Once you have a depression diagnosis, what does it mean to you? I’ve heard a lot of reactions, ranging from a feeling of comfort to dismay to a shrug of the shoulders.
A diagnosis is simply a name given to a set of symptoms, but it’s usually wrapped inside a number of messages, whether spoken or implied. Your response could depend on a specific message that’s delivered with the diagnosis. Given the authority of psychiatrists and other physicians, it’s easy to confuse the two.
Separating Fact from Opinion.
A diagnosis is a bit like a court ruling. The ruling itself is a narrow, technical holding about very specific facts that match certain laws and definitions. But what makes the headlines are the things judges add to explain how they reached their conclusions.
Those are the memorable messages, even though they’re really editorial opinions, reflecting a judge’s philosophy and values. They’re not statements of fact.
The messages wrapped around the name given to your symptoms may have the same effect on you. These are the ideas you’ll remember and react to because they give meaning and context to the bare diagnosis itself. Yet they often reflect the attitudes and beliefs of the physician rather than fact.
Some physicians convey hope and encouragement. Others emphasize medical expertise and dependence on a doctor’s guidance. Still others reflect indifference to your emotional state and see you only as another example of a disorder they need to treat.
Here’s a sample of messages I’ve gotten, whether explicit or implied.
1. Type X Depression is the correct diagnosis.
You’ll probably assume that the doctor has gotten it right, but that’s not always true. Many diagnoses turn out to be wrong. The problem is that the vaguely stated criteria for one type of depression overlap with those of other types and even with different categories of disorders.
Especially if you’ve felt confused or helpless, though, you may not be in any mood to think about that possibility. You may well feel relieved just to know that this condition has a name and is a recognized disorder.
If you’re at all skeptical about physician infallibility or believe your problem doesn’t quite fit the criteria, you should get a second opinion. If that’s not possible, you could periodically revisit the diagnosis with your doctor if the treatments for depression don’t work or you become aware of other problems.
2. You’re not alone.
Another basic message you get from an evaluation and diagnosis is the knowledge that you’re not alone in dealing with these problems.
The ability to put a name to the cluster of symptoms you have, to understand that these are symptoms rather than character flaws, to know that millions suffer from the same condition, all of these may give you a comforting feeling. It was certainly a relief to me to grasp these basic realities.
However, you may react differently, believing that the diagnosis itself is stigmatizing, a brand that will stay with you always. You may have wanted help for your specific problems rather than to have a label attached to you. Knowing you’re not alone isn’t much help if you feel you’ve joined the ranks of a minority that suffers discrimination as well as illness.
3. You have a treatable illness.
This is the big message you probably want to hear. Depression is not only common but you can also do something about it. This is a message of hope, even if you feel quite hopeless when you hear it. It’s probably the most optimistic thing you may ever hear from a doctor.
4. Depression is a brain disease.
A common message these days is that you have a brain disease. You’re told that it’s triggered by a deficiency of certain neurotransmitters and can be successfully treated by medications that increase the availability of these chemicals. You might feel it’s a comforting message because it puts depression in a familiar medical context and offers a simple treatment.
But you may also feel worse because there’s something wrong with your brain. You’ve been dealing with a complicated problem about your feelings and behavior. Now you find you have a defective brain! For some people, that only adds to the depression.
It’s important to know that the concept of depression as a brain disease is hotly debated. Some of the most influential neuroscientists and psychiatrists will routinely describe the illness in this way, but others angrily deny the idea. John Grohol at PsychCentral calls it a myth. They argue that the causes are not well understood but likely involve genetic, family history, social and psychological factors as well as neurochemistry.
5. You’ll never fully recover.
No one ever said this to me in so many words, but, on the other hand, no psychiatrist or therapist ever suggested that I would recover – or encouraged me to expect a life free of depression. I have a hard time imagining that anyone could feel good about this message. It’s hope-stealing rather than hopeful.
All the hope you might have from knowing that you have a treatable illness disappears when you learn that you won’t get over it. You might not feel as hopeless as I did when I first encountered this statement. You might instead feel that it’s better to know “the truth” and prepare yourself to live with it.
Or you might react angrily – as I came to feel. Nobody knows what your future is going to be like. All a doctor can do is cite research studies and probabilities, and there are no studies demonstrating that every person with type X depression will never get over it.
6. You’ll need to take medication indefinitely, probably for the rest of your life.
Hearing this message when you’re first diagnosed, presumably before you’ve tried any treatment, might be pretty confusing. Wouldn’t it make more sense to wait until you knew that medication was going to work? But proof may not mean anything to you when you’re desperate for a remedy.
You may feel, as most people do, that if meds work, you’ll happily take them forever. You’ll do whatever it takes. Or you may be uncomfortable with any medication and accept them only as a last resort. Yet the message assumes that medication, first to last, is the primary treatment you’ll need.
