The Depression Chart – Helping Others Understand Depression

*Ever since I created my Anxiety Chart, I have been asked by readers to create a similar chart for depression.  After much thought and consideration, this is the chart and accompanying graph that I designed.

Many people do not understand depression, assuming it is just random bouts of sadness and crying.  Unless someone has suffered through their own struggle with depression, it is near-impossible for them to truly understand how debilitating it can be to live with that diagnosis.

One of the hardest parts of explaining depression is that it is neither rational nor is it predictable.  It is hard to provide relatable examples because the feelings connected with depression would feel wildly irrational to anyone not experiencing them at that moment.  It is also impossible to predict or predetermine depression because it often comes unexpectedly in waves.

Therefore, instead of providing a chart with relatable examples, the chart I devised shows the increasing intensity of this mental illness.  My hope is that the statements provided at each level, combined with the descriptions included, will help those who have never struggled with depression understand how our frame of mind is magnified as our condition worsens.

It is also important to note that depression is not all sadness and hopelessness.  Instead of providing a chart listing levels 1-9, I have split this chart in half.  There is a 1-4N to designate worsening stages of numbness and a 1-4D to describe stages of downward spiral.  This chart is extremely simplified, yet illustrates how, as depression worsens, the intensity of the condition increases.  However, unlike conditions like anxiety that worsen in one direction, depression can and does frequently occur in both the realms of numbness and hopelessness to varying extents.

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It is also important to note that depression is not linear.  It comes in waves and spikes.  It is not uncommon to struggle with days of increasing numbness, only to wake up the following day in the midst of a downward spiral.  Depression randomly alternates between the two, with no rhyme or reason to the length or intensity on any given day.  Some days you feel nothing at all, other days you feel everything too strongly.  There’s no way to predict when you will be pulled in either direction or how long either will last.

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There will be days when someone might even feel fine, or even just more functional.  On other days, you might be unable to pull yourself out of bed or might seem to cry over everything.  There are days that feel like a struggle and others that feel completely impossible, days where you find yourself crying a little bit more and days you just want to give up.

When describing increased emotional pain, the best example I can think of is to compare it to the pain of loss.  Milder stages of depression might be akin to losing something that matters to you, perhaps something of sentimental value.  As depression increases, imagine the pain of losing a beloved pet, your parents, your spouse or your child.  Imagine the ache and the pain, the feeling in that moment of things never being okay again, of wanting to give up, to crumble under the weight of that pain.

Except the person you are mourning is yourself.  Your happiness and who you used to be.  And the loss comes again and again in waves, sometimes mild, other times so severe that the tears and the pain feel like they will never stop.

At the same time, you loathe and disgust yourself.  You feel worthless, a waste of space.  Your own mind lies to you, convincing you that the world would be better off without you in it.  That is where rationality parts ways.  Everyone can understand loss, pain and grieving.  But it is hard to wrap your head around losing yourself, let alone hating yourself, unless you have spiraled down to those depths yourself.

Yet those feelings are there, along with a tremendous amount of guilt.  You feel guilty that you are such a mess.  You feel guilty for subjecting everyone else to your mess, as well.  Often, you are also ashamed of your illness because you feel you should be stronger, more capable, better than you are.  That shame often leads you to lie or minimize the intensity of your suffering for fear of being judged.  Depression makes you feel like a failure just for being sick.

When someone is struggling with depression, their very perceptions become distorted.  It is common for everything to feel much worse than it actually is.  Think back to when you were a little child.  Things on the counter felt up way too high, the door knob out of reach.  Even simple things like tying your shoes were a struggle and felt like a monumental task that took maximum effort and concentration.  That is how everyday tasks feel when you have depression.  Everything feels harder.  Every problem feels bigger.  You feel small and helpless.

Think back, too, to when you were a young child and were upset with your parents, when you felt completely misunderstood and all alone in the world.  Think back on the time when your four or five year old self was convinced you should run away, that nobody would care if you were gone. Think back to any other point in your life, as well, when you felt completely alone, when you had no help, nobody there.  With depression, those feelings are ever-present.  Your mind tells you that nobody understands, that you are alone in the world.  Depression isolates you by telling lies that you do not matter.

