February 19, 2025 • 29 mins
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.
Mark as Played
Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:02):
Hello and welcome to the One Depression is in your
Bed podcast.
We take a compassionate,judgment-free and
de-stigmatizing approach totalking about how depression
affects individuals andrelationships.
I'm Trish Sanders, your host,in addition to being a licensed
clinical social worker andcertified relationship therapist
.
Both my husband and I havelived with depression for most
(00:24):
of our lives.
Through my experiences, I havelearned 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 itall with you.
In today's episode.
I will begin by reviewing thesymptoms and criteria that
mental health and medicalprofessionals use when
(00:45):
diagnosing depression.
Then I will begin by reviewingthe symptoms and criteria that
mental health and medicalprofessionals use when
diagnosing depression.
Then I will move beyonddiagnosis to start developing an
understanding of the trueexperience of depression.
Through this understanding ofwhat depression really is, I
will begin to uncover cluesabout what strategies may be
helpful for improving andhealing through depression.
I'm very excited to move intothis deeper place of
(01:07):
understanding with you.
So let's get started.
I want to talk about thedefinition of depression.
First, how it is defined in theWestern medicine and mental
health world and, secondly, howI have come to define depression
and understand depressionthrough my own personal and
professional experiences.
(01:27):
I'm starting here because whenyou hear the word depression,
you may certainly have your owndefinition or understanding of
what that means, and there maybe 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 additionalperspectives that I want to
(01:47):
share, because I have found that, as I have come to see and
explain depression, both tomyself and in my relationship,
and even with people that I workwith in my office, I have found
my view of depression to bemore helpful than what is the
medicalized or diagnostic view,and so I wanted to share that
(02:10):
with you today.
So, to start off, I just wantto say that there are many life
experiences that anyone may gothrough at any point in our
lives in which they may have thefeeling of being depressed.
So a person may feel depressedin response to a loss of some
type.
That could be a death loss,like the death of a loved one,
(02:32):
or it could be a non-death loss,like a breakup.
Also, feeling depressed duringa difficult time in life is very
common A time of transition,perhaps, or a time when you
experience a significantdisappointment or something like
that.
So in these cases, having thefeeling of being depressed is
(02:54):
very understandable and it mayvery well not be considered a
diagnosable or clinicaldepression.
However, in those cases, aperson who has the feeling of
being depressed couldpotentially move to a place
where they're experiencing whatwould be thought of as
diagnosable depression.
What makes the differencebetween someone having the
(03:16):
feeling of being depressedversus being able to be
diagnosed with depression has todo primarily with how long
someone is experiencing thosefeelings, the duration of time,
as well as how many ways thedepressed feelings are being
expressed, which in medicalizedlanguage would be how many
(03:38):
symptoms the person isexperiencing and, of course, how
much negative impact theexpressions or symptoms are
having on the person's life isalso considered in diagnosing.
So when we start to look at aprolonged experience of someone
having depressed feelings andthey also have many expressions
or symptoms most doctors andmental health professionals
(04:00):
would start to consider adiagnosis of depression and to
see if someone can be diagnosed.
There is something called theDiagnostic and Statistical
Manual of Mental Disorders andwe're on version number five.
That's the DSM-5 for short,because that's quite a mouthful,
and the DSM-5 is essentiallythe handbook that Western
(04:25):
medical and mental healthprofessionals use in order to
diagnose, and it containsvarious criteria for all of the
diagnoses that are currentlyconsidered active or valid.
So this has evolved over time.
Hence that's why we're on thefifth edition or the fifth
version of the DSM.
There have been diagnoses overtime that have been added or
(04:48):
taken out or changed over theyears.
The DSM also contains what arecalled diagnosis codes, and
they're used for insurancepurposes and insurance
reimbursement.
There are some codes that canbe reimbursed by insurance and
others that don't qualify.
But more on the DSM anothertime.
For today I just want to pointout that the DSM has a category
(05:11):
of depressive disorders.
There's also additionalcategories of mood disorders and
things like that that are mayberelated to depressive disorders
, but basically a depressivedisorder is characterized by
emotional expressions of sadnessand hopelessness and a loss of
interest in activities thatsomebody previously found
(05:33):
pleasurable.
The diagnosis also includes thepresence of physical
expressions or symptoms likeweight change or problematic
sleep or symptoms like weightchange or problematic sleep.
There's also criteria thatinclude unhelpful emotional and
thought patterns, such asexcessively feeling worthless or
frequently thinking of oneselfas a failure.
(05:54):
There could be expressions thatinclude diminished cognitive
functioning, like the inabilityto concentrate, and also,
possibly, for some peoplemeeting the diagnostic criteria,
there could be recurrentthoughts of suicide or death or
a history of one or more suicideattempts.
(06:15):
So that's the officialdiagnostic criteria and you
don't have to meet every singlesymptom.
Depression is not expressed thesame exact way in everybody,
but you have to meet everysingle symptom.
Depression is not expressed thesame exact way in everybody,
but you have to meet several ofthose to meet the criteria for
depression.
And when I talk about depression, when I'm talking about either
people I work with certainlymyself, definitely my husband as
(06:36):
well I am referring to thedepression that would meet the
diagnostic criteria for eithermajor depressive disorder or
persistent depressive disorder,which is also known as dysthymia
.
So, in general, if you'relooking for diagnostic terms,
that's what I am referring to.
(06:57):
However, I choose to not usethe medicalized language of
diagnosis and I want to say thatif you are someone who chooses
to use that language, that'stotally okay.
It's absolutely your choice andyou get to choose the language
that you feel comfortable using.
I have worked with many peoplewho have found comfort or
(07:17):
validation in having a diagnosis, they feel that they aren't
crazy or they feel that theyhave something that's real,
because it has a name.
It's not just something that'sin their heads.
