Depression

Depression rarely looks like sadness. More often it looks like weight: getting up costs, answering a message costs, deciding what to cook costs. It is not that things have become painful; it is that they have become effortful out of all proportion, and have lost their colour along the way.

Many people arrive saying they have no reason to feel like this. They have work, a family, friends — and that makes it worse: on top of the effort sits the guilt of feeling it without a presentable reason.

Signs people tend to play down

• Waking long before the alarm and being unable to fall back asleep.
• Losing interest in things that used to give pleasure, with nothing taking their place.
• Withdrawing from people one declined invitation at a time, to avoid explaining.
• A constant self-criticism that is out of proportion to the facts.

What we can do with it

The work is not about persuading yourself that everything is fine. It is about understanding what that withdrawal is protecting and what it is costing, and rebuilding, slowly, a space in which things carry weight again. It takes time, and the first part is often simply managing to tell someone.

Where the picture is serious, a medical assessment alongside can make sense. That is not a failure of the work, and it is something we discuss together rather than a decision I announce.