Taken from Mental Wellness Today which is located HERE.
With tears streaming down her face, Debbie Basnett would make dinner for her young daughter. Sometimes the tears would last for hours, sometimes for days, and sometimes even for weeks at a time. “Nothing would be wrong really, but I would just burst into tears,” says the now 54-year-old Duncan, British Columbia resident. “And then I just couldn’t stop.”
Basnett’s self-esteem was so low that she entered an abusive marriage because she didn’t believe she had the confidence to give her daughter what she deserved and she thought a father would. “I had very low self-esteem because of all the abuse [I had suffered] as a child, and I just couldn’t believe that I could ever do anything worthwhile. I had no trust in myself, I as nothing.”
Basnett is clinically depressed and suffers from post-traumatic stress disorder. As a result of her illnesses, she says there were many days when she couldn’t get out of bed. She had to quit many jobs because of her extreme anxiety— there were many times she just couldn’t take it any more—and one of those times she attempted to end her life. “It has been hell,” she says. “You just feel like you’re falling into a deep, deep hole. It’s never ending and there’s no way to climb out. I can’t tell you how many times I have fallen into that hole.”
Sadness is temporary
Sadness is a major part of depression, but since it is an emotion that almost everyone feels, it can often be hard to distinguish between normal sadness and the behaviors that require professional help and support. Basnett has had depression since she was a young child, but it wasn’t until age 19 that she realized something wasn’t right. “After I had my daughter, I knew something was wrong but I didn’t know what. I just couldn’t cope.”
Jill Weber, PhD, a clinical psychologist in Northern Virginia, says the first step to determining if what you are feeling is normal is to understand the differences between sadness and depression. “Sadness is a normal emotional reaction and it would be abnormal to not feel sad. Sadness gives us important cues about how connected we are with others and cues us into what’s important. But sadness is, by and large, an emotion that usually passes.”
“Depression, on the other hand, is a mood disorder and it often involves feeling physically depleted,” says Weber. Things like difficulty sleeping or eating, withdrawing from friends or family, and not looking forward to pleasurable activities are signs of depression. And unlike sadness, depression endures for much longer periods of time. If left untreated, it can last for months and even years.”
Cara Gardenswartz, PhD, who runs her own private practice in Los Angeles, California, says clinical depression differs from sadness in both the duration and the severity of symptoms. “Depression— especially if it’s a vegetative depression—is very extreme and can be overwhelming,” Gardenswartz says. “You can have difficulty functioning in your personal life and professional life, and some people become non-functional because they just can’t get out of bed or are crying all the time.” She says normal sadness doesn’t usually affect all areas of a person’s life; sometimes spending time with friends or taking a trip to the shopping mall will cause sadness to go away.
But for someone suffering from clinical depression, even normal activities can become laborious, says Robin Bruce, case manager in general psychiatry at Victoria Mental Health Centre in British Columbia. “For people [who] are depressed, things like getting dressed, showered, or eating—just everyday functioning—becomes rather difficult. For someone who is experiencing sadness, there may be certain times of the day where you may feel better and you can go to an activity and have normal reactions, but depression isn’t like that.”
Plagued by apathy
During the height of Basnett’s depression, she either forced herself to do everyday activities or completely ignored them. I wouldn’t care about my cleanliness except to brush my teeth or wash my face. It was all just too much. Sometimes I would shower after a few days, but sometimes it was a week to two weeks before I managed to force myself [to shower].”
According to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM IV-TR), which is the primary source for classifying and diagnosing mental disorders, a person must have a depressed mood or loss of interest or pleasure in daily activities consistently for at least two weeks to be classified as depressed. They must also have five or more of the following symptoms present: appetite changes, sleep disturbances, agitation or feeling slowed down, feeling useless, feeling helpless, feeling excessively guilty, pessimism or having low self-esteem, irritability, fatigue, trouble concentrating, crying easily, thoughts of suicide, or loss of touch with reality.
Knowing the warning signs of depression may have prompted John Starzynski to get the help he needed much sooner. “I blame my doctor for a lot of things, but I may not have accurately told him what was going on because I didn’t know what was going on,” says the 57-year-old Guelph, Ontario, resident.
Starzynski is a former lawyer who has suffered for many years with bipolar disorder. He worked a high-stress job, was a father and husband who was involved in his church and community, and he thought he was handling everything pretty well. That is, until he started having trouble staying asleep, was tormented by recurring nightmares of burning to death, became irritable at work, lost a lot of weight, suffered through bouts of crying and phantom heart attacks, had a mental breakdown and wound up in the hospital, all within a period of about 18 months.
