Mind Moves: "Life is just one damn thing after the other, if you're lucky; but life is the same thing, over and over again, if you are depressed."
That's how someone once described the experience of severe depression. Putting it that way captures the sense of life becoming reduced to a cramped and colourless affair, a dark place where light seldom enters, where you feel frozen in time and unable to move forward, where dignity and hope dry up.
The poet Rilke likened his experience of waking up daily to depression as "wading through granite".
Hardly surprising if you've felt this way for a long time that you might look at the option of suicide and find it appealing. Only by appreciating the intense pain that being depressed can involve for some people, will we be able to engage courageously with the self-destructive thinking and behaviour that it can produce.
Clinicians of varying persuasions have different takes on the causes of depression. Some see it primarily in terms of biological malfunctioning, requiring a rebalancing of the neurotransmitters involved in regulating levels of arousal; others see it as the implosion of some unspoken grief, the echo of some childhood wound, or simply the result of being burdened for too long by some unrelenting stress which eventually breaks the heart.
We all carry stigmata of hurt and loss in varying degrees, which becomes knitted into the fabric of our physical and emotional lives. But for some people these body memories become vulnerabilities that can easily flare up into intense episodes of depression.
Best practice would indicate that a range of interventions should be considered to overcome the pain of depression, including counselling and therapy, rest, nutrition, exercise and medication.
A growing emphasis in depression care has been on teaching people to recognise their unique "relapse signatures" - those warning signs which indicate the particular factors that trigger painful moods are gathering on the horizon.
Given that depression is rarely a once-off experience, it is vital that people learn how to spot vulnerability scenarios and how to take care of themselves - to weather emotional storms - and avoid repeatedly falling into the dark hole of depression.
Trends indicate an increasing rise in the incidence of depression over the past five years in Ireland. This is despite the proliferation of antidepressant medications, which have been prescribed at an increasing rate annually for the same period.
It is tempting to consider what may be happening in our lives to turn the heat up on this particular human experience. One possibility is that we are now becoming more adept at identifying depression in its many different guises. Certainly GPs have been vilified for years for their failures in spotting depression, particularly when it came disguised in vague or atypical somatic complaints.
Another explanation would suggest the depression rates are not rising, but that more and more of ordinary everyday stress and discontent is being "medicalised" and framed as evidence of clinical depression. In support of this latter explanation, research shows out that the rise in rates of diagnosed depression dates from the introduction of newer antidepressants, and that this rise has been paralleled by a corresponding decrease in the diagnosis of many "anxiety" - what used to be termed "neurotic" - disorders.
Critics of medication are generally concerned with the over-reliance on medication, and the corresponding neglect of those social and psychological elements in a person's life that directly contribute to their dis-ease. This over-reliance on antidepressants has the effect of undermining their value to those who may well derive benefit from them.
It can also disempower people whose depression will never be adequately served by simply taking medication, but who comply diligently with medical regimes, only to discover they don't work for them. This failure to discover relief compounds their feelings of demoralisation and despair.
In preparing this column, I asked two long-term service users - both acquainted with the ravages of severe depression and multiple hospitalisations - what they felt might be the reason for the apparent increase in depression. Both immediately identified the absence of honest emotional communication in everyday life as the primary culprit.
Their answers reflected recent discussions on diminishing "social capital" in our society, those community bonds and circles of friends that create a sense of belonging in people. Where there is a possibility of somebody, be they a friend or mental health professional, looking them in the eye and asking honestly "How are you?" and follow this question with genuine listening.
This week has been deemed Depression Awareness Week by the self-help group Aware. Let's hope the conversations it inspires give hope to people who need badly to feel grounded and connected.
Tony Bates is a clinical psychologist and author of Depression - A Commonsense Approach, published by Newleaf. Aware can be contacted for more information at 1890 303302.
