Phenomenology Online

A Resource for Phenomenological Inquiry

Understanding Depression

 

Gagnon, Rochelle

 

Sitting in a quiet little coffee shop, I glance at my best friend’s face. She doesn’t look up from her cup, but gazes into the liquid like she may find all her answers there. Even though my friend sits in front of me, I feel alone. My mind wanders into the silence as I remember the hundreds of other coffees, we’ve had together, talking and giggling–at the University, griping about our course loads or eyeing the cute jocks running by in those tight biking shorts. A small smile tugs at my lips at the memory. Yes, we’ve had so much fun together. But it was not always just fun. I also recall rushing to her side shortly after the premature birth of her son. And there were other times when we shared sad news. Sometimes we held each other. Sometimes we cried together. But mostly I remember the laughter; how we always laughed at life & but all that’s gone now.

 

My mind drifts back to the present where I see a pale, emaciated woman with stringy unwashed hair and dark sunken eyes sitting in front of me. I feel a surge of anger as I realize that I don’t know this person, this stranger. I want my friend back! I want her to snap out of it and be who she was before this horrible thing called “depression” took a hold of her, took her from me, took her from herself. But she just keeps staring down into her coffee cup, not seeing me, not seeing the world around us, not relating, just barely there.

 

All of a sudden I just want to leave. Not just this place but her also. I want to leave this person, go on with my life and forget about her. But how can I? She’s my best friend, and best friends help each other no matter what. So I end up just looking at her, trying to see her like I once did. But she doesn’t really seem there. Rather it is the depression itself that is there; like it somehow sits in front of her, making her seem faded in comparison. It is as if I have to look through it to see her. I take her hand in mine, holding it tightly, trying to reassure myself that she is in fact still there.

 

Knowing depression

I have attempted to know what is happening to my friend. I even looked up the word “depression” in the dictionary. The Oxford English Dictionary defines “depression” as: pressing down; state of sadness; long period of inactivity in trading; area of low atmospheric pressure; sunken place” (1994, p.132). Somehow the notion of “sunken place” resonates with me. In my mind I see an image of a “depression in the ground.” Is depression then a little like feeling “pressed down” into the ground, into the world? How would it be to feel this way I wonder? Is it a heaviness in the body, like a body weighed down? But what can weigh down on someone’s whole being? I recall the slow and arduous gait that I saw in my friend’s walk, painstaking, like she is dragging the weight of the world behind her.

 

I find myself absorbed in this wondering. My world becoming sensitive to this thing called depression. This inquiry has become “a caring act,” one that I have undertaken because of my deep love for my friend. Hence, it becomes unnecessary to understand depression “simply as a cognitive act but rather I strive to meet her in her weakness and vulnerability where I experience the undeniable presence of loving responsibility” (van Manen, 1998, p.6).

 

Perhaps because of this heightened attentiveness, I was struck by the headlines of a news paper article one day:

DEPRESSION AND THE MEDICAL WORLD.

“Horror on the subway”

 

Toronto doctor throws herself and six-month-old son in front of moving train.
Around 7 a.m., Dr. Suzanne Killinger-Johnson, a psychotherapist, clutched a sleeping Cuyler to her chest and before the eyes of several commuters dove into the path of a northbound train at the St. Clair West subway station. Loblaws employee Alda Tsarouchas, 47, had just stepped off a subway car when she noticed a woman clutching a baby and behaving irrationally.

 

“The woman “was so distraught … I knew something was wrong,” a badly shaken Tsarouchas said. “I saw her heading to the southbound platform … She was running. Then a few minutes later, I saw her going to the northbound platform. She must have jumped at the next train from mine.”
From the outside, Killinger-Johnson had it all — good looks, an elegant manner, a professional career, a prosperous husband, a luxury car, a trendy home, a baby she loved.

