Episode 94: The Different Faces of Depression with Alyssa Scolari, LPC
Episode 94: The Different Faces of Depression with Alyssa Scolari, LPC
Depression might be clinically diagnosed as a very specific set of symptoms, but it is often so much more than that. Does your depression cause you to over-function? Does it cause you to under-function? Has your pain ever been invalidated because your symptoms don’t look like the stereotypical symptoms of depression? If so, you are not alone!
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Alyssa Scolari [00:19]:
Hello. Hello. Welcome back to the Light After Trauma podcast. I’m your host, Alyssa Scolari, back with a solo episode, after taking a few weeks of doing a guest episode with Rebecca Christensen. It was a two-part series on narcissistic abuse. If you haven’t gotten a chance to check it out, it is very good. Go check it out. I was taking a break, mostly because I haven’t been feeling that great and physically I’m feeling mostly okay. But emotionally I have not been feeling well at all. April is just not my month. And so I definitely needed a few weeks off. So Rebecca and I had done this two-part episode and I thought now was a perfect time to be able to share it with you all, because it gave me a little bit of a break just to be able to recuperate and try to recover a little bit. And quite honestly, I am still not feeling good, at all.
Alyssa Scolari [01:33]:
And I think there’s a million reasons why. I already know the answer to the why, but the question of how do I get these feelings to go away or to leave? I have yet to answer that because I’ve been feeling terrible for, I would say at least like a month at this point. I have just been really struggling with depression. And I know that there’s a lot going on. Just as an example, this time of year, particularly, is really hard because four years ago was when my mom got really, really sick and she almost died. In fact, we were told that she was going to die and she made it and she survived, but not without months of her being in the hospital and being in ICU and her being up and down and up and down. And one minute she wasn’t going to make it. And the next minute she might have a chance.
Alyssa Scolari [02:43]:
It was an emotional rollercoaster for months. And I can’t forget it and I will never forget it. And I think this time of year is when it just hits me the hardest. My body… You Bessel van der Kolk said it best, right? Your body keeps the score. And my body has been reminding me that this time of year, four years ago, was really, really hard. I spent like 24 hours a day, just like praying to every God out there, that my mom would live. And she did. But it’s hard because I feel like… I don’t want to sound ungrateful because I’m very, very grateful for the circumstances, and I know other people don’t have circumstances like that. Other people do lose their parents. So I’m trying not to act like this was the worst thing that ever could have happened. But with that being said, I think that I need to acknowledge that it was very traumatic and it’s not even just that. It’s a million other things, too, that have been going on and changes in my life and shifts in my relationships that have been really, really hard for me.
Alyssa Scolari [04:06]:
And I have been depressed. And it’s really interesting to hear myself say that because I have always held… I think prior to becoming a therapist, I have always held such a stigma of depression. And I notice that the people around me, the world around us, people hold such a stigma about it. People are so much more likely to say I have OCD or I have anxiety, right? Anxiety is the big one. Anybody will walk up to you and be like, oh, my anxiety. Oh, my anxiety. But very few people will just kind of start talking about their depression. That is largely in part because of the stigma that we place on depression. It’s okay to talk about anxiety, but it’s not okay to talk about depression.
Alyssa Scolari [05:00]:
I don’t really know why. I could theorize why I think that depression is kind of more serious sounding. And when people think depression, they think suicidal. And when people think suicidal, it makes them very uncomfortable. And therefore, we don’t even want to breach that topic. So we’re not even talking about it. I think that has a lot to do with it. But ultimately, I don’t know for sure. But what I do know is that I even internalized that stigma for a while and had a really hard time talking about my depression. Happy to say, I don’t have that hard of a time talking about it anymore. I feel like I’ve really released that stigma. And so that’s what we’re talking about today.
