Depression is a liar. When I was diagnosed I wanted the truth
Laura Kennedy: The diagnostic test is, among other things, a shot in the dark
“Despite managing it over the years, I don’t fully understand depression.” Photograph: iStock
A diagnosis of depression at the age of 18 made me more interested in the truth, because that condition is a notorious liar. Depression is not as simple as a dopamine or serotonin deficiency. It is not the same as that infamous broken leg people like to wax lyrical about when trying to explain the validity of depression as a medical condition – “You wouldn’t tell him to walk on a broken leg!” people often say, to clarify that depression entails an incapacity to act rather than an unwillingness. At 18, after years of self-imposed isolation, and a sense of complete desolation and bafflement that stalked me through adolescence, I found myself on a floor; both metaphorical and quite real. My legs might as well have been broken. Besides, they didn’t feel like mine because they did not feel connected to me. I was adrift somewhere in the periphery of my own body. Suspended in a dark, viscous liquid. You don’t need legs when there’s nowhere to go, and you can’t stand up anyway.
How it works
Despite managing it over the years, I don’t fully understand depression, because it is more than just another physical illness. Here is how it works when a person is diagnosed with depression; a condition that is, from the outside, nothing more than an immaterial set of inscrutable behavioural characteristics.
You visit a psychiatrist. They will ask you questions. Based on your answers to those questions, they will determine whether you are clinically depressed. To do this, they will drag out (literally or figuratively) a copy of the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders, and look at the nine listed indicators of depressive disorder. They are things such as “significant weight loss when not dieting or weight gain … or decrease or increase in appetite nearly every day”. And “diminished ability to think or concentrate, or indecisiveness, nearly every day (either by subjective account or as observed by others)”. In order for you to receive a diagnosis of depression, you must have five of the nine symptoms on the list. At least one of them must be either “depressed mood most of the day, nearly every day, as indicated by either subjective report (eg, feels sad, empty, hopeless) or observation made by others (eg, appears tearful). (Note: In children and adolescents, can be irritable mood.)” Or “markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day (as indicated by either subjective account or observation)”.
Those who are unfamiliar with the process generally imagine something more scientific, something more comfortingly substantial and delineated; a litmus test, or a bright light blasted into the retina – anything that might be quantified. The diagnostic test for standard depression is nothing so comforting or clean. It is a visual assessment mostly of self-reported behaviour, and a shot in the dark. It is a label placed upon us, with which we might comfort or strangle ourselves at our own pace.
Five of the nine symptoms is sufficient to do the job. Depression is not a disease of the brain, though it may correlate with or possibly sometimes be contributed to or caused by such diseases. It is a disease of the mind. A mind and a brain are different things. One is a physical object, which can be seen and (at least when no longer nestled in a living skull doing its mundane and mystical work) be touched and weighed and smelled.
A mind is a metaphysical concept. When you receive a diagnosis of depression, you are essentially being told that your metaphysical mind (a concept, which you cannot hold or smell or shove in a sling until its broken structure fuses back together) is not working properly, and that you should take these physical drugs to remedy it. In many cases, anti-depressants make a real and important difference to depression, but the discomfort for the patient is the knowledge that no physical deficiency has been found. At first, I thought of depression as a condition alien to me that I would suffer with forever. Now, I think of it more as a collection of tendencies that I should take seriously and manage, but probably not define myself by. Whatever it is, it is part of me.