When Depression is in your bed

Beyond Diagnosis, Understanding Depression

• Trish Sanders, LCSW • Season 1 • Episode 4

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Imagine feeling disconnected from everything and everyone around you, even yourself. This episode, hosted by Trish Sanders, embarks on a journey to unravel the complexities of depression by examining how it manifests beyond clinical labels, through personal insights and professional perspectives. You'll gain an understanding of depression's many faces—how it can arise from life events like loss or transitions, and how it might not always fit neatly into a diagnostic box. By exploring these intricacies, we hope to shine a light on strategies that can aid in healing and foster a sense of well-being.

Trish challenges conventional perceptions by reframing depression as a form of disconnection, questioning whether the language we use to describe mental health truly serves us. While some may find solace in medicalized terms, others may feel confined by them. Through her personal experiences, Trish illustrates how this disconnection impacts one's sense of belonging, and the importance of considering cultural contexts often neglected by traditional models. She briefly discusses the benefits and limitations of medication, pushing for a more holistic approach to mental health.

In a powerful metaphor, Trish introduces "depression goggles" to symbolize how depression can skew our view of relationships and self-worth, making it difficult to see things clearly. She shares her own struggles with these altered perceptions and the challenge of overcoming them. The episode concludes with an invitation to take just one step on your own wellness journey, emphasizing that even small progress is significant. By sharing this episode, you might offer someone the encouragement they need to take that first step toward healing.

- If you are looking to take the first step towards improving your connection and communication with your partner, check out this FREE monthly webinar on "Becoming a Conscious Couple,".

- If you and your partner are ready to co-create the roadmap to the relationship of your dreams, join us for the next in-person "Getting the Love You Want" Weekend Couples Retreat!

For support in how to have deeper connections and better communication in the relationships that matter most in your life, follow the host, Trish Sanders on Instagram , Bluesky or LinkedIn.

Speaker 1:

Hello and welcome to the One Depression is in your Bed podcast. We take a compassionate, judgment-free and de-stigmatizing approach to talking about how depression affects individuals and relationships. I'm Trish Sanders, your host, in addition to being a licensed clinical social worker and certified relationship therapist. Both my husband and I have lived with depression for most of our lives. Through my experiences, I have learned so much about what can support wellness, connection, better communication, living a more joyful life and, of course, having better relationships, and I'm so excited to share it all with you.

Speaker 1:

In today's episode. I will begin by reviewing the symptoms and criteria that mental health and medical professionals use when diagnosing depression. Then I will begin by reviewing the symptoms and criteria that mental health and medical professionals use when diagnosing depression. Then I will move beyond diagnosis to start developing an understanding of the true experience of depression. Through this understanding of what depression really is, I will begin to uncover clues about what strategies may be helpful for improving and healing through depression. I'm very excited to move into this deeper place of understanding with you. So let's get started.

Speaker 1:

I want to talk about the definition of depression. First, how it is defined in the Western medicine and mental health world and, secondly, how I have come to define depression and understand depression through my own personal and professional experiences. I'm starting here because when you hear the word depression, you may certainly have your own definition or understanding of what that means, and there may be a lot of overlap in what we're talking about. I expect that there will be, but at the same time, I also have what may be additional perspectives that I want to share, because I have found that, as I have come to see and explain depression, both to myself and in my relationship, and even with people that I work with in my office, I have found my view of depression to be more helpful than what is the medicalized or diagnostic view, and so I wanted to share that with you today. So, to start off, I just want to say that there are many life experiences that anyone may go through at any point in our lives in which they may have the feeling of being depressed. So a person may feel depressed in response to a loss of some type. That could be a death loss, like the death of a loved one, or it could be a non-death loss, like a breakup. Also, feeling depressed during a difficult time in life is very common A time of transition, perhaps, or a time when you experience a significant disappointment or something like that. So in these cases, having the feeling of being depressed is very understandable and it may very well not be considered a diagnosable or clinical depression. However, in those cases, a person who has the feeling of being depressed could potentially move to a place where they're experiencing what would be thought of as diagnosable depression. What makes the difference between someone having the feeling of being depressed versus being able to be diagnosed with depression has to do primarily with how long someone is experiencing those feelings, the duration of time, as well as how many ways the depressed feelings are being expressed, which in medicalized language would be how many symptoms the person is experiencing and, of course, how much negative impact the expressions or symptoms are having on the person's life is also considered in diagnosing. So when we start to look at a prolonged experience of someone having depressed feelings and they also have many expressions or symptoms most doctors and mental health professionals would start to consider a diagnosis of depression and to see if someone can be diagnosed.

