Bev Cobain, cousin of Kurt Cobain who committed suicide in 1994, describes depression this way:
Everyone feels down in the dumps, bummed out, or sad at times. If nobody had these normal feelings, there wouldn’t be music called ‘the blues.’ People would feel cheerful even after flunking a test, losing a ball game, getting dumped, or arguing with a friend. Being in a bad mood for a few days is natural. Gloomy, unhappy feelings are part of life, and they usually pass.
But sometimes the mood hangs on, affecting your emotions, body, thoughts, and behavior. Maybe you’re unable to get out of bed and face the day. You feel like you’ve fallen into a deep, dark hole with no way to climb out. Experts call this mental state, depression (Bev Cobain, 1998, p. 1)
One can feel very blue for a long time and not be depressed. On the other hand, one can suffer depression and have other symptoms (anxiety, irritability, chronic indecisiveness) and not feel blue. Besides the deep suffering of depression, it can lead to suicide-as it does in an estimated 25% of those who so suffer. So, it is important to understand depression and be able to discriminate the differences between sadness and depression.
Sadness has been called one of the three primary feelings: mad, glad, and sad. Sadness is the result of a disappointment, a hurt, a rejection, or a loss. Sadness is related to similar emotions such as unhappiness, sorrow, grief, dejection, melancholy, and depression. Melancholy describes a sad mood continuing into a loss of interest in one’s life and under-reaction to stimulation. Depression (or clinical depression) describes the “dark hole” in which a person feel incapacitated, helpless and hopeless.
Freud (1917) and other psychologists consider sadness, grief and depression as a condition in which one’s world seems “poor and empty” from a loss of treasured person(s), possessions, or values.
How grief can turn into depression was described by Schoenberg, et al. (1970, p. 189) in terms of a young woman suffering from a degenerative disease of the muscles:
I feel so sad when I think of how I am, I could cry. I think of all the things I could do before. Then I look around me and see all the healthy people my age, and get jealous and begin to hate them. But then I get to feeling guilty because they’ve never done any harm to me, and I’m overwhelmed by a blue feeling.
The sadness of this young woman is a grief because of her great loss. In her frustration, she considers the hopelessness of her condition and its contrast with “normal” people. Understandably she feels jealousy and rage, but her rational mind incriminates her, and she is filled with guilt. These negative feelings about herself and her world lead her into a sense of hopelessness and depression.
Not all depression comes from loss, and crippling or terminal illness do not necessarily lead to depression. Schoenberg’s study (1970, p. 283) shows only 25% of cancer patients becoming depressed. (Adapted from Hunter, R. . Dictionary of pastoral care and counseling, p. 1103.) The fact is that depression may come with no “triggering” or explanatory event. Depression affects so many people in our world, and often with such sad consequences, that we should understand more about it.
Clinicians distinguish several kinds of depression (as outlined and described on the website “Depression.com” and other sources:
Normal depressed mood and grief. Primarily the “natural reactions to losses in life, (these) involve sadness, lethargy, and in serious cases (such as) grief after death of a loved one, often despair, anger, insomnia, poor appetite, or weight gain, obscene thoughts about the lost person, and terrible guilt.” Normally the depressed mood changes in a day or so (after losing a game or flunking a test) or a couple of months (in adults being laid off or teens being dumped) or even a year or so (after the death of a loved one). Normal Depressed Mood, therefore, is triggered by a life event and passes in time. If someone considers him- or herself normally depressed but has symptoms present without a precipitating loss or symptoms that seem out of proportion to the loss, they ought to consult a doctor or therapist.
Adjustment disorder with depressed mood. Occasionally, life’s changes and necessary adjustments prove too much for some people. They feel overwhelmed, even “crazy.” Unable to get themselves under control, they may find themselves depressed. Counseling may help them understand and deal with the change and help them out of their depression.
Mild depression or dysthymia. According to San Francisco psychiatrist, Michael Freeman, “People with mild depression can still function, but they’re sad sacks. They consider themselves losers.” The characteristics of this kind of depression are chronic sadness, poor self-esteem, being extremely critical, and low level symptoms of major depression. Like other forms of depression, mild depression needs treatment.
