No Metaphor Really Encompasses Depression

There’s a commonly used tool in psychiatry and psychology called the global distress score. The patient is asked to respond to a series of prompts like how often the test-taker has thought about suicide, or has been anxious. Each prompt is scored along a scale, allowing patients to say these issues occur daily, occasionally, or at some other interval. There are a number of different designs of the test with variable questions, but at the end, the patient receives a global distress score — the GDS — which can help inform a care provider’s approach to treatment and can also be used to monitor a patient’s response to treatment.

Like any self-assessment, the tool isn’t perfect. If you go to the doctor’s office when you’re having a hard day, for example, you might say that you’ve thought about suicide daily in the last week, even if you actually had a good day or two. But the tool offers a rough guide for understanding a patient’s state of mind, and a glimpse into how a patient is feeling.

It’s also not couched in metaphors.

Designed not just for depression but also anxiety and other conditions, it’s a clinical tool — and when depression is described by outsiders, as well as patients themselves, it’s often framed in metaphors. It’s like being under a cloud, underwater, weighed down — followed, as Churchill famously said, by a black dog. The metaphors for depression seem endless and are used by many patients to describe how they feel, not just to put words to their experiences but to try to get other people to understand them, because the reality of depression can seem too clinical — but because patients may also worry about upsetting people, as we are all trained to not make a fuss.

Thus, instead of saying flatly ‘I want to kill myself every day, and have thought about ways to do it,’ the patient says ‘I feel like I’m drowning and I just can’t find shore.’ These metaphorical understandings of depression become the lens through which outsiders view the condition — making patient-to-patient exchanges so important because each understands the experience of the other. In a sort of nod, a secret handshake, patients can exchange information about their experiences and talk about their moods frankly, knowing that each has an understanding of what it feels like.

There’s a common and understandable drive on the part of people who haven’t experienced depression to try to ‘get’ it, or to say that they’ve been sad now and then so they know how it feels. While their sad periods and genuine grief and upset are not invalid, these feelings are not quite the same as depression — while the emotion can be the same (and can sometimes be at the same level), depression is a persistent, pervasive condition that often doesn’t appear to be linked to anything in particular, that can seem insurmountable to the person who is experiencing it.

Sadness can absolutely lead to what’s known as situational depression — the woman who loses her job, for example, gets sad, and has trouble functioning. Often, she benefits from things like talk therapy and community support while she gets back on her feet and works on finding a new position. Sometimes, situational depression leads to more complicated depressive episodes, or becomes a triggering event for major depression. But all of these things are different — and all are treated and handled very differently by mental health professionals, because they are different things.

The drive to make depression comprehensible, though, may be misguided. Maybe people don’t need to understand it. Perhaps people don’t need to be put into the shoes of a patient with depression. Maybe it’s enough to make people aware of the fact that depression exists, it can happen to everyone and anyone, and that people need to receive treatment without judgment and discrimination. The tendency to try to humanise people with depression may in fact be backfiring, as it reinforces the idea that there are people ‘deserving’ of help and people who are not — in fact, everyone deserves assistance, no matter who they are and what they are struggling with.

Patients with depression don’t need to couch their experiences in metaphors to make them less scary (although if they find this a more comfortable and accessible way to talk about depression, than they should absolutely use metaphors). And the people around them shouldn’t struggle to get or relate to depression — it’s enough to know that someone is depressed, and needs help. People who need help and reach out for it, or who are clearly struggling and aren’t in a place to reach out for help on their own, don’t need to bear the responsibility of humanising themselves to get aid, and the people around them shouldn’t fall into that trap either.

There’s no metaphor that will explain depression. If you’ve experienced it, you know what it feels like — and if you haven’t, you don’t. Hope that you never will, because it is a horrible, horrible feeling, and it is one that can become all-consuming. Just as it is hard to understand other complex human emotions and experiences that you haven’t lived through, like love, or psychotic episodes, it is hard to understand depression if you’ve never been there.

And that’s okay. You don’t need to share an experience to provide support, and you don’t need to get depression to respect that it exists and people need support to manage it effectively.

Image: Clinical Depression, Yuliya Libkina, Flickr.