Winston Churchill referred to it as ‘the black dog’, others call it ‘the fog’; for someone who has never experienced depression, these metaphors can be hard to fully understand. But understanding is crucial to provide the best help and support to people who are fighting the fog every day.
In the fourth quarter of 2020, 1,461 people died of suicide according to the Office for National Statistics. Although the majority of people who experience depression do not die of suicide, having a major depressive disorder increases the risk of suicide. It is estimated thatabout 60% of people who died of suicide have struggled with a mood disorder, including depression.
Understanding depression is not only the job of mental health professionals; with NHS waiting lists long and private services often too costly, it takes our own communities to prevent the worst.
According to the American Psychiatric Association, depression is a mood disorder that negatively affects how you think, feel, and act. It can lead to a variety of emotional and physical burdens, including feeling sad, a loss of interest or pleasure in activities once enjoyed, feeling worthless or guilty, and thoughts of death or suicide. This list is by no means exhaustive, but it demonstrates an awareness of the systems. But, unless we’ve experienced it ourselves, do we really know how it feels?
Essential to understanding the sensations of depression are the accounts of those who have spent years grappling with the symptoms. For these individuals, depression consists of more than neurological anomalies and cognitive spirals. It is a daily confrontation that they must face in both seemingly banal tasks and the most emotionally charged moments.
From a clinical perspective, this understanding enables researchers to adopt a ‘disimpassioned passionate approach’, where treatment contains more personalised care. For non-clinicians, a greater understanding helps us to become more empathic in our day-to-day support for anyone close to us who is struggling with their mental health.
Through conversations with clinical psychologists, neuroscientists, and individuals who resiliently share their personal testimonies, here are some helpful accounts to authentically express what depression feels like.
The abyss: Mark
When Mark described his experience of depression, he described a place. ‘You can go into a very dark place. And no matter what you do, it’s really hard to come out.’
The abyss, while always dark and always deep, is not static. It moves along a path plotted by Mark’s current sources of stress and past points of pain.
How Mark arrives in the abyss is similarly variable. He ‘slips’ into the abyss, he ‘falls’, he ‘crashes’ – the movement is always downwards, out of control, and with lucid awareness of the impending darkness.
Mark’s experience with depression, however, extends beyond simply a place or a movement. Part of Mark’s depression is the hatred he feels for the abyss, for the fall, and for himself.
‘I hate it with a passion. When I’m going through a depressive period, I hate who I am. Depression is something that, you know, you’re reacting in a way that you shouldn’t be reacting. However, it’s out of your control’.
The fog: Annie
‘My first visit from depression was when I was quite young,’ Annie explained. Her depression, which she has nicknamed ‘The Big Sad’, has taken on various shapes and forms over ‘a decade of practice’.
When she was younger, her depression was no more than a feeling of being different – a sensation not too unfamiliar for many adolescents. ‘I felt estranged from everyone else who seemed to enjoy their hobbies and friendships, whereas mine always felt a little fake.’
Today, she typically settles on depression as ‘a fog’. ‘I can usually see it in the distance. I brace myself and wait. Then one day I wake up and things that used to be colourful and familiar are just dark silhouettes. It’s lonely.’
The fog is a vicious fatigue that permeates her daily schedule. It makes getting out of bed feel like heaving herself out of thick mud, chewing feels like ‘a mammoth effort,’ and ‘even the idea of standing up for long is tiring.’
Annie warned that the fog is not simply a state of inactivity. Beneath the shroud is an ongoing and laborious fight. “It might look like I’m lazy or unmotivated, but the opposite is true. I’m fighting harder than I ever normally have to, just to leave the house.”
Annie’s experience of fatigue is backed up by science. At a lecture at Stanford University in 2009, Robert Sapolsky, a professor of biology and neurology, and neurological sciences explained: ‘You look at someone with major depression who’s just mired in this psychomotor retardation stuff and there’s this temptation to start thinking about them as just so wiped out.’
While this all-consuming fatigue (to which he refers using the technical term: ‘psychomotor retardation’) is a common and severe symptom of depression, Sapolsky went on to explain how our failure to understand fatigue means we often ignore the tiresome internal chaos that is often occurring behind the scenes.
‘[There is] this enormous battle; all of it going on internally. This is someone whose body is having a massive stress response 24/7.’
Depression feels like meaninglessness
‘A large portion of people who are depressed don’t feel anything,’ says Daniel Mansson, clinical psychologist and co-founder of Flow Neuroscience. ‘You’re just flat. So, you go through life and look at things that have previously made you happy. And now, nothing. That’s super frightening. Things just pass through and you don’t value or evaluate things. They just pass.’
After years of working with people living with depression, Daniel conveyed that flatness as being most salient to understanding what depression feels like. For clinical psychologist Hanna Silva, one of the principal sensations of depression is hopelessness or ‘meaninglessness’ – feelings which are quite painful.
‘Most things are meaningless or hopeless,’ she says. ‘You feel that way even when positive things happen. For example, when your baby smiles at you, you can’t feel joy.’
Depression feels like forever
When asked what is missing from the common understanding of depressive feelings, Hanna believes that recognising how long the sensations last is at the core of depression misconceptions.
‘The feelings do not fade away as you would expect them to if you were, for example, sad or uninterested in something,’ Hanna explains. ‘The negative feelings are so persistent – you can’t snap out of it; depressed feelings can take hold of a person. Emotions do not change from moment to moment.’
These negative sensations can be compared to the deep sadness and grief that many of us have felt on occasion. However, it is the devastating perpetuity of these feelings that separate depression from even the lowest lows of a depression free life. Daniel similarly cautioned against assimilating depression with commonly understood sadness.
‘The popular picture, that I kind of bought into, was: depression is a sad person,’ adds Daniel. ‘The individual is sad about something. Sometimes they know what they’re sad about, sometimes they don’t. Depression is a lot more complex.’
The security of knowing better things are to come is something that depression strips away.
Empathy and understanding
In many ways, understanding what depression feels like is an impossible task, as the voices featured here would agree. However, by seeking out the voices of those living with the condition we can reach a more empathic level of understanding.
Clinicians and those experiencing depression agree that it is a unique experience, something which cannot be solely slotted into neat symptom descriptors. It is real and raw, and quite contrary to common depictions, it can feel long-lasting and numbing as opposed to only short bursts of deep pain. To be able to understand, treat and manage depression, we must encapsulate the stories of our clients and listen to how it truly feels to be able to implement client-focused treatment plans.