Is depression a single thing? It seems to me that depression has many faces.
One of the fascinating segments of my job as a private tutor is my role as home school teacher. I take on referrals of students who can’t attend school. Sometimes the causes are physical (for example, a student with cancer undergoing radiation therapy). But far more commonly, I wind up home schooling students with emotional or psychological issues. And it’s remarkable to me how confusing and poorly identified and inadequately understood these issues can be.
Over the past two school years I’ve had three referrals that opened my eyes to how little I know, and how little even the school and mental health professionals seem to know, about the many faces of depression. I live and work in one of the most affluent and progressive suburban areas of this country; surely there is no better health care to be found. And yet, getting the right kind of information and help can be scarily difficult. In each case the professionals, the parents, the student and I all struggled to find answers and solutions. There never seemed to be a clear path to follow, and I wonder now if this is because depression never walks the same path twice.
Eva, diagnosed with chronic fatigue disorder, was also later identified as having depression (depression and CFD often go hand in hand). When I first met her, Eva could barely find the will to move her head off the sofa. One day I tried to encourage her to “just try one math problem,” and she shrieked as if I had stuck her with a pin. I was shocked and mortified; I had never imagined she was in such pain.
Molly has fibromyalgia (a chronic pain syndrome) and she then developed depression. Molly had always been a model student, and she was so determined to overcome the fog in her brain and the aches in her body and get her schoolwork done, that she’d push herself until she was wracked with migraines that would set her back for days. I learned to watch Molly carefully for signs of wincing and slow thinking and to stop our lessons before she pushed herself over the edge.
Caitlin would prop her head on her hand and stare at the book, or at me, or out the window. Was this ADD? Or, as too many teachers suspected, was it pure bratty defiance? Caitlin’s hostile glare and refusal to speak when spoken to were easy to misinterpret as insolence. The school year wore on, Caitlin was shuffled from one therapist to another to another (several therapists “fired” her because she refused to talk to them) and we dragged joylessly through our lessons. At one point Caitlin did receive a diagnosis of depression, though then none of the antidepressants seemed to help much.
These three girls were all so different, yet they each touched my heart in their own way and also made me feel so helpless. I always feel competent and effective to handle academic problems, but these cases were so out of my field of expertise. It was devastating to work with these girls every day and feel their pain and not really know what was wrong or what to do. Each suffered some version of depression, blended with other conditions in unique and confounding ways.
Perhaps one reason why depression can be hard to define or diagnose is because it can be a normal human response that has crossed a border into dysfunction. Eva points out that being trapped in what felt like a bottomless pit of fatigue, accentuated by her doctor’s cheery assurance that her CFS would hopefully improve “within two to four years” (an eternity to a teenager!) caused her to feel appropriately hopeless and depressed. Eva’s depression was very real, yet it was also “understandable.” Its cause seemed clear: the CFS caused the depression.
But then, curing Eva’s depression also cured her CFS! This, in any event, is how Eva herself reports it. Wellbutrin worked for Eva; she began to feel mentally better, and then physically better, until now she is almost completely recovered in all respects. And she no longer needs the Wellbutrin.
Molly’s outcome is also a happy one. Her fibromyalgia may never go away entirely, but antidepressants have helped Molly temper her perfectionist streak, allowing her to relax and therefore not aggravate her physical condition so much. She’s learned to set and respect physical and mental boundaries so as to preserve her health.
Caitlin’s situation remains unresolved. She appears to have several psychological issues, one of them being depression, all tangled together in ways that are difficult to sort out. Caitlin was a great reminder to me to never misinterpret a student’s “attitude.” The vast majority of kids I work with are warm and eager and cooperative right from the start. The very few, like Caitlin, who are seemingly cold or rude or otherwise resistant or poorly behaved have always turned out to be concealing tremendous internal pain. I know now to take that pain seriously, and resist any impulses to blame the victim.
Eva and I were talking the other day about how complex and diverse is depression, how depression is surely a different disease for each sufferer. Eva lately feels energetic enough to write, and she’s agreed to work on writing the tale of her chronic fatigue and depression. I hope I’ll be posting her story on my blog soon! The faces of depression need their voices heard.
Cousins, L. (2010). Three Faces of Depression. Psych Central. Retrieved on November 27, 2014, from http://psychcentral.com/lib/three-faces-of-depression/0003755
Last reviewed: By John M. Grohol, Psy.D. on 30 Jan 2013
Published on PsychCentral.com. All rights reserved.