The past couple weeks my depression has made itself very known, in a way that it hasn’t for a long time. Oddly, I’ve been able to, somehow, watch it worsen and study how it interacts with my world and relationships. I’m experiencing it and observing it simultaneously. I’m confident that my education in psychology is an advantage in this encounter. So, if you’ll forgive me the literal lecture, I’d like to share a bit of it.
Mental health and its nefarious twin, mental illness, have become house names. They’re talked of openly and frequently. The problem, though, with this much-needed awareness is over-exposure. As humans, when we become saturated with something, we start to think we know enough, if not everything, about it. The terms are familiar, while the concepts remain foreign. Worse yet, in the case of mental disorders, many of us believe that we understand them so well that we minimize the experience of those who know them from extreme and intimate exposure. Many people report having struggles with depression and/or anxiety, and even those who don’t allege to know much about them. What many people forget is that struggles are not disorders, and seasons are not diagnoses. Yes, many of us have times of difficulty with depression and anxiety. For some, these challenges are fleeting, but many of us require treatment to trudge these stretches. However, there is yet another group. There are some of us, the minority of us, who have major and/or chronic mental illnesses. The requirements for mental disorder diagnoses are specific in both criteria and severity, and should only be made by those qualified—those armed with a hefty manual and years of training.
A word on faith: I’m unfortunately familiar with the idea that people should rejoice their way out of depression and trust their way out of anxiety. This philosophy is akin to telling paralytics to walk their way out of paralysis, without the presence of the Divine. While I do believe that God can—and does—heal depression and anxiety, just as he does other physical ailments, I don’t believe that efforts at a “better” faith life can dispel diagnosed disorders. Not only are depression and anxiety biological afflictions, they are biological afflictions in the brain. The compromised ability is the very one required to be encouraged by Words of joy and peace, to think only on that which is good, to choose how to process the world, and other acts requiring conscious, rational thought. While reminders of God’s faithfulness may—I repeat, may—help an individual with another form of biological ailment, it’s less likely to do so for someone whose brain, the necessary tool, isn’t functioning in its created purpose. I must add that depression and anxiety are often co-morbid, or co-occurring, with other physical illnesses, so my above statement is a cautious one.
I’m focusing on depression and anxiety because they are the “common cold” of mental illness. Most people report some contact with them, personally or relationally. But, as mentioned, there’s still a lot of misinformation and, frankly, ignorance to be had. In this time of isolation and unknowns, depression and anxiety are in full swing for a lot of people, so I think a little psychoeducation is in order. Bear with me as I attempt to condense whole courses and textbooks into a blog post!
I referenced anxiety in | 6 | Hello Disruption | when I summarized the biology and psychology of a healthy fear response. I’ll sum it even more briefly: the older, survival-focused area of the brain takes charge, directing the body to amp up for action (e.g. fight or flee), and drafting a lot of manpower from the younger, logic-focused area of the brain. In essence, the Hulk muscles command from Cap’s sensible hands.
A friend and colleague describes the survival-charged part of the brain as a smoke detector. When there’s a fire in the house, we welcome the rescuing shriek. When there’s burning toast or bad cooking (aka my cooking), it’s annoying and alarming. When the smoke detector, as it were, becomes overreactive, stuck, or confused about what constitutes an emergency, we have a problem. That problem is what we call anxiety.
Anxiety, to the extent of diagnosis, is a frequent, disproportionate, and unruly fear response. And the more it happens, the more the brain gets used to the Hulk calling the shots. The Marvel analogy falls short here, because the Hulk brain is way older than the Cap brain, which is, y’know, wrong. So let’s call them by their real names. The Hulk brain is many different parts of the brain, but the amygdala is most commonly referred to as the fear centre of the brain. The Cap brain is the prefrontal cortex, right behind the forehead. It’s young. It doesn’t finish developing until we’re about 25. So it’s comparatively inexperienced. It takes practice for the prefrontal cortex to calm the amygdala and when the amygdala is overactive, it’s even more challenging. It’s not as simple as talking the self into peace or taking deep breaths, though both of those things can help.
