The value of depression counselling
A version of this article appeared in alustforlife.com
What is the difference between sadness and depression, and can depression counselling help?
In this article if there are differences between these emotions and I ask if depression counselling can help.
We all experience times in our lives when we feel fed up or miserable. One morning we wake up and discover we feel listless. We find we are unable to face our daily schedule. Perhaps we begin to withdraw, both from the world and from our own private pleasures. We lose our sense of direction, and the meaning that life once held begins to recede.
Some version of the above will play out at some point in all of our lives. There will be moments in every human life to make us sad; the inevitable tragic and stressful events that affect us all. And so reactions like those above are to be expected. If the weeks and months drag on, and the feelings continue to persist, we may ask ourselves why? Are we actually depressed? Or, given the tragic events that may have befallen us, are we understandably sad?
Is there a difference between ordinary sadness and clinical depression? And how can we tell the difference? Given that the primary symptom associated with depression is sadness it’s difficult to make a distinction between the two. The first port of call if you think you’re suffering from depression should always be to your GP. With that in mind, I thought it would be useful to highlight some key differences between sadness and depression; between ordinary, appropriate levels of sadness and a level of sadness that is pathological. De
What the clinical manuals say
If you visit your GP or a psychiatrist, they’ll likely consult a diagnostic manual like the DSM or ICD. Of the two, the DSM is the more categorical, listing eight criteria for depression. These include being in a depressed mood most of the day or feeling a lack of energy. . They also include showing a lack of interest in previously pleasurable activities. Another symptom is experiencing feelings of worthlessness or inappropriate guilt. The full list can be found here. Of the eight symptoms in the DSM, an individual must have experienced five of them during the same 2-week period. The symptoms must also have caused significant distress or impairment. And at least one of the first two symptoms on the list must be present.
The ICD in it’s qualification for diagnosis is slightly more prosaic. It cites a ‘subjective feeling of distress and impotence in the face of life’s demands’.
How does this official diagnosis of depression – clinical depression – differ then from sadness (beyond the two week qualification)? The sad person might also feel a lack of energy or feel impotent in the face of life’s demands. They might equally suffer a diminished capacity to think, or feel guilty about their current state of idleness. One major difference between them is one of degree; the extent to which these symptoms impair his or her life.
The differences between sadness and depression
With sadness – though we might feel down in the dumps – we can usually participate in simple activities. Activities such as watching a movie, cooking our favourite recipe, or catching up with friends present no real difficulty. Though we may feel morose, somehow we can still summon enough energy to engage with life. But for someone dealing with depression, this isn’t the case. The depressed individual finds they’re unable face any of the activities that were once interesting or pleasurable. Nothing is remotely interesting or appealing to them. This lack of interest further compounds their feelings. Not only can they see nothing beyond their miserable state, but life’s pleasures are beyond them.
Another difference is with regard to somatic impact. Someone experiencing sadness can usually sleep as normal, maintain their appetite. They remain motivated enough to carry out their workday tasks. Depression on the other hand is often associated with serious disruption of normal eating and sleeping patterns. Even if one could find the energy to cook something, poor appetite often means they barely touch their meal. Sleep becomes fitful and gloomy. On waking, our energy is low. The individual can barely climb out of bed at all. When she does she finds that even the smallest challenges take on the feel of heavy obstacles. Lacking any vitality, she despairs how she’ll ever pick things up.
Yet another difference between sadness and depression concerns the feelings of worthlessness that an individual might experience. When we are ordinarily sad, our self-esteem is usually unaffected by our grief. We might feel regret or remorse for something we said or did, but this is usually fleeting. And if remorse lingers, at least knowing the cause, we have some hope of finding remedy. The depressed individual on the other hand, may find herself caught in recurring, self-diminishing, negative thought patterns. She characteristically feels wretched about herself, full of self-recrimination, guilt, shame, and self-loathing. These negative thought patterns can lead to thoughts of self-harm. In extreme cases they lead to suicidal ideation, or going as far as to have a suicide plan.
On not knowing the cause
Arguably the key difference between sadness and depression is with regard to knowing the cause. Sadness is usually, though not always, due to a particular reason. The roots of depression, meanwhile, are often, though not always, indeterminate. Sad people, usually without much difficulty, can tell us what is bothering them. Not necessarily sad about themselves, they are sad because of something that has taken place out in their life; perhaps the loss of a job, or the ending of a relationship.
Depression, however, needs no such triggering event. The individual suffering from depression just feels sad or hopeless about everything in their lives. They may have everything going for them, with every reason in the world to be happy. Yet, for some unknown reason, life for them has been drained of all pleasure and meaning. Pressed for the cause of their depression, they draw an inconclusive blank. The bitter roots of their sorrows remain, for now, a mystery.
After having consulted your GP, you may then decide it’s time to talk to someone. If to a counsellor, the first thing he or she might do is determine the nature of the disorder.
For the client who knows the cause of their sadness the counsellor supports him in developing a self-care programme. This is usually particular to the type of sadness he is experiencing. Already out in the open, the cause – whether from childhood or adulthood – is easier to talk about. It’s easier to build resilience against any spiralling further downwards or from slipping backwards after recovery.
The duration of counselling for sadness, because it can be addressed more or less directly, is often much shorter
For the person for whom the cause is unknown, depression counselling may take a different path. The depressed individual’s first difficulty may be in attending at all. They have to summon great reserves of energy to get themselves to the consulting room in the first place. Having arrived, they may then have to overcome feelings of worthlessness and guilt in facing the counsellor. They may tell themselves they don’t deserve to have this person listen to their worries for one hour every week. They may worry that the judges them as harshly as their own punitive, thought-patterns. The symptoms that prevent a depressed person from engaging with life may prevent them from engaging with therapy in the first place.
Not knowing where our depressed feelings come from, we can often doubt the legitimacy of those feelings or feel they are doubted by others. We may discover that having those feelings acknowledged and validated by a caring listener can be a relief. With the help of the empathetic and supportive listener, the depressed individual can take steps towards re-engaging in relationship. Counselling provides a stepping stone to understanding what has caused this blight on our lives.
Finding an answer
Not knowing the cause of the depression presents the greatest difficulty for the individual. Paradoxically, however, it offers a glimmer of hope as to the direction depression counselling might take. After establishing the therapeutic relationship, the goal is to shed some light on the cause of someone’s illness. We often find the cause, for whatever reason, has retreated to some dark recess of their consciousness. Ultimately, the goal becomes moving the individual from a place of inexhaustible despair to the loss of something particular. This is typically some unresolved childhood trauma; perhaps the love from one or other of our parents that we never got, perhaps some childhood humiliation. When we finally reach the source of our pain, we finally have the opportunity to mourn the loss.
This will generally prove to be an agonising and painful journey to undertake. For those who take it, the catharsis that mourning allows makes the journey worthwhile. If we are able to leave the dark continent of depression behind we may some day arrive in the land of ordinary unhappiness. And once there, we may discover that hope and beauty once again find a place in our lives.