Alyssa Scolari [05:45]:
We are talking about depression. I think we really haven’t yet just sat down, me and you, the listener, and had a chat about depression. I’ve had people on the show that I’ve talked about depression. Depression has been a theme of almost every episode that we’ve done, but what does it actually look like? And I think that what has really inspired me lately to share about this topic and to speak on this topic is, I think a lot of the judgements that I have received about my own depression, because if you had a conversation with me, you would have no clue that I was depressed. In fact, you would get the impression of the exact opposite. You would think that I was the happiest person in the world. In fact, people often describe me as being bubbly, which blows my mind, because that is the furthest thing from how I view myself… like bubbly me.
Alyssa Scolari [06:53]:
Absolutely not. I’ve often been compared to… I don’t know if anybody’s going to remember this, but the Powerpuff Girls with Buttercup, Bubbles and Blossom. That was one of my favorite shows growing up. People often compared me to Bubbles, who was like this very adorable little bubbly blonde. She was my favorite when I was growing up. And people often compare me to her and I don’t see myself that way at all. So let’s just talk for a second about what depression actually is, because contrary to what I think a lot of folks believe, depression is very, very, very different from sadness and in the DSM, which is that book that has all of the mental health diagnoses, it is really classified by multiple symptoms. And those symptoms are not like sadness. Sadness or a sad mood, is not a symptom of depression. That is how different they are… they’re not even close. Sad versus depression… completely different things.
Alyssa Scolari [08:08]:
So some of the symptoms of depression include, a loss of appetite or overeating… so maybe issues with getting in touch with your hunger and fullness cues, or even your hydration cues, your thirst cues. Issues with sleeping… having depleted energy, or maybe being tired all the time, feeling fatigued all the time. Having a low self-esteem, difficulty with concentrating or making decisions. Feelings of hopelessness or despair is another one. The loss of interest and pleasure in a lot of the activities that you used to once find very pleasurable. Problems sleeping… either you can’t fall asleep or you wake up throughout the night or you’re having nightmares all the time. Perhaps changes in weight. Perhaps not always. We talked about low energy, problems thinking or making decisions, thoughts of guilt or worthlessness. And it can be, again, not always, repeated thoughts of death or suicide or a suicide attempt.
Alyssa Scolari [09:20]:
So basically there’s two different kinds of depression in the DSM. There’s major depressive disorder. And then there’s different severities of that. So it can be mild, it can be moderate, it can be severe. It can be with psychotic features without psychotic features. Or we’re not going to go into that today, because honestly, that’s just going to bore you, but major depressive disorder… and that is when you have to have these symptoms, at least five of the symptoms for at least two weeks, then you can classify or qualify for having major depressive disorder. Then there’s dysthymia. And dysthymia is also known as persistent depressive disorder. Now, persistent depressive disorder, or PDD, or dysthymia as you’ll hear me call it throughout this episode, is less severe than major depressive disorder, but it lasts for much longer. So instead of having to meet five of those symptoms that I listed for PDD, you only have to meet two of those symptoms.
Alyssa Scolari [10:31]:
So it’s certainly a less severe form of depression. But in order to have dysthymia, you have to have felt this way for at least two years with little to no relief. Whereas major depressive disorder is sort of like extremely depressed, noticeable changes, severe changes, but then you come out of it and then maybe you go back into it again, dysthymia is sort of this lower level or like lower grade depression that is just always there. I got to be honest. I don’t love this. I really don’t love the way the DSM breaks down depression, because honestly, what the fuck? Like, okay, well, what if somebody has both? What if somebody has low level depression all the time, but then it gets really, really bad sometimes. Or there’s just so many loose ends with these with the way that depression is listed in the DSM.
Alyssa Scolari [11:31]:
And I’ve also almost always seen depression be a part of other mental health disorders. So it’s, is this person dysthymic? Do they have PDD or do they have trauma that’s taking them years to recover from. And as a result of the trauma, they have depression. Do we keep throwing diagnoses at people and just say, oh, well you have major depressive disorder. Oh, well it’s been two years. And now you have PDD… I guess I don’t agree with it. I think it’s very confusing for folks. And I think it’s very confusing even for mental health professionals. But, alas, this is what we’re working with here. But I think that it’s important to note that this really isn’t the be-all end-all for depression. I know I’ve said this before, but in order to even create these diagnoses, there’s no one way to create a diagnosis that’s going to be the way for all of eternity.