The number one thing I’ve learned in psychology is that humans are an exquisite puzzle. Everything about us comes from a reciprocally influential list of contributors: genetics (including the encoding of our ancestors’ experiences), the prenatal environment, and every single life experience, relationship, and lesson we have. Anxiety is no different. Some people are more susceptible to anxiety, either as a tendency or as a diagnosable disorder. Genetics, environment, experiences, and personality can all make an individual more likely to suffer from anxiety. It’s not a shortcoming or failure. It’s an illness, though not an untreatable one.
Depression is, in short, a disorder of mood. But it’s so much more than feeling depressed. Not localized to emotions, it involves physical, cognitive, and behavioural symptoms. Emotionally, depression is despair, dread, hopelessness, emptiness, numbness, restlessness, agitation, anger, irritation, shame, and worthlessness. Physically, depression is a sense of heaviness and slowness, exhaustion, insomnia, weight loss or gain, persistent and recurring aches and pains, and exacerbation of other conditions. Cognitively, depression is thinking in a fog, forgetfulness, indecisiveness, distraction, poor concentration, fixation on failures, and, in some cases, suicidal ideation. Finally, depression is changes in behaviour like eating too much or too little, sleeping too much or too little, social withdrawal, lethargic movement and speech, and loss of interest in pleasurable activities. All of these symptoms interact with one another; for example, clearly a change in eating patterns may result in weight gain or loss. The key for diagnosis is that there’s several symptoms, they’re persistent, and they interfere with functioning. We all have down days. This is more than a down day or a set of down days.
Both anxiety and depression have several forms. It’s relevant to point out the differences in depression because there are significant disparities in severity. Major depression involves several of the symptoms being present most days, no matter one’s life circumstances. It’s ruthless and very real, even if there are few obvious reasons to be depressed. Persistent depression, or dysthymia, is similar but less severe. It involves fluctuations in intensity, and can be combined with bouts of major depression—it’s then called double depression. Let’s make this personal. My dad has major depression, whereas I have persistent depression. His disorder is almost always severe, while mine is much less so. His lowest lows dip deeper than my lowest lows. I can only ever understand my dad’s experience in part, and remembering that is essential to our relationship and my capacity for empathy.
There are several other forms of depression, such as seasonal depression (SAD), postpartum depression (PPD), and manic depression (bipolar disorder), but y’all don’t have all day. I’ll cover the last relevant one: situational depression. This one looks a lot like major depression in symptoms but it’s a logical response to something. It’s important to note, though, that its severity and longevity are out of proportion to the stimulus. It’s more of a disorder of adjustment than of mood. When we experience time-limited, non-recurring, and reactionary depression, it’s situational. This is an important form of depression to review because we all have good cause to be situationally depressed right now.
Depression is not unlike anxiety in that it involves the interplay of contributing factors. Everything I wrote about susceptibility to anxiety applies to depression as well. However, depression has many defined biological determinants. There is significant evidence that genetics are involved in depression and there are visible, physical differences between a depressed brain and a healthy brain. Depression is often linked to irregularities in hormones and a variety of malfunctions with neurotransmitters. I won’t go into further detail on that because, again, y’all don’t have all day. Depression can vary in its cause and, therefore, in its presentation and treatment. The point here, is that depression has undeniable biological sources and should be recognized as a physical disorder.
As much as diagnosed anxiety and depression are often present regardless of circumstance, they’re also vulnerable to intensifying stimuli. For individuals with mental illness, our current situation is rife with triggers. An invisible, equal-opportunity hellion and an unpredictable future are sun and water to anxiety. Aimless, sedentary days, loss, isolation, and lack of solitude foster depression. My hope is that a reminder of the realness and heaviness of mental illness will arm us with grace for ourselves and our loved ones who live with psychological disorders. To combat the brain’s accustomed tendencies and biological set-up, one must be rightly equipped. In this environment, most of our resources are being used to survive, physically and psychologically. It’s unjust to expect that individuals with mental disorders should be doing much more than coasting right now—that’s not to say, of course, that we can’t exceed expectations.
So, if you’re in the trenches of mental illness, our hats—and helmets…and masks—are off to you. No, wait; nobody is taking masks off! If you’re not in the trenches check on someone who is. We’re under heavy fire. We may not show much appreciation for your kindness, because that requires energy we can’t spare; but we appreciate it. Really.