Not even the rich, famous and funny are immune to the ravages of depression, an equal opportunity malady that is controversial even in its classification as a disease. People who suffer from depression know it can be every bit as debilitating, even deadly, as illnesses such as cancer, diabetes or heart disease. Frequently misunderstood, depression is much more than unhappiness and people affected with it cannot just “pull themselves up by the bootstraps,” or “snap out of it.” For many, major depression is a lifelong condition with alternating periods of wellness and recurrence of the illness.
According to the Centers for Disease Control and Prevention (CDC), one in 10 U.S. adults reports current depression. Major depression is frequently unrecognized and untreated, and may lead to tragic consequences, including suicide and impaired relationships. The National Alliance on Mental Illness (NAMI) calls it a “serious medical illness” that affects one’s feelings, thoughts, mood, behavior, and physical health.
There is considerable debate over whether depression should be considered a disease, a mental disorder, a psychological syndrome, a brain dysfunction or something else entirely. Stephen Diamond, Ph.D. is a forensic psychologist who says for him the problem comes from trying to apply the medical model to psychiatry and psychology. The medical model uses symptoms of a physical ailment which can be diagnosed. Depression is vague. There is no blood test, X-ray or brain scan that can diagnose it. Therefore many experts are reluctant to call it a disease.
As Robin Williams himself said “depression is no laughing matter,” and his suicide this week once again demonstrates that depression is an equal opportunity disease that can affect anyone. Some suggest that suicide is selfish, but this stems from a lack of understanding of the illness (disease?) and the feelings of utter hopelessness and misery that can accompany it. Those who have not suffered from depression have no idea of the pain that it can cause, or the depth of difference between true depression and a bout of the blues.
There is no logic to depression, there is no logic to who the disease chooses to affect and there is no logic to the thought patterns of those who have it. One strong argument for calling depression a disease is the lack of ability to process information and think as a “normal” person can. The brain of someone with depression simply does not work that way, and the sufferer cannot logically talk themselves out of their mood, even when there is no visible reason for them to feel that way. It is not helpful for others to tell them they have “nothing to be depressed about.” Depression itself has no logic in who it affects.
No one really knows what causes depression, but it is generally accepted that it is a combination of environmental and genetic factors. Stressful life events can make it more likely, but it is not necessarily related to anything external. The confusion about the condition is increased by the fact that “depression” is a word used to describe both a long-lasting low mood that affects the ability to function or enjoy life, and a short-term episode of sadness.
Symptoms of major depression include feelings of sadness, less interest in activities that have previously been enjoyable, weight loss or gain, agitation, fatigue, guilt, difficulty concentrating and possible recurrent thoughts of death. According to the American Psychiatric Association, diagnosis of depression requires that five or more of these symptoms be present for at least two weeks. The CDC says that and episode of depression that is left untreated leaves the individual at a 50 percent risk for experiencing another.
Depression can be treated, although major depression cannot be cured. Combinations of antidepressant drugs and psychotherapy have been shown to be effective in helping many people, but there is no standard treatment. Each individual affected requires individual management, often through a frustrating process of trial and error.
Mental health is a mystery to science and society. Many people think that because they were sad about something and got over, that feeling better for a depressed person is just a matter of time. As shown by the recent loss of Robin Williams, depression is an equal opportunity disease that no one truly understands.
By Beth A. Balen