The Difference Between Being Sad and Being Depressed

We must not confuse the two as the treatment needs to be different as does the diagnosis.  Let us return to the brain and its three levels.  There is a big difference between sad and depressed. Sad is strictly limbic, second line emanating from amygdala, hippocampus and other key limbic structures.  Depression  lies deeper in the antipodes of the brain, out of reach, part of the shark/dinosaur legacy.  It makes me think that utter hopelessness can derive from an ancient brain,  the same brain that harbors rage and fury.  It can only be described in global notions of heaviness, no energy,  no ambition, no future, etc.  There are no words on this level which makes it difficult to treat; and certainly a cognitive, word-laden approach will not touch it.  That is why in desperation some doctors insist on electroshock therapy. Blasting the brain because they simply do not know what to do.  Pretty clumsy and massive.  The opposite of delicate and targeted.  What else can they do?  Talk to the shark brain and convince it of the ineffectiveness of its ways?  It doesn’t talk and won’t respond.  Doctors want to blast the brain because it seems so unyielding.  The station of last resort are pills; they help kill pain. But not forever; therein lies the rub.  We are mollifying, not curing.  We are adding  sop to the process hoping for the best.

Can we offer hope? Maybe, but against what?  Hope to get out and be free.  Who knows that is the problem?

Depression seems to come out of nowhere; it comes out of the non-verbal brain.  Herein lies one key difference.  Sadness can be described as to how it feels.  Depression cannot. Sadness is often situational/existential.  There might be a reason for it;  lost a lover, failed a class, did not get the promotion, lost a job.  It seems to come from outside.  And psychological counseling can help.  Depression can only be described by its internal effects, a heaviness,  cannot get out of bed.  What is being described are first line brainstem effects.  The problem is that deep hopelessness can be life endangering and can lead to impulsive suicidal acts.  The act comes out of an impulse laden brain that can act but not reason and cannot rationalize.  It cannot delay act-outs because that brain is what is behind act-outs; a brain with no great cerebral cortex to hold back action. And those who cut themselves sense this when they cut into themselves; they understand it is inside and deep and that they must reach it even in their crude ways.  They do not know there is a deep imprint there but it is all they can do.  It is what deep depression is.  I see it often when the depressed patient comes in immersed that state and begins to relive  the birth trauma or even before when the mother was  drugged during pregnancy and the child has no way to escape. It is indeed hopeless, there is no exit, no way out, to quote Sartre.

That all encompassing lassitude is what animals do when all is hopeless, locked in cages and unable to escape. The system gives up. It is just awful but it is treatable; no easily but possible.  The whole system accommodates to this state with  drop in vital signs.  The voyage to the deep brain has to be slow because we must travel deep into the brain that is millions of years old, and it must be done methodically and carefully.  In no other way can we become close to our archaic history.  I believe that in some of us the imprint may lie in the period when the system was on the verge of giving up; passivity and lifelessness were imprinted and drove our personal evolution.
 Those deep unconscious pleas to live must see the light of day so we know exactly what it is and what we are dealing with; only then can we say, “Cure.”