And for many years I've hadespecially teenagers come into
my office in a first session,oftentimes and sit down in front
of me and just say, hey, I havedepression, and they're
(07:38):
self-diagnosing because there isa lot of information out there
on the diagnostic criteria.
You can Google it, though Idon't necessarily recommend that
you do.
When you start self-diagnosing,you can fall down a rabbit hole
pretty quickly, but there is alot of information out there and
that can be positive, althoughit definitely has a downside.
But there is a shift in oursociety where people are paying
(08:01):
more attention to their emotionsand their emotional states and
how that's being expressed, andwe're noticing more and more
when things are off and whenwe're not feeling well, when
we're not at our best, and thatis positive.
Again, if this applies to you,or if you choose to use
medicalized language ordiagnostic language, if that's
what makes sense to you, pleaseknow that I support you in using
(08:23):
that language.
I really recommend that peoplechoose words that feel like a
fit for them in regards toanything, and there's nothing
different here.
So my stance is that, whilethere can be a positive reason
for using diagnostic language, Ipersonally have found it to be
oftentimes harmful or unhelpful,and so I choose not to use that
(08:44):
kind of language, because ittends to pathologize mental
health and so it places thefault in the individual, and the
label can imply that what ishappening to someone is
unhealthy or that they'reexperiencing an abnormal
reaction.
And I hold a different view,which I will go into.
The medical model also does nottake into account cultural
(09:07):
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 orcertain groups of people.
And in addition to that, themedical model tends to use
diagnosis as a way to determinetreatment, of course, which is
(09:29):
part of the purpose of diagnosis, and in Western medicine often,
too often, in my opiniontreatment means the prescribing
of medication, and I'm nottalking about medication in
depth today, but just to put itout there.
I'm not saying that I'm againstmedication.
I absolutely think that thereare some people who live with
depression who really couldbenefit, or do benefit, from
(09:53):
being on a prescriptionmedication, either in the
shorter term or in the longerterm, even lifelong.
But what I'm saying is thatmedication is not the only thing
that helps depression or theonly thing that improves
someone's experience ofdepression, and I support using
a wider scope of healing, andsometimes that just doesn't
(10:14):
always fit within the medicalmodel or it's not always
accepted or acknowledged.
So, lastly, I will mention thatI've also had experience, both
personally and professionally,where diagnoses can actually
have an adverse effect, anegative effect on the person
being diagnosed, because itcould sometimes lead to feelings
(10:36):
of helplessness andpowerlessness in the case of
someone feeling like, oh I havethis diagnosis, there's this
thing happening to me and Ican't do anything about it.
I'm powerless, I'm stuck.
This is just something that Ihave to deal with, and it can
sometimes support someone infeeling stuck.
So I'm sure we can dive intothis more deeply, but what I
(10:59):
really want to share today ishow I have come to understand
depression and the language thatI have used for many years.
The way that I describedepression is not necessarily by
describing all of the differentcriteria, even though, like I
said, the depression that I amtalking about, that criteria is
often met.
But I simply say thatdepression is disconnection.
(11:20):
It's a disconnection oftentimesfrom yourself, from your
authentic self and from yourfeelings.
It can be a disconnection fromyour joyful feelings, certainly,
but also there could be ageneral numbness that comes
along with depression.
So it can be a realdisconnection from the whole
spectrum of your emotions.
And there's often adisconnection from other people
(11:44):
or activities that you did atone point care about or enjoy.
And there's also a feeling ofgeneral disconnection from the
larger world.
It could be from spirit or ahigher power, or it could also
be a disconnection from natureor, you know, just not feeling
like you're a part of something.
(12:05):
That feeling of isolation thatcomes so oftentimes with
depression.
And when I was a teenager itwas so clear to me that there
seemed that there was thisbarrier between me and the
things that I intellectuallyknew in my brain mattered to me.
But when I was in a depressivestate there was just this block
(12:27):
between me and them.
I just felt this clear sense ofdisconnection and it was just
the simplest way I could explainit.
And it was a prominent feelingin my experience and I remember
being probably about 15 or soand hanging out with a group of
my friends, close friends.
We had a good group of friendsbeing at someone's house,
(12:48):
standing outside on the frontsteps and feeling so
disconnected and so separatefrom the group, even though I
knew I liked them and caredabout them, and I felt cared
about and liked by them, and Iwould just walk away and walk
down the street.
I wouldn't say anything toanybody, I would just walk down
the road to the corner, becausebeing by myself didn't feel good
(13:11):
but it felt better to somedegree than being around people
that I cared about, that I feltdisconnected from, and so it was
very clear to me that thisdisconnection was present and it
would show up time and timeagain in my life.
And, of course, from arelational perspective, I know,
(13:32):
on the flip side, that when myhusband is experiencing a
depressive episode I know thathe was hard for me to reach I
could feel how disconnected hewas, and of course the reverse
is true when I was sitting withdepression, he would also feel
my disconnection.
But it's very clear that youcan have this experience of
(13:53):
knowing you love someone orknowing that someone loves you,
and in that moment that doesn'teven feel like it's there
anymore, like there's this totalsevering of that connection.
It feels like a total severingof the connection anyhow, and so
, as I mentioned earlier, Ifound this simple definition of
depression is disconnection, andone of the things that I have
(14:15):
found helpful about it is thatthere's sort of like this clue
about what we need to do,because if depression is
disconnection, then moving awayfrom depression would be moving
away from disconnection, whichmeans moving towards connection.
So how do we connect,particularly if there's this
barrier, of course, is the realquestion.
(14:35):
But knowing that that's part ofthe answer, so to speak.
We want to move towardsconnection.
Knowing that can really be verypowerful because people can
begin to find the answer inthemselves.
And I remember being in graduateschool when I was pretty
severely depressed.