Think back to the last time you were sick, laid up in bed with a bad flu or stomach bug.  Remember how physically and mentally exhausting it felt to even move or pull yourself out of bed?  How easily you found yourself worn out, just wanting to lay back down and sleep?  How you put off going to the bathroom for hours because you didn’t even want to move?  How you ate frozen waffles or canned soup for three days because you just did not have the energy or the desire to cook a real meal?  That is what depression is like, too.

The numbness, however, is hard to explain to anyone who has not experienced it firsthand.  If you’ve ever had someone or something upset you so much that you no longer cared, magnify that lack of concern tenfold.  It is similar to that catatonic shock following an accident or trauma.  You feel nothing, lost, blank, numb.  Eventually, you mentally shut down.  You are immobile, held hostage, trapped in your own mind.  You have no interest or motivation to do anything.  You see no point in even trying.

I wish there were more relatable examples I could give but it is impossible to rationalize the irrational.  There are some examples that are somewhat similar in one way or another, but even those don’t quite equate.  The best I can do is to illustrate the directions depression can go and to quantify how bad it can get.

When trying to explain depression, the best someone who is struggling can do is to explain how close we are at the given moment to either shutting down or wanting to give up.  The worst part is that the status can change in a moment’s notice on any given day.  There is no way to predict when it will veer off in either direction, let alone the severity of the bout.  You cannot even predict what will cause your condition to worsen, or whether it will even be something large or small.  Something as tragic as a great loss is just as likely to cause a period of numbness as a simple broken plate is to cause a severe downward spiral.  There are times we are honestly not even sure why we are feeling the way we do, only that the depression is there.  There is no rhyme, reason or rationality to any of it.

It is not something that a person can control in any way, either, let alone simply snap out of on their own accord.  Depression is a mental illness.  It is a medically-diagnosed condition that severely affects the ability to cope with life, negatively impacting and impairing both thoughts and behaviors.  Having a mental illness is no different than having any other type of illness.  Much like a diabetic has a pancreas that is malfunctioning, when a person has a mental illness, their brain is not working correctly.  The only difference is the organ affected.  Both conditions need medical treatment.

I understand how difficult it must be for someone who has never suffered from depression themselves to understand. Depression seems irrational because it is.  It doesn’t make sense, even to those of us struggling with it every day.  We find ourselves on a roller coaster ride that is speeding out of control, flying up and down every which way, with no way to stop or slow down.  Nobody asks for a mental illness.  Depression is not something anyone has done to themselves or is causing because they are not trying hard enough.  We don’t understand how we even ended up on this ride, let alone how to get off.  How can we adequately explain something we don’t even understand ourselves?

The confusion surrounding depression is also in part due to the stigma attached to mental illness in general.  For years, anyone with a mental illness was labeled as lazy, crazy, dangerous or a joke.  Either way, they were not taken seriously.  Mental illness was a dirty word that wasn’t discussed openly.  People fear or mock what they don’t understand.  The lack of education about medical conditions like depression led to wide-spread ignorance and misinformation.  Unfortunately, once that cat is out of the bag, the damage is done and it will take much longer to properly educate people about mental illness than it took to originally spread the falsehoods and misconceptions.

I understand fully that depression makes no sense to someone who has never experienced it themselves.  It honestly makes no sense to us, either.  But please know that depression is much more than just merely feeling sad from time to time.  With depression, you sometimes feel everything so strongly that it is completely overwhelming, the emotions feel agonizingly painful and never-ending, and the world feels utterly hopeless.  Other times, someone with depression is completely numb, feeling absolutely nothing at all.  Either way, everything feels much harder, more intense.  Depression is exhausting, both physically and mentally.  Perhaps worst of all, you feel helpless to do anything, like you have no control over your own mind.  And depression is not linear.  It goes up and down, every which way, changing direction and intensity on the drop of a dime.

I wish I could provide a chart that was more relatable for those who have never experienced depression, but, as I have stated before, there really is no way to rationalize the irrational.  The best I can do is to lay out what depression is like in a very simplified form and hope for your empathy, compassion, understanding and patience.

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I Have Depression.. But I am Happy..

