Depression: Defining the 'Black Dog'
Ask five different health professionals for a definition of depression,
and you are likely to get five different answers. To a physician it is
a disease, something you can treat with medication. To the pharmacy industry,
it is an opportunity to make lots of money and some psychiatrists will
define it as a physical brain disorder.
Depression is a term for a complex set of processes but is not necessarily
a 'thing'. It is a useful label, but telling someone that they are depressed
could be seen as permission to adopt a certain way of thinking and reacting.
This is not to deny that to experience depression is a real and debilitating
event and should always be taken seriously by any therapist, but it may
be more useful for the person suffering, to acknowledge that people can
be involved in the process of depressing themselves. That is, it is not
an outside force that attacks them, but a process that they have the
power to turn around and change. A therapist can help their patients
or clients to realize that they have control over their own fate and
do not have to be passive victims of a disease.
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People describe their 'depression' in many ways and the words used
are symbolic representations of complex facts and feelings. Expressions
such 'falling endlessly into a black hole', 'locked inside a cage', 'silently
screaming and knowing that no one will hear' are only some of the phrase
used. Everybody 'does' depression in different ways but the pain is the
same. In some people, depression is denied and unrecognized because they
control it by acting out in self harmful ways, such as eating disorders,
alcohol or drug abuse or aggressive behaviour.
As a psychotherapist I have a duty of care when a client presents to
me with depressive ideation, to ensure that they do not have suicidal
thoughts and plans. In such cases, I will always recommend that they
see a GP to discuss anti depressant medication as well as continuing
therapy. In most other situations I do not suggest pharmaceutical medication
because I do not see depression as an illness but as a way of coping
with overwhelming circumstances. These may be past traumas that have
not been dealt with, current issues such as loss of a loved one or most
often, a build up over time of many losses, griefs and causes to be sad.
Depression can then be seen as a coping mechanism which can help to numb
the overburdened person from life's pain and opt out of dealing with
unwanted issues. This should not be seen as a sign of weakness but as
a survival skill.
If depression is a way to deal with unbearable pain, how then does someone
learn to change their way of thinking to move into a non depressed state?
This fascinating question is dealt with in part
2 of this article.
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