★Metaphors for depression, clean language, and the DSM
I've used a lot of metaphors for depression to myself, to help me understand what I'm feeling. And to remember later how it was - perhaps to exorcise it, to capture it, and to study it. And because I often want to write when I'm depressed, and the depression crowds out almost everything else.
It's a black veil, making it hard to take in a deep breath of clean air, masking all the colour, making it hard to even imagine colour.
It's a friction, a downwards. I feel like an ungainly bird trying to lift off, flailing and thrashing hard to heave off against the heaviness. I look at the others, aloft, buoyed by thermals, only needing a lazy flap here or there. They can't imagine how much more work it is to lift off than stay up.
When I'm still functioning in the face of the depression, I feel like I'm flying inches above the treetops. It takes only a slight drop in the wind and then I'm being snagged by a stray branch, stumbling and wheeling awkwardly, feeling the darkness of the forest yawning and gaping underneath me.
The physics of it makes me feel like a rocket yearning for escape velocity. On the ground the gravity is strongest, and from a standing start it's going to take a truly concerted burst of effort to make any headway - even a gigantic plume of flame barely seems enough to shrug off the inertia. But eventually, gradually, there is motion. But is it enough? Are you going to run out of go before you run out of slow? It feels like there's so so much more stop to start with. And every time you stall, defeat surrounds and clothes and clings to you, like raindrops in a drizzle.
But there are moments during the ascent that feel like suddenly bursting through the clouds, when thrust exceeds gravity and it feels like the acceleration could be endless. Smiles and good fortune are in arm's reach in every direction, like reassuring rounded pebbles on a British beach. Treasure and relive those moments, and they will help sustain you through the difficult times.
I suppose the message from the physics of a rocket is to keep on afterburnering upwards as fast as you can, that a small constant effort is never going to be enough to achieve escape velocity. This is why the NHS NICE guidelines suggest that you combine both intensive CBT and antidepressants for more serious or long-lasting depression. You need as much acceleration as soon as possible. And my hunch is that the different components have different timecourses, e.g. exercise gives you a quick boost, medication takes a few weeks to really kick in, and the cognitive interventions probably have the longest-term effects.
Suffocation and colour and friction and gravity. Intensity and activation and expansion.
Postscript: a testable hypothesis & treatment idea
One further thought.
Of course, there are other metaphors that people have used. Could there be something to the different kinds of metaphors that people use?
After all, we try to characterise individual symptoms as precisely as we can, and to pay attention to how they cluster, as our means of individuating and categorising diseases. Could metaphor be a way to characterise the phenomenological symptoms, as a clue to what's underlying them?
There's evidence to suggest that depression isn't a unitary condition. This might explain why different people respond differently to medication.
Could we use something like clean language to gather people's metaphors for their depression, characterise the kinds of metaphors used, and then attempt a systematisation and diagnosis of depression by metaphor?
Or better still, try and map the system of metaphors to the patterns we see from our more traditional evidence-gathering, with brain imaging, response to medication, in symptoms, etc? "Ah, heavy-veil, with family history, but no mania - try Sertraline until your sleep symptoms improve." Oh, you're getting "Black-dog with occasional mania and increased schmorbito-florbital activity - stop ruminating, and eat fewer hamburgers.".