Major Depression. What “outsiders” need to understand about major depression is its utter despair, hopelessness, and incapacitating power. Sufferers may be unable to feel pleasure or to get out of bed. And it may develop with no precipitating event. According to DSM-IV, major depression “involves at least two weeks of deep despair and at least four of the following:”
Sleeping all the time or insomnia.
Loss of appetite or a major weight gain.
Apathy, lethargy, lack of interest and energy.
Feelings of worthlessness, hopelessness, and/or terrible guilt.
Difficulty in concentrating or unusual indecisiveness.
Suicidal thoughts or suicide attempts.
Bi-polar disorder (manic-depression). This illness involves the characteristics above (major depression) alternating with high-energy periods of wildly unrealistic expectations or activity. Bi-polar disorder has been explained as a chemical imbalance and develops without a clear cause.
Atypical depression. Meaning unusual, atypical depression may exhibit different kinds of symptoms (happiness or normality combined with periods of anxiety or irritability).
Holiday depression. This depression strikes some people who have experience serious loss or trauma around the time of that holiday or find the holiday to highlight their personal imperfections in contrast to the spirit of the celebration.
Seasonal affective disorder (SAD). Contrary to giddy “spring fever,” the short, dark days of winter with its light deprivation causes some to sink deeply into “winter blahs.” The farther north a person lives, the greater their risk (or the opposite in the southern hemisphere). Treatment of winter depression is an increase of artificial light or a trip to warmer climate with greater sunlight. Light has also been found to help those suffering from other forms of depression.
Post-partum depression. Also known as the “baby blues,” depression in mothers after a baby’s birth has many causes and a variety of treatments. It may be possible for those who have worked very hard to achieve certain athletic or artistic feats (or the completion of a difficult Ph.D. thesis) to suffer in the void that follows the achievement.
There may be a billion depressed people in the world, one out of five persons…many of them self-medicating on drugs or alcohol, many following self-destructive patterns of behavior. In the U.S. alone, at least a quarter of a million teenagers attempt suicide each year, and 2,000 complete it. This figure represents a doubling of teenage suicide since 1960. Girls attempt suicide more often than boys, but boys kill themselves four times more often than girls and usually do so with guns.
Although the teenage years are known as an emotionally turbulent time in a person’s life, most young people are doing quite well. Peter Muehrer of NIMH has pointed out that 99.9% of teenagers do not kill themselves. Still, parents worry and face two difficulties in their concern. One is that the teenage years can be a time of wild emotional fluctuations including some emotional outbursts that match major depression. The other difficulty is that teenagers often express depression in ways not considered typical. Rather than being sad and morose, they may become very angry and irritable or exhibit anti-social behavior in school or community. And, of course, these can also be characteristics of teenagers who are not depressed.
It is important that parents and other concerned adults listen carefully and seriously heed teenagers’ signs of suicidal thoughts. There are local and national resources for troubled young people. One great problem is parents who are too busy or self-absorbed to care. Whether or not this is the case, sensitive and caring teachers and youth leaders along with peer support groups are very important in spotting depressed teenagers and directing them to adequate help.
Questions for Reflection and Discussion
Are you a depressed teenager (or do you know of any)? What are the apparent symptoms? What kind of help will you (or they) accept?
Did you find anything in this article especially helpful? Is there anything here you question of with which you disagree?
How important do you consider this issue of adolescent depression to be?
What do you think needs to be done about it?
Considering suicide, accidental deaths caused by alcohol or extreme risk-taking, and drug over-doses, depression is a leading cause of death among adolescents.
Besides being a matter of life and death, depression incapacitates young people to a great degree. Much of their potential can be robbed by treatable depression.
It is important that we distinguish bad moods from clinical depression. Friends can help us out of bad moods, but clinical depression needs to be treated by professionals.
The information in this article and elsewhere in the Youthworker’s Encyclopedia is not meant to be professional advice, but it provides general knowledge for lay leaders and encourages referrals to professionals.