“I would have extreme chest pains and be taken to the hospital where they would give me oxygen and I would perk up,” Starzynski says. “Then I would say ‘I’m out of here,’ and I wouldn’t want them to do tests because I didn’t have time. I was very busy with my practice and I just wouldn’t take the time. But emotionally I was a wreck, mentally I was dead, and physically I was exhausted.”
Even though his mother had suffered from depression, Starzynski says he just didn’t want to believe that anything was wrong. “When my mother was hospitalized, we didn’t talk about it because she had gone to the ‘nut house.’ As a kid, having your mother experience that, you’re afraid of it and embarrassed about it. So when it was happening to me, there was absolutely no way I was going to admit that I had a problem.”
Starzynski says the pressures and beliefs of the law profession also make it hard to realize and get help when a mental health problem arises. “One of the myths of being a lawyer is that we can’t have problems because we solve them. Also, the concept of self-care just isn’t there; when I talk about that to lawyers, they look at me like I have three heads, because it just isn’t part of our vocabulary. Lawyers of my vintage—in their 50s and 60s—were taught that you put your head down and you keep working and you work through it.”
Society values productivity and getting on with it, so even when Starzynski finally collapsed after not sleeping for four days and had to be hospitalized, he says the main purpose of the treatment he received was not to get healthy, but to get back to work as quickly as possible.
After attempting to commit suicide for the second time, Starzynski’s wife took him to a mental health facility to get help. He has been through a lot of counseling and has found the medications that work for him. On the whole, he says he is fairly stable. Although he no longer practices law, Starzynski is the volunteer executive director of the Ontario Lawyers’ Assistance program, where he shares his story and talks with other lawyers about the importance of good mental health. “Education is so important. You don’t have to know everything about the disease—just a few bullet points, so that if you’re not feeling well you can get it checked out. If I had known that these were the warning signs I should be looking for, I might have got to my doctor sooner.”
Monitor your feelings
Jerome Wakefield, co-author of The Loss of Sadness: How Psychiatry Transformed Normal Sorrow into Depressive Disorder [Oxford University Press, 2007] and a professor at New York University, says it isn’t always easy to tell the difference between depression and sadness even if you do know the signs. “The two can look very similar on the surface so that even though there are differences in principle at least at a given moment, people can show the same kinds of feelings and symptoms in one as the other.”
There are lots of things in our lives that can cause enormous amounts of sadness and distress, such as getting divorced, the unexpected end of a relationship, losing a valued job, financial loss, or even a life-threatening illness. As a result, Wakefield says these losses can make things seem very empty for a while and thus people can exhibit many of the common symptoms of depression sometimes for two weeks or more.
“You may be somewhat immobilized, you may not sleep as much, not have an appetite, be distracted, [and] focused on the loss—all of which are common symptoms of disordered sadness.” But he points out that these are just normal responses to what life throws our way and not necessarily depression.
Wakefield says one of the main differences between sadness and depression is that normal sadness usually continues only while the situation that triggered it still exists. “If you are feeling sad because of a major financial disaster, for instance, and the situation is reversed and all of your money is returned to you, if it’s the normal kind of sadness, you might recover immediately. Disordered sadness becomes disengaged and continues to exist even if the original trigger is reversed. So all of your money is returned to you and yet you are still immobilized.”
Although the symptoms of sadness can be similar to those associated with depression, people dealing with sadness do not usually have the more severe symptoms. “Being totally immobilized for prolonged periods of time would be unusual for normal sadness. You’re still able to do things and get by even if you feel terribly blue and distracted.”
Suicidality is another indicator that a person is experiencing more than just sadness. “We are talking about something [sadness] that appears to be a biologically designed response to stress or loss that has a natural trajectory of getting better, so although you sink into these blue feelings…eventually you start coming back and reintegrating your life, rethinking things and recreating your situation in a way that gets past your loss.”
With clinical depression, however, you don’t have the normal trajectory of coping, and the response becomes super intense and out of proportion to whatever is happening, says Wakefield. Normal sadness is usually a reaction to something in the environment, whereas depression can have no clear cause.
“There are two main roots to the disorder,” Wakefield says. “The first is called endogenous depressive episode where, for absolutely no reason, a person just goes into a tailspin and is stuck in a deeply immobilizing depressive state. So there is nothing in the environment that explains why they are feeling bad.”