 

There was shock yesterday when colleagues learned the woman who had taken her baby to his death was the attractive and polite woman who seemed to have everything. “I wonder if there was a post-partum depression going on … I can’t think of any other reason,” said Dr. Gregory Koval, executive vice-president of the King’s Health Centre on University Ave., one of two clinics where Killinger-Johnson worked. “She was very professional, very polite at all times. She kept to herself primarily, but she was a very friendly, private person.” Killinger-Johnson, who graduated from the University of Western Ontario medical school in 1988, worked in Toronto as a general practitioner and specialized in counseling. (by Ian Robertson and Alan Cairns Toronto Sun, August 12, 2000)

Dr. Killinger-Johnson never regained consciousness and died 8 days later of her injuries.

 

How could this happen? I wonder. This woman was a therapist herself and ironically, specialized in the treatment of depression. How then could someone so knowledgeable in regards to this illness not have been able to diagnose herself? What, I wonder, is it that specialists themselves really know about the illness of depression? How could this happen, that someone who knows all about depression could not have safeguarded herself and her child? I have been trusting that the “professionals” will help my friend come back to herself; what is it they know that I don’t? I decided then to consult the psychiatric handbook called The Diagnostic and Statistical Manual of Mental Disorders (1994) or the DSM-IV for short. This handbook is a diagnostic tool that aids the specialist in the diagnosis of mental illness. In it the following symptoms are listed for the diagnosis of clinical depression:

  • – depressed mood most of the day, nearly every day.
  • – markedly diminished interest or pleasure in all, or almost all, activities.
  • – significant weight loss or weight gain.
  • – insomnia or hypersomnia.
  • – psychomotor agitation or retardation.
  • – fatigue or loss of energy nearly every day.
  • – feelings of worthlessness or excessive or inappropriate guilt.
  • – diminished ability to think or concentrate.
  • – recurrent thoughts of death.

This handbook provides a glimpse of the knowledge base that psychotherapist, Dr. Suzanne Killinger-Johnson, would have possessed when she threw herself and her baby in front of the subway train. These are also the symptoms that should help me to recognize the illness of my friend. And yet, does this medical diagnostic knowledge help me to understand what Dr. Suzanne Killinger-Johnson may have experienced? Does it help me to understand what it means for my friend to be so depressed? It seems that there is an important difference between “knowing” about an illness and “understanding” an illness. The medical description tells me what my friend “has” but not what she is living experientially. In other words it verifies that, yes, in fact she is suffering from depression but it does little to help us to understand her in her own unique experience of this illness.

 

It seems that the diagnostic medical knowledge was not effective in helping Dr. Suzanne Killinger-Johnson to deal in a positive manner with her depression. So, perhaps it is not surprising that the list of symptoms did not seem to be of help to my friend either. It did not even help her to recognize her own condition:

While I was waiting for my doctor I read the medical criteria from the DSM-IV on the back of her door.
“That’s not me,” I thought. I don’t feel sad. After a brief talk the doctor recommended that I join a support group at the local hospital that dealt with general mental health issues such as stress and anger management.
I went and sat in a large circle with people talking about the different experiences that they were having at the time. A few explained that they were having difficulty concentrating and one said it seemed like she was “walking under water.” While none spoke of feeling sad or even depressed, they told the group that they were being treated for depression. At that moment a light bulb went off inside of me and I realized, “So that’s what this is. I’m depressed.” It took me a long time to understand how I could be depressed when I didn’t feel sad.

Like my friend, I have always associated being depressed with feeling sad. This is probably why I often try to “cheer her up.” I sometimes even ask her what may have triggered her condition. “Was there anything that happened that made you feel sad?” But my friend explained that she does not really feel sad. She explained that when you feel sad, you feel sad “about” something or in relation to some event. Nothing really happened that made her feel sad. It was not really sadness that she felt.

