lose energy, to see the world in a dark, dreary light. If this is the case, a person may recover from depression in a similar way they might recover from lingering sadness: time in vast quantities. The best way for you to help someone suffering from depression of this sort is to be there and to remind them their life is not pointless, help them keep on keeping on – and honestly, try not to be too cheerful about it.
Sometimes loss-induced depression may require counseling to get better. A trained therapist can work wonders in helping a person to see why their life isn’t pointless, and in helping a person to heal and move on from a huge loss.
But sometimes depression isn’t caused by a huge loss or other situation. Sometimes it seems to come from nowhere. What causes it then? Well, there are a lot of theories but the true answer is we have absolutely no freaking idea. “Chemical imbalance” is a phrase thrown around a lot, and people take it for fact that that’s a cause. Maybe. We have absolutely no idea but we (meaning actual psychologists and psychiatrists and whonot) act like we do. The point is, there are some medications that help, but we don’t actually know why they work, making depression a hard disease to deal with.
(By the way – medications don’t work 50% of the time and when they do work, much is accounted as placebo effect so therapy is probably the better way to go. The min study from which I say this is called “Efficacy and Effectiveness of Antidepressants: Current status of Research” and it was published 2010. I’ve never been great with citations but I believe this is the correct APA for it: Pigott, E. H., Leventhal, A. M., Alter, G. S., & Boren, J. J. (2010). Efficacy and effectiveness of antidepressants: Current status of research. Manuscript submitted for publication, Department of Psychology, , Available from Psychother Psychosom 2010;79:267–279. (10.1159/000318293).)
So what do you do if you have a friend who has depression, and it isn’t from a huge loss?
Stop treating it like sadness. It isn’t. Sadness may be involved, but as a symptom. If your friend is depressed, your instincts might dictate you invite them to go hang out with the guys/girls or get ice cream or go watch a movie. Those things treat sadness. You might ask them to talk about it. There’s no identifiable thing causing it. There’s probably nothing to say. You’re inducing more sadness by treating it like just sadness. I hear depressed friends say things like “I’m sorry I can’t feel better. I want to, but I can’t. Sorry.” In other words: now I also have guilt that I’m suffering from a disease that I can’t control, in addition to suffering from the disease over which I have no control. See also: making things worse.
If you have a friend who is depressed, encourage them to see a therapist/psychiatrist who is trained to do something helpful. Try to help them with the tasks that must be done, menial things like dishes. If it’s a roommate or child, you might try talking them into going to work on days where they just can’t. Don’t be frustrated when you fail. Depression is a trying thing; now’s the time to show what kind of friend (or relative) you are.
Should you wish for a better insight on what it’s actually like to feel depression, try some of the more recent posts from Hyperbole and a Half (http://hyperboleandahalf.blogspot.com/); the author, Allie Brosh, had suffered from the standard Major Depressive Disorder for a while before she was able to recover via medication, and she made a few very insightful posts about her experience. (Also Hyperbole and a Half is just friggun hilarious so if you have a few hours to go through the posts, you should.) There is a lot of other media circulating about which discusses depression and how difficult it is to deal with – and how it’s definitely a real thing. And finally, a great source would be the good ole’ DSM-IV-TR itself. Or the DSM-V if it’s finally out when you’re reading this. For those of you who don’t know – the DSM is the Diagnostic and Statistic Manual, or the Great Big Book Of Everything Psychological Disorder. IV/V is just the version that’s most recent, and TR just stands for ‘text revision’.
And once again: Depression isn’t extreme sadness. Depression is a void where there is no joy or energy and everything is pointless. Sadness is an emotion. Depression is a disease.