The Mayo Clinic offers the following advice: “If you feel depressed, make an appointment to see your doctor or mental health professional as soon as you can.” Feeling depressed must be an urgent matter, if the medical experts want you to see a professional as soon as possible. So, how do you know if you’re feeling depressed? What is it like to feel depressed?
The Mayo Clinic says that feeling depressed “may include” the following emotions: Sadness, emptiness, hopelessness, irritability, frustration, anger, anxiety, agitation, worthlessness, elevated self-esteem, guilt, and sensitivity to rejection. That’s a whole lot of different emotions, many of them quite distinct from the others.
What’s more, some of these emotions are contradicted by other symptoms listed by the Mayo Clinic. Feelings of worthlessness and elevated self-esteem are obvious opposites. Though many people have different assessments of self-worth at different times, it’s difficult to understand how any subjective experience of “feeling depressed” could simultaneously include both confidence and self-loathing.
The clinic also advises that feeling depressed “may include” restlessness and outbursts of irritability, but then says that feeling depressed “may include “tiredness and lack of energy, so even small tasks take extra effort,” as well as “slowed thinking, speaking or body movements”. So, according to this definition of depression, you might be feeling depressed if you’re highly active and easy to provoke, but you also might be feeling depressed if you’re unusually inactive and difficult to provoke.
Understanding what “feeling depressed” might mean becomes more even challenging with the caveat that the feeling might include the emotions listed by the Mayo Clinic, but then again might not. Given this conceptual ambiguity, a clear diagnostic process would be helpful, but what the clinic describes is more of a scattershot approach that includes widely varying techniques depending on the skills of the health practitioner, ranging from a laboratory blood test to the subjective impressions gathered through a conversation with a psychotherapist. If the methods of diagnosis vary so widely, how can we know that they’re measuring the same thing?
Emotionally, depression is all over the map, a medical condition characterized by a haphazard collection of many different feelings rather than a coherent feeling in itself. So, instead of describing ourselves as feeling depressed, and leaving others unsure of just what manifestation of depression we might be referring to, we can use our sense of emotional granularity to be more specific.
For example, we might describe ourselves as miserable. There’s no ambiguity about misery. It’s not sad sometimes and angry at other times. When we’re miserable, we feel consumed by pain because of the troubles that beset us.
The Online Etymology Dictionary defines the word misery as a “state of grievous affliction, condition of external unhappiness”. The English word diverged from the French word misere, which referred to misfortunes as well as the emotion that those misfortunes provoke, about 700 years ago. Misery is distinct from depression in that it’s an emotion we feel in response to external circumstances, rather than an illness that provokes a variety of emotions.
This distinction became clear to me when I went to a psychotherapist to get help in a time of trouble. My father had just died. I was caring for my mother, who had developed dementia. I was going through a grueling, years-long process of divorce that was causing severe financial difficulty. I was feeling miserable, and I went to the psychotherapist for advice, for fresh perspective, and to learn coping mechanisms.
After I explained my situation, the therapist told me that I had depression and suggested that I begin taking antidepressant medication. “I don’t think I have depression,” I responded. “I don’t feel the way I do because of a chemical imbalance. I feel the way I do because my life is falling apart.”
“I need a label that we can submit to your insurance company for payment,” she said. Treating me as if my problems were medical in origin would make the therapist eligible for insurance reimbursement. Health insurance companies pay for services for people who are sick, but not for people who feel miserable. Identifying my troubles as medical in origin, the therapist explained, would require the medical response of a prescription drug.
In this arrangement, depression wasn’t even a true mental illness. It was an economic tactic.
I decided to pay the therapist directly, in cash.
How many other people have gone to therapists feeling miserable, but been treated for depression instead, because that’s where the money is?
Misery can’t be solved with a pill. If I had taken the antidepressants that therapist suggested, my feelings might have changed, but antidepressants could not eliminate the problems that caused those feelings. They couldn’t make my father come back to life, bring my mother’s memories back, or save my marriage.
Life is tough. It inevitably brings heartache and failure.
There’s something sinister in a system that responds to the problems of life by telling us that we’re sick for feeling miserable when life gets hard.
I’d rather feel miserable as I struggle to put my life back together than treat my emotions as a symptom in need of artificial suppression.