 

It isn’t that depression is not like sadness but more that depression isn’t caused by something. It is more like a mood that overcomes you; it literally comes over you. Without cause. It isn’t just sadness, or anxiety or despair although a depressed person may feel all that. But depression is more something all encompassing. It is more like a state of being in the world, in a depressed way, rather than as a reaction to something in one’s environment. It may finally be simply about finding oneself one day in the world differently than one was previously.

 

I began to realize that there is no point trying to cheer my friend up. Cheering up does not defeat depression.

 

The inevitable inadequacy of words

The word “mental illness” was commonly used to describe the condition of clinical depression. More recently, depression is called a “mental disorder.”  The reason is that mental illness has “prejorative undertones.” Perhaps removing the word “illness” make the idea of depression more acceptable. A person may be more readily willing to admit to being depressed if it does not lead to the stigma associated with mental illness. Does the term “mental (dis)order” more accurately describe the experience of mental illness? Perhaps, the term “disorder” speaks to one aspect of the depression, that of being mentally confused and unable to think clearly. But it glosses something very important: depression is not just a mental experience. It is not just something in the head. The depressed person’s entire being, his or her entire world is depressed.

 

Until the early 20th century the term “melancholia” was used to describe depression. The term melancholia referred to the black bile that was supposedly responsible for the state of sadness of the depressed person. Although as stated above, sadness is not always present in depression it often is. Medicine identifies sadness as a defining symptom of depression. But this may result in a tendency to narrow the profoundly overwhelming mood in which  depression is experienced. Perhaps the same could be said about the newer term “disorder.” Those suffering from depression sometimes speak of feeling deeply confused and completely unable to think clearly.

 

It seems as in all things, as humans we continuously strive to find the right word, the best word, the word that will accurately tell us what an experience is like. But as with all words, ultimately we encounter the inadequacy of language to fully describe what something is. Words such as illness, disorder and melancholia will only ever offer small glimpses into what depression really is like. Yet, words are all we have in trying to describe the life of a depressed person. Therefore, perhaps it is in this striving to find the words that come closest to revealing the actual lived experience that we may uncover a little more of what it means to be depressed.

 

The (de)pressed body

I look across the table and say to my friend, “How do you know you are depressed? What is it really like?” She answers,

I’ve been feeling more and more tired. Everyday seems to demand more from me than I can give. I sleep enough but always feel I need more rest. To the point where I no longer feel I can get out of bed, so deep is the lethargy. Often I feel like I am just part of the bed, like I’m sinking lower and lower into the mattress. I sleep most of the day and then when the children come home from school I make an appearance and rustle together the easiest thing I can find for supper. I never eat with them, as my appetite is long gone. I try to ask them about their day but I just really don’t care. As soon as I can, I make my way back to bed; it has become my refuge from the world.

As I listen to her I wonder silently, how a mother could not be interested in what her children have to say? It might be easy to jump to the conclusion that my friend is an awful person or that she should be able to care for her children regardless of her mood. Losing interest in one’s children seems almost blasphemous.  But I know her and she has always been a wonderful and loving mother, therefore if it is not her personality that is to blame then something else must account for her neglectful behavior?

 

My friend’s use of the word “lethargy” struck me. The etymological root of  “lethargy” comes from the Greek for lethargoslethe meaning “forgetfulness” and argos meaning “idle” where one was said to be “inactive through forgetfulness.” Could it be that the “depressed body” has somehow forgotten itself? Forgotten what its purpose is? Forgotten how to move forward into the world? The condition of depression points to the fundamental inseparability of mind and body. It is one’s whole embodied being that is depressed, and that is why for the depressed person the “body” feels heavy and tired all the time, but so does one experience a “heavy” mood–the whole world is tired and heavy.

 

The tiredness of which my friend speaks appears quite different from ordinary tiredness at the end of one’s workday. This tiredness is more tired than tired; not simply heavy but weighed down from a tiredly tiredness. I sense this in how my depressed friend must make an effort to even to sit up in the chair across from me. As if a small gust of wind could flop her forward onto the table between us, laying her head in the plates. She would feel better in this flopped over position I sense. I feel tired just looking at her.

