A basic reading of the definition of Major Depressive Disorder fails to reveal the true danger of the illness. Why is it considered a chronic illness when the symptoms seem to be so vague and ordinary?
The simple answer is in the statistics:
- the World Health Organization has stated that depression is the leading cause, worldwide, of living with a disability;
- it is the second leading cause of disability in the United States;
- one in five women, and one in ten men, will experience at least one depressive episode in their lives;
- if untreated, an episode will be followed by others with each subsequent episode lasting longer and its fall being deeper;
- forty percent or more sufferers of the disorder will consider suicide, with ten percent succeeding in their attempt (this translates to over two million deaths in the United States each year and far more globally);
- the group at greatest risk? – single white males aged fifty-plus.
The statistics reveal the chronic nature of the disorder, the very real risk of death. They do not, though, explain how this risk arises.
In this post, I’ll attempt to flesh out an explanation for you. This explanation comes from my own experiences with MDD and is reasoned conjecture on my part. I can’t point you to any study or paper or book that agrees with me, but then again I’m not an expert in the field. I’m someone who has experienced the chronic danger first hand and survived. I’m one of those single white males, aged fifty-plus, who considered, and then attempted, suicide.
In my opinion, the true danger lurks within the definition of the Disorder. I believe that it is the cumulative effects of the symptoms that create a danger that is far greater than the individual components suggest. I propose that each affect works in concert with the others to amplify the result much like alcohol can amplify the effect of depressants.
Again, I have no proof for this statement, but it feels right to me.
For the balance of this post, I will explore each symptom of the Disorder individually. Keep in mind, though, that when you consider the effect upon the sufferer, it’s my conjecture that it’s a multiplying effect, not one of addition. Remember that each and every day, for most of each day, he or she (from now on, I’ll just say he) is battered by a multitude of mental and physical affects that just wear a person down. To the sufferer, there doesn’t seem to be a reason for this, which serves to create frustration and confusion worsening the overall impact.
While Major Depressive Disorder seems to begin with mood – that is, after all, the first symptom described in the definition – it really begins within the brain. Neuroscience tells us that our brains have zones that regulate appetite, sleep, mood, pain, memory, and all other facets of our being. Some zones are special in that they’re designed to monitor and regulate other zones, but all of them communicate with each other.
Two of these zones, the prefrontal cortex, the thinking part of the brain, and the limbic system, the feeling part, are the key zones involved in depressive episodes. Of the two, the limbic system is the older. Thus, our ancestors developed a fight or flight system before rationality, an exploration of the true extent of the danger, developed. Over time, the rational brain came to regulate the emotional brain. This gave us the ability to assess the danger and plan solutions.
In some of us, however, the communication between these two zones is faulty. The prefrontal cortex, the thinking brain, doesn’t regulate the limbic system, the feeling brain, in its designed way. In essence, thinking no longer regulates mood, mood regulates thinking. This fault in our brains is the true cause of Major Depressive Disorder. It gives us an insight into why Mood is so dominant in the definition and in the sufferer’s experience.
So, we begin with mood. Every day, for most of the day, the MDD sufferer feels sad. It’s not feeling sad, in the traditional sense. Usually, when we talk of someone being sad, we can point to a cause and can reasonably expect him to regain an emotional balance over time. Sadness, then, tends to have both cause and closure.
For a depressed person, however, this is not the case. The sadness does not have any readily discernable cause, nor does it have any closure. It persists, and persists, and persists, no matter what is done to get out of it. Further, for many sufferers what they experience isn’t truly sadness, it’s numbness. There’s an emptiness where there should be emotion. For others, an emotion is felt by its absence, not its presence. No matter the case, though, it’s clearly more than what we commonly mean when we think of sad.
The definition of MDD presents an alternative affect of mood, the loss of the ability to perceive or experience joy. People can laugh and cry and celebrate all around the MDD sufferer, and he is indifferent to it. This indifference creates a disconnect, a distance between the depressed person and the world around him. Activities that were once enjoyed have lost their lustre. They have become uninteresting. And this lack of interest spreads throughout his world, infecting his job, relationships, and social connections.
In either circumstance, the first effort is to try to think a way out of the problem. But this doesn’t work, because the connection between the thinking brain and the feeling brain is faulty. The sufferer doesn’t know this. All that’s known to him is that there’s no reason to feel as he does. He’ll try to fix things but can’t.
By themselves, these two primary symptoms are distressing. Consider all the joys the world brings to life: the laughter of children; the play of the wind on leaves; the soothing tinkle of wind chimes; the warmth of a companion; the sharing of friendships. Now consider a life that’s unable, for no apparent reason, to leave glumness behind or see this joy and participate in it. Consider how empty that life must seem. Consider how painful this must be.
You can see how, in these circumstances, the depressed person can experience a loss of energy, a reduction in vitality. If nothing brings him joy, if nothing breaks through the gloom, every small thing feels difficult and becomes draining. He is listless and unmotivated. He will feel guilty, wondering what is wrong with him. With guilt comes annoyance at himself for not being able to shake the mood off. Annoyance brings irritation and negative self-talk.
