Themes in the Questionnaire responses

 

During 2011, project researchers at Durham University conducted an on-line questionnaire asking people about their experiences of depression. It was developed in consultation with researchers from the UK mental health charity SANE. Click here to find out more about the questions posed to participants about their experiences of depression, and click here to see representative examples of responses to the questionnaire. The responses to the questionnaire are having a significant impact on current research – click here to view publications.

A key motivation behind inviting people to participate in the questionnaire is to understand how people explain and elucidate the experience of depression. Questions were asked about interpersonal relations, the experience of time, changes to emotions and moods, the extent to which depression affects cognition, changes to ordinary activities and actions, how depression effects the way the body feels and how it alters the conception of life more generally.

The responses to the questionnaire are evidence of the heterogeneous character of the experience of depression.  Nevertheless it is possible to identify a number of common themes in how the experience is articulated, themes which interrelate and are very often mutually illuminating. Below is a representative sample of responses characterized as expressing such themes.

 

Experience of the world

Depression is often described as involving changes to how the world appears, sometimes expressing how ‘the wold of depression’ seems to differ from the ordinary world. Painful feelings of being ‘cut off’ from the world or being disengaged and disconnected from it are commonly reported.

“It feels as if I am a ghost – I cannot touch or see the world clearly and it all becomes grey and transparent.”

“I feel disconnected from the rest of the world, like a spectator. I only see I was depressed when it stops. It’s like dust, you don’t notice it until you wipe it off and see the difference”.

“Often, the world feels as though it is a very long way away and […] it takes an enormous amount of effort to engage with the world and your own life. It feels as though you’re watching life from a long distance. At times it felt as though I was looking through a fish eye lens, and couldn’t see clearly around the periphery, or even very well at all. I felt slightly pulled back from reality, as though there were cotton wool between my brain and my senses. A feeling of exhaustion often prevented me from being able to interact with the world, adding to the inability to process what was going on around me.”

“I feel like I am watching the world around me and have no way of participating.”

 

Changes to bodily experience

Depression is often assumed to involve changes to a person’s ‘mental’ states in contrast to changes that affect the body. But virtually all the responses to the questionnaire, as well as well-known published autobiographical accounts, emphasize that bodily aspects of depression are central. Here are some responses to the question: ‘How does your body feel when you’re depressed?’  

“Very tired and uncomfortable”

“As heavy as lead. I can’t drag it out of bed most of the time.”

“Tired, aching”

“Tired and painful. I feel like gravity is pushing me down.”

“My body seems very heavy and it’s an effort to move.”

“Exhausted, drained, no energy”.

“Tired but not sleepy. Tight neck and shoulders giving headaches.”

“It aches. I can feel fluish. My stomach and throat can ache and I feel anxious.”

“Exhausted, heavy limbs, aching, headaches, tired, spaced out.”

“Heavy, arched and with hot and cold sweats. Vulnerable and hollow.”

“No energy. Just totally run down.”

 

Hopelessness and despair

Feelings of hopelessness and despair are frequently described as a core aspect of depression. This often expresses how a person’s thoughts and actions, their relations with others and their projects quite generally appear doomed or futile. The questionnaire responses suggest that such feelings can be far-reaching.

“Life seems completely pointless when depressed. Depression is the worst feeling in the world and when you’re absorbed in its depths you just don’t even want to be there, anything to stop the numbness and pain. You can’t see far into the future so you can’t see aspirations or dreams. Everything I ever wanted to do with my life before seemed impossible now. I also would think that I would never get out, that I’d be depressed forever. It brings quite irrational thinking because it’s not a rational illness. It makes you think all sorts of things about life and yourself that aren’t true. I thought I’d never escape from the depths of depression and never achieve anything with my life.”

“The world looks very different when I am depressed, because everything looks dark/black and bleak. To me it looks like the colour and joy has been sucked out of the world and that the world looks completely dull.”

“I can’t see any future for myself or the rest of the human race.”

“The world seems pointless because when I am depressed I can’t see the world in a positive way. All I see is a place full of suffering which I often feel I would be better off escaping from.”

“See no future or a hopeless future.”

“When depressed I see life as pointless and sometimes cruel. I cannot see any possibilities for change or improvement.”

 

Feelings of guilt

Guilt is also a common feature of depression. The responses suggest that the guilt experienced in depression often becomes associated with being a particular kind of person – one that seemingly warrants negative evaluation. Feelings of guilt are thus closely connected to a person’s sense of their own ‘essence’.

“When I am depressed everything seems so bad. It seems as if there is nothing good in the world and that all the bad is because of me somehow.”

“[When depressed] I hate myself. The reason my life is so awful at these times is because I am a terrible, wicked, failure of a person. I’m not a proper human being, I am a failed human being. Everything that goes wrong in my life is directly my fault; I caused it by not doing things I should have done, or doing things I shouldn’t have done. I am a waste of a human life. No-one knows just what a horrible useless nothing of a person I really am, because I hide it from people – if they ever found out the truth, they will all hate me and I will never have a single friend in the world ever again.”

“Feel hopeless, like I shouldn’t exist and it would be better for family and friends if I wasn’t here. Just feel dark, worried, impending feeling of doom.”

