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Q. Is it depression or do I have PTSD? 

My friend hasn't been "happy" now for years. He has flashes of real joy, but then usually sinks into extended "dark" periods. He can be the life of a party, but if we talk about it later he remembers it as having been "not fun". Even if we are doing something he wanted to do recreationally, in the midst of the activity he is usually depressed. 

He was around 13 years old when his father was killed in a plane crash. Is it possible that the stress of this led to his depression? 

A. No one can diagnose your friend from a distance. To get an accurate differential diagnosis, he needs to see a qualified mental health professional. 

I can however explain how PTSD can look a lot like depression. 

Your question is a wonderful example of why I donít like to use mental health language. Instead, Iíd mention normal feelings like sadness, grief, and pain. Then we can discuss the limitless and inventive ways human beings avoid these feelings. 

When you have experienced a tragic loss or severe trauma, your mind and body will naturally keep returning you to your loss and trauma until you experience these feelings out of your system. 

I often use the analogy of stomach flu to explain this. When you have the stomach flu, your mind is drawn back to the pain in your stomach until you vomit or have diarrhea enough for the flu to progress out of your system. 

I always cringe when I use this example, because the stomach flu is extremely unpleasant. So it is with grief and trauma, extremely unpleasant. Repeatedly reliving your loss and trauma is awfully painful. But it is still a completely normal and healthy response to grief and trauma. 

It seems that any active emotional participation in your life can cause you to become more aware of your feelings. And right now those feelings are all related to sadness, loss, hurt and pain. Then, experiences like hope, love, fun, exercise, and setting goals for your future cause pain instead of pleasure. 

Sometimes people avoid the normal expression of this emotional pain in a variety of creative ways. Avoidance can look a lot like depression. Avoidance creates an ever-narrowing circle around your life. 

People avoid remembering their trauma. One way to do this is to censor your thoughts and feelings. You stop any activities connected to your trauma. Then you stop any other activities that might trigger you to remember the activities connected to your trauma. 

Avoidance doesnít stop there. People continue on and drop any interest in activities that they enjoyed before their trauma. They distance themselves from others and avoid intimacy. People also limit their ability to feel their full range of feelings. Some people carry this very far, and become almost totally numb. And last, people stop hoping and thinking positive thoughts about their future. 

People donít do this knowingly. They are usually unaware of their avoidance activities. Unfortunately, avoidance can continue for a personís whole life. And it can extend further into all kinds of behaviors that are self-destructive, like drug or alcohol abuse and unhealthy relationships. 

How this shows up is a very individual matter. It depends upon your friendís life at the time of his fatherís violent death, his relationship to his father, and his ability at 13 to understand his experience of horror, loss, and sadness. 

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