The second root to depressive disorder is when the tailspin happens after being triggered by an initial loss. There is something in the environment that can explain why the person is feeling the way he or she is.
Wakefield believes that since the symptoms of normal sadness and depression can often be so similar, our society has a tendency to label people as disordered when they are not. “The vast majority of responses are normal responses and our society is moving in a direction where we have a tendency to quickly label those responses as likely disorders.”
The DSM IV-TR only allows one exception to its two-week limit before a person is diagnosed as depressed, and that is when someone is grieving the death of a loved one. Bereavement is considered a normal response as long as the person does not have any of the more serious symptoms, like suicidality, and the grieving does not last for more than two months. Wakefield argues that exceptions should also be made for some of the other things that make people sad, such as divorce or financial loss.
“The bereavement exclusion says nothing about all the other situations in which normal people become intensely sad for a while and manifest these symptoms, and therefore it seems to potentially label an awful lot of people as disordered and maybe incline physicians to give them antidepressant medications more easily when, in fact, many of them may just be responding to difficult life events.
“While one doesn’t want to glorify the pain of sadness, which is painful and which we all want to avoid as much as possible, it is also true that medicating it out of existence is probably a bad idea.”
Gardenswartz says one of the things that can make it hard to differentiate normal sadness from depression is the fact that the word ‘depressed’ is being used so often in regular, everyday conversations. “People use the word ‘depression’ so freely these days,” she says. “So someone says ‘Oh I’m depressed,’ but what they mean a lot of the time is ‘I feel sad.’ They often don’t know the difference between depression and sadness and might not be able to relate to someone who is experiencing a full clinical depression.”
Weber agrees. “People use the word so often, but it’s rare for anyone to talk on an in-depth level about what that phrase [‘I’m depressed’] actually means. It’s a catchall word and it can mean so many things for so many people. When someone says it, we don’t ask, ‘Well what do you mean? What’s going on?’ So when someone is really depressed, it’s easy to rationalize and say, ‘Oh I’m fine; everyone’s depressed, everyone has hard days.’ That’s when people don’t seek the help they need.”
Learning the language
Greg Fromson, 41, is the office manager of the Mood Disorders Association of British Columbia in Vancouver and he has struggled with depression for the past 31 years. He agrees the word depression is used so much that it has become synonymous with sadness. “Depression goes way beyond sadness,” he says. “The sadness itself is excessive and way beyond normal. The thing to stress is that depression is far more than just a bad mood: it’s physical too. I’ll notice things like my legs feel heavy. I will feel like I’m twice as much as my usual weight. When I’m walking, I’m sort of stiff and when I come out of it I feel lighter and I’m just moving more freely.”
He says he would like to see depression recognized as more than “just sort of ‘Well, I’m feeling depressed today.’ That makes it seem like it’s something you have control over. If we could snap out of it, I think we would. None of us wants to live with this.”
When it comes down to it, Robin Bruce says the best way to determine whether what you’re feeling is normal sadness or depression is to talk to a professional about it. “Seek a medical opinion. Talk to your family doctor who can do a depression screening test, because depression can be life threatening. There is such a high risk of suicide for someone who is severely depressed.”
As for Debbie Basnett, she’s glad her suicide attempts were all unsuccessful. Although she still struggles with her illness, there is a lot more happiness in her life today. “There isn’t a moment of my childhood [in which I] was happy, but I look at my life now, even compared to 10 years ago, and it’s so much better. I’ve been blessed a lot. I am alive and I don’t have many side effects from taking prescription drugs or from trying to kill myself.”
Basnett is also a licensed practical nurse (LPN) and has worked at her local hospital for the last few years. “It was so hard for me to go through that course [to become an LPN]. It was like becoming a doctor to me,” she says. “In fact, both of my doctors came to my graduation because they knew how hard it was for me with my illness.”
Although she still has her ups and downs, Basnett says she knows when she needs to see a doctor and take her medications. “I consider myself to be well, but there are some days I come home and it’s been a really hard day and I still have a good cry. There are still some days when I wonder what it would be like if I were gone.”
Basnett says her daughter, who is now 35, has kept her going through all her hard times. “There were times [when] I did give up, but my daughter kept me going. I always think about what would happen to my daughter if I wasn’t here, and even though she’s older now, I know she would be devastated if I wasn’t here for her.”
Thinking back to the day Basnett almost handed her daughter over to the doctor to put her up for adoption brings tears and emotion to her voice. “I just think if he had taken her, I would have had nothing left and I probably wouldn’t be here today.”