Module 67 Depressive Disorders, Bipolar Disorder, Suicide, and Self-Injury
In the past year, have you at some time “felt so depressed that it was difficult to function”? If so, you were not alone. In one national survey, 31 percent of American college students answered Yes (ACHA, 2009). In a survey of American high school students, 29 percent “felt so sad or hopeless almost every day for 2 or more weeks in a row that they stopped doing some usual activities” (CDC, 2008). You might feel deeply discouraged about the future, dissatisfied with your life, or socially isolated. You may lack the energy to get things done, to see people, or even to force yourself out of bed. You may be unable to concentrate, eat, or sleep normally. You may even wonder if you would be better off dead. Perhaps academic success came easily to you in middle school, but now you find that disappointing grades jeopardize your goals. Maybe social stress, such as loneliness, feeling you are the target of prejudice, or experiencing a romantic breakup, has plunged you into despair. And perhaps low self-esteem increases your brooding, worsening your self-torment (Orth et al., 2016). Likely you think you are more alone in having such negative feelings than you really are (Jordan et al., 2011). Most of us have had some direct or indirect experience with depression: Misery has more company than most suppose.
“ My life had come to a sudden stop. I was able to breathe, to eat, to drink, to sleep. I could not, indeed, help doing so; but there was no real life in me.”
Leo Tolstoy, My Confession, 1887
Joy, contentment, sadness, and despair exist at different points on a continuum, points at which any of us may find ourselves at any given moment. To feel bad in reaction to profoundly sad events is to be in touch with reality. In such times, sadness is like a car’s low-fuel light—a warning signal that we should stop and take appropriate measures. Biologically speaking, life’s purpose is not happiness but survival and reproduction. Coughing, vomiting, swelling, and pain protect the body from dangerous toxins and stimuli. Similarly, depression resembles a sort of psychic hibernation: It slows us down, prompting us, when losing a relationship or blocked from a goal, to conserve energy (Beck & Bredemeier, 2016; Gershon et al., 2016). There is sense to suffering. When we grind temporarily to a halt and reassess our life, as depressed people do, we can redirect our energy in more promising ways (Watkins, 2008). Even mild sadness helps people process and recall faces more accurately (Hills et al., 2011). They also tend to pay more attention to details, think more critically (with less gullibility), and make better decisions (Forgas, 2009, 2013).
“ If someone offered you a pill that would make you permanently happy, you would be well advised to run fast and run far. Emotion is a compass that tells us what to do, and a compass that is perpetually stuck on NORTH is worthless.”
Daniel Gilbert, “The Science of Happiness,” 2006
But sometimes this response, taken to an extreme, can become seriously maladaptive and signal a disorder. The difference between a blue mood after bad news and a depression-related disorder is like the difference between breathing heavily after a hard run and being chronically exhausted.
In this section, we consider three disorders in which depression impairs daily living, focusing on the two principal forms (formerly known as mood disorders). Major depressive disorder is a state of hopelessness and lethargy lasting several weeks or months. Persistent depressive disorder is similar, but with milder depressive symptoms that last a much longer period of time. Bipolar disorder (formerly called manic-depressive disorder) is when a person alternates between depression and overexcited hyperactivity.