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We Need More Words for Depression

14/01/2016 11:29 GMT | Updated 11/01/2017 10:12 GMT

'Depression' is such an umbrella term, one word encompassing a multiplicity of experiences from the deep sadness that follows, say, a relationship break-up, to years spent semi-catatonic, hardly able to get out of bed. It's a problem, I think, because the breadth and vagueness of the word can often make being depressed, in whatever sense, even harder and more lonely.

It might help to consider a physical analogy. Imagine that, instead of the terms 'asthma', 'chronic bronchitis' and 'lung cancer' we had just one overarching term, let's say 'chest trouble'. Now imagine you had one of these three conditions. A doctor could do the appropriate tests, discuss your symptoms in detail with you, identify the precise nature of your 'chest trouble' and treat you accordingly. But in everyday conversation, there'd be no easy way, no quick label you could use, to tell someone precisely what you had. That might feel quite disabling, right? It could make it hard to communicate, and lead to misunderstandings and false equivalencies. It might even, by compounding your physical symptoms with feelings of frustration, isolation and confusion, make you feel materially worse.

I've been getting treatment for what can best be described as 'episodic depression' since I was 20. My relationship with SSRI (Prozac family) anti-depressants has always been uneasy: I've never liked the idea of being dependent on medication, it's never sat easily with my self-image or control-freakish tendencies, and from time to time I've come off them, only to start suffering again and eventually go back on. The last time this happened was shortly after I'd moved house, and I met with a new doctor who said some wise, illuminating things that, amazingly, after all those years, I'd never heard before. "You've got depression. It's not you, it's a condition, like high blood pressure - some people have it and we don't really know why. You're unlucky, but there are things that can help". I explained that I felt profoundly disappointed in myself; that I couldn't escape the thought that I should be stronger and somehow capable of controlling it. Her very slight smile said: Oh, you Type As, you make me crazy. "You can't fix a broken mind with a broken mind", she said.

Here's my best attempt at describing what a depressive episode feels like for me. (Incidentally, I've never been able to pinpoint any triggers, and these days I'm 99 per cent sure none exist, perhaps apart from shifts in my body chemistry). It starts with a portentously familiar feeling, like that ephemeral sense you sometimes get that you're coming down with a cold. Sometimes I feel fatigued, like everything is harder work than usual, but it's subtle, and often I will only realize later, when things have built up, that the feeling was there at all. Over the course of maybe a couple of weeks, that quiet hum crescendos into a deafening roar of rough, overwhelming emotion. The feelings are panic, fear, despair - and it's feelings that define it, rather than thoughts, but one of its most insidious features is that it will hook on to certain negative thoughts and insecurities, and inflate them beyond any reasonable size. For example, work is a sensitive issue for me having let my career slide since having a baby, but what are normally mild worries at worst transform during a depressive episode into Oh my god it's all gone wrong, I've made a terrible mistake that's completely unfixable, I'm a fundamentally incapable person... It's very undermining. And there's this double consciousness that goes with it, too: on one level, I know I'm in the grip of a depressive episode and therefore that I probably shouldn't pay too much attention to the thoughts thundering through my head, but at the same time the depression whispers in my ear: This bit is the truth. It's actually now that you're seeing clearly. After all, when you think about it, don't you always end up here?

Once things reach their peak, it typically takes no more than a day or two for me to wear myself out with all the battling and unstoppable weeping, more tears than one pair of eyes ought to be able to produce. Then I enter a recovery phase, when I coddle myself like I'm frail or sick, reducing living to a series of very small, simple components, taking each slowly in turn. One. Foot. In front. Of the other. That'll last for a week or two. It's a fair chunk of lost time.

Inevitably, that account feels inadequate, and I have no idea how much it might resonate with anyone else, but what I do know is that since my doctor helped me gain some clarity about exactly what it is - this thing I've got, that I've been dragging around with me for most of my life - I've taken a leap in learning to accept it and finally found some sort of peace. Maybe I'll be able to come off the drugs again one day, and maybe I won't, but for now I'm glad to have stopped resisting what, for now, can help me. A better understanding has been key to that, but a more precise word - one that differentiated my experience from all those other things we call 'depression'; one that sounded less dull and more violent; one that captured the relative brevity and painful repetition of my episodes, as well as the propensity of my particular condition to be controlled by medication - a word like that might, I think, have got me here more quickly. Crucially, a clearer label would have made it easier to communicate my experience to others, and helped me avoid some of the understandable misunderstandings that at times have compounded my pain by making me feel silenced and alone. We use language to connect with one another and interpret our own experience. Better words may help us get better.

The full version of this article is available at www.alicebellreeves. com

Photo: 'Abstrato' by Guilherme Yagui https://www.flickr.com/photos/yagui7/