 

Action and agency

The experience of depression often involves changes to how a person acts or behaves. Typically, these changes include a felt reduction in the capacity to act and a sense that ordinary tasks and routine activities are impossibly difficult.

“When I’m depressed I find it very hard to perform routine tasks. Motivation is a big problem, though I find if forced then once I get going I’m generally fine.”

“I feel too scared to move, like I have to sit in one place and not move and I’ll be ok then.”

“The world seems a bleak, cold and threatening place. What I would normally see as a challenge seems like an insurmountable problem. My whole perspective becomes negative, and I am unable to see the good and the potential in anything.”

“Everything seems 10 times harder. I had to do everything in such tiny steps. Just the simple task of getting out of bed or leaving a building would be a huge deal. I would have to tell myself ‘first get into a sitting position. Then we’ll worry about the rest of it afterwards.’ I would see everything as such an ordeal, all these little things bundled into one huge thing. I just felt like there was this massive problem and I had no idea what to do about it.[….] Things seem almost impossible. Just getting out of bed is difficult. […] It was an effort to do things like have a shower and get dressed. Everything was so difficult. It would take a lot of encouragement for me to begin to do anything.”

“It’s a struggle to get out of bed and make a drink. I can only usually get a glass of squash, it’s too much effort to stand there and wait for the kettle to boil to make tea. […] your whole body struggles to move and […] moving it is like pushing your way through treacle.”

 

Changes in the experience of time

Many people describe how time is experienced differently when they are depressed. Often it is reported that the passage of time is affected – typically it is experienced as if it was passing more slowly. Other responses described time as ‘losing significance’ and others that time seemed to speed up or be ‘running out’.

“It goes very, very slowly. Like I remember lying awake at about 4am in my uni room and it was going so slowly, all I had to do was get through to the morning so I could get some help and it seemed almost impossible just to get through those few hours because it was taking so long.”

“Things seem much slower, time drags”.

“Time seems to drag. A day feels like a year.”

“Time goes so slowly when I’m feeling really bad.”

“When I am depressed I feel like time goes slowly, yet at the same time I feel like I – or anyone else – has hardly any time to live at all. It feels as if time is running out.”

“When depressed, time seems to slow down, and to a certain point can become irrelevant. It is easy to lose track of days without realising it.”

“Yes, days go past slower and more boring feeling like everything’s going to drag on. On the other hand can feel like life going too fast and the years are flying by and start getting depressed thinking not long to live now etc.”

“I just felt very detached from time, it simply didn’t matter”.

“When I am depressed I don’t seem to notice time, it just doesn’t matter to me, it all seems to blend into a mass of nothing. [….] Time loses significance.”

“I have no concept of time when I am depressed.”

“Time becomes insignificant. It passes and that’s all that matters.”

 

Interpersonal relations

The responses demonstrate that, in a variety of ways, a central feature of depression is changes to a person’s relations with others. Many describe difficulties in maintaining everyday social relations and report feeling unable to trust other people. A number of responses also emphasized how, because of depression, they feel a burden to others. 

“The world appears to be a frightening place full of people who are bad and threatening.”

“I can feel very paranoid and unsafe, like I’m on the verge of being attacked, mocked, the subject of any kind of negative attention.”

“When I’m depressed I feel like my relationships are less stable and I trust others a lot less. I try to avoid people, as they seem angry and irritated at me, and like they don’t want me around. I feel like a burden to others and don’t want to cause anyone unnecessary distress.”

“I withdraw from people when I’m ill and feel an outcast but even when I’m better I feel an outcast because it’s always there and find it hard to trust people enough to let my guard down.”

“I find it extremely difficult to trust anyone; it feels like they have all ‘guessed’ there is something wrong with me and now they are all conspiring to get me ‘sorted out’ i.e. remove me from normal society so that I don’t affect everyone around me with my awful, scary madness”.

“When I’m depressed, strangers scare me, I trust no one.”

“I feel very separate from people, fearing that if I talk about how I’m feeling they’ll reject or disapprove of me. And yet, on the flipside of that, I can become very clingy and over-reliant on people, particularly my boyfriend, and fear that without him I’ll somehow disappear. Seeing people becomes a huge chore, so I avoid friends, but then get upset when I’m not invited to things, feeling rejected and left out.”

 

Changes to possibility

Many of the responses included descriptions of how a sense of what is possible is changed. This can take different forms. It could involve how ordinary actions and activities seem impossible or that the future is no longer ‘open’. Such changes have profound effects on a person’s motivation, their sense of self and interpersonal relations.

“I remember a time when I was very young – 6 or less years old. The world seemed so large and full of possibilities. It seemed brighter and prettier. Now I feel that the world is small. That I could go anywhere and do anything and nothing for me would change.”

“It is impossible to feel that things will ever be different (even though I know I have been depressed before and come out of it). This feeling means I don’t care about anything. I feel like nothing is worth anything.”

“The world holds no possibilities for me when I’m depressed. Every avenue I consider exploring seems shut off.”

“When I’m not depressed, other possibilities exist. Maybe I won’t fail, maybe life isn’t completely pointless, maybe they do care about me, maybe I do have some good qualities. When depressed, these possibilities simply do not exist.”

 

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