Q. Is it depression or do I have PTSD?
My friend hasn't been "happy" now for years. He has
flashes of real joy, but then usually sinks into extended "dark" periods.
He can be the life of a party, but if we talk about it later he remembers
it as having been "not fun". Even if we are doing something he wanted
to do recreationally, in the midst of the activity he is usually depressed.
He was around 13 years old when his father was killed
in a plane crash. Is it possible that the stress of this led to his
depression?
A. No one can diagnose your friend from a distance.
To get an accurate differential diagnosis, he needs to see a qualified
mental health professional.
I can however explain how PTSD can look a lot like
depression.
Your question is a wonderful example of why I don�t
like to use mental health language. Instead, I�d mention normal feelings
like sadness, grief, and pain. Then we can discuss the limitless and
inventive ways human beings avoid these feelings.
When you have experienced a tragic loss or severe trauma,
your mind and body will naturally keep returning you to your loss
and trauma until you experience these feelings out of your system.
I often use the analogy of stomach flu to explain this.
When you have the stomach flu, your mind is drawn back to the pain
in your stomach until you vomit or have diarrhea enough for the flu
to progress out of your system.
I always cringe when I use this example, because the
stomach flu is extremely unpleasant. So it is with grief and trauma,
extremely unpleasant. Repeatedly reliving your loss and trauma is
awfully painful. But it is still a completely normal and healthy response
to grief and trauma.
It seems that any active emotional participation in
your life can cause you to become more aware of your feelings. And
right now those feelings are all related to sadness, loss, hurt and
pain. Then, experiences like hope, love, fun, exercise, and setting
goals for your future cause pain instead of pleasure.
Sometimes people avoid the normal expression of this
emotional pain in a variety of creative ways. Avoidance can look a
lot like depression. Avoidance creates an ever-narrowing circle around
your life.
People avoid remembering their trauma. One way to do
this is to censor your thoughts and feelings. You stop any activities
connected to your trauma. Then you stop any other activities that
might trigger you to remember the activities connected to your trauma.
Avoidance doesn�t stop there. People continue on and
drop any interest in activities that they enjoyed before their trauma.
They distance themselves from others and avoid intimacy. People also
limit their ability to feel their full range of feelings. Some people
carry this very far, and become almost totally numb. And last, people
stop hoping and thinking positive thoughts about their future.
People don�t do this knowingly. They are usually unaware
of their avoidance activities. Unfortunately, avoidance can continue
for a person�s whole life. And it can extend further into all kinds
of behaviors that are self-destructive, like drug or alcohol abuse
and unhealthy relationships.
How this shows up is a very individual matter. It depends
upon your friend�s life at the time of his father�s violent death,
his relationship to his father, and his ability at 13 to understand
his experience of horror, loss, and sadness.