Alyssa Scolari [12:30]:
Basically what happens is a bunch of mental health professionals get together in a room and decide what criteria needs to be in place in order to meet… in order to get a diagnosis. So humans are fallible. Therefore, I think that all of these diagnoses in themselves can be fallible. And that’s what we’re talking about today, because the way that depression is listed in the DSM and the way that therapists are trained to spot depression is very, very stereotypical, which is great, but the majority of people don’t operate like this. Maybe not the majority, but many, many, many people do not experience these symptoms, but have depression or don’t experience these symptoms outwardly, I should say.
Alyssa Scolari [13:28]:
So for example, if we can look at Winnie the Pooh for a second… bear with me. Let’s take a look at Eeyore. Eeyore is your classic depression. He is depressed, right? Whether he has major depressive disorder or dysthymia… I would say he could probably have both. He perpetually has a low grade level of depression. I think sometimes maybe he feels a little better, especially after he finds his tail. But I would say that he also can suffer from major depressive disorder. I think that he doesn’t function as well as the other members of Winnie the Pooh. And I do think that he could meet… I mean, I don’t know for sure, but I think that if we talk to Eeyore, if I had him in my office, I think there’s a strong possibility that he could have at least five of the symptoms that also would give him a diagnosis of major depressive disorder.
Alyssa Scolari [14:36]:
When we look at Eeyore, we have no questions about it. We are… Eeyore is depressed, but we can’t really look at many people and go, that person is depressed. We just can’t. It doesn’t work like that. Most people don’t walk around acting that way or showing that, and depression has so many different faces. And this is where I tend to get very frustrated because I think that again, as a society, people expect that depression is going to just look like the moping sad person, but it’s not. And I have had multiple interactions lately, where, especially in this last month, as I said, I have not been doing well with… my depression has been… it’s felt unbearable, to be honest. I don’t feel well. And it sucks. And I am doing my best to work through it. And I am engaging in all of the coping skills.
Alyssa Scolari [15:42]:
I am not isolating myself. I’m trying to go out with friends. I am trying to get outside as much as I can, but at the end of the day, I still feel depressed. I still do. And I am just sort of like trying to ride the wave and wait for it to pass. But because I don’t look depressed, my depression doesn’t get taken seriously. So let’s talk about what depression might look like on me, because, well, basically when we look at depression and anxiety and perhaps a few other mental health disorders, we have people who go into really essentially two different categories. We have chronic overfunctioners and then we have chronic underfunctioners.
Alyssa Scolari [16:34]:
I am somebody who is an overfunctioner when I am depressed… meaning I will get out of bed. I will brush my teeth. I will do my hair. I will work the entire week. I will extend myself when people need me. If people reach out to me, I will make sure that I respond immediately. I will answer all my emails. I will prepare all my meals. I will eat. I will drink. I will go out with friends. Like I am go, go, go, go, go, go, go. I appear happy. I appear bubbly. I am laughing. I am cracking jokes. I know I shared on my Instagram story… for those of you who follow me, a couple weeks ago, I shared that I had gone out with friends and I went out to meet them for really the first time this… the one person I knew I hadn’t seen her in years, but the other people, I didn’t know. And that is really, really scary for me. Especially being in a state where I had been feeling really depressed and really vulnerable.