 

The contagious nature of mood

Why do I feel tired when I am with my friend? At times I even feel depressed myself when I am around her. How is it that her mood seems to taint my own mood? Redfield Jamison speaks to this when she writes, “Moods are by nature compelling, contagious, and profoundly interpersonal, and disorders of mood alter the perceptions and behaviors not only of those who have them but also of those who are related or closely associated” (Jamison, 1993, p.25). If this is true then I wonder why it is that my good mood does not seem to have any effect on her? If mood is contagious then shouldn’t she feel happier when around me?

 

It doesn’t seem to work that way. It’s more like my friend can’t respond to me when I am happy or playful. As if happiness is now somehow foreign to her; like she no longer picks up positive emotions on her inner radar screen. Must I then dwell in the depression with her in order to be able to relate to her? In what way am I experiencing depression through her by simply being near her? Is this perhaps why I feel better when I leave her? Like a dark cloud has lifted from around me when she is gone?

 

The tone of the world

Although I feel depressed when I’m around her I know it is not the same as the depression she suffers from. When she leaves, I will feel the depression walk away with her. In a moment, the world will reach out to me, like she had somehow been holding it at bay. When I look over the flowers will once again be bright, the sky will be a crystalline blue and I will bathe in the warmth of the sun on my face. Somehow when she is there I seem to see the world through her eyes, not mine. The world seems grey, slowed down and dull she has told me. Yes I see it, I think. But I know that the world is not “really” what I am seeing when I am with her. I know that “really” in reality the world is many times, sunny, colorful and warm. Why is it that her world seems to be showing her something different? Styron speaks to this sense of the world outside oneself changing when he describes the onset of his own depression,

It was not really alarming at first, since the change was subtle, but I did notice that my surroundings took on a different tone at certain times: the shadows of nightfall seemed more somber, my mornings were less buoyant, walks in the woods became less zestful, and there was a moment during my working hours in the late afternoon when a kind of panic and anxiety overtook me, just for a few minutes, accompanied by a visceral queasiness. (Styron, 1990, p.42)

We don’t often think of the “tone” of the world. We live for the most part in a taken-for-granted state where we respond to the world as it comes to us. Somehow depression changes this and makes the person “experience” the world differently and more sensitively. Why is it that the person feels it is the outside that is changing when really it is the inside? Is it like van Manen says?

We may first discover that we are ill, not because we feel body symptoms, but because we notice how changed aspects of the outside world become symptomatic of something that must be wrong within us. The food looks less appetizing, the radio is too loud, the sunshine too bright or the overcast sky too depressing. Everything seems to become too much, too difficult, too cumbersome. Quite literally the world has become sick. (van Manen,1998, p.7)

In this sense depression may reveal how very much our sense of self and our world are intimately interconnected. We and our world are one. Or, as Heidegger says in describing his notion of Befindlichkeit, that “we are always situated, in situations, in the world, in a context, living in a certain way with others trying to achieve this or that. A mood is not just internal, it is this living in the world. We sense how we find ourselves in situations” (Gendlin, 1988, p. 44).

 

From this we might say that we live in the world “moodily” and are swayed in turn by the moods of the world. Can we not relate to this sense of responding to our world when we wake to a cloudy, rainy day? Does it not have the effect of making us feel depressed? Dragged out and lethargic? And once the sun comes out does our mood not lift?

 

For my friend though, it would seem that she does not respond to the world in this way as she continues to perceive everything as dull, irregardless of the actual light in the world. Van den Berg believes that “the world about which the patient speaks is as real to him as our world is to us.” The patient’s world is even more real than ours, says van den Berg, for, “whereas we are able to rid ourselves of the spell of a depressing landscape, the patient is unable to liberate himself from his gloomy scenery” (van den Berg, 1972, p. 20). This gloom or dimming of light is so real to the person experiencing depression that van den Berg reports of a [depressed] patient going out to buy a stronger light bulb because he believed the light in his room was less bright (van den Berg, 1972, p. 45).

