Is depression an illness, an attitude, a request for help, or something else?
Depression is an illness. However, this term refers to a diagnosis, and not simply to a common expression or to the way a person may describe themselves by saying, “I am depressed.” Depression as an illness corresponds to a state of reduced activity of the “psychological” brain, that is, the part of brain function from which the main manifestations of thought, behavior, and feeling arise. It is an illness because it follows its own course in a stereotyped way and, although it causes suffering in the person, it alters the mechanisms that, in a healthy person, make it possible to resolve suffering or to “react.”
Do experiences, disappointments, and external events in general have anything to do with depression?
Looking for near or distant “reasons” is an exercise that can always be carried out, because in life there are, or have been, events capable of producing feelings or periods of sadness, disappointment, and loss of confidence. These feelings, which are normal reactions to negative events, are not depression.
The fact that a depressive episode develops after a major negative event is true only in some cases, but this sequence is often misleading: frequently, the negative event is already an initial consequence of the depression that is developing, which brings with it withdrawal, loss of initiative, a tendency to break off relationships, or an inability to carry out plans. It is therefore more accurate to say that negative events may occur as a consequence of depression than that depression necessarily results from them.
Furthermore, many people become depressed while simultaneously losing ground socially or in their personal relationships. This may lead others to think that the cause lies in these failures, or in the realization of mistakes that have been made. Typical examples are depressions following marital infidelity, or after suffering financial collapse or legal problems. In these cases, attention should also be directed toward the preceding mental state, that is, the state in which the person may have made rash decisions superficially, or become involved in situations that later turned against them.
In such cases, depression is only the endpoint of a “two-stage” phenomenon, with an earlier euphoric phase followed by a depressive one.
Do people with depression “play it up”?
This is a widespread prejudice. If depression were not an illness, as it is, it could be anything else. Some forms of depression are taken more seriously, while others are not believed at all. These include so-called “atypical” forms, in which the person maintains some fundamental functions and may even manage to feel well in certain circumstances, but inexplicably seems, whenever possible, to retreat into themselves, feel sorry for themselves, take offense at perceived wrongs, or regret having no motivation.
For example, there are forms of depression in which a person may appear normal at work, but once at home may spend entire days, especially days off, isolated and frightened by the idea of going out, meeting someone, being contacted, or being confronted with thoughts of the past, regrets, and memories.
Is it good to “shake” someone who is depressed? Is it helpful to force oneself to react?
This is not really a relevant issue. A depressed person does not respond either to attempts to force themselves or to being shaken by others. What is forced is the mobile component of depression, namely anxiety, which worsens, or aggression.
Family members often complain that whenever the depressed person is questioned or someone tries to make them react, they become agitated, perhaps cry, or do react, but by accusing others of not understanding them, saying that they want to be left alone, or simply pushing them away harshly.
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Scrittura
Shouldn’t a depressed person realize that they are also causing suffering to other people?
A depressed person often already has this idea very strongly within them. If not exactly that they are making others suffer, they nevertheless think that they are disappointing them or that their presence is a burden. When other people make an effort to be helpful, support the depressed person, or “shake them out of it,” even in a good-natured way, with jokes or by telling them that “they also suffer seeing them like this,” the depressed person may perceive this as a message of annoyance or irritation. They may even consider it justified, because a depressed person is often the first to have a negative view of themselves and of the condition they are in.
Sometimes family members say, “In the end, you’ll have to treat me too, because the depression has affected me as well,” but this kind of comment should be avoided in front of a depressed person.
Another unhelpful observation is sometimes made when depressed people improve, but not decisively, for example: “The treatment helps, but you have to do your part too,” or “You also have to fight back.” With no other illness would we expect half of the symptoms to disappear with treatment and the patient to get rid of the other half on their own. Just as a severely depressed person cannot simply overcome their condition by willpower, neither can someone with a less severe depression.
Why are depressed people sometimes aggressive, and why do they seem not to appreciate what others do for them?
Depressed people are often emotionally numb or emotionally depleted. In other words, they may experience only negative emotions, or may no longer experience emotions at all, as if they were empty, too weak to feel, or too hopeless to become emotionally engaged.
They feel guilty about this, especially mothers and fathers toward their children, and they may feel ashamed, as though it were not an illness but a moral flaw. However, periods of “calm” depression can sometimes alternate with irritability, accompanied by a tendency to reproach others, accuse them of not doing enough, not helping enough, and so on. Particularly among young people and women, or in forms of depression associated with alcohol or drug use, these aspects can become exhausting for family members.
There may also be episodes of aggression involving the destruction of objects or furniture, as well as self-harm. These features can sometimes point toward a diagnosis of depression occurring within a more complex mood disorder, such as bipolar disorder, rather than straightforward unipolar depression.
Depressed people sometimes say that they can no longer do things, or that their brain no longer works, even though this is not actually true. Why?
A depressed person’s perception of themselves is negative and increasingly pessimistic: they see themselves negatively and often worse than they actually are. Above all, however, they are unable to make positive judgments about themselves. So if someone tells them that “deep down” they are not doing so badly, they may shake their head and say the opposite: that they could not possibly feel any worse.