I had an extreme feeling ofdisconnection while I was there,
(14:56):
and I think in part it wasbecause, when I went to graduate
school, I was super excited tobe in social work school and I
thought I was going to connectwith a lot of people.
And I was in New York City,which I love the city, and I
thought it was going to be thisreally connecting experience.
And when I got there I foundout that everyone was really
busy and we would go to classand have a really good class
(15:18):
experience, but then everyonewould leave and go their
separate ways and in myapartment I didn't even really
know anybody in my building andI ended up having a pretty
significant experience of beingdisconnected.
And it ended up actually reallybeing something very positive
because it led me to meet myhusband.
But I will share that storyanother time.
(15:38):
So stay tuned for how Ben and Imet Ben's, my husband.
I don't know if I've mentionedhis name yet, but when I was so
severely depressed at that timeit became very clear to me that
one experience where I couldsafely move towards connection
was with my cousin and hispartner, and luckily they lived
really close to me in the cityand so I frequently went to
(16:00):
their apartment and I would gothere really depressed and they
wouldn't ask me a lot ofquestions or certainly they
would not pressure me at all.
They just accepted me as I wasin my probably rather mopey and
unfun state and they would justput in a movie and they would
make some brownies and we wouldjust be together without
(16:25):
pressure.
And I started to reallyunderstand and value that, even
when I felt so deeplydisconnected, there were avenues
towards something that feltlike a safe connection.
There were things I couldaccess, and this really became
key for me, and it's how Istarted to talk with people in
(16:46):
my life and again, definitelypeople in my office and
historically I've worked with alot of depressed teenagers,
because I myself was a verydepressed teenager and it was a
population that I reallyempathized with and could deeply
validate their experience, andso I've worked with depressed
teens for the entirety of mycareer and I also would talk to
(17:08):
them.
In addition to the idea ofdepression is disconnection.
I would talk to them about whatI would call depression goggles
, and so this is the idea thatwhen you're looking at people or
things, as I said before, thatintellectually I knew in my head
these are people that I love,these are my friends, these are
people that I love, these are myfriends, these are people that
I care about.
They're people that care aboutme, but when you have on your
(17:30):
depression goggles, they lookdifferent.
You question things about them.
Do they really care about me?
You don't feel the same levelof connection to them a lot of
the time.
So I started to realize prettyearly on in my teenage life that
there was a difference when Ihad the goggles on and when I
(17:50):
didn't have the goggles on right.
And so I started using thatlanguage in my office with the
people I was working withbecause it just made sense.
I didn't really know how totake off depression goggles for
a long time.
Even working with people in myoffice, I didn't always know how
to tell them how to get thegoggles off, but just that they
(18:11):
were there was really importantbecause I could start to
separate and I could help thepeople I was working with start
to separate.
Okay, this is a thought that'sin my head and it's very
negative, either about myself orabout another person or about
the world in general, and youmight be feeling alone or
worthless, feeling incapable.
(18:33):
But if you could recognize Ihave on my depression goggles
and eventually they'll be off.
Right now, I really believethis very negative thought
wholeheartedly, but I know thatit's because it's attached to
these goggles.
I'm looking at the worldthrough this perspective and it
won't last and relationallyagain, being on the other side,
when my husband had on hisdepression goggles, it was a
(18:56):
very it is still, when ithappens, a very difficult
experience because itdrastically changed how he saw
me.
So when he was depressed, itdrastically changed how he saw
me.
So when he was depressed he sawme in a very different light.
And it was very challenging tobe on that side of somebody
wearing the depression goggles.
And of course, when I had mineon, you know, then we were both
(19:17):
looking at each other,oftentimes in a very unhelpful
way.
But it really was clear to methat eventually depression
goggles come off Again.
But it really was clear to methat eventually depression
goggles come off Again.
A long time ago I didn't knowhow to actively loosen them, you
know, or take them off.
I have a lot more tools now tohelp with that.
But over the years it justreally helped me to know that
(19:38):
that's what was happening, thatit didn't mean that thoughts I
was thinking were actually true.
It's just that they wereattached to these depression
goggles that I was wearing, thatwhat I knew would eventually
come off, and sometimes it tookmonths and months.
I mean, I have been throughpretty long lasting depressive
episodes.
Most of my life I have beenthrough pretty long lasting
(20:00):
depressive episodes, andcertainly my husband as well.
And this is a little bit of atrigger warning.
But I think it's important tosay, because it was really
helpful for me, immenselyhelpful for me, that I even took
the idea of depression, gogglesand connected it to thoughts of
suicide.
And so for me, I spent a lot oftime having thoughts of suicide
(20:22):
over my life.
It did change when I had my son.
It shifted a lot, the severitychanged a lot after I had my son
.
But I knew that if I was havingthoughts of suicide they were
just because they were attachedto the goggles.
So if I had a thought in myhead I would say, oh, I guess
I'm depressed, and so it came tomean something different.
(20:43):
And having you know, and so itcame to mean something different
, and having thoughts of suicide, thoughts of death, is
certainly scary, and especiallywhen you believe them.
But I just didn't.
I attached them to the goggles.
I said, look, I know thisthought is in my head but it's
not mine.
And it really helped me tonavigate for, I don't know, a
decade and a half or two decadesprobably, of dealing with
(21:05):
suicidal thoughts.
A significant amount of thetime it didn't make my thoughts
go away automatically, but itdidn't make them worse, which is
pretty significant.
That's kind of the goal that Ihave learned.
It's one of the big goals.
You can't necessarily magicallymake depression go away quickly
, but you do have a pretty goodamount of power about not making
(21:26):
it worse.
Again, I will talk about thatin great detail with you.
But this brings me to my thirdpiece of how I understand
depression, which has beenreally helpful for me, and so I
have always called it the stepsof depression.
So hopefully this comes throughvia podcast here.
(21:49):
You can't see it.
I would draw this out for youif we were together in the room.
