If I began this paragraph with a racial epitaph, you would experience an immediate, intense, visceral and cognitive reaction that automatically restructured your thinking in ways that you could not defend. Only those with extensive training could alter the cognitive and emotional impact of hearing that kind of word. In other words, the language and the specific words we choose have an important and powerful impact on the listener or reader that is often underestimated. Some words have more power and meaning than others; an error in describing a car part is less important than an error a neurosurgeon makes during an operation.
Words used by the public and mental health practitioners have a power and danger akin to the neurosurgeon’s language. There is not a more worn-out, overused, misused, and misguided word thrown around the mental health field than the “d” word (depression). Imprecise phrases such as “I am so depressed about that grade,” or the commercials describing the standard symptoms of depression (irritability, loss of appetite, feelings of sadness, sleep disruption, etc.) create a cognitive and emotional reality that leads us to sometimes inaccurately attribute all bad feelings to depression. When we assign all of our bad feelings to a concept such as depression, we are susceptible to search for strictly biological remedies such as the latest pill for depression. I chuckle when I see these ads because I wonder who wouldn’t qualify for a list like that? All people feel at least some of those things everyday, and all of those things over a lifetime.
Depression, suffering, and grief are relatives but not the same. It is extremely important to split hairs when it comes to their definition. Suffering is unavoidable pain that we feel moment to moment that is part of being a human being. We live in a world that is not necessarily working against us, but it is at best benignly defying us and requiring effort and persistence that often involves suffering. We also suffer because of the many things in life that are out of our control; death, loss, the complexity of relationships, and our feelings. Suffering is similar to depression but our society makes room for the low-lying, persistent, and ordinary feelings of suffering; it’s normalized.
Grief is very commonly confused with depression and often the symptoms present as similar, if not identical to depression, except when someone is grieving they typically are not feeling the shame and self-loathing of depression (a point made by Freud in Mourning and Melancholia). Grief is refreshing because it is not clouded or mysterious in origin. If we lose a loved one, we grieve and we know why. Grief feels temporary, whereas depression feels permanent and suffering is a permanent reality. When grieving begins, I feel deeply affected and altered, however, each day I sense I am progressing and in time healing will occur without outside intervention. Our minds are self-healers when grief is felt, acknowledged and allowed to run its course.
Depression is an experience of intense feelings identical to grief other than two major differences. First, we don’t know exactly “why” we are depressed. We are mostly puzzled and suffering from an unidentified antagonist and the cause is internal, not from an external event (or at least not a clear one). Second, self-loathing is keen and incisive, and involves the magical thinking of a child in that when a depressed person is trying to explain his feelings, he is looking to blame himself first for a crime he did not commit. Listening to a depressed person speak is similar to listening to dream-language; the meaning of the feelings are unclear and symbolic.
Psychotherapy will only become unnecessary when there is pill for grief. What we often mistakenly refer to as depression is really recurring and unmetabolized grief or suffering that needs to be brought to consciousness so the mind can heal itself. To my patient’s suprise, when I treat the pain of “depression” I rarely eliminate the pain. I change their relationship with depression from a vague, meaningless, incomprehensible pain into meaning-making relationship. I accomplish this mostly through “trianglular listening” as described in an earlier essay in which the significance of their grief is felt and understood as connected to meaningful experiences in their lives in which a grieving process was previously skipped over, incomplete, or not allowed.