 

The medical world is quite aware of the impact that a lack of sunlight can have on the body. Seasonal Affective Disorder Syndrome, or SADS, is the result of this impact and is a known trigger for depression. But  “light” also means the opposite of heavy. To feel light and buoyant comes in contrast then to the feeling of being “pressed down” and heavy in body that the depressed so often speak of. Is it then that light can somehow “lighten” our way of being in the world? And the fact that a real or perceived loss of light may contribute to this sense of being “weighed down heavily” in one’s body?

 

What I feel when with my friend is that “gloom” and “dullness” emanate from her and like the cloudy day I feel her gloomy disposition settle on me. I am in the world gloomily when with her and like the sun on a cloudy day, only her absence restores my mood. How then do I manage to remain with her?

From the corner of my eye I see my friend making movements to leave. I shake myself from my reverie and get up from the table. As we walk slowly from the caf� she turns to me and says,

You know I have been waking up everyday feeling that nothing matter any longer. Why live like this? I no longer want to go on… It is not that I activily think about committing suicide. But as I lie in bed, and upon opening my eyes in the morning, I feel as if I am slowly dying already. And I don’t care. I know death would be better than continuing to live this way. I want it all to stop. Even reminders of my children aren’t enough to make me want to go on.

My love for her suddenly stands up in me. In that moment I say, “I think I understand. I just want you to know that I am here for you. I am your friend.” She begins to cry as we hold each other in the street.

 

We are our world

Today I realize that perhaps all one can do to understand something like depression is to know that the person suffering is no longer “in” the world as we are, that as van den Berg says, “To be ill&means above all, to experience things in a different way, to be different yonder, to live in another, maybe hardly different, maybe completely different world” (van den Berg, 1972, p.45). Do I now understand depression?

 

Perhaps one can only truly understand this human experience if one suffers from it oneself. To be depressed is to live in a different world. It is one’s reality that is depressed. The experience of depression does not belong to the same reality as mine or others who are healthy, but it is not less real. Perhaps it is even more “really real” since the depressed person cannot take distance from his or her world. The state of depression is like a terrible trick, a slight of hand making one believe that these horrible feelings have always been and will never end. Can the depressed person ever fool the fooler, trick the trickster? The answer itself may be depressing.

 

 

References

American Psychiatric Association. (1994). Diagnostic and Statistical Manual of Mental Disorders(4th ed.). Washington, DC: Author.

Armstrong, S. (2001). 밊rom Despair to Devotion.� Chatelaine Magazine. Retrieved March 11th, 2003 from: Klein, E. (1971). Klein’s Comprehensive Etymological Dictionary of the English Language. Amsterdam: Elsevier.

Gendlin, E.T. (1988). Befindlichkeit: Heidegger and the Philosophy of Psychology. In K. Hoeller (ed.) Heidegger and Psychology. A special issue from the Review of Existential Psychology and Psychiatry. Seattle.

Hawkins, J. M. (1994). The Oxford English Dictionary. Oxford, England: Clarendon Press.
Oxford English Dictionary. New York: Oxford University Press.

Redfield, Jamison, K. (1993). Touched by Fire: Manic-Depressive Illness and the Artistic Temperament. New York, NY: Simon and Schuster.

Styron, W. (1990). Visible Darkness: A Memoir of Madness. New York, NY: Random House.

Van den Berg, J. H. (1972). A Different Existence: Principles of Phenomenological Psychopathology. Pittsburg, PN: Duquesne University Press.

Van Manen, M. (1997). Researching Lived Experience: Human Science for an Action Sensitive Pedagogy. London, ON: The Althouse Press.

Van Manen, M. (1998). 밠odalities of body experience in illness and health,� Qualitative Health Research: An Interdisciplinary Journal.
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