Alyssa Scolari [17:40]:
I put myself in this situation, which I thought was going to help my depression. And it did. I think that it did, but I went out and I had a good time. Everybody was great. I felt like I was with people who were very similar to me. And I was the life of the party. I was literally the life of the party. I was cracking jokes. I was telling stories. I was laughing. I was engaged. I was making eye contact. I wasn’t on my phone at all. I was playing with the animals. I was great. If anybody had been in that room and they had talked to me or they had even watched me, they would say, nope, there’s zero risk factor here. What people don’t know is that I came home that night and I was getting ready for bed. And I was very much in my head about, oh my God, did they like me? Did I say something stupid? Was I annoying? They probably hate me. I wonder if I’ll be invited back. No, I definitely am not going to be invited back.
Alyssa Scolari [18:48]:
And I had a quick exchange with my husband and he said something to me that I interpreted incorrectly as a result of already being on edge. I sort of thought that he was like upset with me and I lost it. Like had a panic attack that lasted four hours. And look, I know that a lot of people love to say panic attacks only last three to five minutes. That is some bull shit, okay? That is some bullshit. If somebody says that to you, that’s because they’ve never had a panic attack before. Panic attacks do not last for only three to five minutes. I could not breathe for hours. I was hyperventilating. I was sobbing. I was disassociated. I was… I was gone. I was gone. I was in a level of emotional pain that felt absolutely unbearable for me.
Alyssa Scolari [19:54]:
And as a result of that chronic breakdown, I barely slept. I woke up the next day feeling emotionally hungover. I was exhausted. And when I’m tired, I get even more depressed. So I kind of like lost my weekend to a meltdown that I had merely hours after going out and appearing like everything was absolutely fine. When I am depressed, and when people who are overfunctioners are depressed, you’re not going to see us kind of like laying in bed. You’re going to see us going and going and going and going until we break. And that is sort of… that is what I do. That is my tendency. And the more depressed I am, the more high energy I’m going to be. Maybe that sounds a little wild, but here’s my reasoning behind it.
Alyssa Scolari [20:50]:
I can’t speak for other people, but my reasoning behind it is because the more upset I feel… the more depressed I feel, the more vulnerable I am and I hate being vulnerable. It is really, really terrifying for me. I am working on it, right? The part of this podcast is… this whole episode is me being vulnerable. This is really hard to talk about, but when I’m vulnerable, because I hate it so much, I feel like I need to put on more of a show so that people can’t tell that I’m hurting because it almost keeps people at bay, right… because people can’t look at me and see my sadness. So they’re not going to ask… because I’m like, don’t ask me. Please don’t look at me. Please don’t see through me. I don’t want you to see through me and see that I am in agony. I over function. So nobody knows.
Alyssa Scolari [21:44]:
Outwardly I don’t display any of those symptoms, but I come home and I fall apart. And every symptom is there. I know one of the sure-fire ways when I am depressed, is that I stop drinking water. I literally just stop. Like I cannot get in touch with my thirst cues at all. And then my hunger cues go away. And then I feel tired all the time and I stop eating. And it’s like… this past Saturday, I don’t think I ate a full meal until four o’clock. And that is so unlike me, because I’m usually so good at getting all my meals in.
Alyssa Scolari [22:26]:
So depression can look like over-functioning. So please do not look at the people around you who appear to have it all together and say, oh, you don’t know what it feels like. You don’t know what it’s like to be depressed… because I’ve had several people kind of say that to me this past month where, if somebody asks me how I’m doing, and I’m, honestly, I haven’t been doing well. Or I said… I had an event to go to where I actually said hey, I don’t think I’m going to be able to make it. I’m not really feeling well. And you know, this person was, oh, are you sick? And I was, no, honestly, just emotionally not doing well. Don’t think I want to go. I really think I need this night to myself. And this person was… this person is not a close friend of mine, at all.
Alyssa Scolari [23:16]:
So I didn’t really… it’s not like this person like knows me really well. And it’s not like I really care all that much that this person said this, but it does kind of piss me off… in general, I’m not angry at the person, but just in general, as a society like that, we think this way, because this person was, oh, but you look happy all the time, when I see you. I didn’t know you were going through stuff emotionally. And I wanted to be, well, we are all going through stuff emotionally. Have you not been around for the past several years? We are all going through it. What do you mean, I didn’t look sad? Oh, I’m sorry. I’m sorry I didn’t look sad. And I’ve just had several little comments like that throughout my life of people being, oh, well you didn’t look sad or, oh, well, depression… you never told me you were depressed. First of all, I don’t need to tell you. I don’t need to tell you.