But if you can just simplyimagine a set of 10 steps, and
at the bottom step is thedeepest, darkest, most hopeless,
powerless depths of despairthat someone can be in, and then
at that very top step it'sstill depression, but it's kind
of like the going through themotions, like sort of feeling
(22:12):
numb, but still, you know, goingto 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 ofdifferent colors.
So you can also imagine it likethe bottom step is black and
then as you get up it turns intogray and maybe the very top
(22:33):
first step.
You're still in the grays, butmaybe it's a light gray, right.
And so I started to reallyunderstand these steps of
depression.
And that was so incredibly key.
Because if you are on the verybottom step and you do something
that helps you get up one step,or even half a step up, you're
feeling better than when youwere in the absolute deepest,
(22:55):
than when you were in theabsolute deepest, darkest
depression.
But one step or a half a stepup from your deepest possible
depression is also still prettyterrible, right.
And so this is how I think ofit as depression feeding itself,
because when you are depressedand you put in effort and it
takes so much to just get a halfa step up, and you're like,
(23:17):
okay, I did something and I'mstill feeling terrible, this
failed, I'm a failure, thisdidn't work, it's not worth it.
And then you go right back down.
Of course, by the way, when youthink those things, you fall
right back into the deeperdepths.
Right, this idea of like tryingnot to make depression worse,
that's really kind of a highpriority, but it's easy to make
depression worse, especiallywhen you're wearing depression
(23:37):
goggles and everything seemspretty awful.
So these ideas that depressionis disconnection and then,
therefore, wrapped up in thatdefinition or understanding is
the idea that the way that youdeal with depression or the way
that you move away fromdepression is by moving towards
connection and how you figureout how to safely connect.
(23:59):
And then if you realize thatyou're wearing depression
goggles and you're going tothink things when you're
depressed and you're not goingto question them because they're
in your mind and so you'regoing to think that it's your
absolute truth, but if you knowthat this is only my truth right
now, it's not my authentictruth, it's not in alignment
with my true self.
(24:20):
I'm thinking this thoughtbecause I have on depression
goggles and so it looks veryreal to me right now because I'm
experiencing it in my headright, or I'm looking at the
world right now through my eyes.
But knowing these things, youstart to have flexibility and if
you know that you have ondepression goggles, that can be
a helpful tool in moving you upthe step.
Because instead of believingyour terrible thoughts, which
(24:43):
keep you really deeply rooted,oftentimes in deep depression or
, you know, keep you deeplystuck in depression, thinking
things like I'm worthless andI'm undeserving of happiness,
and you believe those things100%.
But if you can say, okay, Iknow that I'm just wearing
depressed goggles, yourdepression will likely improve.
(25:05):
If you can come to it with thisidea of like, okay, these
thoughts are not authenticallymine and maybe you'll just move
up from a step 10 to maybe 9.75.
Maybe it's just a little tinymovement up, and again that can
feel frustrating, to say theleast.
But to know, okay, I'm going inthe right direction, right, I'm
moving away from the deepestpart to a higher step.
(25:28):
And then you can continue tothink how do I connect?
Or you can start to askyourself what do I need?
To feel safe enough to move aquarter step up or a half step
up?
How can I have compassion formyself 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 theway down to a 10.
That means I'm using somestrategies here, that I didn't
(25:51):
slide all the way down.
So now you can start to havethis 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 tothe people that I've worked with
.
I hope it's been of like thefoundation of how I have come to
view depression, and in thenext episode I will be talking
(26:19):
about how these threefoundational concepts that have
guided me through being able tosuccessfully navigate my own
depression how these threeconcepts actually I have started
to learn over the last fewyears, as I've been learning
more about polyvagal theory,which has been around for far
longer than the last couple ofyears.
I've been learning more aboutpolyvagal theory, which has been
around for far longer than thelast couple of years, but
somehow I have only come to itin the last couple of years.
(26:41):
But I will talk about polyvagaltheory in the next episode in
greater detail, but just so youknow for now, it's a theory that
talks about how the autonomicnervous system, particularly the
vagus nerve, which runsthroughout our whole body, is
connected to our emotionalregulation, our social
engagement and how we respond toemotional and physical threats,
(27:03):
and so it essentially is anexplanation about how our
nervous system is deeplyconnected to our mental activity
and therefore our mental healthand our well-being.
And there are components of thepolyvagal theory which I would
say give further explanation tothe three foundational concepts
(27:24):
that I have developed through myown experience with depression.
These foundational conceptshave been really healing for me
and have provided me withopportunities to learn and grow
and develop strategies that havebeen really effective for me,
and adding the additional pieceof being able to connect what's
happening to my nervous systemhas helped me in a profound way,
(27:47):
and I cannot wait to share itwith you next time.
So thanks for showing up today.
As our time comes to a close,and as you continue to travel
along on your own uniquewellness journey, I leave you
with an invitation to move fromwhere you are today to where you
want to be.
The path may seem long ordaunting or unclear, and I want
(28:10):
you to know that that is totallyokay.
You do not have to create thewhole way all at once.
My invitation to you today isto take a step, just one, any
type, any size, in any direction.
It can be an external step thatyou can be observed or measured
(28:30):
, or it could be a step youvisualize.
Whatever makes sense to you.
I invite you to take a steptoday because healing, growth,
connection and joy is possiblefor everyone, including you, and
even when depression is in yourbed.
If you connected with today'sepisode, please subscribe so you
(28:51):
can be notified when eachweekly episode gets released.
I encourage you to leave areview.
Your feedback will help guidefuture episodes and please share
this podcast with anyone whoyou 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.
Hello and welcome to the One Depression is in your
Bed podcast.
We take a compassionate,judgment-free and
de-stigmatizing approach totalking about how depression
affects individuals andrelationships.
I'm Trish Sanders, your host,in addition to being a licensed
clinical social worker andcertified relationship therapist
.