Speaker 1:

There is something called the Diagnostic and Statistical Manual of Mental Disorders and we're on version number five. That's the DSM-5 for short, because that's quite a mouthful, and the DSM-5 is essentially the handbook that Western medical and mental health professionals use in order to diagnose, and it contains various criteria for all of the diagnoses that are currently considered active or valid. So this has evolved over time. Hence that's why we're on the fifth edition or the fifth version of the DSM. There have been diagnoses over time that have been added or taken out or changed over the years. The DSM also contains what are called diagnosis codes, and they're used for insurance purposes and insurance reimbursement. There are some codes that can be reimbursed by insurance and others that don't qualify. But more on the DSM another time.

Speaker 1:

For today I just want to point out that the DSM has a category of depressive disorders. There's also additional categories of mood disorders and things like that that are maybe related to depressive disorders, but basically a depressive disorder is characterized by emotional expressions of sadness and hopelessness and a loss of interest in activities that somebody previously found pleasurable. The diagnosis also includes the presence of physical expressions or symptoms like weight change or problematic sleep or symptoms like weight change or problematic sleep. There's also criteria that include unhelpful emotional and thought patterns, such as excessively feeling worthless or frequently thinking of oneself as a failure. There could be expressions that include diminished cognitive functioning, like the inability to concentrate, and also, possibly, for some people meeting the diagnostic criteria, there could be recurrent thoughts of suicide or death or a history of one or more suicide attempts. So that's the official diagnostic criteria and you don't have to meet every single symptom. Depression is not expressed the same exact way in everybody, but you have to meet every single symptom. Depression is not expressed the same exact way in everybody, but you have to meet several of those to meet the criteria for depression.

Speaker 1:

And when I talk about depression, when I'm talking about either people I work with certainly myself, definitely my husband as well I am referring to the depression that would meet the diagnostic criteria for either major depressive disorder or persistent depressive disorder, which is also known as dysthymia. So, in general, if you're looking for diagnostic terms, that's what I am referring to. However, I choose to not use the medicalized language of diagnosis and I want to say that if you are someone who chooses to use that language, that's totally okay. It's absolutely your choice and you get to choose the language that you feel comfortable using.

Speaker 1:

I have worked with many people who have found comfort or validation in having a diagnosis, they feel that they aren't crazy or they feel that they have something that's real, because it has a name. It's not just something that's in their heads. And for many years I've had especially teenagers come into my office in a first session, oftentimes and sit down in front of me and just say, hey, I have depression, and they're self-diagnosing because there is a lot of information out there on the diagnostic criteria. You can Google it, though I don't necessarily recommend that you do. When you start self-diagnosing, you can fall down a rabbit hole pretty quickly, but there is a lot of information out there and that can be positive, although it definitely has a downside. But there is a shift in our society where people are paying more attention to their emotions and their emotional states and how that's being expressed, and we're noticing more and more when things are off and when we're not feeling well, when we're not at our best, and that is positive.

Speaker 1:

Again, if this applies to you, or if you choose to use medicalized language or diagnostic language, if that's what makes sense to you, please know that I support you in using that language. I really recommend that people choose words that feel like a fit for them in regards to anything, and there's nothing different here. So my stance is that, while there can be a positive reason for using diagnostic language, I personally have found it to be oftentimes harmful or unhelpful, and so I choose not to use that kind of language, because it tends to pathologize mental health and so it places the fault in the individual, and the label can imply that what is happening to someone is unhealthy or that they're experiencing an abnormal reaction. And I hold a different view, which I will go into. The medical model also does not take into account cultural context, components and norms, and so it really is not an accurate representation for all, and it's not just not equally representative of all people, but it actually is often biased against certain people or certain groups of people.

Speaker 1:

And in addition to that, the medical model tends to use diagnosis as a way to determine treatment, of course, which is part of the purpose of diagnosis, and in Western medicine often, too often, in my opinion treatment means the prescribing of medication, and I'm not talking about medication in depth today, but just to put it out there. I'm not saying that I'm against medication. I absolutely think that there are some people who live with depression who really could benefit, or do benefit, from being on a prescription medication, either in the shorter term or in the longer term, even lifelong. But what I'm saying is that medication is not the only thing that helps depression or the only thing that improves someone's experience of depression, and I support using a wider scope of healing, and sometimes that just doesn't always fit within the medical model or it's not always accepted or acknowledged. So, lastly, I will mention that I've also had experience, both personally and professionally, where diagnoses can actually have an adverse effect, a negative effect on the person being diagnosed, because it could sometimes lead to feelings of helplessness and powerlessness in the case of someone feeling like, oh I have this diagnosis, there's this thing happening to me and I can't do anything about it. I'm powerless, I'm stuck. This is just something that I have to deal with, and it can sometimes support someone in feeling stuck. So I'm sure we can dive into this more deeply, but what I really want to share today is how I have come to understand depression and the language that I have used for many years.

