It’s 4380 hours of hell.
That’s what a major depressive episode is: 4380 hours of unrelenting, unforgiving, soul-destroying hell. It lasts hour after hour, day after day, month after month, with no relief in sight. At the end of these hours of hell many, too many, succumb to their illness and die by suicide. In this post, I’ll try to show how they got to that point.
Major Depressive Disorder
Once again, here are the key symptoms of Major Depressive Disorder:
- Depressed mood most of the day, nearly every day;
- Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day;
- Significant weight loss when not dieting or weight gain or decrease or increase in appetite nearly every day;
- Insomnia or hypersomnia nearly every day;
- Psychomotor agitation or retardation nearly every day;
- Fatigue or loss of energy nearly every day;
- Feelings of worthlessness or excessive or inappropriate guilt nearly every day;
- Diminished ability to think or concentrate, or indecisiveness, nearly every day;
- Recurrent thoughts of death, recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide.
I begin with an observation: the existence of suicidal thoughts is the final symptom in the definition of Major Depressive Disorder. To my mind, this makes perfect sense. It’s a tacit acknowledgement that the preceding symptoms somehow bring about that result, that final act. Admittedly, not all succumb, but I’d venture to say that most have considered it.
I also make an admission: this explanation is reasoned conjecture derived from my own experiences with depression. I can’t point you to any study, paper, or book that agrees with me, but then again I’m not an expert in the field. What I do have is life experience and firsthand knowledge of the weight that the accumulated affects, the 4380 hours of hell, have on a person. They lie heavily upon you, tiring you, draining you, growing heavier with each passing hour.
In medicine, there’s a term: enhanced synergy or synergistic amplification. It describes an interaction between two drugs where the effect of one or both is greater than the effect of each individually. In other words, the sum of the whole is greater than the parts. I contend that the symptoms of depression operate in a similar fashion creating an overwhelming whole. Again, I’ve no proof for this statement, but it feels right to me.
When you consider the effect upon the depressive, it’s my conjecture that it’s a multiplying effect, not one of addition. Remember that each and every day, for most of each day, for 4380 hours, the depressive is battered by a multitude of mental and physical affects that just wear a person down. To the depressive, there doesn’t seem to be a reason for this, which serves to create frustration, confusion, and guilt worsening the overall impact. 4380 consecutive hours of hell. 182.5 consecutive days.
We begin with mood. Every day the depressive feels sad, empty, hopeless. It’s not sadness in the traditional sense. The additional words, empty and hopeless tell us that. This sadness doesn’t have a readily discernible cause, nor does it have any closure. It persists, and persists, and persists, no matter what’s done to get out of it.
It persists not for an hour or even a day but for a week, a month, six months, or more. 4380 hours of unending sadness, emptiness, hopelessness.
Piling on top of this is the inability to perceive or experience joy. People can laugh and cry and celebrate all around the depressive and he’s indifferent to it. He doesn’t want to be and doesn’t understand why he is. Nonetheless, this indifference creates a disconnect, a distance between the depressive and the world around him.
Activities that were once enjoyed have lost their lustre. They’ve become uninteresting. And this lack of interest spreads throughout his world, infecting his job, relationships, and social connections.
It makes sense that someone who can’t feel pleasure every day will feel empty or hopeless, or how someone who feels empty or hopeless every day can’t feel pleasure. The inability to feel wears you down. It’s a weight on your shoulders, around your neck, pressing the life right out of you. For 4380 hours of hell. Imagine how empty that life must seem, how painful this must be.
There’s more. His sleep suffers. Sleep is often denied him because his mind won’t rest. He’ll consider and reject permutation after permutation in an effort to think his way out of the problem. The racing thoughts will include denigration and shame. On other occasions he sleeps non-stop, yielding to the need, but he doesn’t rest. He’s over-tired, ever-tired, beyond fatigued. The internal dialogue continues on a subconscious level, infecting his dreams. Dreams mean there’s no escape.
The body and the mind are exhausted. With this exhaustion comes increased impatience and irritability. He’ll lash out at friends, family, and co-workers. The depressive feels guilty about lashing out, guilty about not being able to snap out of it, guilty at feeling so horrible for no reason. The guilt is there day after day after day, 4380 hours of it, all of it eating away at his self-esteem.
Psychomotor Retardation, Fatigue, Diminished Ability to Think
The pile grows yet again. He experiences a loss of energy, a reduction in vitality. If nothing brings joy, if nothing breaks through the gloom, every small thing feels difficult and becomes draining. He’s listless and unmotivated.