Both my husband and I havelived with depression for most
(00:24):
of our lives.
Through my experiences, I havelearned 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 itall with you.
In today's episode.
I will begin by reviewing thesymptoms and criteria that
mental health and medicalprofessionals use when
(00:45):
diagnosing depression.
Then I will begin by reviewingthe symptoms and criteria that
mental health and medicalprofessionals use when
diagnosing depression.
Then I will move beyonddiagnosis to start developing an
understanding of the trueexperience of depression.
Through this understanding ofwhat depression really is, I
will begin to uncover cluesabout what strategies may be
helpful for improving andhealing through depression.
I'm very excited to move intothis deeper place of
(01:07):
understanding with you.
So let's get started.
I want to talk about thedefinition of depression.
First, how it is defined in theWestern medicine and mental
health world and, secondly, howI have come to define depression
and understand depressionthrough my own personal and
professional experiences.
(01:27):
I'm starting here because whenyou hear the word depression,
you may certainly have your owndefinition or understanding of
what that means, and there maybe 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 additionalperspectives that I want to
(01:47):
share, because I have found that, as I have come to see and
explain depression, both tomyself and in my relationship,
and even with people that I workwith in my office, I have found
my view of depression to bemore helpful than what is the
medicalized or diagnostic view,and so I wanted to share that
(02:10):
with you today.
So, to start off, I just wantto say that there are many life
experiences that anyone may gothrough at any point in our
lives in which they may have thefeeling of being depressed.
So a person may feel depressedin response to a loss of some
type.
That could be a death loss,like the death of a loved one,
(02:32):
or it could be a non-death loss,like a breakup.
Also, feeling depressed duringa difficult time in life is very
common A time of transition,perhaps, or a time when you
experience a significantdisappointment or something like
that.
So in these cases, having thefeeling of being depressed is
(02:54):
very understandable and it mayvery well not be considered a
diagnosable or clinicaldepression.
However, in those cases, aperson who has the feeling of
being depressed couldpotentially move to a place
where they're experiencing whatwould be thought of as
diagnosable depression.
What makes the differencebetween someone having the
(03:16):
feeling of being depressedversus being able to be
diagnosed with depression has todo primarily with how long
someone is experiencing thosefeelings, the duration of time,
as well as how many ways thedepressed feelings are being
expressed, which in medicalizedlanguage would be how many
(03:38):
symptoms the person isexperiencing and, of course, how
much negative impact theexpressions or symptoms are
having on the person's life isalso considered in diagnosing.
So when we start to look at aprolonged experience of someone
having depressed feelings andthey also have many expressions
or symptoms most doctors andmental health professionals
(04:00):
would start to consider adiagnosis of depression and to
see if someone can be diagnosed.
There is something called theDiagnostic and Statistical
Manual of Mental Disorders andwe're on version number five.
That's the DSM-5 for short,because that's quite a mouthful,
and the DSM-5 is essentiallythe handbook that Western
(04:25):
medical and mental healthprofessionals use in order to
diagnose, and it containsvarious criteria for all of the
diagnoses that are currentlyconsidered active or valid.
So this has evolved over time.
Hence that's why we're on thefifth edition or the fifth
version of the DSM.
There have been diagnoses overtime that have been added or
(04:48):
taken out or changed over theyears.
The DSM also contains what arecalled diagnosis codes, and
they're used for insurancepurposes and insurance
reimbursement.
There are some codes that canbe reimbursed by insurance and
others that don't qualify.
But more on the DSM anothertime.
For today I just want to pointout that the DSM has a category
(05:11):
of depressive disorders.
There's also additionalcategories of mood disorders and
things like that that are mayberelated to depressive disorders
, but basically a depressivedisorder is characterized by
emotional expressions of sadnessand hopelessness and a loss of
interest in activities thatsomebody previously found
(05:33):
pleasurable.
The diagnosis also includes thepresence of physical
expressions or symptoms likeweight change or problematic
sleep or symptoms like weightchange or problematic sleep.
There's also criteria thatinclude unhelpful emotional and
thought patterns, such asexcessively feeling worthless or
frequently thinking of oneselfas a failure.
(05:54):
There could be expressions thatinclude diminished cognitive
functioning, like the inabilityto concentrate, and also,
possibly, for some peoplemeeting the diagnostic criteria,
there could be recurrentthoughts of suicide or death or
a history of one or more suicideattempts.
(06:15):
So that's the officialdiagnostic criteria and you
don't have to meet every singlesymptom.
Depression is not expressed thesame exact way in everybody,
but you have to meet everysingle symptom.
Depression is not expressed thesame exact way in everybody,
but you have to meet several ofthose to meet the criteria for
depression.
And when I talk about depression, when I'm talking about either
people I work with certainlymyself, definitely my husband as
(06:36):
well I am referring to thedepression that would meet the
diagnostic criteria for eithermajor depressive disorder or
persistent depressive disorder,which is also known as dysthymia
.
So, in general, if you'relooking for diagnostic terms,
that's what I am referring to.
(06:57):
However, I choose to not usethe medicalized language of
diagnosis and I want to say thatif you are someone who chooses
to use that language, that'stotally okay.
It's absolutely your choice andyou get to choose the language
that you feel comfortable using.
I have worked with many peoplewho have found comfort or
(07:17):
validation in having a diagnosis, they feel that they aren't
crazy or they feel that theyhave something that's real,
because it has a name.
It's not just something that'sin their heads.
And for many years I've hadespecially teenagers come into
my office in a first session,oftentimes and sit down in front
of me and just say, hey, I havedepression, and they're
(07:38):
self-diagnosing because there isa lot of information out there
on the diagnostic criteria.
You can Google it, though Idon't necessarily recommend that
you do.
When you start self-diagnosing,you can fall down a rabbit hole
pretty quickly, but there is alot of information out there and
that can be positive, althoughit definitely has a downside.