Speaker 1:

The way that I describe depression is not necessarily by describing all of the different criteria, even though, like I said, the depression that I am talking about, that criteria is often met. But I simply say that depression is disconnection. It's a disconnection oftentimes from yourself, from your authentic self and from your feelings. It can be a disconnection from your joyful feelings, certainly, but also there could be a general numbness that comes along with depression. So it can be a real disconnection from the whole spectrum of your emotions. And there's often a disconnection from other people or activities that you did at one point care about or enjoy. And there's also a feeling of general disconnection from the larger world. It could be from spirit or a higher power, or it could also be a disconnection from nature or, you know, just not feeling like you're a part of something.

Speaker 1:

That feeling of isolation that comes so oftentimes with depression. And when I was a teenager it was so clear to me that there seemed that there was this barrier between me and the things that I intellectually knew in my brain mattered to me. But when I was in a depressive state there was just this block between me and them. I just felt this clear sense of disconnection and it was just the simplest way I could explain it. And it was a prominent feeling in my experience and I remember being probably about 15 or so and hanging out with a group of my friends, close friends. We had a good group of friends being at someone's house, standing outside on the front steps and feeling so disconnected and so separate from the group, even though I knew I liked them and cared about them, and I felt cared about and liked by them, and I would just walk away and walk down the street. I wouldn't say anything to anybody, I would just walk down the road to the corner, because being by myself didn't feel good but it felt better to some degree than being around people that I cared about, that I felt disconnected from, and so it was very clear to me that this disconnection was present and it would show up time and time again in my life. And, of course, from a relational perspective, I know, on the flip side, that when my husband is experiencing a depressive episode I know that he was hard for me to reach I could feel how disconnected he was, and of course the reverse is true when I was sitting with depression, he would also feel my disconnection. But it's very clear that you can have this experience of knowing you love someone or knowing that someone loves you, and in that moment that doesn't even feel like it's there anymore, like there's this total severing of that connection. It feels like a total severing of the connection anyhow, and so, as I mentioned earlier, I found this simple definition of depression is disconnection, and one of the things that I have found helpful about it is that there's sort of like this clue about what we need to do, because if depression is disconnection, then moving away from depression would be moving away from disconnection, which means moving towards connection. So how do we connect, particularly if there's this barrier, of course, is the real question. But knowing that that's part of the answer, so to speak. We want to move towards connection. Knowing that can really be very powerful because people can begin to find the answer in themselves.

Speaker 1:

And I remember being in graduate school when I was pretty severely depressed. I had an extreme feeling of disconnection while I was there, and I think in part it was because, when I went to graduate school, I was super excited to be in social work school and I thought I was going to connect with a lot of people. And I was in New York City, which I love the city, and I thought it was going to be this really connecting experience. And when I got there I found out that everyone was really busy and we would go to class and have a really good class experience, but then everyone would leave and go their separate ways and in my apartment I didn't even really know anybody in my building and I ended up having a pretty significant experience of being disconnected. And it ended up actually really being something very positive because it led me to meet my husband. But I will share that story another time. So stay tuned for how Ben and I met Ben's, my husband.

Speaker 1:

I don't know if I've mentioned his name yet, but when I was so severely depressed at that time it became very clear to me that one experience where I could safely move towards connection was with my cousin and his partner, and luckily they lived really close to me in the city and so I frequently went to their apartment and I would go there really depressed and they wouldn't ask me a lot of questions or certainly they would not pressure me at all. They just accepted me as I was in my probably rather mopey and unfun state and they would just put in a movie and they would make some brownies and we would just be together without pressure. And I started to really understand and value that, even when I felt so deeply disconnected, there were avenues towards something that felt like a safe connection. There were things I could access, and this really became key for me, and it's how I started to talk with people in my life and again, definitely people in my office and historically I've worked with a lot of depressed teenagers, because I myself was a very depressed teenager and it was a population that I really empathized with and could deeply validate their experience, and so I've worked with depressed teens for the entirety of my career and I also would talk to them.

