Someone who is depressed can appear to others around them, to be “well.” That is because depression can be felt all the time, and hidden most of the time. As much as people do not want to feel depressed, they generally do not ask for help, because they do not want anyone to know they are depressed. In fact, the instinct to mask feelings of depression is very common. People suffering from depression often find it difficult to participate in social activities, isolating from the world around them. They frequently succumb to inner pressures that compel them to avoid any interactions, even if it means missing school, work, or important events.
Severe depression can be compared to cancer in the way it ravishes the body and mind. Yet, for all the inner turmoil depression inflicts, it cannot be seen in the way that cancer attacks the body and can be detected by blood work. This can be hard to comprehend for those that have not experienced severe depression …how it is that a physically healthy looking person, someone who is able to interact and seem cheery in one situation, is then unable to answer the phone, stay at their job, or sit at dinner.
Three of the most prominent, and crippling, features of depression are the thought patterns, Negative Selectivity, Pleasure Deprivation, and Running Commentary. Negative Selectivity is the tendency to selectively become most conscious of what is “wrong” with an experience. As such, it becomes routine to note failure and disappointment. Negative Selectivity begins to direct all interpretation and experience, until it becomes habitual. People with depression begin to expect a “lack” of appreciation and rejuvenation when eating, sleeping, listening to the sounds of nature or music…looking at beauty, reading, or even thinking. Most experiences are stripped of the “nutritional” value, the dimension and nuance that makes them special. The depression leads people to almost exclusively report what was “wrong” with their day, how “unpleasant” work was, how they slept, “terribly.” The depressed person’s new “norm” becomes that of the “lack of pleasure.”
The ongoing lack of pleasure, or Pleasure Deprivation can become a serious condition. Like the lack of Vitamin D, or Iron, it is most often an unknown occurrence that goes on for an extended period of time, until acute symptoms demand the person seeks treatment. In the case of Vitamin D and iron deficiencies, a person may experience serious fatigue, memory lapses, or syncope. Pleasure deprivation resulting from depression, on the other hand, is not routinely tested. In fact, there is no conventional screening that people think of to explain the tendency to focus on negativity. This penchant for focusing on negativity is looked at as a habit, not something that can be diagnosed.
Without treatment, deficiencies cause compromise in capability, and create adaptations that provide only temporary solutions. More often than not, deficiencies produce secondary and tertiary conditions. In the case of Pleasure Deprivation, people who are depressed are likely to develop, “Anhedonia” (from the Greek, an = “without,” and hedone = “pleasure”). Anhedonia has two components, Motivational Anhedonia, and Consummatory Anhedonia. The first is the lack of desire to engage in an activity; the latter is the loss of pleasure from the activity, itself. Nothing is pleasing. Meals are “only alright.” Activities, such as physical intimacy, or social engagements seem “Not worth the effort.” Trips to places that would appear to be amazing fall flat. Routine activities, such as listening to music or going out to the movies, become unfulfilling, and, in fact, seem to require, “Too much effort.” As with an iron or vitamin D deficiency, a person’s energies and appearance shift. Because of the way we organize ourselves socially, people who cannot enjoy themselves sometimes cause others to feel uncomfortable, challenged, angry, or helpless.
The chain of events lead people with depression to feel alienated, and ultimately to become more isolated. As a result, people suffering from depression often find themselves becoming increasingly distant from acquaintances, friends, and loved ones. The alienation energizes the depression, as the experience of loss and isolation is interpreted as confirmation of ineptitude and worthlessness. Almost as a defense, or a means of conservation, the repetitive and consistent deprivation of pleasure results in a shutdown of part of the Self.
The bombardment of negativity and pain caused by Negative Selection and Pleasure Deprivation directly influence Running Commentary. Running Commentary is a thought pattern that is an endemic symptom of depression. It is a form of circular thinking that gains hegemony over all other waking thoughts. The commentary seems to be linked to the belief system, as opposed to being experienced as a separate “oddity” that the person suffering with depression can examine at arms length, with an objective perspective. As such, the commentary is experienced as if it is insidious, like brainwashing. Day in and day out, this commentary interprets the person’s ideas, efforts, actions, and achievements as having a quality-range from poor to embarrassing… from failing to repulsive and exemplary of what is abhorrent…not to be conveyed or displayed to others for fear of judgment.
With these internal experiences governing their external experiences, people suffering from depression frequently feel incompatible with others and not in sync with day-to-day routine. Someone suffering with depression is likely to have a distinctly different experience than those around them who are not depressed, or not familiar with the depth of depression. Herein lies one of the most difficult aspects of depression: how to bridge the gap between the individual’s “inner world” and the “world around them.”
From the earliest age that a person can think about themselves, people suffering with depression grapple with the notion that they ought to be able to “fix” the problem, themselves. Just as the onlooker does not see the thoughts and beliefs within the depressed person…the person suffering with depression also cannot make sense of how there appears to be no external source for the internal suffering. There appears to be, “Nothing going on,” but it feels as if, “Everything is wrong.” Mistakenly, depressed people are often misperceived by themselves, and by others, as stubborn, or lazy, because they do not follow their own practical advice, or the suggestions of others.
Without clarity, the person suffering with depression, and those who try to help them, do not understand that depressed people often can’t follow the advice of others. It is not that they will not, it is that they can not. In fact, people who are so depressed are unable to will themselves to do much of anything that would appear to be constructive, productive, or positive. The whole experience, for both, seems irrational and can even become maddening. Blame and self-blame are usually unavoidable. The premise that the depressed person could “fix” the situation if they, “Just did ‘X’, ‘Y’, and ‘Z'”–though not true–becomes the framework and perspective by which the depressed person regards themselves as a failure. In fact, in the depths of depression, people think that they are the only depressed person who cannot follow “common sense” to pull themselves up by their bootstraps. There is an idea that people with depression can use common sense and will themselves to reconnect with others and let go of their negative beliefs about themselves. Of course, though untrue, this idea is utterly convincing to someone suffering with chronic depression. At its worst, people with severe chronic depression have a rapid succession of thoughts that are dehumanizing, and so painful, that the “action” of these thoughts cause the individual to slip into deeper darkness. Devastated, but hidden, the Self fades…until unseen by the naked eye.
Written by Westport Family Counseling Director, Nicholas Strouse, LCSW