The d-word

We know that more and more of the general population are seeking medical help for depression. It's been suggested that it's a result of hard economic times - poverty, and the fear of poverty, are seen as the culprits. But, following Robin Williams's death, a few well-known, successful people have talked about their own dark times. They aren't financially stressed and seem to have everything they could possibly want. Nor has there necessarily been any major event in their lives to trigger the condition. There's no common theme. 

Last February's article explained how you can be happy inside even if bad things happen around you. In fact, happiness is completely "inside" and only appears to be caused by people and events around you. And so it is for the other emotional side: you can become very unhappy, whatever your circumstances, even when there's no real change in your circumstances. Or to put it another way, people get depressed for no reason.

This is very difficult for anyone who hasn't experienced it to understand. Alastair Campbell, the former UK government press secretary, said, "We have a long, long way to go. I met the health secretary, Jeremy Hunt, last year. We talked about depression and he said he found it really hard to understand 'why someone like you, with the life you have, would have depression'. I was, I admit, quite shocked. He was reflecting an opinion that many hold, and this is the fight - to understand that depression has nothing to do with how popular or famous, unpopular or unknown, you are. It just is. Like cancer is. Like asthma is. Like diabetes is. Some people get it, some people don't. It is a truly horrible illness, and must be viewed and treated as such."

If you're depressed then you can't just "snap out of it". For most people the answer is to seek medication that alleviates the worst symptoms and allows them to recover. It's not a cure and, just like the onset, when the episode ends then it ends for no apparent reason.

How can you tell if someone you know is suffering?  A quick google returned the following list of symptoms:

• Feelings of helplessness and hopelessness
• Loss of interest in daily activities
• Appetite or weight changes
• Sleep changes
• Anger or irritability
• Loss of energy
• Self-loathing
• Reckless behaviour

If you're experiencing these you'll certainly be very aware of it.  But I think you'd have to be quite perceptive to notice most of these symptoms in someone else.

Just like the skills I've written about before, and just like happiness, anxiety and depression are thinking patterns - in a sense, self-inflicted.  I don't mean that to blame the sufferer.  They can't control these patterns - otherwise, presumably, they would.  They'd make themselves better - or never get ill in the first place.  They simply don't know how.  But that doesn't mean it can't be done.

I said that there's no reason for depression, no objective reason that is. But there is a process, the way your internal world develops so that you become less and less capable of functioning normally.

You can argue that people who never suffer depression must be doing "it" right somehow.  Conversely, those who do suffer are doing "it" wrong. So what are they doing (thinking) differently? What are the processes of depression?

An article by Dr Richard Bolstad and Margot Hamblett goes into this in detail. I'll summarise it here.

The authors characterise depression as the "negative trance of learned pessimism" (implying that it's an altered state of awareness - or trance - with an associated thinking style - of pessimism). They go on to identify six "programs" and "strategies" which generate this state. These are the things that depressed people do:

Chunk Up In Problem Situations
If something goes wrong you generalise, saying something like, "This happens every time", or, "Why do I always get things wrong?"

Associate into Pain, Dissociate from Pleasure (Traumatic response)
Unpleasant experiences seem to be very real and are easily re-lived in the imagination.  Pleasant experiences seem to be false, as if they happened to someone else.

Temporal Orientation Towards the Past
May have no sense of the future at all or shapes the future in terms of the past: "I'll never be successful because I failed before."

Auditory Digital - Kinesthetic Loop (Negative self-talk)
You feel bad about something (not yet depressed). You talk to yourself about how bad it is and how it will get worse - and about how it's all your fault. You then access your feelings and find, of course, that you feel worse.

Kinesthetic Shutdown (Psychomotor retardation)
Physical activity is suppressed. This may interfere with sleep, leading to tiredness and so even less exercise. This "unresourceful" physiology reinforces the general, unresourceful state.

Not at Cause (Lack of a sense of control)
Thinking that there's an inevitability about the future and denying their ability to influence outcomes by taking appropriate actions.

The article explains how a coach can help a sufferer by taking a consultative approach, assisting the person who is making their own efforts to avoid or re-program these destructive patterns. The authors specifically warn against attempting to "rescue" a depressed person, for example by trying to cheer them up or taking work-load from them. Support of this kind simply reinforces the sense of helplessness that is at the heart of their experience.

So what can you do if someone you know is depressed?

Nothing. That's Bolstad and Hamblett's message. Unless you're an experienced practitioner in this field, almost anything you do will makes things worse. Referring them to a professional is just about the limit - and even that may well be resisted.

What if you are depressed?

Well, see your doctor who will be able to prescribe medication and refer you to a suitable therapist. Anything else I say here won't change your reality. But you can change it - and sooner or later you will.