What is Depression?

Depression exists in varying forms. The word depression as used in everyday language refers to at least two conditions: a mood and an illness. The depressed mood is that sad, down, blue feeling everyone has experienced. Usually transitory, it does not affect the general state of well-being or level of functioning.

However, depression is also used to describe a grouping of symptoms, the most pronounced of which is the persistent sadness of mood which typically occurs in response to a loss. This depressive mood affects the entire personality. The sufferer is mentally preoccupied with the real or imagined loss, socially withdrawn from family and friends, and spiritually troubled with feelings of alienation from God. The subject may also be physically plagued with decreased appetite, weight loss, and insomnia. A feeling of hopelessness and thoughts about suicide are also common.

Normal Grief Reaction. Glenn Thomas, a pastor, was a dynamic speaker and empathetic counselor who continually reshuffled his church duties for these other interests. When the board requested his resignation, although he initially responded gracefully, over the next few weeks he was troubled with insomnia, loss of appetite, and fatigue. He suffered from headaches and thought he might have a brain tumor. After a physical examination, he was told he had tension headaches. He met with the doctor several more times and finally admitted his distress over the loss of his pastorate. He then decided he would really enjoy a position where he could devote himself full-time to speaking and counseling without the administrative work. After finding such a position, his headaches disappeared and his feeling of well-being returned.

This case illustrates the main characteristics of a normal grief reaction. Thomas was basically healthy psychologically. He suffered a significant loss which triggered a grief reaction. And the depression actually helped him organize his life so that in a few months his depression had been resolved.

Neurotic Depression. John Smith, another minister, sometimes felt that depression was a way of life for him. He was a hardworking perfectionist who became depressed if his work or ability was eclipsed by anyone he thought of as a competitor. He occasionally had trouble falling asleep, or losing his appetite, but experienced no significant weight loss or any inability to function. At times he felt very good and could enjoy his work and family immensely. He sought the help of a psychiatrist after years of going in and out of “low” periods. Through therapy, he became aware of his tendency to interpret his imperfections or failings at work as a reflection on his personal worth. With this understanding, his depressions then became less frequent and less severe.

This case illustrates the characteristic features of a neurotic depression. There were predisposing psychological factors—loss of emotional security during an early childhood hospitalization, and a continuing lack of emotional support because his parents were very unexpressive. This no doubt contributed to his later sensitivity to losses, which frequently were more symbolic than real. Physical symptoms were transient. This type of depression is often a psychological trap which prevents the sufferer from finding new solutions to the problem. This is the opposite of a normal grief reaction in which depression is often the impetus for finding new solutions.

Endogenous Depression. Samuel Trenton, also a pastor, worked long hours to meet the needs of his growing congregation and family. Things were going well, except for an ongoing conflict between two charter members of his congregation. In trying to help resolve the conflict, he was caught in the middle and criticized by both members.

Subsequently, he became depressed. He began to feel his whole ministry was a failure, that he was bad for his congregation and his family. He developed severe insomnia, lost his sex drive, and had no appetite, resulting in a loss of fifteen pounds in little over a month. His favorite hobby of bird watching no longer interested him. He withdrew from friends and found it increasingly difficult to preach and meet people after the service.

Finally, when he collapsed in tears at home following a Sunday service, his wife took him to a local psychiatrist. In the interview with him, the pastor admitted he had frequent thoughts of suicide and had begun to plan how he might do it. He also recalled that years before his mother and an aunt had been hospitalized because they were severely depressed. He was immediately hospitalized and given antidepressant medication. The psychiatrist gave him psychotherapy to help him understand his sensitivity to interpersonal conflict.

The primary predisposing factor in this endogenous depression is the inherited tendency for depression, indicated by the family history of depression. Loss may be present at the onset of the depression, but it is usually not prominent or even immediately obvious. Physical symptoms are severe and persistent in this type of depression. The mood is unremitting; the sufferer loses all interest in life and becomes preoccupied with suicidal thoughts.