Sunday, October 14, 2012

Living without pleasure

People tend to think of depression as a syndrome characterized primarily by pervasive feelings of sadness.  To be depressed is to be in such despair that it becomes difficult to function.  Many of us have either known someone struggling with depression or have seen it somehow depicted by cultural media.  As a result, few of us are completely unfamiliar with what it means to be depressed.

Many of my patients struggle with depression.  For every new patient seen in our clinic, we obtain a full biopsychosocial history and perform a complete diagnostic assessment.  Ideally, the goal of this assessment is to generate an overview of the patient's "problem," preferably in the form of a clinical diagnosis.  In reality, however, I find that few patients really need me to tell them what's wrong; most of them already have an idea of what's wrong, which is the reason they've sought help in the first place.  In other words, a person struggling with depression already knows he feels depressed; he gains very little from having me slap a label on it. 

From time to time, however, I encounter patients who seem clearly depressed to me but who are quite surprised to hear me say it.  "I don't feel depressed," they say.  You see, depression doesn't always look the way we think it does.  In fact, it's quite possible for someone who doesn't necessarily feel depressed to meet the diagnostic criteria for Major Depressive Disorder.  Rather than feeling depressed, the problem for such a person might be that he doesn't feel much of anything at all. 

Anhedonia has been described, quite poetically, as the "paralysis of emotion."  It comes from a combination of the Greek a + hedone, literally meaning "not pleasure."  In mental health, it refers to an inability to experience pleasure in activities that one would typically find enjoyable. 

Patients relate how they experience it.  "I just feel 'blah," is a quite common description.  Others talk about lacking motivation.  "I don't feel like doing anything," they say.  "I can't get motivated."  Still others become distressed by what they perceive as a personal failing.  "I don't even enjoy spending time with my kids.  The whole time I'm with them I'm looking at my watch, wanting it to be over;" or perhaps, "I know I love my kids, but I just can't feel it." 

I wish I could conclude my little presentation with some wisdom about how we can all learn to experience pleasure in life.  The truth is, I let out an inward groan everytime a patient tells me he is unable to find pleasure in anything.  That's because as a symptom, anhedonia is notoriously difficult to treat. As a therapist, I can encourage you to engage in activities that should theoretically be enjoyable, but I can't make you enjoy them.  I'm not even sure I can teach you to enjoy them.  How do you teach something like that?  Treatment with antidepressant medications have very limited success as well.  It's a situation that often makes me feel helpless.

But if I feel helpless, imagine how the patient must feel.  Imagine a life without pleasure.  What kind of life would that be?


  1. You can't possibly give people meaning in their life. But also you can't "do" yourself into experiencing pleasure. Drugs only prolong the ennui.
    It's more like enjoy whatever you are engaged in good or bad as they all provide some learning.

  2. You might find this interesting:

  3. That sounds to me like pure hell....

    I go through bouts of depression but they are usually situational and I am lucky enough to feel everything...


  4. It is living Hell every single day. Can't feel any "feel-good" emotions like comfort, peace, thankfulness, pleasure, motivation. Nothing is funny. Can't laugh. Emotionally numb. Can't feel a back massage. Force a shower once or twice a week. Can't leave the house most of the time, and everything is "hard". Existing is hard. Cannot feel pleasure from music like I used to. Can't watch tv.. interest in things is totally gone. That includes interest in people, as well. Can't be around people.. feel to bad. Can't talk most of the time. Don't want to text, don't want to email. There is a big "nothingness" to EVERYTHING. No breaks, never get relief. Depression for 30 years, but 4 years ago a move triggered ptsd and deeper depression, than 2 yrs ago a series of traumatic events and devastating losses occurred triggering even deeper depression and losing more of the ability to "feel" anything. Tried therapist after therapist.. none of them knew how to do therapy! Most of them were social workers. I do not think they r trained in therapy as much as a psychologist, plus it can be difficult to find the right fit. I fear I will have to live the rest of my life this way. Don't want to go another day every day, but 3 suicide attempts and none of them have been successful. Oscilate from very little hope to no hope constantly. Try to live without hope.. it is very, very difficult. Can't feel sadness since I can't feel my emotions. I would give anything to feel the sadness that used to come w/ my depression. No appetite 6 out of 7 days a week. Nothing tastes good. Nothing helps the symptoms. Walking makes me feel worse when I am able to force it which ends up being once a month. have lost old personality.. adventurous, outdoors person, hiker, camper, backpacker, mtn biker, love of animals and nature, nice, caring, empathetic person. Now, I have none of these qualities. Cannot feel anything around animals. Always had dogs and derived so much joy out of them. Went to the spca.. could feel nothing around the puppies. nothing. I am just "existing" every day for what I do not know. It is a very cruel and isolating disease.

  5. also tried shock treatments.. they made me worse! So beware that they can make you worse. they don't help everybody. I became suicidal after each of the last 3 treatments and was able to feel even less than I was before them. I also tried (TMS)transcranial magnetic stimulation for 6 weeks every day. It was very painful and w/ the 3rd week of treatments, I lost the ability to feel "comfort" completely, and lost the ability to feel ANY pleasure from music. Music had always been a big part of my life :( Since I couldn't watch tv, I would listen to music for hours at night and it would sooth me and I was able to get something out of it. No more. It has been a very long year without it. And, not being able to feel comfort from anything is sooo hard. I used to feel comfort from having my roommate around. Now, it's as if no one is there. I can feel "nothing". TMS is new and they aren't going to tell yo about the people it makes worse. They are trying to sell the idea to make money. It wasn't even a doctor that administered the treatments. It was an office worker. I wish I could sue for the losses I have had to go through. My life is totally empty without being able to feel comfort and pleasure from music. That was all I had left. After the fact, I read that TMS is used to treat moderate depression.. not severe like I had. I don't want anyone else to get worse from these things, so just know that it can make things worse for you. Now, I cannot go back. The damage is done. I have to live with it.

  6. Find The.Luciferian.Doctrine.pdf


My Favorites