Before I start I wanna say that it’s legit ok to feel sad sometimes. Humans are not supposed to be happy all the time. That’s impossible. Humans are supposed to feel a wide range of emotions. Even emotions that can be very uncomfortable or just plain suck to feel. That’s life. Hiding from those emotions or pretending you don’t feel certain emotions doesn’t fix a damn thing or make you a more evolved person (but that’s another post for another time). So what’s the difference between being sad and being depressed? Mental disorders, in many cases, are more extreme/intense (aka outside of the average person’s experiences) versions of everyday emotions and experiences. Anyone who has ever taken an abnormal psychology course probably has heard of the 4 Ds method of thinking about mental disorders: Deviance, Distress, Dysfunction, and Danger.
- Deviance: Whether someone’s behavior is acceptable in their specific culture (or cultures) and society. For example, “disorganized speech” (where someone is impossible to understand due to a disorder in how their thoughts are put together) is a symptom of schizophrenia. It is incredibly important for therapists (and all mental health professionals) to understand someone’s background/context before diagnosing them. The situation changes completely if the person was speaking in tongues while praying. In that case, speaking in tongues would not be considered disorganized speech aka a symptom of a mental disorder because it is an appropriate part of that religion/culture. See what I mean?
- Distress: Do the symptoms this person is experiencing cause them (or the people around them) clinically significant distress (EG: a lot of anxiety, sadness, pain, etc)? If you’re wondering why causing other people clinically significant distress in written into the diagnosis: For certain mental disorders (personality disorders, etc) and in other situations, a client may not notice their symptoms or the impact these symptoms have. This is called having “poor insight”. But just because the person can’t tell that anything is off/wrong, doesn’t mean that their loved ones and others around them aren’t affected. Example: A spouse who is currently having a manic episode and impulsively spending all the rent money. A therapist could still use this information to diagnose their client.
- Dysfunction: Do the person’s symptoms affect their ability to function in society (hold a job, pay bills, maintain social relationships/obligations, personal hygiene, etc). This does not mean the person’s whole life has to be dysfunctional. Symptoms could affect 1 area of someone’s life so much that it qualifies. For example, social anxiety symptoms that affect a person’s ability to go on successful job interviews, but don’t come up when hanging out with friends would still count.
- Danger: And finally, do the person’s symptoms cause them to be a danger to themselves or others. [Note: Danger alone does not mean someone has a mental illness. Lemme say that again: violence, abuse, and any other kind of danger (emotional, physical or otherwise) alone does not mean someone has a mental illness. So stop saying every person who is engaging in violence has a mental disorder. That’s NOT true at all. It adds to the stigma against people living with mental disorders (who are more likely to be victims of crimes/violence/abuse/neglect and therefore are always shafted in terms of healthcare and treatment because of this stigma). And it lets people who engage in violence, and this society that enables them, off the hook instead of really addressing root causes of violent behavior.
A given mental disorder does not have to have all 4 Ds, but usually will have at least one. The 4 Ds method is a nice guideline/tool for thinking about what makes something a mental disorder.
- Feeling depressed (or other people think you look depressed) nearly every day; Kids might look irritable instead of depressed
- Translation: Feeling shitty, cranky/irritable, down, etc so intensely that it causes distress and/or dysfunction, etc
- No longer interested or no longer enjoying all or almost all activities most of the day, nearly every day
- Translation: You just don’t care about the stuff you used to or the same stuff doesn’t make you feel good anymore. You might find yourself pulling away from people and being social
- Huge weight loss/gain or appetite decrease/increase
- Translation: Eating can either feel like a chore, be your new best friend, or all of the above depending on the context. The important part here is that your usual behavior has changed
- Insomnia or hypersomnia nearly every day
- Translation: You have problems falling sleep and/or staying asleep or you sleep for hours more than you usually do
- Psychomotor agitation or retardation nearly every day that other people gotta be able to see
- Translation: Agitation – Looking agitated (think restless movements like nail-biting, skin-picking, pacing, fidgeting, etc) to people or Retardation – Looking as if your speech, thoughts, and physical movements have slowed down, taking longer than usual to react, and/or you are talking much less, much quieter or with much less feeling. Psychomotor retardation is what can make doing every day activities (showering, cooking, household chores, paying bills, answering emails, doing homework, work, etc) feel impossible to do because it feels like you are physically incapable, almost like there are invisible weights/pressure on and all around you.
- Feeling fatigue or loss of energy nearly every day
- Translation: Feeling tired to the bone. Even the smallest activities might make you feel exhausted and you don’t get shit done the way you usually do
- Feeling worthless or excessively/inappropriately guilty nearly every day
- Translation: Holding yourself to unrealistic expectations, constantly ruminating/reviewing past mistakes, and/or seeing everything as evidence that you ain’t shit or blaming yourself for things that couldn’t possibly be your fault
- Difficulties concentrating or indecisiveness nearly every day
- Translation: Feeling distracted often, having trouble remembering things, and/or making even small decisions feels incredibly hard
- Repeatedly thinking about death, thinking about suicide, thinking about suicide with a specific plan on how to do it, or attempting suicide
- Translation: Passively wishing you could go to sleep and not wake up and believing that others would be better off if you weren’t alive on the lower risk end of the spectrum and constantly thinking about committing suicide, having a specific plan of how to do it, and/or attempting suicide would be on the higher risk end of the spectrum
I’m telling you all this, not so y’all can run around diagnosing people on the internet or IRL. Diagnosing a whole human being is not something you can do after reading a few pages in a manual. There’s so much work that goes into diagnosing a client: proper information gathering, taking into account the many parts of what makes each disorder, how the disorder develops in theory and in real life, risk factors, cultural issues, gender-related issues, and then comparing similar symptoms within multiple disorders to make sure that the diagnosis is as accurate as possible, etc. Basically, y’all, what I’m saying is take these good tips I’m giving you at face value and stay in your lane before you cause damage trying to diagnose or read someone’s mental status. Thanks!
This information is to build self-awareness so you can recognize possible signs and symptoms in yourself. Having a clear understanding of the symptoms and what makes those symptoms flare up is key. This post does NOT give you the ability to self-diagnose a major depressive disorder. Unless you have been diagnosed by a mental health professional, you cannot say you are clinically depressed (I should write a post about the overuse/inappropriate use of mental diagnostic labels & how it’s used as a shortcut to actually using more accurate/descriptive words for how you feel. And how people being uncomfortable delving too deep leads to using labels that don’t fit…). Again, what this post does do is help you identify any potential symptoms and give you a basic level of understanding. The first steps to healing are education and awareness. From there you can think about your options: using coping skills, asking for support from loved ones, looking for treatment, etc.
- National Suicide Prevention Lifeline – 1-800-273-8255 (1-800-273-TALK); Available 24/7
- The Trevor Project Hotline (LGBTQ youth) – 1-866-488-7386; Available 24/7; TrevorText: Text the word “Trevor” to 1-202-304-1200; 7 days a week 3pm-10pm EST; TrevorChat: Click this link for the chat portal; 7 days a week 3pm-10pm EST
- Trans Lifeline – 1-877-565-8860; Available 24/7
- Mental Health Hotline – 866-677-5924