What is a depressing reality?

Answered by: David Kahn

Loss in one form or another is the main reality factor that causes feelings of sadness and depression. The boundary between a "normal" reaction to loss, and depressive illness, is when we can't rebound, and instead go on to develop frank and persistent symptoms of depression such as loss of pleasure from positive things, ongoing sadness, changes in sleep and appetite that don't get better over time, loss of concentration, and feelings of worthless, hopelesness, and even suidality.

Loss means different things to different people - it can be an obvious calamity such as the death of a loved one, or loss of a much-needed job. It can be loss of health from a chronic illness. It can be a shared, public disaster like 9/11 or Hurricane Katrina. It can also be a more personal loss, such as self-esteem in a difficult relationship, or even an anticipated, imagined loss like fear of failing in a new responsbility such as a promotion at work, or having a new child. It can even be a loss of an important, identity-defining role in life, like retiring at age 65 and not knowing what to do next, even when everything else seems fine in life to an outsider looking in.

People who are biochemically prone to depression will sometimes find that "depressing realities" or other real, stressful events get to them in an intense way, even triggering episodes of illness when other people around them somehow manage to cope.

In terms of realities we all eventually experience, mourning a death (or comparable serious loss) can take a long time; many weeks or months can go by before a person starts to feel back in the swing of things without this necessarily being the same set of feelings or symptoms that a person experiences in depressive illness; but mourning can also progress to real depression, and the fact that it began with a "depressing reality" doesn't make the subsequent illness any less real or undercut the benefits of treatment with psychotherapy or even medication.

All illnesses result from some combination of real, outside events (a virus, too many servings of high-fat food, etc.) and internal vulnerability to the effects of those "realities".

A final word is that when reality hurts, even without causing all the symptoms of clinical depression, psychotherapy can still be big help to sort through choices and compromises that have to be made and to better accept or effectively overcome the situation.

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David Kahn, M.D.

David A. Kahn, M.D.

Dr. Kahn is the Diane Goldman Kemper Family Clinical Professor of Pyschiatry Emeritus, Columbia University Medical Center; and attending psychiatrist, New York Presbyterian Hospital.

He received his B.A. from Haverford College in 1975, completed medical school and internship in medicine at Columbia, and was resident and chief resident in psychiatry at Columbia Presbyterian Medical Center and the New York State Psychiatric Institute. He then received an NIMH extramural research fellowship at the Psychiatric Institute, where he worked in the area of mood disord...
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