About the series
Last week marked the start of a new series of posts on the
less-talked-about symptoms that tend to go along with depressed mood.
Direct contact can be difficult... |
The first post reviewed the standard symptom list used for
diagnosis. While useful, these diagnostic criteria run the risk of implying
that they describe depression in its entirety. In other words, if you have any additional bits of
experience not described by the items in the list, then you must have
additional psychological problems – and how depressing is that? In fact, the
diagnostic criteria include only a small subset of the symptoms of depression.
But in describing the additional symptoms we run a different
risk: that people will recognize that they have experienced them, and will
conclude that they must have clinical depression.
Not so. All of
the symptoms of depression, diagnostic or otherwise, are elements of normal
human experience. We have all had days of feeling low and disinterested, a week
of insomnia, a period of inexplicably low energy, an increase or reduction in
appetite, a phase of poor concentration.
Whenever I’m speaking to a group of clinicians and run
through the list of diagnostic criteria for depression, there are always a few
nervous laughs when I mention impairments in concentration and decision-making
(often coming from the participants who find themselves in midlife and beyond).
So if you recognize these so-called “depression symptoms” in
yourself, do not conclude that you must be depressed. They are all normal symptoms of being human. They simply tend to become more
pronounced when we are depressed.
The Wall
Social withdrawal is a standard symptom of depression – so
standard that clinicians often strain to remember whether it is in the
diagnostic list. (It isn’t.) It seems to go along with symptoms that are in the
list, however. Low energy,
disinterest in enjoyable activities, feelings of worthlessness – if you have
these, then you will hardly be inclined to race out to parties.
Overcoming depression is, in part, a matter of pushing back
against the depressive temptation to withdraw, and so many depressed people
find themselves, by choice or circumstance, in social settings. These may be
large events (attending movies or parties) or small (going for coffee with an
old friend). While in these situations, it is normal (so normal that it
is tempting to say predictable) to experience what many describe as The Wall.
The Wall is a powerful sense of separation between oneself
and others. It is as though between you and other people there is a barrier
made of thick plexiglass – impenetrable and isolating. You can see them, you can hear them. But they are separate in a way that
perhaps they have never seemed before.
This is not just self-consciousness. We all find ourselves regularly
imagining what others see when they look back at us, and we are often harsh
critics, paralyzing our ability to perform naturally. Depressed people experience this too, and it is often quite
pronounced.
But during depression (and in other psychological states as
well), there is often a profound feeling of separation from others that goes
beyond apathy or low self-worth.
The sensation is something like the feeling one sometimes gets when
speaking in a language one has not mastered, or with someone attempting our own
language but haltingly. It is awkward and uncertain, and we are profoundly
aware of the gulf in perception that separates us. We know the idea we want to
express, to push across that gulf, and it is with a sense of detachment that we
watch the other person to see if they have grasped what we intended. The awareness is focused very much on
the gap between us, rather than on the person we hope to relate to.
When we speak with someone we open a kind of emotional
pipeline between our own internal world and theirs. We can sense how they are
feeling at an almost instinctive level. When The Wall is in place, we try to
install that pipeline, but none of the emotions seem to come through. We understand the content of what they
are saying, and perhaps they seem to understand us. But the indescribable
feeling of connection is absent.
Who Cares?
The Wall is significant because it seems to have meaning. We
naturally ask why it is there. “Why can’t I relate to Joan? What’s different
between us?” It’s tempting to conclude that it is something about the other
person (“She’s absent”), or about the relationship (“We seem to have grown
apart”), or about us (“I can’t relate to people anymore; I don’t get anything
from socializing”).
All of these conclusions push us toward more withdrawal and
solitude. “What’s the point of doing this if I don’t enjoy it?” This promotes
the depression.
What do we do about it?
The solution to The Wall, in most instances, can be summed
up as a set of steps:
- Reinterpretation. We remind ourselves where the experience comes from. “This is a normal aspect of my mood right now; it’s not a sign that I need to dump Joan or abandon all hope of having a social life.”
- Acceptance. “This will pass, but the more I get alarmed about it and focus on it, the stronger it gets. I need to let it be here, and even give it permission to be here, before it will eventually fade.”
- Opposite action. “This tempts me to withdraw, but what it really shows is that I need to get out with people regularly so that it can fade and I can relearn how to relax and be with people.”
If there are other contributing factors – shame, low self-worth, extreme self-consciousness – then these may take some additional work. But The Wall itself tends to fade with exposure. We may experience it most or all of the times we are with other people, but every encounter can shave a millimeter from its thickness.
We will never notice its final shattering. Only later will
we look back and say “Oh, right, THAT feeling. I haven’t had that in a while.”
Next week: The "I have no life" oscillation.
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