But there is a shift in oursociety where people are paying
(08:01):
more attention to their emotionsand their emotional states and
how that's being expressed, andwe're noticing more and more
when things are off and whenwe're not feeling well, when
we're not at our best, and thatis positive.
Again, if this applies to you,or if you choose to use
medicalized language ordiagnostic language, if that's
what makes sense to you, pleaseknow that I support you in using
(08:23):
that language.
I really recommend that peoplechoose words that feel like a
fit for them in regards toanything, and there's nothing
different here.
So my stance is that, whilethere can be a positive reason
for using diagnostic language, Ipersonally have found it to be
oftentimes harmful or unhelpful,and so I choose not to use that
(08:44):
kind of language, because ittends to pathologize mental
health and so it places thefault in the individual, and the
label can imply that what ishappening to someone is
unhealthy or that they'reexperiencing an abnormal
reaction.
And I hold a different view,which I will go into.
The medical model also does nottake into account cultural
(09:07):
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 orcertain groups of people.
And in addition to that, themedical model tends to use
diagnosis as a way to determinetreatment, of course, which is
(09:29):
part of the purpose of diagnosis, and in Western medicine often,
too often, in my opiniontreatment means the prescribing
of medication, and I'm nottalking about medication in
depth today, but just to put itout there.
I'm not saying that I'm againstmedication.
I absolutely think that thereare some people who live with
depression who really couldbenefit, or do benefit, from
(09:53):
being on a prescriptionmedication, either in the
shorter term or in the longerterm, even lifelong.
But what I'm saying is thatmedication is not the only thing
that helps depression or theonly thing that improves
someone's experience ofdepression, and I support using
a wider scope of healing, andsometimes that just doesn't
(10:14):
always fit within the medicalmodel or it's not always
accepted or acknowledged.
So, lastly, I will mention thatI've also had experience, both
personally and professionally,where diagnoses can actually
have an adverse effect, anegative effect on the person
being diagnosed, because itcould sometimes lead to feelings
(10:36):
of helplessness andpowerlessness in the case of
someone feeling like, oh I havethis diagnosis, there's this
thing happening to me and Ican't do anything about it.
I'm powerless, I'm stuck.
This is just something that Ihave to deal with, and it can
sometimes support someone infeeling stuck.
So I'm sure we can dive intothis more deeply, but what I
(10:59):
really want to share today ishow I have come to understand
depression and the language thatI have used for many years.
The way that I describedepression is not necessarily by
describing all of the differentcriteria, even though, like I
said, the depression that I amtalking about, that criteria is
often met.
But I simply say thatdepression is disconnection.
(11:20):
It's a disconnection oftentimesfrom yourself, from your
authentic self and from yourfeelings.
It can be a disconnection fromyour joyful feelings, certainly,
but also there could be ageneral numbness that comes
along with depression.
So it can be a realdisconnection from the whole
spectrum of your emotions.
And there's often adisconnection from other people
(11:44):
or activities that you did atone point care about or enjoy.
And there's also a feeling ofgeneral disconnection from the
larger world.
It could be from spirit or ahigher power, or it could also
be a disconnection from natureor, you know, just not feeling
like you're a part of something.
(12:05):
That feeling of isolation thatcomes so oftentimes with
depression.
And when I was a teenager itwas so clear to me that there
seemed that there was thisbarrier between me and the
things that I intellectuallyknew in my brain mattered to me.
But when I was in a depressivestate there was just this block
(12:27):
between me and them.
I just felt this clear sense ofdisconnection and it was just
the simplest way I could explainit.
And it was a prominent feelingin my experience and I remember
being probably about 15 or soand hanging out with a group of
my friends, close friends.
We had a good group of friendsbeing at someone's house,
(12:48):
standing outside on the frontsteps and feeling so
disconnected and so separatefrom the group, even though I
knew I liked them and caredabout them, and I felt cared
about and liked by them, and Iwould just walk away and walk
down the street.
I wouldn't say anything toanybody, I would just walk down
the road to the corner, becausebeing by myself didn't feel good
(13:11):
but it felt better to somedegree than being around people
that I cared about, that I feltdisconnected from, and so it was
very clear to me that thisdisconnection was present and it
would show up time and timeagain in my life.
And, of course, from arelational perspective, I know,
(13:32):
on the flip side, that when myhusband is experiencing a
depressive episode I know thathe was hard for me to reach I
could feel how disconnected hewas, and of course the reverse
is true when I was sitting withdepression, he would also feel
my disconnection.
But it's very clear that youcan have this experience of
(13:53):
knowing you love someone orknowing that someone loves you,
and in that moment that doesn'teven feel like it's there
anymore, like there's this totalsevering of that connection.
It feels like a total severingof the connection anyhow, and so
, as I mentioned earlier, Ifound this simple definition of
depression is disconnection, andone of the things that I have
(14:15):
found helpful about it is thatthere's sort of like this clue
about what we need to do,because if depression is
disconnection, then moving awayfrom depression would be moving
away from disconnection, whichmeans moving towards connection.
So how do we connect,particularly if there's this
barrier, of course, is the realquestion.
(14:35):
But knowing that that's part ofthe answer, so to speak.
We want to move towardsconnection.
Knowing that can really be verypowerful because people can
begin to find the answer inthemselves.
And I remember being in graduateschool when I was pretty
severely depressed.
I had an extreme feeling ofdisconnection while I was there,
(14:56):
and I think in part it wasbecause, when I went to graduate
school, I was super excited tobe in social work school and I
thought I was going to connectwith a lot of people.
And I was in New York City,which I love the city, and I
thought it was going to be thisreally connecting experience.
And when I got there I foundout that everyone was really
busy and we would go to classand have a really good class
(15:18):
experience, but then everyonewould leave and go their
separate ways and in myapartment I didn't even really
know anybody in my building andI ended up having a pretty
significant experience of beingdisconnected.