I have struggled with depression my entire life, in part due to a genetic mutation passed down to me from my parents that affects the way my body metabolizes specific chemicals my brain needs to moderate my moods.  I regularly go through horrendous downward spirals where I feel completely broken and worthless, where life feels utterly hopeless.  I struggle with long periods of numbness where I have difficulty functioning or even finding the motivation to get out of bed.  On bad days, I will cry until my face is sore and my voice is hoarse, and it is unlikely I will be able to accomplish much more than basic self-care.  I am battling an illness that warps my very perceptions of life and continuously exhausts and pains me both physically and mentally.

But I am happy.

I have an amazing fiance who is very supportive of me and my diagnosis.  I have healthy, kind, smart and all-around wonderful children who have grown into incredible adults.  My fiance’s children are both amazing, as well. Together we have all formed a beautiful, blended family that I love with all my heart and am proud to call my own.  I have a team of doctors who actually listen to me and a treatment plan that is slowly but surely helping improve my quality of life.  And I have a blossoming writing career that has given me a true sense of purpose and an ability to help others in need.  I have many wonderful blessings in my life to be grateful for, many reasons to be happy.

Yet I have been diagnosed with depression.

That is because a mental illness like depression has nothing to do with happiness.  Depression is not caused by being in the wrong frame of mind or just not trying hard enough to be happy.  Having a depression diagnosis has nothing to do with feeling sad, a little blue or under the weather.  People with depression aren’t being Negative Nancys or Debbie Downers who just need to learn to lighten up and look on the bright side.  My diagnosis wouldn’t just disappear if I just tried to smile a little harder or maintained a more positive outlook on life.  My depression has nothing to do with whether or not I am happy.

I have trained myself to find reasons to smile everyday.  I am usually the first to look for something positive in even the roughest of situations.  No matter how hard my own day might feel, I always try to show compassion and kindness to others.  If nothing else, I am grateful each day I wake up and thankful of all the loving and supportive people in my life and share that sentiment regularly.  I am hopeful for the possibilities the future may have in store for me, as well.  Some of my friends lovingly joke that I am the happiest, most positive little depressed person they know.

Yet I continue to struggle with my depression diagnosis.

My brain does not care whether or not I am happy or grateful, whether I am hopeful, compassionate or kind.  My mental illness is caused by my brain not working properly, much like a diabetic’s pancreas malfunctioning causes their condition.  I have no more control over having a mental illness than someone else having diabetes, heart disease or another medical condition they may have been passed genetically.  Yes, events in my life may have further exasperated my mental illness, much like having excessive sugar might worsen a person’s diabetes or having foods high in cholesterol might affect the severity of heart disease, but my condition preceded any of the traumas and abuses I have endured over the years.  I have even sought treatment to help resolve those issues to the best of my ability, yet my depression has remained.

Because depression is an illness, a medical diagnosis with both mental and physical causations.

It is not all in my head.

It is not a state of mind or an emotion.

Depression isn’t about being sad.

The cure for depression is not happiness.

Like any other illness, depression needs ongoing medical treatment.  Doctors need to not only diagnose the condition, but also to isolate and treat both the mental and physical reasons for the illness, as well. Though doctors often utilize psychological treatments like therapy, meditation and mindfulness, they usually also include psychiatric methods and medications to help treat the physical causation.  That is because doctors recognize mental illnesses such as depression as a verifiable disability that deserves a comprehensive, multi-pronged treatment.

In cases like mine where my depression has a genetic causation, my diagnosis is permanent.  I was born with it much like some children are born diabetic.  You would not blame a child for being born with a pancreas that was incapable of functioning properly so please don’t blame me for the fact that I was born with organs that malfunctioned, as well.  The only difference in my case are the organs affected.  No matter how happy I am or how positive my outlook is on life, my liver will never be able to metabolize the substances my brain needs in order to function properly.  I will have this medical diagnosis and need ongoing treatment until the day I die.

If I confide in you that I am struggling with depression, please don’t try to encourage me to try to be happier and more positive, or point out all the blessings I have in my life.  I am happy and grateful already.  You do not need to remind me to be hopeful for the future because I already am.  Please don’t blame me for my diagnosis either, insinuating that I wouldn’t be ill if I just tried a little harder.  I did not ask for this diagnosis, nor did I cause it.  What I need from you is the same compassion, understanding and support you would give anyone else with any other medical diagnosis.

Because, though I am already happy, knowing you were doing your best to be supportive and treat me with the same respect you would someone struggling with other illnesses would make me even happier.

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Republished on the Mighty on 4/4/19.

