Your character has just flunked a class, is sad, and is lazy. Do you know what your character has? Not depression.
A lot of media has improved in the way mental illnesses have been portrayed, but there are still overwhelming stigmas and stereotypes that are pervasive in everyday life. In this series, I consult our friend, a doctoral student who goes by Sanjiv, on her field of Psychology as it pertains to literature and character creation.
On this episode we are going over Major Depressive Disorder (MDD), also known as Depression.
Most of what Sanjiv and I know are centered around research done of MDD in North America. It is interesting to note that there has been a lot of research done on cultural differences in how depression is experienced. In North America it is the norm for MDD to be experienced as a primarily psychological condition. But in other areas of the world, depression is often experienced with an emphasis on somatic or physical symptoms (headaches, insomnia, dizziness, pain vs. depressed mood). Understanding the how and why of these differences is complex and an ongoing area of research. Historically, studies regarding mental health across cultures have been loaded with various biases.
Example: a largely somatic symptom presentation is often found in Chinese populations – past research suggested that this was the result of Chinese being a more primitive language and not containing a well-developed emotional vocabulary (Leff, 1981, “Psychiatry around the globe: A transcultural view”)
A character might be depressed if certain symptoms have been present for at least two weeks:
- Anhedonia (loss of interest in most or all activities previously found pleasurable)
- Depressed mood most of the day, nearly every day (feeling sad, empty, hopeless, apathy) – pervasive and persistent is good way to describe
- NOTE: In children/adolescents – can be experienced as irritable mood
- Significant weight loss or weight gain or decrease/increase in appetite nearly every day.
- NOTE: In children – Failure to make expected weight gain
- Insomnia or hypersomnia nearly every day
- Psychomotor agitation (inability to sit still, hand-wringing, pulling at skin/clothes) or retardation (slowed speech, body movements, noticeably increased pauses in speaking, decreased inflection) nearly every day (must be observable by others)
- Feelings of worthlessness or excessive or inappropriate guilt (not just guilt about being “sick”)
- Diminished ability to concentrate or think, or indecisiveness
- Recurrent thoughts about death/recurrent suicidal ideation, or an attempt, or a specific plan
Misconceptions about mental disorders can make those who have them feel as though their experiences are demeaned and trivialized and can be very harmful to those who need treatment. Some misconceptions people have are:
- Depression must be triggered by a stressful negative event, or series of events.
Although negative life events can contribute to the development of depression, it is not necessary to its development or onset.
- People who are depressed are lazy or unmotivated or ungrateful for the positives they have in life.
- People can “snap out of it” or just “think positive.”
Depression is complex and persistent. It involves persistent and enduring patterns of negative thoughts about yourself, others, the present, and the future.
- Depression is sadness.
Depression is not sadness. In our language, the two terms have become interchangeable, but they are not the same. Sadness is painful, but it is a normal reaction to difficult life events. Depression encompasses much more. When we use depression to describe sadness, we are trivializing the experience of depression. This can lead to well-meaning, but ultimately harmful ideas and expectations about what people with depression are going through.
We have found some great examples in literature. Holden Caulfield from J.D. Salinger’s The Catcher in the Rye shows some obvious symptoms of MDD. He is apathetic(anhedonic- unable to enjoy anything/lack of interest in anything) and pervasive/widespread negative thoughts (everyone is phony, but also doesn’t think highly of himself. or anything except Allie and Phoebe) through most of the book showing signs of depression previous to getting kicked out of school. He considers suicide several times, recurring thoughts about death/dying (Allie died 3 years ago, the enduring impact that this has on Holden goes beyond “typical” bereavement)
In conclusion, don’t reinforce already pervasive stereotypes, understand the differences between bereavement, sadness, and depression. Don’t use the word or the condition casually.
Let us know what books you’ve read with depressed and/or “depressed” characters in the comments below and see you on Friday!