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Tuesday 21 February 2012

Hidden Symptoms of Depression: The Plexiglass Wall

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:

  1. 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.”
  2. 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.”
  3. 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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