You can also appreciate how this depressed mood or inability to find joy can harm someone’s thinking. Indecisiveness, confusion, irritability all seem to flow from the general ideas of “what’s the point?”, “it isn’t going to make a difference”, “it just doesn’t matter”. Moreover, because of increased fatigue, his thinking ability and his body have both slowed down. Plans can take an eternity to reach and another eternity to implement. In fact, so much energy is taken to plan or act, that neither reaches completion. He becomes paralyzed with his inability to plan or do. This too will foster guilt and shame and negative self-talk.
His sleep suffers. On many occasions, sleep is denied him because his mind will not rest. He will consider, and reject, permutation after permutation, in an effort to think his way out of the problem. The racing thoughts will include denigration and shame. On other occasions, he sleeps non-stop, but he doesn’t rest. The internal dialogue remains on a sub-conscious level infecting dreams. Either way, both the body and the mind are fatigued. With this fatigue comes increased impatience and irritability. He’ll lash out at friends, family and co-workers. His social relationships will suffer.
Issues with weight and appetite seem obvious in these circumstances. By doing less, fewer calories are burned. Body fat and weight grow. Alternatively, there’s no motivation or energy to cook, or eat, and weight plummets. In either circumstance, bouts of guilt at the weight gain or weight loss may cause binge eating or binge dieting to compensate. Both cause growth in negative self- image.
The MDD sufferer loses all self-esteem. He’s filled with guilt and shame and a growing sense of worthlessness. Unknowingly, everything around him that validates the guilt, justifies the shame, and confirms his worthlessness, is absorbed, adding to the negative feelings. He feels guilt even if it isn’t his fault. He feels shame even when there’s nothing to be ashamed about. He feels worthless despite all evidence to the contrary. Increasingly, he engages in an internal dialogue of negative self-talk and external actions of self-abuse. He’ll sabotage his relationships giving credence to his lack of self worth. He may cut himself. For some, suicide will be considered and implemented.
Negative thinking patterns have become the norm. A day, filled with both positive and negative events, seems to be nothing but a bad day. The depressed person does not see, cannot see, the positives. He also cannot feel positive emotions. He’s become numb or, at best, feels the emotion by proxy, by its absence. He relies on the actions of others to give him the social cues to navigate through the world.
Practicing emotion by proxy allows the sufferer to don a mask of normality. He always wears this mask. No-one can be allowed to see who he truly is because he is unworthy of compassion or empathy, friendship or love. In his eyes, if his true self is revealed, everyone will see that he’s a fake, that there’s something wrong with him, and that he’s undeserving, thereby confirming his lack of self-worth.
In addition, he remembers how he lashed out and is ashamed. He believes that he cannot be forgiven and convinces himself that this thought, is fact.
Isolation becomes commonplace. It takes too much effort to socialize. It’s easier to just stay at home. But this generates its own guilt and shame adding to the sense of worthlessness. While alone, the guilt and shame, the inability to figure out what’s causing all this, increases the volume and frequency of negative self-talk and self-abuse. The depressed person will try to shame himself into action, and shame himself again for not being able to act. In fact, everything becomes an occasion to shame himself. He will belittle himself in ways he would never belittle anyone else. He’s worthless, he deserves it.
Consider how it must be to live in such a quagmire. To suffer without cause, to endure without respite. The definition of Major Depressive Disorder tells us that two weeks of this life is too much. Sadly, a typical episode of MDD lasts from six to nine MONTHS. If a person has had multiple bouts of MDD, without treatment or failed treatment, episodes can last YEARS. Consider that: at the bottom end of the typical depressive episode, six months, the sufferer is bombarded with this bleakness every day, for most of the day, for over 180 consecutive days, over 4,000 hours. Remember my contention that the affects have a cumulative effect so it isn’t just about 4,000 hours, it’s 4,000 cumulative hours of constant accumulation of affects. Any respite is fleeting.
It’s no wonder that the final symptom has such attraction. It offers an end to the suffering. Just as emotion is experienced by its absence, so suicide attracts, not because he wants to die, but because it’ll end the pain. It’s the end of pain, not death, that’s sought.
The danger of Major Depressive Disorder lies in how each symptom acts in concert with the others to create a downward spiral into an existence filled with gloom, despondency, increasing emptiness, increasing numbness. Experiencing all of this, concurrently and cumulatively, takes its toll on the sufferer. The toll is both psychological and physical. The toll can be deadly.
All of this doom and gloom can seem to present a hopeless picture. However, not all who suffer will attempt suicide (yet the majority of those who attempt suicide do suffer). More importantly, there is a way out. My journey is proof of that.
I remind you that I’m not a mental health professional. I live with Major Depressive Disorder and, from time to time, I experience depressive episodes. The most recent depressive episode prompted my reaching out for help. My own research, the guidance and lessons shared by fellow-sufferers, the compassion of therapists, and so much more, have all inspired me to share what I’ve learned with you. It is information. It is not a diagnosis. If you believe that you’re in need of help, I urge you to speak to your family doctor. If you are experiencing suicidal thoughts, SEEK HELP IMMEDIATELY BY DIALING 911 OR VISITING YOUR LOCAL HOSPITAL EMERGENCY ROOM.
Do you agree with my conjecture? Does a cumulative effect of symptoms make sense to you? Please speak out in the comments.