Alyssa Scolari [24:17]:
But second of all, I don’t care what I look like. I’m telling you my experience. Why are you invalidating it? And so I think the people who have depression, who over-function really struggle with this, as much as we kind of over-function because it’s protective for us and we don’t want to let people in. We also feel really, really hurt when people invalidate us. Now, listen, I’m not saying that’s anybody’s problem to fix. I need to be perhaps not so guarded and I need to learn how to tone down my over-functioning and I have… even telling somebody, hey, no, I can’t go to this, I need to take care of myself… that is huge for me because in the past I would’ve been like, go, go, go, go, go. Because I grew up being taught that it is never okay to inconvenience somebody else for your own personal needs.
Alyssa Scolari [25:13]:
Right? I grew up being taught that all that matters is making other people happy. I grew up being taught that it only matters what you look like to others… doesn’t actually matter how you feel. What matters the most is what you look like to others. But some people, when they’re depressed, they become underfunctioners. And that is okay. We tend to glorify overfunctioners. And I hate that because overfunctioners, as a result of never letting themselves really feel their feelings and slow down, they tend to develop high blood pressure and high blood pressure is actually considered the silent killer. It is considered the silent killer and studies have found over the years that so many folks with high blood pressure have been able to manage it through stress management. So it is all so linked. So, but here we are glorifying overfunctioners.
Alyssa Scolari [26:15]:
underfunctioners don’t necessarily have the same struggle with the high blood pressure. They might, right? They may, but it’s not necessarily a result of them under functioning because your underfunctioners are people who have trouble showering. They have trouble brushing their teeth in the morning. They have trouble eating or drinking, or they will not text anyone back for weeks at a time. They won’t show up to anything. They sort of fall off the face of the earth and they struggle with even the most basic things. Simply the act of breathing can feel difficult on the days where the depression is really, really bad.
Alyssa Scolari [27:05]:
Now there is also a stigma against underfunctioners. And that stigma is that they are lazy. They are flaky. They are dirty, right, especially when we talk about how hygiene can sometimes go, when we’re feeling really depressed. So many people turn their nose up to that. Ew, oh God, Ew. How could you not brush your teeth? I don’t understand how you could just not brush your teeth and lay in bed all day. Or I don’t understand how you could just not wash your sheets for two months. I get infuriated when people say things like this, and honestly, I have been surrounded by people my whole life who are overfunctioners who disparage underfunctioners. How could you let your house get dirty? How could you do this? How could you do that? It’s called depression and we need to stop judging it.
Alyssa Scolari [28:07]:
Now I am not saying that every single person with a filthy home has depression. That’s not what I’m saying here, but what I’m saying is these can be signs of depression. If you walk into someone’s home for the first time and you notice that it is dirty, that might not be because that person is lazy or doesn’t care or wasn’t raised right. No, that can be a huge red flag for depression. Somebody’s bad breath could be a huge red flag. Maybe it was all they could do just to get to work. So I’m trying to get us to understand that depression doesn’t just look like some sad, mopey, Eeyore-like character. Depression can look like the person who comes in with a full face of makeup. You know, they come into work with a full face of makeup and a minty fresh breath, or it can be the person who comes in… they look like they barely put a comb through their hair and their breath reeks.
