We all experience times in our lives when we feel fed up or miserable. We wake up one morning and find ourselves feeling listless. For some reason, unable to face the day that lies ahead. We begin to withdraw, both from the world and from our own private pleasures. We begin to lose our sense of direction. The meaning that life once had begins to recede.
Some version of the above will play out for each of us. There will be moments in any human life that will make us sad – tragic and stressful events come to us all – and reactions like these are inevitable. If the weeks begin to drag on, however, and these feelings continue to persist, we may begin to ask ourselves why? Are we depressed? Or, as might be expected sometimes, 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 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 and sadness and depression; between what is ordinary and what 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? The sad person might also feel a lack of energy or feel impotent in the face of life’s demands. One difference between the two is one of degree; the extent to which an individual 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 we can still summon enough energy to engage with life. 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 to them.
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 the 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 having 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, 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 because of the loss of a job, the ending of a relationship, or the death of a loved one.
When it comes to depression, however, no such trigger is needed. A person suffering from depression may feel sad or hopeless about everything. It’s entirely possible they have 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. Press them for a reason and they draw an inconclusive blank. The bitter roots of their trouble remain, for now, a mystery.
They are simply depressed.
Having consulted your GP, you may 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, is already out in the open, and so it’s more easily thought about and talked about. It’s easier to build resilience against spiralling any further downwards and simpler to find ways of preventing someone 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 individual, for whom the cause is unknown, the goal will be different. The first difficulty may be in attending at all. The depressed individual has to summon great reserves of energy to get themselves to the consulting room in the first place They may also have to overcome their feelings of worthlessness and guilt in facing the person 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 the counsellor judges them as harshly 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 them acknowledged validated by a caring listener can be a relief for a sufferer of depression and provide a stepping stone for coming to an understanding of what has caused this blight on our lives. With the help of the empathetic and supportive listener, the depressed individual can once again take steps towards in engaging in relationship.
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. Ultimately, the goal of the counsellor 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; the love from one or other of our parents that we never got, or perhaps some childhood humiliation. When we finally reach the source of our pain, we finally have the opportunity to mourn the loss.
This can be 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.
About the author:
Declan Gernon is one of our team at The Therapy Centre. He’s an experienced and compassionate counsellor and works with anger management and other issues. To read more of his writing visit his website.