Feeling Depressed, and ‘Depression’.
Feeling sad, lost, or emotionally overwhelmed is something all of us experience at times. It’s part of what it means to be human and no one seriously expects to be happy all of the time. While we shield children from life’s harshest realities, we expect that as they mature into adulthood they will develop a degree of emotional resilience that allows them take on more and more knowledge of the darker parts of our world.
While many people feel low at points in their lives, the term “depression” carries a more specific meaning within the psychiatric system. In clinical settings, it’s used to identify a group of symptoms that, when experienced together, may lead to a formal diagnosis.
How Is Depression Diagnosed?
Medical professionals often refer to tools like the ICD-10 (International Classification of Diseases) and the DSM-V (Diagnostic and Statistical Manual of Mental Disorders) to diagnose mental health conditions. These guides are the international standards for assessing emotional distress, developed from decades of clinical data.
In the ICD-10, for example, a typical depressive episode is described as including persistent low mood, loss of interest in daily life, fatigue, sleep difficulties, low self-esteem, and more. The aim is to create consistency in diagnosis — a shared language for treatment providers around the world.
But can a human experience as complex and personal as suffering truly be captured by a checklist?
The Limitations of Diagnostic Labels
Even the authors of these diagnostic manuals acknowledge variation, especially among adolescents. They describe “typical” experiences and what symptoms people “usually” report — but emotional distress and a depressed mood rarely fits neatly into discrete categories.
One concern I often see as a clinician is when clients have already received a diagnosis of depression from a G.P. or psychiatrist. While this label might help explain what they’re feeling in a general sense, it doesn’t speak to their individual experience. The word “depression” becomes a placeholder — standing in for the nuanced, layered, and personal story behind their suffering. I think it’s fundamentally important for anyone feeling depressed in an enduring way to access psychotherapy to name or verbalise more completely what they are going through in order to gain some control over their situation. That this can be a pivotal way to actively direct their lives into a better head space.
Diagnosis Doesn’t Equal Understanding
A diagnosis often implies a treatment timeline: based on the previous experience of others, and often millions of others, there is a standardised conceptualisation of how a ‘typical’ person will ‘usually’ respond to different forms of treatment. In my clinical experience with those diagnosed with ‘depression’ there is an expectation and prognosis that improvements will occur within a predetermined time frame and that medication will have had a specific and measurable effect within a specified timeframe.
Medication may relieve symptoms — for some, it’s an essential support. However I don’t think it should ever be prescribed without an engagement in some form of talking therapy, and in only very rare situations should it be considered as the first form of treatment. Psychoanalytically speaking, symptoms are more than dysfunctions to fix — they are expressions of something yet to be fully verbalised and understood. They have meaning. They ask to be understood, not just medicated. This includes feelings of depressed mood. I would argue that only when such feelings of depressed mood can be better understood and traced back to their origins can we expect to alter them permanently. No one wants to spend any longer than necessary taking such medications if they can find an alternative that has more satisfying and lasting effects.
Your Suffering Is Valid — With or Without a Diagnosis
The key message here is this: you don’t need a formal diagnosis to take your feelings seriously. If you feel weighed down, hopeless, or emotionally stuck, that experience is already valid — whether or not a professional has named it.
In psychoanalytic therapy, we focus less on fitting your experiences into categories and more on exploring where they come from, what they might represent, and what needs to be spoken aloud to shift them.
Moving Beyond Shame, Towards Meaning
In Northern Ireland and across the UK and Ireland, conversations about mental health have come a long way. But we still carry cultural legacies of silence, stigma, and the need for external validation. If we are to grow beyond those legacies, we must also move beyond the belief that a doctor or authority must “confirm” our suffering before we can attend to it. You know your own experience. That’s enough.
If you're struggling and would like to explore how psychoanalytic therapy might help, you're welcome to make contact — your story is worth being heard.