Denise Grobbelaar:


Jungian Analyst, Psychotherapist & Clinical Psychologist.

What is Depression?

Clinical depression is a medical illness that encompasses an emotional state of dejection and sadness affecting a person's mood, mind, body, and behaviour. While occasional feelings of sadness and existential questioning are part of the human experience, clinical depression disrupts daily functioning, impacting work performance, social life, and family relations, often leaving individuals incapacitated in their day-to-day activities. For those experiencing milder episodes, while functioning may not be severely impaired, sustaining normal daily living requires a substantial effort. Clinical depression episodes may last from a few weeks to a few months, while dysthymia, a milder yet more chronic form, can persist for years. Clinical depression consists of a range of symptoms that vary in degree and manifestation from person to person.

Recognized as a disturbance in mood distinct from one's normal functioning, clinical depression manifests in a persistent sad or sorrowful mood, often accompanied by constant unexplained tearfulness. Loss of interest or pleasure in previously enjoyed activities, including sex, is another common symptom. However, in children and adolescents, it may present solely as an irritable mood, and in certain cultures, somatic symptoms like persistent headaches, nausea, stomach pain, or backache may be more predominant. Cognitively, depression affects memory, concentration, clear thinking, and decision-making.

Biological markers include unintentional changes in sleeping and eating patterns, energy levels, and psychomotor activity. Sleeping excessively, insomnia, waking up in the middle of the night, and difficulty falling asleep are possible signs of depression. Sudden loss or increase in appetite resulting in either weight loss or gain, fatigue, lack of energy, and noticeable slowing down in responsiveness are other indicators. These physical symptoms may lead to neglect in self-care, personal appearance, and responsibilities, contributing to a sense of overwhelm.

Psychologically, a person may experience feelings of worthlessness, helplessness, excessive guilt, exaggerated self-blame, low self-esteem, and shame. These symptoms often manifest in ruminative negative thoughts and may, in some instances, take on delusional proportions. Contrary to common misconceptions, a sufferer cannot simply snap out of it or change their attitude. Another myth surrounding depression is that the sufferer is lazy and lacks motivation. While a person's drive and motivation are affected, this is not by choice and is distressing to the individual. The person may feel unwanted, lonely, and disconnected from others, leading to social withdrawal and isolation.

Clinical depression is at the extreme end of normal feelings and responses to stressful life events and loss. In cases with identifiable stressors and less disabling impacts, the diagnosis of adjustment disorder may be more appropriate. External stressors such as divorce, bereavement, illness, loss of employment, stressful pregnancy, childbirth, or relocation can erode a person's natural resilience. On a less tangible level, a loss of self, dreams, and hopes may insidiously erode well-being, eventually culminating in a depressive episode. Unsupportive or abusive relationships and adverse circumstances like poverty or unemployment can impact dignity, self-respect, self-esteem, and a sense of mastery, leading to prolonged low mood and feelings of meaninglessness, which, without intervention, may escalate to full-blown clinical depression. People who have experienced developmental trauma and persistent parental failures may be more susceptible to depression.

Individuals facing intense and persistent anguish may, in their despair, contemplate suicide as a means of escaping the seemingly insurmountable suffering they are experiencing. It's crucial to recognize that suicidal thoughts are indicative of profound distress, and addressing them requires compassionate intervention and professional support. Mental health professionals, friends, and family can play vital roles in offering assistance, empathy, and resources to those grappling with such overwhelming pain.

High-functioning depression’ refers to a subtype of depression where individuals outwardly appear to be functioning well in their daily lives despite experiencing significant depressive symptoms internally. Unlike typical stereotypes of depression where individuals may struggle visibly and show overt signs of distress, those with high-functioning depression often mask their inner struggles behind a facade of normalcy, competence, or even cheerfulness.

Key characteristics of high-functioning depression include:

  • Maintaining Daily Responsibilities: Individuals with high-functioning depression can often fulfil their work, social, and personal obligations despite internal emotional turmoil.
  • Masked Emotions: They may appear happy, successful, and well-adjusted to others, concealing their true feelings of sadness, emptiness, or even despair.
  • High Achievers: Some individuals with high-functioning depression are overachievers, excelling in their professional and personal lives to compensate for their internal emotional challenges.
  • Inner Struggles: Internally, they may experience symptoms typical of depression, such as persistent feelings of sadness, low energy, self-doubt, difficulty concentrating, changes in sleep and appetite, and a diminished interest in activities they once enjoyed.
  • Difficulty Seeking Help: Due to their ability to present a composed exterior, individuals with high-functioning depression may find it challenging to acknowledge their own struggles or seek help.

It's important to note that high-functioning depression is not an official clinical diagnosis but rather a term used colloquially to describe a specific manifestation of depressive symptoms. Even though individuals with high-functioning depression may appear to have it together, they are still dealing with a serious mental health condition that can benefit from professional intervention and support.