We all experience times in our lives when we feel fed up or miserable. We wake up one morning and discover we feel listless. We are unable to face our daily schedule and, as the days pass, we begin to withdraw, both from the world and from our own private pleasures. We lose our sense of direction, and he meaning that life once held begins to recede.
Some version of the above will play out, at some point in our lives, for each of us. There will be moments in any human life to make us sad – the inevitable tragic and stressful events that touch us all – and reactions like the above are to be expected. If, however, the weeks and months drag on, and these feelings continue to persist, we may begin to ask ourselves why? Are we depressed? Or, given the inevitability of tragedy, are we understandably sad at the events that have befallen us?
Is there a difference between ordinary sadness and clinical depression? And how can we tell the difference? Given that the primary symptom associated with depression is sadness it’s sometimes difficult to arrive at a distinction between the two. While the first port of call if you think you’re suffering from depression should always be to your GP, I thought it would be useful to pen a short article highlighting some of the differences between sadness and depression; between ordinary, appropriate levels of sadness and sadness that is pathological.
If you visit your GP or a psychiatrist, they’ll likely consult a diagnostic manual like the DSM or ICD. Of the two, the DSM is the more categorical, listing eight criteria for depression including: being in a depressed mood most of the day, showing a lack of interest in previously pleasurable activities, feeling a loss of energy, and experiencing feelings of worthlessness or inappropriate guilt. The full list can be found here. Of the eight symptoms in the DSM, an individual must have experienced five of them during the same 2-week period and the symptoms must have caused significant distress or impairment (and must have at least one of the first two symptoms on the list).
The ICD is slightly more prosaic, citing a ‘subjective feeling of distress and impotence in the face of life’s demands’ as a qualification for diagnosis.
How does this official diagnosis of depression – clinical depression – differ then from sadness (beyond the two week qualification)? The sad person might also feel a lack of energy or feel impotent in the face of life’s demands. They might equally suffer a diminished capacity to think, or feel guilty about their current state of idleness. A major difference between them is one of degree; to the extent experiences his or her symptoms, and the extent to which these symptoms impair his or her life.
With sadness, for example, though we might feel down in the dumps for a day or two, we can still enjoy simple activities, such as watching a movie, cooking your favourite recipe, or catching up with friends. Though we may feel morose, somehow we can still summon enough energy to engage with life, with work, and with relationships. But for someone dealing with depression, this isn’t the case. The depressed individual find we can no longer face any of the activities that were once interesting or pleasurable. Nothing is remotely interesting or appealing to them. This lack of interest can then further compound their feelings, as they see nothing beyond their miserable state.
Another difference is with regard to somatic impact. Someone experiencing sadness can usually sleep as normal, maintain their appetite, and remain motivated enough to carry out their workday tasks. Depression on the other hand is often associated with serious disruption of normal eating and sleeping patterns. Even if one could find the energy to cook something, poor appetite often means they barely touch their meal. Sleep becomes fitful and gloomy. On waking, our energy is low. The individual, if he can climb out of bed at all, finds that even the smallest challenges take on the feel of heavy obstacles. Lacking any vitality, he despair how he’ll ever pick things up.
Yet another difference between sadness and depression concerns the feelings of worthlessness that an individual might experience. When we are ordinarily sad, our self-esteem is usually unaffected by our grief. We might feel regret or remorse for something we said or did, but this is usually fleeting. And if remorse lingers, at least knowing the cause, we have some hope of finding remedy. The depressed individual on the other hand, may find herself caught in recurring, self-diminishing, negative thought patterns. She characteristically feels wretched about herself, full of self-recrimination, guilt, shame, and self-loathing. In extreme cases, these negative thought patterns can lead those to have thoughts of self-harm, suicidal ideation, or going as far as to have a suicide plan.
Arguably the key difference between sadness and depression is with regard to knowing the cause. Sadness is usually, though not always, due to a particular reason, whereas the roots of depression are often, though not always, indeterminate. Sad people, usually without much difficulty, can tell us what is bothering them. Not necessarily sad about themselves, they are grief-stricken because of something that has taken place out in the world; perhaps the loss of a job, or the ending of a relationship. While these are tragic events in anyone’s life, there is some small comfort to be taken in knowing the cause of our moods.
When it comes to depression, however, no such trigger is needed. The individual suffering from depression may feel sad or hopeless about everything in their lives. They may have everything going for them, every reason in the world to be happy and yet, for some unknown reason, life for them has been drained of all pleasure and meaning. Pressed for the cause of their depression, they draw an inconclusive blank. The bitter roots of their sorrows remain, for now, a mystery.
They are simply depressed.
After having consulted your GP, you may then decide it’s time to talk to someone. If to a counsellor, the first thing he or she might do is determine the nature of the disorder.
For the client who is sad, who knows the cause of their ailment, the counsellor might support him in developing a programme of self-care to combat the particular kind of sadness he is experiencing. The cause of the sadness – be it from childhood or adult life – already out in the open, is more easily thought about and talked about. It’s easier to build resilience against any spiralling further downwards or from slipping backwards after recovery.
In the case of sadness, because the issue can be addressed more or less directly, the duration of counselling is often much shorter.
For the depressed person, for whom the cause is unknown, the path may be somewhat different. The depressed individual’s first difficulty may be in attending at all. They have to summon great reserves of energy to get themselves to the consulting room in the first place. Having arrived there, they may then have to overcome their feelings of worthlessness and guilt in facing the person, the counsellor, sitting across from them. They may tell themselves they don’t deserve to have this person listen to their worries for one hour every week. They may worry that this person judges them in the same harsh manner as they are judged by their own punitive, thought-patterns. In short, the symptoms that prevent a depressed person from engaging with life, may prevent them from engaging with therapy.
Not knowing where our depressed feelings come from, we can often doubt the legitimacy of those feelings. Having found our way to a counsellor and having stayed there for some time, we may find that having those feelings acknowledged and validated by a caring listener can be a relief for a sufferer of depression. With the help of the empathetic and supportive listener, the depressed individual can begin to take steps towards once again engaging in relationship. This then provides a stepping stone for coming to an understanding of what has caused this blight on our lives.
If not knowing the cause of the depression presents the greatest difficulty for the individual, paradoxically it offers a glimmer of hope on which direction they therapy might take. The goal is to move from this place of ignorance to a place of knowing; from darkness into light, to borrow a phrase. Ultimately, the goal of the therapy is in moving the individual from a place of inexhaustible despair to the loss of something in particular, typically some unknown and unresolved childhood trauma; perhaps the love from one or other of our parents that we never got, perhaps some childhood humiliation. When we finally reach the source of our pain, we finally have the opportunity to mourn the loss.
This is an agonising and painful journey to undertake, but, for those who take it, the catharsis that mourning allows makes the journey worthwhile. Having left the dark continent of depression behind, we may find we have arrived in the land of common, ordinary unhappiness. And once there, we may discover that hope and beauty once again find a place in our lives.
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