Clinical depression can be thought of as in part a social illness. Any serious illness affects more than the sick person. If you have, for example, heart disease, then withdrawal of your self from the social world (work, family life, friends and relatives) is a result of the illness. You may be forced to stay in a hospital for a long time, or be too sick to leave the house for anything outside of doctor visits. However, if you have depression, social withdrawal 'is' the illness and one of the overlapping consequences of having this disease.

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Understanding of what depression really means aids in the process of acceptance. The deeper the under-standing, the better able the individual is to cope with what can often be in irrational disease. It can be an aid to effective self-management and better coping skills.

'Social withdrawal' is only one of many illness aspects that overlap with the results or symptoms of having chronic depression. This article outlines four issues that affect those with depressive illness. These issues here are social in nature. They affect both the sick individual, and those in his or her life-world.

1. The prevention and coping with social isolation (including social withdrawal takes an odd twist when you consider that for this illness, (mostly) voluntary social withdrawal is the reason for the isolation. The reasons for this are often related to lack of self-esteem, high levels of anxiety, inability to concentrate, and general feelings of not belonging. - Of being out of place, out of touch, and unable to connect to that internal resource called 'the self'. The person we are - that we label as 'I' or 'me'-is a resource. A human disconnected from his or her self can no easier get things done than any individual could get done without other people. One man in the two-man bobsled is not going to win the race. He/she can't even play. "Social withdrawal is both a consequence of the condition and one of its [depressions] chief defining characteristics." -David R. Karp, Boston College (1994)
2. Dealing with uncertainty. And with the high anxiety levels that often accompany this illness, uncertainty can become quite limiting. Indecision takes over - we are stuck. We are uncertain of our self and our relationships with family, friends, and work-mates. If we have not been able to work, or find it hard to keep a job, finances are always there in front of us with a big question mark. We are uncertain of what others are thinking silently to themselves when they see us. Or what those significant others are saying to others when we are not around.
   
   Do they think we are crazy? Do they think we are lazy? Stupid? Selfish? This is an internal negative feedback loop that can destroy us if we let it. The reassurance of family and friends and employers can be a great benefit. That is, if they know about it. If you have managed to hide it well enough, then you are doing, well, better than some of us are. That much is for certain.
3. Normalizing social and interpersonal relationships. The symptoms of depression are mostly to completely invisible to those outside of the person with the illness, The symptoms, being internal for the most part, have only external manifestations associated with other sick roles to use as "proof" of an illness. Admission of this illness is an admission to being mentally ill. If we have to take off sick from work, we have to tell our boss something. If our sex life with our mate is non-existent, she or he has to know the reason why. Our friends need to know that we care, but we do not and can not handle being in groups of people at social events. Our children need to know that we love them and support them despite the way we may be acting. And how we go about acting 'as if' we are normal creates its own internal problems. If we pretend too much, we may lose touch with who we are completely. We may hide the real issues even from ourselves - and doing that can lead to major problems later on. You know, 'when the rubber meets the road.' Denial leaves us stuck in place. Lying to ourselves leaves us without a self we can rely on. Suicide can result if the spiral downward continues going deep enough and for long enough.
4. Managing stigma. To be stigmatized is to be labeled as different from others. We all stereotype to one degree or another. However stigmatization goes much deeper. To be stigmatized is to wear a costume that displays who and what you are so completely, that you are judged as non-person. You are a 'generalized other'. A sociologist studied stigma. The title one of his essays (Erving Goffman) on the issue of stigma: "Stigma: Management of a Spoiled Identity". Now that kind of sums up definition. So defined your ability to be treated as a unique individual with wants and needs and abilities and talents and something to contribute to the world becomes nullified.

Men in our culture are particularly vulnerable to denial due to fears of stigmatization because, well, it is not 'manly' to be emotionally distraught, depressed, unable to support your family, etc. Instead, to avoid stigma, men more so than women, often hide their illness through alcohol or drugs. Even from themselves.

Having depression myself, I can testify to the absolute 'need' to withdraw into ones self. Depression disconnects you from yourself. It is almost as if the brain is saying, 'back the truck up, we can't deal with the outside world if we are in pieces. Stay put and get yourself together.' A biological defense mechanism to protect what is left of the whole self? The 'ego' knows that it is not whole. It does not want to risk further damage.

And yet what depression may tell us we need to avoid can be exactly what it is that we need the most. It is a fact: we are not human in isolation. We are both a product of everything that brought us to this point in time and space- and we are also an ongoing process. We are always in a state of becoming. This is a very large paradox. To pop the paradox is to create some freedom from the confines of a self that cannot get past it.

References:

Bloom, Howard. (1995) The Lucifer Principle. New York: Atlantic Monthly Press
Goffman, Erving. (1963) Asylums. Essays on the Social Situation of Mental Patients and Other Inmates. New York: Anchor.
Karp, David. A. (1994) The Dialectics of Depression. Journal of Symbolic Interaction. 17(4), 341-366.
Kramer, Peter. (1993) Listening to Prozac: A Psychiatrist Explores Antidepressant Drugs and the Remaking of the Self. New York: Penguin.
Strauss, Anslem. (1975). Chronic Illness & Quality of Life. St. Louis: Mosby.
Turner J.H.., Beeghley L.. Powers. C.H. 1989. The Emergence of Sociological Theory. Belmont, CA: Wadsworth Press.

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