Speaker 1:

In addition to the idea of depression is disconnection. I would talk to them about what I would call depression goggles, and so this is the idea that when you're looking at people or things, as I said before, that intellectually I knew in my head these are people that I love, these are my friends, these are people that I love, these are my friends, these are people that I care about. They're people that care about me, but when you have on your depression goggles, they look different. You question things about them. Do they really care about me? You don't feel the same level of connection to them a lot of the time.

Speaker 1:

So I started to realize pretty early on in my teenage life that there was a difference when I had the goggles on and when I didn't have the goggles on right. And so I started using that language in my office with the people I was working with because it just made sense. I didn't really know how to take off depression goggles for a long time. Even working with people in my office, I didn't always know how to tell them how to get the goggles off, but just that they were there was really important because I could start to separate and I could help the people I was working with start to separate.

Speaker 1:

Okay, this is a thought that's in my head and it's very negative, either about myself or about another person or about the world in general, and you might be feeling alone or worthless, feeling incapable. But if you could recognize I have on my depression goggles and eventually they'll be off. Right now, I really believe this very negative thought wholeheartedly, but I know that it's because it's attached to these goggles. I'm looking at the world through this perspective and it won't last and relationally again, being on the other side, when my husband had on his depression goggles, it was a very it is still, when it happens, a very difficult experience because it drastically changed how he saw me. So when he was depressed, it drastically changed how he saw me. So when he was depressed he saw me in a very different light. And it was very challenging to be on that side of somebody wearing the depression goggles. And of course, when I had mine on, you know, then we were both looking at each other, oftentimes in a very unhelpful way. But it really was clear to me that eventually depression goggles come off Again. But it really was clear to me that eventually depression goggles come off Again. A long time ago I didn't know how to actively loosen them, you know, or take them off. I have a lot more tools now to help with that. But over the years it just really helped me to know that that's what was happening, that it didn't mean that thoughts I was thinking were actually true. It's just that they were attached to these depression goggles that I was wearing, that what I knew would eventually come off, and sometimes it took months and months.

Speaker 1:

I mean, I have been through pretty long lasting depressive episodes. Most of my life I have been through pretty long lasting depressive episodes, and certainly my husband as well. And this is a little bit of a trigger warning. But I think it's important to say, because it was really helpful for me, immensely helpful for me, that I even took the idea of depression, goggles and connected it to thoughts of suicide. And so for me, I spent a lot of time having thoughts of suicide over my life. It did change when I had my son. It shifted a lot, the severity changed a lot after I had my son. But I knew that if I was having thoughts of suicide they were just because they were attached to the goggles. So if I had a thought in my head I would say, oh, I guess I'm depressed, and so it came to mean something different. And having you know, and so it came to mean something different, and having thoughts of suicide, thoughts of death, is certainly scary, and especially when you believe them. But I just didn't. I attached them to the goggles. I said, look, I know this thought is in my head but it's not mine. And it really helped me to navigate for, I don't know, a decade and a half or two decades probably, of dealing with suicidal thoughts. A significant amount of the time it didn't make my thoughts go away automatically, but it didn't make them worse, which is pretty significant. That's kind of the goal that I have learned. It's one of the big goals. You can't necessarily magically make depression go away quickly, but you do have a pretty good amount of power about not making it worse. Again, I will talk about that in great detail with you.

Speaker 1:

But this brings me to my third piece of how I understand depression, which has been really helpful for me, and so I have always called it the steps of depression. So hopefully this comes through via podcast here. You can't see it. I would draw this out for you if we were together in the room.

Speaker 1:

But if you can just simply imagine a set of 10 steps, and at the bottom step is the deepest, darkest, most hopeless, powerless depths of despair that someone can be in, and then at that very top step it's still depression, but it's kind of like the going through the motions, like sort of feeling numb, but still, you know, going to work or going to school, even going to social gatherings, right. So if you can imagine that, then there's a lot of steps in between. Right, depression has a lot of different colors. So you can also imagine it like the bottom step is black and then as you get up it turns into gray and maybe the very top first step. You're still in the grays, but maybe it's a light gray, right. And so I started to really understand these steps of depression. And that was so incredibly key.

