Beyond the Diagnosis of Clinical Depression

If I had a pigmented spot on my skin, I would want to know whether it was a freckle or a melanoma. If I had swollen ankles, I would want to know whether it was due to heart failure or kidney problems. If I had depression…


A diagnosis of depression is only half the answer.


Regrettably, many experts still hold the view that depression is one condition varying only in severity and then manage the condition first on the basis of their own professional training and background, and then according to a one size fits all approach.

The Black Dog Institute’s Clinical Model recognizes that there are different types of depression and that each expression of the illness responds to different forms of treatment including different classes of medication and psychological interventions.

Just as an accurate position is necessary if you are going to drill for oil in the seabed, or find a good spot for fishing, so too is it very important to identify the specific type of depression before implementing a treatment plan that works.

Depression, because of the lack of understand around it, can be one of the loneliest diseases…

Throughout my journey, I have come across so many people who do not warrant that depression is a medical problem and believe that you can just shake yourself out of it, if you really want to. Again, from experience, I know that this is not true, although I wish it was as easy as that. I have found that with some people it is just easier to pretend that everything is OK; and when I have severe bouts of depression, it has been easier to just pretend I have a virus or cold to stop the inevitable questions that would follow if I told the truth. Any questions are just too hard to cope with when you are not feeling at your best. This is the reason that this disease can be so alienating, isolating us from the people around us.

I have found that some people will accept you and some people will not. I have found that the people who can accept you are great to have around, and usually they are people who have a positive outlook on life. Don’t get me wrong, they do not always know what to say or what to do to help you, but they will take you at face value and do their best to minimise your suffering.*

Acknowledging the black dog

It’s been twelve years since I was first diagnosed as being clinically depressed and for ten years following that diagnosis I struggled to understand or acknowledge the black dog that had sunk its teeth into me. In fact, I was of the opinion that people, particularly young, fit, red-blooded men, didn’t suffer clinical depression in the first place.

Growing up in a Catholic family, I was taught that a man should be stoic, resilient, never show weakness, rarely show emotion, roll with the punches, work hard, marry and support a wife and kids. In my father I recognised all of the above traits and qualities. I wanted to be like him, wanted to make him proud. ‘A man’s man’ was the phrase I hoped others would use when referring to me.

Mental illness was not discussed in those days. Not in my home, at school, with one’s peers or in the community. Admitting you had a mental illness like depression just didn’t happen. Unfortunately, the terrible stigma attached to having any metal illness was common. In fact, not much has changed to this day. Reactive depression was accepted when a tragedy occurred such as a death or physical illness. But to be depressed for no apparent reason wasn’t. I thought it was a cop-out, a sign of weakness, particularly for a man.

Even in my late teens and early twenties, deep in my conscience I had doubts about my character and ability to live up to my own and others’ expectations. I had a sense of being a bit different. By that I mean a bit more sensitive than others, a bit thin-skinned, a little more insecure, and a sense that I might not measure up.

By 1993, I was a twenty-six-year-old country boy living with my future wife, expecting our first child and working in a well-paid job. I had it all, yet I was feeling as low as can be. I’d hit a wall. I didn’t want to get up each morning, dreaded going to work, wished I could sleep and never wake up. I cried for no reason, felt guilty about my lack of interest, energy and motivation. I felt like a failure and my being on this earth a waste of good oxygen.

I didn’t believe the doctor when he said I was depressed. I shuddered at the thought that taking a pill each day would get me back to ‘normal’. I thought I must have a virus because ‘real men don’t get depression’. Only wimps and malingerers got depression. They used it as an excuse for their weakness of character. The doctor prescribed an antidepressant but I refused to take it. I didn’t need pills and God forbid that anyone should find out what the doctor diagnosed, I had to just snap out of it. I refused to admit I wasn’t coping with everyday life or that I needed help.

And for ten years following that visit to my general practitioner I fought against the idea that I had a legitimate illness and possibly always would. My memories of that mostly miserable decade are incomplete. A carousel of taking pills for a while, then throwing them out when I felt well, only for the grey fog to return. The black dog had a strong grip and wasn’t giving an inch. The merry-go-round continued with suicidal thoughts and attempts to harm myself, hospital admissions, changes to my medications… I had a string of psychiatric assessments from numerous general practitioners, psychiatrists and nurses. All the while I had a strong belief that I was at fault, that I was weak and hopeless, and that everyone who knew me must think the same.

I became reclusive, anxious and pessimistic. I worried about everything but mostly what others must think of me. I could no longer hold down a job, was granted a disability pension and told I was permanently incapacitated and would most likely never work again.

Anti-anxiety drugs were added to my medications… things were about to change and the black dog I saw as uncontrollable would soon be a little tamer.*

Useful resources – Books on Depression & Bipolar Disorder

* Journey’s with the Black Dog…

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