And it ended up actually reallybeing something very positive
because it led me to meet myhusband.
But I will share that storyanother time.
(15:38):
So stay tuned for how Ben and Imet Ben's, my husband.
I don't know if I've mentionedhis name yet, but when I was so
severely depressed at that timeit became very clear to me that
one experience where I couldsafely move towards connection
was with my cousin and hispartner, and luckily they lived
really close to me in the cityand so I frequently went to
(16:00):
their apartment and I would gothere really depressed and they
wouldn't ask me a lot ofquestions or certainly they
would not pressure me at all.
They just accepted me as I wasin my probably rather mopey and
unfun state and they would justput in a movie and they would
make some brownies and we wouldjust be together without
(16:25):
pressure.
And I started to reallyunderstand and value that, even
when I felt so deeplydisconnected, there were avenues
towards something that feltlike a safe connection.
There were things I couldaccess, and this really became
key for me, and it's how Istarted to talk with people in
(16:46):
my life and again, definitelypeople in my office and
historically I've worked with alot of depressed teenagers,
because I myself was a verydepressed teenager and it was a
population that I reallyempathized with and could deeply
validate their experience, andso I've worked with depressed
teens for the entirety of mycareer and I also would talk to
(17:08):
them.
In addition to the idea ofdepression is disconnection.
I would talk to them about whatI would call depression goggles
, and so this is the idea thatwhen you're looking at people or
things, as I said before, thatintellectually I knew in my head
these are people that I love,these are my friends, these are
people that I love, these are myfriends, these are people that
I care about.
They're people that care aboutme, but when you have on your
(17:30):
depression goggles, they lookdifferent.
You question things about them.
Do they really care about me?
You don't feel the same levelof connection to them a lot of
the time.
So I started to realize prettyearly on in my teenage life that
there was a difference when Ihad the goggles on and when I
(17:50):
didn't have the goggles on right.
And so I started using thatlanguage in my office with the
people I was working withbecause it just made sense.
I didn't really know how totake off depression goggles for
a long time.
Even working with people in myoffice, I didn't always know how
to tell them how to get thegoggles off, but just that they
(18:11):
were there was really importantbecause I could start to
separate and I could help thepeople I was working with start
to separate.
Okay, this is a thought that'sin my head and it's very
negative, either about myself orabout another person or about
the world in general, and youmight be feeling alone or
worthless, feeling incapable.
(18:33):
But if you could recognize Ihave on my depression goggles
and eventually they'll be off.
Right now, I really believethis very negative thought
wholeheartedly, but I know thatit's because it's attached to
these goggles.
I'm looking at the worldthrough this perspective and it
won't last and relationallyagain, being on the other side,
when my husband had on hisdepression goggles, it was a
(18:56):
very it is still, when ithappens, a very difficult
experience because itdrastically changed how he saw
me.
So when he was depressed, itdrastically changed how he saw
me.
So when he was depressed he sawme in a very different light.
And it was very challenging tobe on that side of somebody
wearing the depression goggles.
And of course, when I had mineon, you know, then we were both
(19:17):
looking at each other,oftentimes in a very unhelpful
way.
But it really was clear to methat eventually depression
goggles come off Again.
But it really was clear to methat eventually depression
goggles come off Again.
A long time ago I didn't knowhow to actively loosen them, you
know, or take them off.
I have a lot more tools now tohelp with that.
But over the years it justreally helped me to know that
(19:38):
that's what was happening, thatit didn't mean that thoughts I
was thinking were actually true.
It's just that they wereattached to these depression
goggles that I was wearing, thatwhat I knew would eventually
come off, and sometimes it tookmonths and months.
I mean, I have been throughpretty long lasting depressive
episodes.
Most of my life I have beenthrough pretty long lasting
(20:00):
depressive episodes, andcertainly my husband as well.
And this is a little bit of atrigger warning.
But I think it's important tosay, because it was really
helpful for me, immenselyhelpful for me, that I even took
the idea of depression, gogglesand connected it to thoughts of
suicide.
And so for me, I spent a lot oftime having thoughts of suicide
(20:22):
over my life.
It did change when I had my son.
It shifted a lot, the severitychanged a lot after I had my son
.
But I knew that if I was havingthoughts of suicide they were
just because they were attachedto the goggles.
So if I had a thought in myhead I would say, oh, I guess
I'm depressed, and so it came tomean something different.
(20:43):
And having you know, and so itcame to mean something different
, and having thoughts of suicide, thoughts of death, is
certainly scary, and especiallywhen you believe them.
But I just didn't.
I attached them to the goggles.
I said, look, I know thisthought is in my head but it's
not mine.
And it really helped me tonavigate for, I don't know, a
decade and a half or two decadesprobably, of dealing with
(21:05):
suicidal thoughts.
A significant amount of thetime it didn't make my thoughts
go away automatically, but itdidn't make them worse, which is
pretty significant.
That's kind of the goal that Ihave learned.
It's one of the big goals.
You can't necessarily magicallymake depression go away quickly
, but you do have a pretty goodamount of power about not making
(21:26):
it worse.
Again, I will talk about thatin great detail with you.
But this brings me to my thirdpiece of how I understand
depression, which has beenreally helpful for me, and so I
have always called it the stepsof depression.
So hopefully this comes throughvia podcast here.
(21:49):
You can't see it.
I would draw this out for youif we were together in the room.
But if you can just simplyimagine a set of 10 steps, and
at the bottom step is thedeepest, darkest, most hopeless,
powerless depths of despairthat someone can be in, and then
at that very top step it'sstill depression, but it's kind
of like the going through themotions, like sort of feeling
(22:12):
numb, but still, you know, goingto 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 ofdifferent colors.
