Depression can originate from life events or personal history or without apparent cause. Depression permeates throughout the crisis; Midlife Crisis could be renamed Midlife Depression. The permeating depression has roots in personal history and usually has a catalytic event which occurred 12-36 months prior to Bomb Drop. It is this type of depression to which I refer through out.
Covert Depression: Hidden or masked depression. The visible signs of Covert Depression are atypical from what is understood about depression. Rather than exhibiting depressive symptoms, a person exhibits avoidance behaviour. Author Terrence Real describes the symptoms of Covert Depression as the footprints or defense mechanisms men use to avoid Overt Depression.
Overt Depression: Visible Depression. The external behavior matches the symptomatic descriptions and ideas common to depression listed below.
Symptoms of a Major Depressive Episode, DSM IV
List distilled, see below for full DSM IV description
- Feeling sad or empty, appearing tearful
Note: can be irritable mood in children and adolescents.
- Anhedonia: loss of pleasure or interest in pleasurable activities
- significant weight loss when not dieting or weight gain or daily decrease or increase in appetite.
- daily insomnia or hypersomnia
- energy increase: restlessness, agitation OR energy decrease: physical retardation
- daily fatigue or loss of energy
- daily feelings of worthlessness or excessive or inappropriate guilt
- daily diminished ability to think or concentrate, or indecisiveness
- recurrent thoughts of death, recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide
In Western culture women are allowed to express emotions and vulnerability, thus they are more accepting of their emotions and emotionally open; they recognize and feel their sadness. Society considers it a sign of weakness in men to be emotional and has thus trained them to repress their emotions, leading to internalization; in such circumstances emotions, like sadness, turn inward and are expressed in more violent manners such as through anger and aggression. Where women will express their depression openly as sadness and seek help and comfort in relationships, men express their feelings indirectly as being tired and burned out and seek to isolate themselves. They cut themselves off emotionally and are unable to recognize the root emotions. Their insistence on feeling fine leads them to work harder to prove they are fine and become more burned out, since the feeling is real, they assume it is the only explanation.
Depression in midlife is not an external problem. It is about issues within one's Self. Replay is Covert Depression, a running away from the self manifested through anger and external blame, as well as a variety of self-medications; affair, drugs, alcohol, risky behaviour, spending, new friends and activities, often an interest in exercise and an obsession with youth and aging. It is a monster that feeds itself. I don't want to feel despair and hopeless or face my demons (Overt Depression) so I'm going to drink, party and have an affair. I'm bad, I have tremendous guilt. I've cheated on my wife...this just can't be fixed. He adds another demon to the Overt Depression he's avoiding and run further away at an even faster pace. Covert Depression is a self-medication taken in an attempt to avoid Overt Depression.
When there is quiet, he can think, and thinking brings on Overt Depression, so he keeps running, being active; it is an avoidance stemming from a fear of what is inside. It is his own internal demons that he has been running away from, and they will eventually catch up. He fights, but they drag him down to the bowels of the great chasm. The only cure for it is Overt--Liminal Depression. Some cling desperately to the ledge, no longer self-medicating but still not facing the Shadow Self. Overt Depression is despair, hopelessness and feels eternal; it is the place where they are forced to face all those things they have repressed from childhood--the issues at the root of the MLC.
Major Depressive Episode
more) of the following symptoms have been present during the same 2-week period and r
- Five (or more) of the following symptoms have been present during the same 2-week period and represent a
change from previous functioning; at least one of the symptoms is either depressed mood or loss of
interest or pleasure.
Note: Do note include symptoms that are clearly due to a general medical condition, or
mood-incongruent delusions or hallucinations.
- depressed mood most of the day, nearly every day, as indicated by either subjective report (e.g., feels
sad or empty) or observation made by others (e.g., appears tearful).
Note: In children and adolescents, can be irritable mood. markedly diminished interest or
pleasure in all, or almost all, activities most of the day, nearly every day (as indicated by
either subjective account or observation made by others) significant weight loss when not dieting
or weight gain (e.g., a change of more than 5% of body weight in a month), or decrease or
increase in appetite nearly every day.
Note: In children, consider failure to make expected weight gains.
- insomnia or hypersomnia nearly every day
- psychomotor agitation or retardation nearly every day (observable by others, not merely subjective
feelings of restlessness or being slowed down)
- fatigue or loss of energy nearly every day
- feelings of worthlessness or excessive or inappropriate guilt (which may be delusional)
nearly every day (not merely self-reproach or guilt about being sick)
- diminished ability to think or concentrate, or indecisiveness, nearly every day (either by
subjective account or as observed by others)
- recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific
plan, or a suicide attempt or a specific plan for committing suicide
- The symptoms do not meet criteria for a Mixed Episode. The symptoms cause clinically significant
distress or impairment in social, occupational, or other important areas of functioning.
- The symptoms are not due to the direct physiological effects of a substance (e.g., a drug of abuse,
a medication) or a general medical condition (e.g., hypothyroidism).
- The symptoms are not better accounted for by Bereavement, i.e., after the loss of a loved one, the
symptoms persist for longer than 2 months or are characterized by marked functional impairment, morbid
preoccupation with worthlessness, suicidal ideation, psychotic symptoms, or psychomotor retardation.
Major Depressive Disorder
- Presence of a single Major Depressive Episode
- The Major Depressive Episode is not better accounted for by Schizoaffective Disorder and is not
superimposed on Schizophrenia, Schizophreniform Disorder, Delusional Disorder, or Psychotic Disorder
Not Otherwise Specified.
- There has never been a Manic Episode, a Mixed Episode, or a Hypomanic Episode.
Note: This exclusion does not apply if all the manic-like, mixed-like, or hypomanic-like episodes
are substance or treatment induced or are due to the direct physiological effects of a general medical
- Presence of two or more Major Depressive Episodes.
Note: To be considered separate episodes, there must be an interval of at least 2
consecutive months in which criteria are not met for a Major Depressive Episode.
- The Major Depressive Episodes are not better accounted for by Schizoaffective Disorder and are not superimposed on Schizophrenia, Schizophreniform Disorder, Delusional Disorder, or Psychotic Disorder Not Otherwise Specified.
- There has never been a Manic Episode, a Mixed Episode, or a Hypomanic Episode.
Note: This exclusion does not apply if all the manic-like, mixed-like, or hypomanic-like episodes are substance or treatment induced or are due to the direct physiological effects or a general medical condition.
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