Even more is added. Depressed mood and the inability to find joy harm his thinking. That thinking is filled with “what’s the point?” or “it doesn’t matter”. Moreover, because of increased fatigue, his thinking ability and his body have both slowed down. Plans can take an eternity to create and another eternity to implement. In fact, so much energy is taken to plan or act, that neither reaches completion. He becomes paralyzed with his inability to plan or do. This too will foster guilt and shame and negative self-talk.
4380 hours, all eating away at your self-esteem relentlessly, all piling onto you increasing your sense of hopelessness and emptiness.
But it doesn’t end there. The depressive loses all self-esteem. He’s filled with guilt and shame and a growing sense of worthlessness. Unknowingly, everything around him that validates the guilt, justifies the shame and confirms his worthlessness, is absorbed, adding to the negative feelings. He feels guilt even if it isn’t his fault, shame even when there’s nothing to be ashamed about, both despite all evidence to the contrary.
Increasingly, he engages in an internal dialogue of negative self-talk and external actions of self-abuse. He’ll sabotage his relationships giving credence to his lack of self-worth. He may cut himself.
He’s become numb or at best feels the emotion by proxy, by its absence. He relies on the memory of who he once was to navigate through the world.
Practicing emotion by proxy allows the sufferer to don a mask of normality. He always wears this mask. No-one can be allowed to see who he truly is because he’s unworthy of compassion or empathy, friendship or love. In his eyes, if his true self is revealed everyone will see that he’s a fake, that there’s something wrong with him, that he’s undeserving, thereby confirming his lack of self-worth. 4380 hours of convincing yourself how unworthy you are.
Isolation becomes commonplace. It takes too much effort to socialize. It’s easier to just stay at home. But this generates its own guilt and shame adding to the sense of worthlessness. While alone, the guilt and shame, the inability to figure out what’s causing all this, increase the volume and frequency of negative self-talk and self-abuse. The depressed person will try to shame himself into action and shame himself again for not being able to act. In fact, everything becomes an occasion to shame himself. He will belittle himself in ways he would never belittle anyone else. He’s worthless, he deserves it.
He thinks this way every day, week after week. 4380 hours of negative self-talk. 4380 hours of hell.
Weight and Appetite
Issues with weight and appetite seem obvious in these circumstances. By doing less, fewer calories are burned. Body fat and weight grow. The depressive may turn to comfort foods, trying to recapture small pleasures.
Alternatively, there’s no motivation or energy to cook or eat, and weight plummets.
In either circumstance, bouts of guilt at the weight gain or weight loss may cause binge eating or binge dieting to compensate. All cause growth in negative self- image.
Consider how it must be to live in such a hell. To suffer without cause, to endure without respite. Affect piled atop affect, smothering you with negativity, eroding your self-esteem. Physically and mentally you’re beyond fatigued.
The definition of Major Depressive Disorder tells us that two weeks of this life is too much. Sadly, a typical episode lasts from six to nine months. If a person has had multiple depressive episodes, without treatment or with failed treatment, episodes can last years.
Consider that: at the bottom end of the typical depressive episode, six months, the sufferer is bombarded with this bleakness every day, for most of the day, week after week, month after month for 4380 hours. For some, it can be 8760 hours or more.
It’s no wonder that the final symptom has such attraction. It offers an end to the suffering. Suicide is appealing not because the depressive wants to die, but because it’ll end the pain. The end of 4380 hours of unrelenting, unforgiving, soul-destroying hell.
Sadly, my writing can’t fully convey the extent of the 4380 hours of hell within which the depressive is trapped. But I hope that I’ve given you a glimpse of what it’s like. And in that glimpse, I hope you’ll think twice before blaming the depressive for succumbing to the illness. After all, suicide is the final symptom.
That last word, symptom, is key. It’s a symptom, not a sentence. There is a way out of The Black. My story attests to that. If you believe that you’re in need of help, I urge you to speak to your family doctor. If you’re experiencing suicidal thoughts, SEEK HELP IMMEDIATELY BY DIALING 911 OR VISITING YOUR LOCAL HOSPITAL EMERGENCY ROOM.
You are worthy of life, of compassion. Please, claim what’s yours!
For the other earlier posts in this series please visit: Pt 1, Pt 2, Pt 3; and Pt 5.
Image by Jeroným Pelikovský from Pixabay