Lilmod Ulelamaid:
You ask good questions. I don’t know if there’s a clear-cut answer. Actually, I know that there isn’t. Doctors ask a lot of questions to a depressed person, in order to try to figure out what’s happening.
They don’t just “know” automatically, and sometimes they miss it big time.
People are often not willing or even able to say what’s really going on inside. They may just say a couple of things that are going wrong, that don’t seem so deep, without expressing the intense distress that those things are causing.
I am certain it is not an exact science.
Sometimes medications make a difference. Often they do not. There’s a lot of experimentation, and it’s always trial and error. Anxiety medications are more predictable, I think.
I don’t know if it’s a continuum.
Personally, I don’t think depressive thoughts lead to clinical depression automatically, but there is definitely a progression when a person is in fact heading into a what I described, which is a major depressive episode, that it will start with mild stuff and keep growing. So it’s a symptom, not a cause. The difference can be seen – retroactively. And if a person has a history, than there is a lot more reason to pay close attention, if a “bad mood” doesn’t start to fade away when distractions are introduced.
Just for the record, many “moody” or (what people call) “depressed” or “negative” people don’t work on their middos at all, make everyone around them miserable at times, and still don’t end up with major clinical depression! If you catch them off guard, you will see them getting enjoyment from something. Even they can see the comedy in their refusal to be positive.
It seems that some people will never get this kind of sick. They will get other types of sick, though. For example, perhaps if I experience high levels of distress, and I ignore it, and bottle it up inside, it could end up as a physiological depression.
Other people might have a heart attack long before they have the amount of stress/distress that accumulated in me!
Nobody would condemn them for the heart attack!
Well, almost nobody.
So does that mean I have weak nerves, or that my heart is too strong?!
It’s really hard to understand the dynamics of depression.
As far as suicidal ideation is concerned, I think in the cases you are referring to, it’s considered a symptom. The person is in an unbearable amount of emotional pain with no clue how to make it stop. Perhaps it wouldn’t have gotten that far if they had the ability to honestly face whatever it is that they find unbearable (unacceptable), process it, and skillfully express it clearly enough to get help. Usually that is something that is taught by example, and nobody taught it to them. Often the very real fear of judgement, and rejection by others is enough to prevent them from sharing, or admitting their feelings even to themselves. That’s what therapy is often about.
The more we make other people feel truly “safe”, to share their distress, without fear of any reprisals, or dismissiveness, the more we are doing to literally save lives.
I don’t know if one has to be clinically depressed to be literally Terrified of rejection or judgement, and the resulting pain that they know it will cause. Really, I do not know. But severe terror is not a “bad mood” or a case of “lowered” or, as so many here insist on calling it, “depressed” feelings. Terror does sometimes cause people to do irrational things.
Certainly, clinical depression has a high risk of suicide. That’s probably the most dangerous part of it. How does one escape from the hell inside their own head??
I don’t know why I am even bothering to respond to RebYidd23. Maybe it’s my concern for anyone who could read what he wrote, and use it against themselves.
IF I understood you correctly, you are saying depression is depression, just like cancer is cancer. It’s just a matter of whether or not that particular case is responsive to treatment.
That would be a good analogy, if we didn’t claim to have an array of “tried and true” self-help solutions, and middos improvement programs to treat depression. If the depression doesn’t go away despite those suggestions, would you then say the depression was treatment resistant, or the “patient” was?? Since we have significant sources for those solutions, programs, and self-improvement ideas, it would appear that it is reasonable to expect them to work, at least a little, if the “patient” is trying.
In fact, when it comes to the kind of “depression” that is just a mild, or more intense emotion, those things DO help! Uppers also always work with that: a good joke, or even some ice cream or chocolate gets the most resistant among us to smile, despite ourselves.
Depression(Clinical) doesn’t usually shift much in response to a “good time” The ice cream doesn’t have much of a taste, and the chocolate is kind of flat. The person usually doesn’t find the jokes funny. The exercise is done by rote, with no enthusiasm, effort, or interest. It’s not that the middos program or the exercise isn’t working. IT ISN’T INDICATED.
Treatment resistant Cancer is NEVER considered to be a character flaw of the patient! Actually, it’s a great example though. Because, Loshon Hara is sometimes referred to as a Cancer in our generation, correct? Does that mean that radiation can treat Lashon Hara?! No. Because it isn’t really Cancer literally. It was a metaphor.
Even if there is a continuum, (I don’t know), there is a point where there is a drastic (not gradual) change in symptoms; behaviors, affect, appetite, personal grooming – whatever is affected, is impeded by disinterest. It has become something else. A state in which the patient doesn’t remember how to care. Even if they “try”. It feels empty and meaningless.
For a while, I used to thank HaShem every day for the miracles of life, meaning, satisfaction, will, pleasure…. and emotions – things that I didn’t have while I was (clinically) depressed, and didn’t know that I would ever have again. Boruch HaShem I’ve gotten accustomed to normalcy. I have a range of emotions again, and I’m busy with the vicissitudes of life. I sometimes forget to be thankful.
Which is in itself another miracle.