[Content note: depression, suicide]
Yesterday I came across the story of Junior Seau, an NFL linebacker who committed suicide on May 2. He shot himself in the chest and was found in his home by his girlfriend. Although little is known of Seau’s mental health leading up to his death, he had apparently suffered from insomnia for the last seven years of his life.
Sportswriter Chris McCosky wrote a beautiful column in the Detroit News about Seau’s death and continuing ignorance about depression and suicide. In the column, McCosky shares his own experiences with depression and suicidal thoughts and laments how difficult it is to explain them to people. He notes, as I’ve noted before, that one common reaction that non-depressed people have is to wonder what the hell we have to be so sad about. He writes, “It’s almost impossible to talk about it to regular people (bosses, spouses, friends). They can’t fathom how somebody in good physical health, with a good job, with kids who love them, who seems relatively normal on the outside, can be terminally unhappy.”
The unbearable frequency at which McCosky and I and probably everyone else who tries to talk about depression get this response could be a testament to the fact the most visible symptom of depression is usually sadness. So that’s the one people latch on to: “What do you have to be so sad about?” “Cheer up!” “You have to decide to be happy!”
Because of the sheer obviousness of our sadness, we’re often forced to try to use it to describe depression. We say that we’re just extremely sad, or unhealthily sad, or a different kind of sad. It’s sadness that never goes away like sadness is supposed to. It’s sadness that’s out of proportion to the troubles that we face in our lives. It’s sadness that we can’t stop thinking about. For those of us with bipolar or cyclothymic disorder, it’s sadness that comes and goes much too quickly.
And it is. But the truth is that sadness actually has very little to do with depression, except that it is one of its many possible symptoms.
Based on the diagnostic criteria for depression, you don’t even need to be chronically sad to be considered “depressed.” Anhedonia, which means losing the ability to feel pleasure from things that you used to enjoy, could be present instead. Under the formal DSM-IV definition, you must have at least five of nine possible symptoms to have major depression–and one of the five must be either depressed mood or anhedonia–and only one of those symptoms involves sadness. (If you so some very basic math, you will notice that this means that two people, both of whom officially have major depression, might only have one symptom in common. Weird, huh?)
So, even if your particular depression does include sadness, it’ll only be one of many other symptoms. The others might be much more painful and salient for you than the sadness is. Some people can’t sleep, others gain weight, some think constantly about death, others can’t concentrate or remember anything. Many lose interest in sex, or food, or both. Almost everyone, it seems, experiences a crushing fatigue in which your limbs feel like stone and no amount of sleep ever helps. Then there are headaches, stomachaches, and so on.
So, depression doesn’t necessarily mean sadness to us. (And, a gentle reminder to non-depressed folks: being sad doesn’t mean you’re “depressed,” either.)
Depression is not sadness; it’s an illness that often, though not always, involves sadness. No amount of happy things will make a depressed person spontaneously recover, and, usually, no amount of sad things will make a well-adjusted person with good mental health suddenly develop depression. (Grief, of course, is another matter.) And sadness, on its own, does not cause suicide.
We need to start talking about mood disorders as disorders, not as emotional states. McCosky writes:
Junior Seau wasn’t sad when he pointed that gun to his chest. He wasn’t being a coward. He wasn’t being selfish. He was sick. I wasn’t sad when I thought about swerving into on-coming traffic on Pontiac Trail some 20 years ago. I was sick.
What he’s saying is that people don’t kill themselves because they’re sad. They kill themselves because they have an illness that, among other things, makes them feel sad. It also makes them feel like their life is worthless, like they’re a burden to others, like death would be easier, and all the other beliefs that lead people down the path to suicide.
There is a tendency, I think, to assume that people are depressed because they are sad. A better way to look at it is that people are sad because they are depressed. That’s why, even if we could “turn that frown upside down!” and “just look on the sunny side!” for your benefit, it would do absolutely no good. The depression would still be there, but in a different form.
Junior Seau did not leave a suicide note, so nobody will ever know what he was thinking when he died. I would guess, though, that he was thinking about much more than just being sad.