It is a kind of pessimism directed toward oneself. Even when a person is still functioning well, they may anticipate that this is merely the beginning of an inevitable decline.
Older people often present themselves by saying that they are incapable of doing even the simplest things, that they no longer understand anything, that they are no longer mentally sharp, that they can no longer read, write, or count, that they cannot remember anything—not even how to cook or drive a car. In reality, these deficits are apparent and should not be mistaken for conditions such as dementia. They are what is sometimes referred to as “depressive pseudodementia.”
The same phenomenon can occur in young people, although in their case it is obvious that dementia cannot be the explanation, which can make the situation seem even more paradoxical. There are athletic young people who suddenly feel that they can no longer remember the movements involved in their sport, who can barely remember how they used to play or train. There are artists who do not even want to look at their own work because they believe they will never be able to paint, play music, or write again.
The whole experience is therefore a depressive point of view, amplified and experienced as true—even if not in the present, then certainly in the future—by the person experiencing it. Sometimes this perspective even extends into the past.
Why does a depressed person sometimes describe their life as a failure, difficult and painful, without remembering the positive things?
The memory of a depressed person tends to highlight negative aspects and minimize positive ones, as though the ultimate and most truthful meaning of everything were the pain of the present.
It is as if the person were retrieving all the elements needed to explain how they “ended up like this”: sometimes because of fate, sometimes because of their own fault, sometimes because of injustices they suffered, or because of mistakes they made. In any case, it becomes a story in which things may have appeared positive at the time, but in retrospect they were supposedly never truly positive, given how they eventually turned out.
Depressed people often say that they have always been unhappy, that they have always been failures, that they have never accomplished anything worthwhile, or that they have gotten everything wrong. Family members may feel deeply hurt because, within this narrative, they no longer seem to matter, or are instead regarded as examples of mistakes and failures.
A depressed person may feel that they have failed as a father or mother, as a son or daughter, at work, and may view the results of their life as a series of mistakes or defeats.
This kind of perception should not be mistaken for detached, rational reflection. Arguing against it simply tends to agitate the person experiencing it, without managing to convince them otherwise.
Should depression only affect people who are already depressed by nature?
No. Depression is not exclusive to any particular personality type, and it also frequently affects people who have always been exuberant or hyperactive.
In these people, the change is often easier to notice and appears earlier, because it can seem as though their personality has changed radically. In someone who already has a more depressed temperament, on the other hand, the onset can be more subtle.
Why would a young person have a reason to be depressed? Isn’t it unnatural for someone in the prime of life, with their whole life ahead of them, to become depressed?
Depression is not a matter of age. It can also occur in children, and it is common during adolescence.
The way adults view youth often does not correspond to the experience of those actually living through it. Young people may alternate between moments of enthusiasm and periods of profound despair.
During these periods, a young person can be particularly vulnerable because they have not yet achieved definite or significant goals. When they become depressed, they may therefore think that they will never achieve them, or that they have failed before they have even had the chance to accomplish anything.
Feelings of guilt and shame toward important figures in their lives, such as their parents, can be particularly strong, especially in close-knit families where the bond with parents and the desire to meet their expectations are strong.
A bad grade or a romantic disappointment can become a source of profound despair for young people, experienced, paradoxically, as irreversible damage, as opportunities that will never come again, or as permanent failures.
Do we know what causes depression?
When depression begins at a young age, there is usually already a family history, and therefore a genetic component.
It also appears that part of the vulnerability to stress may be transmitted from mother to child through environmental rather than genetic mechanisms, perhaps through caregiving and attachment. Significant and prolonged life experiences that threaten a person’s sense of survival may therefore, even unconsciously, induce a particular susceptibility to stress that persists over time, even when circumstances improve.
It can nevertheless be said that classic depression is generally spontaneous, and that even when it begins after negative events, it usually appears clearly disproportionate to and somewhat disconnected from those events, in terms of the nature of the thoughts, the reactions, and the duration of the condition.
What can family members do for a depressed person?
There are two fundamental functions. The first is providing care, as one would for any person who is ill. The second is accompanying them throughout the treatment process.
These are simple forms of support that are often appreciated once the person recovers their functioning, and that do not unnecessarily increase the anxious component of the illness.
The only area in which it may make sense to insist is treatment—not necessarily by contradicting the patient’s view of their condition, but simply by pointing out the opportunity and importance of receiving treatment.
Depressed patients often seek treatment in order to please their relatives, out of passivity, or because refusing treatment and disappointing their family members makes them feel more distressed. They may also accept treatment because they think that, at the very least, they will feel less ashamed in front of relatives who continue to insist, even though they themselves do not trust that treatment will work.
As a result, despite their distrust of treatment, their negative view of themselves that does not allow for criticism, and the passivity that might otherwise make them feel that there is no point in trying to get better, many patients who are supported by their families ultimately receive effective treatment and recover from their condition.
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