It’s the “rest of your life” part that really bugs me, for the same reason that I have trouble with “never recover.” There is no evidence that these statements are always true. You may reach these conclusions as a result of your own experience over many years, but that’s your decision, not an arbitrary assumption.
Another View of Diagnosis
It’s important to know that the major symptoms you live with match a condition that is well known and has a name. But a diagnosis is only a pointer toward the right treatment. And there is no diagnosis or treatment that works for everyone.
There is a distinctive way that depression has blended with your life and caused it harm. And there will be a distinctive form of recovery that only you can define for yourself.
Psychiatrists, medication and psychotherapy don’t cure you, though they can give you a powerful assist in turning the corner. It’s your own effort that will make the difference between feeling relief from symptoms and getting back a fulfilling life. You need a lot of support and a sense of empowerment to keep going through any recovery process.
If a diagnosis arrives wrapped in messages of hope and empowerment, it’s a big plus, the kind of send-off you need to start on a path to recovery. If it comes with messages that encourage perpetual dependence on anyone or anything, it’s disempowering and a roadblock.
I want the ribbon-cutting send-off.
What messages came with your diagnosis? Did they give you hope or take it away?
Image by digitalpimp at Flickr
LCSW therapist says
Depression is such a very bad mental health issue which don’t have complete treatment but this can be reduced by doing proper meditation and therapy. In such case, only mental health therapists help the patient to get rid of their issue. So if someone have these type of issues can consult with some mental health therapist so you can get rid from this issue.
The very first time I was officially depressed, a psychologist named it and it was a relief, actually, to have something to call how horrible I felt. At that time, I was 19 and living at home with my parents and siblings, feeling like I was trapped there and wanting to die. I had a lot of anger. I did feel hopeful, though, when I realized that it was anger turned inward.
A decade or so later I found myself depressed again but not able to figure out what I was so angry about. I thought I was angry with my husband, but I eventually realized it was much older than that and ended up taking medication, which I have been on ever since, to help make my life manageable. I had a good doctor who never said anything to make me feel hopeless, but he got me thinking about where it all came from and once I became aware of that, THEN I started feeling hopeless, oddly enough, because I was believing all the depression messages my head was telling me.
Today, I think I’m realistic about the idea of maybe having to always deal with this, but I have hope that it won’t have to be so crippling now that I have more resources and knowledge. I even have a little hope that it might go away forever some day. Maybe I’ll be pleasantly surprised…..
John Folk-Williams says
Hi, Judy –
Thanks for describing a bit of your history with the illness. Was the doctor who got you to think about where the feelings came from a psychiatrist or your family physician? How did you manage to stop believing the depression messages? I ask because even though I worked with psychiatrists many times over a few decades, none of them gave me a diagnosis in DSM terms. Their concern was always to help me understand and reconnect with my feelings about my own life – which had become quite hidden. Their help was critical in laying the groundwork for recovery.
John, sorry to be so late replying, as I didn’t get any notification of your response. Anyway, the first doctor who got me thinking about where the feelings came from was a psychiatrist – a real gem. But it took me years to START to work on not believing the depression messages because I still couldn’t believe that they weren’t my own. Nobody ever really focused on any diagnosis and it didn’t seem to matter much, until my first therapist told me I was a borderline personality without even explaining what it was. Then, I REALLY wanted to die after researching it myself. My next and current therapist believed that what was actually going on was, yes, depression, but also PTSD and a dissociative disorder. That all was news to me, but she explained it all and it made a lot of sense. I started figuring out, through a number of methods, what had happened to me as a child, realizing that I didn’t remember much of it and I still don’t have a lot of conscious memory from those years. But going on what I do remember and anecdotal evidence from a few people, it all fits. So, the work I’ve been doing has been under the premise of healing childhood trauma. And that has made the most sense of all.
Until I got into therapy, I didn’t believe I had any opinions about anything (it made life conflict-free!) and didn’t allow myself to feel angry at anyone I cared about. But that armor started to get chinks in it, thank goodness, although it was hell at first. I could barely even talk in therapy because my feelings were so removed from my consciousness, I could only answer questions – but they were the right questions!
When I was 16, I was diagnosed with depression for the first time. It came as somewhat of a surprise to me despite the fact I had all the classic symptoms. I didn’t know that at the time, though. My PCP prescribed an antidepressant and said, “I’m only going to give you one week’s worth at a time so you can’t kill yourself with them.” That was what shocked me. Because although I had entertained the idea of suicide, I certainly didn’t want anyone else to know it. I thought, “Is it that obvious?” In hindsight, he was right to only give me a week’s worth, but at the time I was outraged and resentful that he would not trust me. And I ultimately quit going to him (and quit the medication) because of his lack of trust, despite the fact that his suspicious were correct. For some reason, not being trusted made me feel even more depressed.
John Folk-Williams says
Hi, Donna –
That’s not surprising that trust was so important. There are studies on the effectiveness of psychotherapy, and much of it comes down to belief in the process and trust in the therapist.