Depressed minds, distressed folk - the nature and onset of depression

Abstract

Feelings of sadness and disappointment are part of the human condition, experienced by everyone at some point in their lives. The boundary between normal state and abnormal symptoms, if it exists at all, is a far from well-defined one. For practical purposes, features which are intense, pervasive, persistent and which interfere with day to day functioning are considered pathological. The clinician usually attempts to discern a break or discontinuity in the habitual patterns of affect or behaviour before he draws a distinction between, say, a depressive temperament, which might be subject to a transitory dysthymia and a clinically defined depressive illness. This disjunction might be apparent if the individual in whom it is sought has previously made a good adjustment. But a previously unhappy person can also become depressed, when the change becomes an apparently quantitative one. The depth of the depressed mood is a matter of degree as are the symptoms which are discussed in later sections of this chapter. The cognitive change of common unhappiness does not differ from that in depression; poor attention and concentration may lead to impaired memory in both instances; intellectual functioning and judgment are also impaired in both states. Suicidal behaviour is possible in both. Biological dysfunction does not yield the expected clue - sleep, appetite, sexual desire, menstrual and bowel functioning may all be affected in both states of unhappiness and depression.