So you can also imagine it likethe bottom step is black and
then as you get up it turns intogray and maybe the very top
(22:33):
first step.
You're still in the grays, butmaybe it's a light gray, right.
And so I started to reallyunderstand these steps of
depression.
And that was so incredibly key.
Because if you are on the verybottom step and you do something
that helps you get up one step,or even half a step up, you're
feeling better than when youwere in the absolute deepest,
(22:55):
than when you were in theabsolute deepest, darkest
depression.
But one step or a half a stepup from your deepest possible
depression is also still prettyterrible, right.
And so this is how I think ofit as depression feeding itself,
because when you are depressedand you put in effort and it
takes so much to just get a halfa step up, and you're like,
(23:17):
okay, I did something and I'mstill feeling terrible, this
failed, I'm a failure, thisdidn't work, it's not worth it.
And then you go right back down.
Of course, by the way, when youthink those things, you fall
right back into the deeperdepths.
Right, this idea of like tryingnot to make depression worse,
that's really kind of a highpriority, but it's easy to make
depression worse, especiallywhen you're wearing depression
(23:37):
goggles and everything seemspretty awful.
So these ideas that depressionis disconnection and then,
therefore, wrapped up in thatdefinition or understanding is
the idea that the way that youdeal with depression or the way
that you move away fromdepression is by moving towards
connection and how you figureout how to safely connect.
(23:59):
And then if you realize thatyou're wearing depression
goggles and you're going tothink things when you're
depressed and you're not goingto question them because they're
in your mind and so you'regoing to think that it's your
absolute truth, but if you knowthat this is only my truth right
now, it's not my authentictruth, it's not in alignment
with my true self.
(24:20):
I'm thinking this thoughtbecause I have on depression
goggles and so it looks veryreal to me right now because I'm
experiencing it in my headright, or I'm looking at the
world right now through my eyes.
But knowing these things, youstart to have flexibility and if
you know that you have ondepression goggles, that can be
a helpful tool in moving you upthe step.
Because instead of believingyour terrible thoughts, which
(24:43):
keep you really deeply rooted,oftentimes in deep depression or
, you know, keep you deeplystuck in depression, thinking
things like I'm worthless andI'm undeserving of happiness,
and you believe those things100%.
But if you can say, okay, Iknow that I'm just wearing
depressed goggles, yourdepression will likely improve.
(25:05):
If you can come to it with thisidea of like, okay, these
thoughts are not authenticallymine and maybe you'll just move
up from a step 10 to maybe 9.75.
Maybe it's just a little tinymovement up, and again that can
feel frustrating, to say theleast.
But to know, okay, I'm going inthe right direction, right, I'm
moving away from the deepestpart to a higher step.
(25:28):
And then you can continue tothink how do I connect?
Or you can start to askyourself what do I need?
To feel safe enough to move aquarter step up or a half step
up?
How can I have compassion formyself 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 theway down to a 10.
That means I'm using somestrategies here, that I didn't
(25:51):
slide all the way down.
So now you can start to havethis 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 tothe people that I've worked with
.
I hope it's been of like thefoundation of how I have come to
view depression, and in thenext episode I will be talking
(26:19):
about how these threefoundational concepts that have
guided me through being able tosuccessfully navigate my own
depression how these threeconcepts actually I have started
to learn over the last fewyears, as I've been learning
more about polyvagal theory,which has been around for far
longer than the last couple ofyears.
I've been learning more aboutpolyvagal theory, which has been
around for far longer than thelast couple of years, but
somehow I have only come to itin the last couple of years.
(26:41):
But I will talk about polyvagaltheory in the next episode in
greater detail, but just so youknow for now, it's a theory that
talks about how the autonomicnervous system, particularly the
vagus nerve, which runsthroughout our whole body, is
connected to our emotionalregulation, our social
engagement and how we respond toemotional and physical threats,
(27:03):
and so it essentially is anexplanation about how our
nervous system is deeplyconnected to our mental activity
and therefore our mental healthand our well-being.
And there are components of thepolyvagal theory which I would
say give further explanation tothe three foundational concepts
(27:24):
that I have developed through myown experience with depression.
These foundational conceptshave been really healing for me
and have provided me withopportunities to learn and grow
and develop strategies that havebeen really effective for me,
and adding the additional pieceof being able to connect what's
happening to my nervous systemhas helped me in a profound way,
(27:47):
and I cannot wait to share itwith you next time.
So thanks for showing up today.
As our time comes to a close,and as you continue to travel
along on your own uniquewellness journey, I leave you
with an invitation to move fromwhere you are today to where you
want to be.
The path may seem long ordaunting or unclear, and I want
(28:10):
you to know that that is totallyokay.
You do not have to create thewhole way all at once.
My invitation to you today isto take a step, just one, any
type, any size, in any direction.
It can be an external step thatyou can be observed or measured
(28:30):
, or it could be a step youvisualize.
Whatever makes sense to you.
I invite you to take a steptoday because healing, growth,
connection and joy is possiblefor everyone, including you, and
even when depression is in yourbed.
If you connected with today'sepisode, please subscribe so you
(28:51):
can be notified when eachweekly episode gets released.
I encourage you to leave areview.
Your feedback will help guidefuture episodes and please share
this podcast with anyone whoyou 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.
Popular Podcasts
24/7 News: The Latest
The latest news in 4 minutes updated every hour, every day.
Stuff You Should Know
If you've ever wanted to know about champagne, satanism, the Stonewall Uprising, chaos theory, LSD, El Nino, true crime and Rosa Parks, then look no further. Josh and Chuck have you covered.
Dateline NBC
Current and classic episodes, featuring compelling true-crime mysteries, powerful documentaries and in-depth investigations. Follow now to get the latest episodes of Dateline NBC completely free, or subscribe to Dateline Premium for ad-free listening and exclusive bonus content: DatelinePremium.com