My mother used to ask me, is it depression with a small “d” or a capital “D?” She’s a psychologist who has spent over 35 years working with people suffering from depression. I remember hearing this distinction before I was a psychologist and feeling a little bewildered. What does she mean small “d” or capital “D?” After working with many people who experience depression, I now understand.
For many people who are grappling with the idea that they may be depressed, it can all be very confusing. They may go through a period where they feel sad, empty, or fatigued, don’t feel like socializing, lose interest in things they used to find pleasurable, or even have difficulty thinking clearly. I think most people have felt these feelings at some point, but they usually dissipate within a few days or weeks.
Depression often alters your ability to perceive reality as it actually is. It’s completely confusing. One day you’ll feel fine and the next you’ll feel insecure and worthless, without understanding why. It can happen to anyone, regardless of how successful others think you are in the world. It’s not uncommon for someone to call me and say they need help because they think they’re depressed. I’ll ask them what’s going on, and they’ll say something like, “I just don’t feel the same way I used to and it’s hard for me to get out of bed.” On a side note, just about everybody I’ve worked with who experiences depression always feels most comfortable staying in bed. Who wants to face the world when you feel far from your best? How often do you hear anyone say, “I’m really sick and I can’t prevent the snot from dripping out of my nose, but let’s go face the world!”
This type of depression is extremely difficult. It makes most aspects of life uncomfortable, and makes you question your life and worth as a human being. However, this type of depression can usually be resolved with a few small steps. Those experiencing depression are not thinking clearly. The pleasure center of the brain has been held hostage and isn’t generally set free until some demands have been met. It’s important to create a plan before it happens, because in the moment it’s much more difficult to think of anything helpful. If you cannot change your environment, you can always change your thoughts about your environment.
My plan can be distilled down to a two-step process: “be prepared, take action.” For instance, you already know getting out of bed will be difficult. Put a little sheet of paper next to your bed at night that says, “You are expecting your thoughts to lie to you and tell you you must stay in bed.” Then remind yourself in the morning that you are prepared for this situation and knew your thoughts were going to mislead you.
Next, take action. You could get out of bed and listen to one song you usually enjoy, go for a two-minute walk, call a friend, get a coffee, etc. Remember, most people experiencing depression have low energy, so make the action as small and attainable as possible. Small steps often lead to large progress. Just keep taking very, very small steps no matter how many times your thoughts tell you to give up. Over time, you will feel better. Practice your plan when you’re not feeling depressed to develop a routine. It will take less thought to continue it when you are actually feeling depressed and have trouble thinking clearly.
This form of depression is the small “d” my mother was referring to. It’s awful, but it’s different than depression with a capital “D.” Imagine everything in your life felt like it was going perfectly. You just landed your dream job, met your dream partner, and everyone around you is constantly telling you how wonderful you are. But instead of feeling fabulous for all of this good fortune, you don’t know whether you’ll make it through the morning.
Friends, partners, family members, and people in general will look at you with confusion because they can’t understand what’s wrong. They actually cannot understand what you are experiencing. If they did understand, they would know that questioning you about why you can’t be happy at this moment only makes you feel even worse. People who experience depression with a capital “D” generally come by it honestly. They have a physiological imbalance in their neurotransmitters, and no matter how good life looks on the outside, on the inside life is intolerable. No one with depression with a capital “D” wants to feel bad, but unfortunately many aspects of the situation are out of their control. The things that can work small miracles with small “d” depression often don’t make a dent in the capital “D” cases.
Increasing social support can be helpful, therapy can make a big difference, and depending on the individual’s constitution, psychiatric medications can sometimes really help. I’ve learned an important lesson while working the capital “D’s.” You don’t have to feel great all the time. Really, you don’t. Many people punish themselves for not feeling as good as the world expects them to. In moments when everything feels endlessly hopeless, there is an important aspect of life you should never forget. Nothing remains the same. Everything in life changes with time. Just as that perfect moment or period of life will not always remain the same, neither will those times when life feels unbearable.
Matt Traube, MFT
Child and Adult Psychotherapy
Phone: (805) 324-4684 and (781) 223-8629