The other day, a good friend sent me a link to an article about “almost depression,” telling me that she thought this described her, and asking what I thought about it. My friends and family are often hesitant to ask my opinion about psychological matters (“I don’t want to make you work on your off time!”), but the truth is that when it comes to my personal life, I’m never really able to be a “professional”—I make no bones about having my personal opinions and observations and share them. So when my friend asked me for my opinion, I shared it, but it also got me thinking about this term, “almost depression.”
Maybe it’s my take on the word "almost," but “almost” anything sounds like it’s not all that serious, and that’s certainly not how I react to the idea that someone has a few symptoms, but not enough to meet criteria for diagnosis. In the case of diagnosing Major Depression, for example, you have to experience at least 5 of the 11 symptoms in a 2 week period to be “clinically depressed.” So if you only have 4 of the symptoms, does that mean that you have no problem or “almost” a problem? I don’t think so.
I acknowledge I have a horse in this race—I am clearly a proponent of therapy and think that it is helpful for most people who are struggling. And given the ongoing stigma associated with mental health issues (we haven’t beaten this yet, but we’re making progress!), it makes it quite a tightrope walk for people to reach out for help. It is not uncommon that people sit across from me in my office clearly in emotional pain, and at the same time saying things like, “I shouldn’t be wasting your time,” or “this really isn’t a big deal.” However, I have yet to think of a time when someone said that to me and I actually thought that they were wasting my time, or that what they were talking about in therapy was small potatoes. Usually, these kind of “time wasters” are thoughts and feelings that are difficult to pin down, and don’t become clear until they are really talked about.
When I worked in the U.S., I always had to come up with a clinical diagnosis to justify treatment, and luckily in Canada, this is less often the case. Don’t get me wrong—diagnoses can be helpful. They can give people a direction in their google searches and can help shape how we proceed with treatment. Sometimes it gives people a sense of relief that there are many others who experience the same thing they do. But what happens when people don’t fit neatly into a diagnostic category? What I see in my office are people who feel miserable and then feel like they have no right to complain because they don’t meet clinical criteria for a mental health diagnosis. But they continue to suffer.
Whether we call it “almost depression,” “almost posttraumatic stress disorder,” or “almost panic disorder,” if we’re getting into the ballpark of “almost”, there’s clearly a difficulty. Since I’ve learned to speak Insurance, I know how to document things accurately so that my clients can use their insurance to pay for my services. And as it turns out, there are actual diagnoses that capture the “almost” experience, which I find useful, such as “Depressive Disorder, Not Otherwise Specified (NOS).”
I have a feeling that Dr. Carson, the author of the CNN article who is an associate of the Department of Psychology at Harvard, probably knows a great deal about the NOS categories. I am grateful that she’s talking about Depression in a way that makes it accessible to more people—people who may not be so comfortable with a clinical diagnosis. The important thing here is that it’s getting people talking—my friend is talking about this to me and to other people, and hopefully some of you reading this will talk to others about mental health, too. It’s this kind of talk in the everyday that helps reduce the stigma of mental health so that people might seek treatment, as well as learn how to support one another.