Wednesday, 16 July 2014

What does it feel like to be depressed?

We're used to reading about depression as a checklist of symptoms. These lists have their uses, but arguably they miss the human story of what depression truly feels like. Now the psychologists Jonathan Smith and John Rhodes have published their analysis of the first-hand accounts of seven therapy clients, (three women and four men) about what it's like to be depressed for the first time. The participants had an average age of 44, and all had been referred for therapy in London.

The first theme to emerge from the interviews was the feeling of being "depleted" - in one's relationships, bodily, and in respect to the past and future. Ravi (names have been changed), who'd recently lost his job and separated from his wife, described his "relational depletion" like this:
You get into a state I think mentally where, you're just like out on an island ... You can see from that island another shore and all these people are there, but there's no way that you can get across [ ] or there is no way that you want to get across.
The idea of bodily depletion was conveyed by Sally, whose son had recently been imprisoned for nine years. "It's like part of you gone, your heart, I don't know. Perhaps half my heart has gone away." Later she adds: "I don't feel like I'm part of my body when I'm down. [ ] It's like something's gone inside me and swept my happiness away."

The feeling of the past and future being depleted (what the researchers call "temporal depletion") was captured by Paul: "I feel that everything I do, everything has been a waste." Pamela, who had been suspended from work, shared a similar sentiment:
I feel like sometimes my life is on hold. [ ] I'm going to be out of a job and that's my life over because [ ] [the company] has been my life for 20 years, you know, I've, I don't know anything else.
The second key theme to emerge from the interviews was of "being shaken" - including experiencing overwhelming emotions ("I was waiting for that fearfulness to come on like a wave," said Paul); frenzied thinking ("It feels like my brain is just racing all the time and I'm trying to think all the time," said Ravi); and the sense of an uncertain self. Regards this last point, Stewart (who'd lost access to his son after a divorce), put it like this:
Depression for me is not liking yourself, having no confidence in yourself, seeking reassurance, hanging onto anything that you can, pretty much anything emotionally, get your hands on. Lacking courage.
Reflecting on their analysis, Smith and Rhodes said it was clear that all the interviewees had in common that they felt alone, empty and that they had no future. The picture, the researchers explained, was not of a "steady, flat, fixed-state" but of a "fluctuating see-saw between long periods of descents into emptiness and moments of explosive emotion."

The authors summed up: "To feel oneself as not in relation, as not having a body and as not having a life or a future means that one is either lacking or questioning the very taken for granted qualities of human experience. This helps illuminate depression as a very powerful phenomenon which makes aberrant the most basic existential features of life."

The pair hope the insights from their research may have therapeutic implications - for example, they said an open discussion with clients of what depression entails could reassure them that their experiences are shared by others, and help to "make links between what is being felt now and what has happened to the person."

_________________________________ ResearchBlogging.org

Smith, J., and Rhodes, J. (2014). Being depleted and being shaken: An interpretative phenomenological analysis of the experiential features of a first episode of depression Psychology and Psychotherapy: Theory, Research and Practice DOI: 10.1111/papt.12034

--further reading--
What's it like to have OCD?
Recovering patients describe their battles with an "anorexia voice"
A study of suicide notes left by children and young teens
What clients think CBT will be like and how it really is

Post written by Christian Jarrett (@psych_writer) for the BPS Research Digest.

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