Alyssa Scolari [29:11]:
We can’t call people names as a result of either. We cannot look at underfunctioners and make judgements on their character when we don’t know, because that could be the face of depression. The person with a full face of makeup could be the face of depression. I am the face of depression. I am one of the many faces of depression. I struggle with depression on a regular basis. I have been so tired at times that I haven’t been sure how I am going to go on. There are days where I under function as well. They are a little bit more rare for me because my tendency is to over-function, but there have been days where I’m like, I can’t get out of this bed. I just can’t do it. And therefore, I didn’t eat. Therefore, I never got to brush my teeth and you know what? I am no less of a person. It doesn’t make me lazy. It doesn’t make me gross. It doesn’t make me unhygienic. My teeth haven’t fallen out. I have not hurt anybody as a result of my under functioning.
Alyssa Scolari [30:33]:
So there are stereotypes of both, overfunctioning under functioning, major depressive disorder, dysthymia. Whatever you may be struggling with, whatever anybody may be struggling with, it is still excruciating pain. And I want us to remember that the next time we go to cast aspersions on somebody or make judgements. And I want us to remember that the next time that we are in conversations with people, because I, myself am like a victim of being… or not a victim. I’m not a victim. I am a victim of people kind of looking at me and saying, oh, well, you can’t be depressed, but I have been wrong before by looking at other people and being like, huh? Why didn’t you shower? Like what is going on here? Right. I have judged people by being like, what the heck happened. That can be a face of depression.
Alyssa Scolari [31:31]:
So this is something for all of us to work on, but this is also something for us to learn about ourselves. Are you an over-functioner? Are you an underfunctioner? What does your depression look like, because what I described coming out of the DSM, that’s not all depression can look like. And I think that once we sort of identify for ourselves what it looks like for us, then we are able to catch it much more quickly and can then work to recover from it. It’s not always going to look like it does in the textbooks. It’s going to look different for each and every one of us. So I think it is really helpful to figure out what it looks like for you.
Alyssa Scolari [32:14]:
And one way you can do that is by journaling, right? What does my depression look like for me? And you can think of all of the examples that I’ve just given and you can decide for yourself. And maybe there are things that I’ve left out. Maybe there are things that I am not aware of myself. Hey, let me know. You know where to find me, and, oh, I don’t think I mentioned that at the beginning of this episode, but you can give us a follow over at Light After Trauma on Instagram.
Alyssa Scolari [32:42]:
And if you are a Patreon member, and you would like, you can certainly request an episode topic. I know a few of you have done so, and I am working on getting to them. When I get an episode topic, I like to do my research on said topic because I don’t want to come in just like making stuff up… obviously that’s not helpful for anybody, so I like to do my research. So once you request a topic, it is going to take me some time because I want to look into it. I want to read about it. And I want to feel equipped enough to be able to share with you what I’ve learned, especially if it’s not something that I’m familiar with. So just keep that in mind. The Patreon is in the show notes, so you can feel free to go and check that out.
Alyssa Scolari [33:29]:
And thank you so much for the support as always. If you have not done so already, please feel free to leave a rating or review of the podcast. It helps so much. I hope that everybody’s having a good week. I am hoping and I’m praying for a better week on my end. I am just… yeah, I am feeling terrible and I don’t have any follow ups… there’s no buts after. There’s no, oh, I know it’s going to get better because… I do know it’s going to get better, but it’s not helpful for me to kind of say that. Sometimes we just need to be in it. And that’s kind of where I am. I just need to be in it. I just need to acknowledge that I am not even a little bit okay, but I am I’m here and I’m doing my best to keep myself moving and enjoying the sunshine and just making the most. But it is what it is for right now until I feel better.
Alyssa Scolari [34:35]:
So I hope that you are all doing very well. I love you all. I am holding you in the light and I will see you next week. Thanks for listening everyone. For more information, please head over to lightaftertrauma.com or you can also follow us on social media… on Instagram we are @lightaftertrauma and on Twitter it is @lightafterpod. Lastly, please head over to patreon.com/lightaftertrauma to support our show. We are asking for $5 a month, which is the equivalent to a cup of coffee at Starbucks. So please head on over. Again, that’s patreon.com/lightaftertrauma. Thank you. And we appreciate your support.