Speaker 1:

Because if you are on the very bottom step and you do something that helps you get up one step, or even half a step up, you're feeling better than when you were in the absolute deepest, than when you were in the absolute deepest, darkest depression. But one step or a half a step up from your deepest possible depression is also still pretty terrible, right. And so this is how I think of it as depression feeding itself, because when you are depressed and you put in effort and it takes so much to just get a half a step up, and you're like, okay, I did something and I'm still feeling terrible, this failed, I'm a failure, this didn't work, it's not worth it. And then you go right back down. Of course, by the way, when you think those things, you fall right back into the deeper depths.

Speaker 1:

Right, this idea of like trying not to make depression worse, that's really kind of a high priority, but it's easy to make depression worse, especially when you're wearing depression goggles and everything seems pretty awful. So these ideas that depression is disconnection and then, therefore, wrapped up in that definition or understanding is the idea that the way that you deal with depression or the way that you move away from depression is by moving towards connection and how you figure out how to safely connect. And then if you realize that you're wearing depression goggles and you're going to think things when you're depressed and you're not going to question them because they're in your mind and so you're going to think that it's your absolute truth, but if you know that this is only my truth right now, it's not my authentic truth, it's not in alignment with my true self. I'm thinking this thought because I have on depression goggles and so it looks very real to me right now because I'm experiencing it in my head right, or I'm looking at the world right now through my eyes. But knowing these things, you start to have flexibility and if you know that you have on depression goggles, that can be a helpful tool in moving you up the step.

Speaker 1:

Because instead of believing your terrible thoughts, which keep you really deeply rooted, oftentimes in deep depression or, you know, keep you deeply stuck in depression, thinking things like I'm worthless and I'm undeserving of happiness, and you believe those things 100%. But if you can say, okay, I know that I'm just wearing depressed goggles, your depression will likely improve. If you can come to it with this idea of like, okay, these thoughts are not authentically mine and maybe you'll just move up from a step 10 to maybe 9.75. Maybe it's just a little tiny movement up, and again that can feel frustrating, to say the least. But to know, okay, I'm going in the right direction, right, I'm moving away from the deepest part to a higher step.

Speaker 1:

And then you can continue to think how do I connect? Or you can start to ask yourself what do I need? To feel safe enough to move a quarter step up or a half step up? How can I have compassion for myself if I slide down a little bit? Or if you notice like, oh wait, hey, like I'm actually on step seven, I didn't slide all the way down to a 10. That means I'm using some strategies here, that I didn't slide all the way down. So now you can start to have this experience. That is much more. I think it's much more valuable. It's been valuable to me, certainly. I think it's been valuable to the people that I've worked with.

Speaker 1:

I hope it's been of like the foundation of how I have come to view depression, and in the next episode I will be talking about how these three foundational concepts that have guided me through being able to successfully navigate my own depression how these three concepts actually I have started to learn over the last few years, as I've been learning more about polyvagal theory, which has been around for far longer than the last couple of years. I've been learning more about polyvagal theory, which has been around for far longer than the last couple of years, but somehow I have only come to it in the last couple of years. But I will talk about polyvagal theory in the next episode in greater detail, but just so you know for now, it's a theory that talks about how the autonomic nervous system, particularly the vagus nerve, which runs throughout our whole body, is connected to our emotional regulation, our social engagement and how we respond to emotional and physical threats, and so it essentially is an explanation about how our nervous system is deeply connected to our mental activity and therefore our mental health and our well-being. And there are components of the polyvagal theory which I would say give further explanation to the three foundational concepts that I have developed through my own experience with depression. These foundational concepts have been really healing for me and have provided me with opportunities to learn and grow and develop strategies that have been really effective for me, and adding the additional piece of being able to connect what's happening to my nervous system has helped me in a profound way, and I cannot wait to share it with you next time.

Speaker 1:

So thanks for showing up today.

Speaker 1:

As our time comes to a close, and as you continue to travel along on your own unique wellness journey, I leave you with an invitation to move from where you are today to where you want to be.

Speaker 1:

The path may seem long or daunting or unclear, and I want you to know that that is totally okay. You do not have to create the whole way all at once. My invitation to you today is to take a step, just one, any type, any size, in any direction. It can be an external step that you can be observed or measured, or it could be a step you visualize. Whatever makes sense to you. I invite you to take a step today because healing, growth, connection and joy is possible for everyone, including you, and even when depression is in your bed. If you connected with today's episode, please subscribe so you can be notified when each weekly episode gets released. I encourage you to leave a review. Your feedback will help guide future episodes and please share this podcast with anyone who you think may be interested or enjoy what I have to share. Until the next time we connect, take care of yourself and take a step.