The Physician's View

by Dr. Grant Mullen
Nov/Dec 2002

Part 6 of a Series on Emotional Disorders

What is Depression?

I have been allotted months of futility and nights of misery have been assigned to me. When I lie down I think, 'How long before I get up?' The night drags on, and I toss till dawn. My days are swifter than a weaver's shuttle, and they come to an end without hope. Remember, O God, that my life is but a breath; my eyes will never see happiness again.
Job 7:3-7

The general public does not correctly differentiate between normal and abnormal "depression.'' If we are going to help those who need it most, we must be able to tell who is suffering from the illness of depression.

Depression is by far the most common form of mental suffering. It is however, a poorly defined condition which means different things to different people. We must be able to distinguish between the transient discouragement of someone unhappy about a recent disappointment and the severe crushing despair of one who has for many years lost all interest in life. I choose to use the term "discouragement" for temporary mood fluctuations which would be commonly referred to as the "blues" and would never be considered an "illness." "Depression" is reserved for prolonged disorders of mood which require professional help.

It is not always easy to distinguish between these two conditions and it requires considerable training and experience. There is presently no blood test or X ray that will diagnose mental illness. Understanding what a person is thinking and feeling is the only way to separate these conditions. This difficulty in making the diagnosis has caused enormous difficulty in getting _the right people into treatment.

At this time we have no screening tool to use on the population to find all those that are depressed needing help. It is much easier to find people with vision impairment since the vision screening chart is widely available and well accepted by the public. Our ability to diagnose depression depends on a person's ability to describe what they are thinking to someone who understands illnesses of mood. This requires a significant level of insight, motivation and verbal skill. There are many sufferers who are just unable to communicate their thoughts and so they remain untreated. Since we have no test, we cannot prove that someone has a depressive illness. This allows skeptics to influence a depressed person not to accept treatment or to accept another explanation of their symptoms. The inability to measure mood causes the public to see psychiatric treatment as unreliable, unpredictable, "hocus pocus" and to be avoided. It is a constant struggle for physicians to try to convince sufferers that there is a scientific and reliable treatment for something that can not be measured scientifically.

I will try to describe the differences between true depression and what I call discouragement.

Discouragement is transient with an obvious cause and the person is still able to enjoy other unrelated activities. It resolves with time and supportive counseling. A discouraged person can still be hopeful, with good thought control and concentration. Depression is usually very prolonged with unrelenting symptoms. It is often, though not always, characterized by sadness. There is an inability to enjoy activities and all interests fade. There is general hopelessness and a lack of ability to control or steer thoughts. This is a much more disabling condition than discouragement.

In the next issue we will look at the causes of depression.

Dr. Grant Mullen is a mental health physician in Grimsby, Ontario, Canada. He is the author of Why do I feel so down when my faith should lift me up? Nov/Dec 2002 Issue