Are We To Blame For Our Depression?

Someone in a group I belong to recently posed the question “Is it my fault I’m depressed?”.

People immediately began chiming in on both sides of the fence, with the overwhelming majority stating a firm and clear “absolutely not”.  I hesitated to answer because I don’t think there is such a clear cut yes or no answer.  Life is rarely simply black and white.  There are many shades of gray.

I spent many years struggling with my own mental illness.  I saw many doctors, took a multitude of medications in all different dosages and combinations.  I tried changing my diet, exercising more, busying myself with arts and crafts, talking long nature-filled walks, everything anyone had suggested might work.  In my case, nothing helped.

Last year, my newest doctor sent me for a genetic test and we discovered that I had a genetic mutation that prevented my body from breaking down a specific vitamin my brain needed to function properly.  That broken-down vitamin is used by the brain to transport the chemicals, whether made naturally or in the form of antidepressants, where they are needed. Because my brain never received that substance, nothing my body made, no pill I took, even had a chance to work.

There is a pill version of that broken-down vitamin on the market.  My doctor prescribed it.  It took almost a year of fighting my insurance company to get it covered.  Now that I have it, there is a noticeable difference.  It is not a panacea, my depression is still here, but it is a start.  I have a long road ahead of me but at least I am finally on the right track.

It brings to mind a quote from Maya Angelou:

“Do the best you can until you know better. Then when you know better, do better.”

For years, I tried again and again to get help even though nothing worked.  I cannot blame myself for not knowing that, on a genetic level, my body was incapable of making what it needed in order for any treatment to work.  But now that I know better, I am doing better.

I do not believe we can blame ourselves when our bodies malfunction.  When someone is diabetic, their pancreas is not making the proper amounts of insulin and glucose.  People go to a doctor and get treatment so they can live a healthier life.  They are not to blame for their organ ceasing to work.  With mental illness, the only difference is the organ involved.  No one has any control over their brain not working properly.

But everyone does have control over whether or not they get the treatment they need.

I know some people will play devil’s advocate and say a diabetic wouldn’t have gotten diabetes if they hadn’t eaten so much sugar and likewise, someone who is mentally ill may have made poor life choices that put them in their predicament, as well.  However, that is not how it works.  Millions of people drink soda and other sugary drinks every day, yet not all of them have become diabetics.  Likewise, many people struggle with everything from drinking, drugs, bad relationships and dead-end jobs without experiencing depression.

There are many known hereditary and biological causes for mental illness.  Many people are predisposed to depression, having been passed through their family line.  For others, it can be caused on a genetic level from mutations.  In some cases, the onset is caused by an unforeseen tragedy or event that shakes a person to the core.  With me, it is a combination of them all.

Living a rough life does not guarantee depression any more than drinking a soda guarantees diabetes.  On the contrary, people from all walks of life, all socio-economic backgrounds, different races, religions, sexual orientations, upbringings all struggle with their mental health.  A hard life might contribute to a person’s mental illness but it does not cause it, much like drinking sugary drinks are a contributing factor to diabetes.  There is a big difference between causation, though, and a contributing factor.

Though we have no control over whether any of our organs are working properly, I believe there is a clear line here where we need to accept personal responsibility.  As Maya Angelou said “..when you know better, do better”.  Once we realize something is not working correctly in our bodies, it is our responsibility to take steps to fix the problem.  We need to do what we can to be healthier, live healthier.

Once a person has realized they are struggling with a mental illness, they need to at least attempt to get help.  I understand the frustration all too well when nothing seems to work, but we need to at least try.  Again, to quote Maya, “Do the best you can until you know better”.  Try therapy, meditation, medication, homeopathic remedies.  Something.  Anything.  Embrace whatever works for you.  But at least DO something.  Don’t suffer needlessly.  Take care of yourself the best you can. Then “..when you know better, do better”.

Nobody asks to be depressed.  No one has any control over whether or not they are diagnosed with a mental illness.  But you do have control over whether or not you treat your illness and you ARE to blame if you knowingly neglect yourself and your well-being.

Please take care of yourself the best that you can.  Get help when you need it.  Don’t let the judgment or stigma from anyone else prevent you from taking care of your mental health.  It is okay to need help, especially when your body is not working like it should be.  There is no shame in having a mental illness.  The only shame is in not getting the treatment you need.