World Mental Health Day 2020. Perhaps we should rename it World Mental Health YEAR to reflect the difficulties we have all faced since the start of the pandemic. Wyn Bramley wrote her most recent title, Understanding the Depressions, before we had even heard of Covid-19 – her book was always going to be important, but now it is vital.
She writes, in her postscript: “Still reeling, and exhausted from trying to manage the immediate consequences of COVID, can our beleaguered government find the wherewithal to see and plan for the massive mental health provision of a holistic kind that is going to be needed as the outbreak subsides, especially for the treatment of the Depressions?”
Whether extra funding will be found remains to be seen, but with a book like Wyn’s we can learn about depression whether we are the ones suffering or whether we are worried about those around us.
Wyn helpfully distinguishes between ‘little d’ and ‘big D’ depressions.
‘Little d’ depression is “Any so-called depression that fails to resolve itself – becomes protracted, adversely affects otherwise good relationships, or causes the person to not enjoy their usual pleasures and interests. The person knows something is going wrong; they are up against psychological distress beyond common unhappiness.”
‘Big D’ depression covers Depressions that require medical intervention on top of any other help; they have to be defined as an illness whatever other crises may be occurring. These depressions often recur on a regular or irregular basis so that the sufferer comes to know and manage the warning signs.”
Although a grey area exists between ‘little d’ and ‘big D’ depressions, it’s important to realise that depression is a process, rather than something you’ve ‘got’ or ‘not got.’ Many things can cause low mood, but low mood doesn’t always have to develop into something more serious. In the introductory chapter of her book, Wyn talks about loneliness and social isolation being a common starting point for serious depression – this is perhaps the most relevant idea if we look at society in 2020…
“…social isolation and loneliness, especially in old age, can descend into one of the Depressions without anyone noticing. Loneliness creates the conditions for rumination, the surfacing of regrets, the missing of dead partners and friends. This ‘ordinary’ colloquial depression may be tolerated til one day the sufferer appears in the GP’s surgery unable to carry on. Common unhappiness without neighbourly or family input easily degenerates into ‘little d’ or even, if neglected long enough, ‘big D’ Depression. Ever receding realistic hope of companionship leading to inner desolation is the main culprit here.”
Understanding the Depressions: A Companion for Sufferers, Relatives and Carers by Wyn Bramley is available now.