Written by : Dr. Samantha Boardman

The Pebbles Can Pummel You

Depressed woman

Determining whether a person is clinically depressed is not an arbitrary decision. Psychiatrists follow strict guidelines specified by the DSM (Diagnostic and Statistical Manual of Mental Disorders) and look for at least five of the following nine symptoms lasting at least two weeks:

  1. Feels depressed most of the day, nearly every day, as indicated by subjective report (e.g., feels sad, empty, hopeless) or observation made by others (e.g., appears tearful)
  2. Feels markedly diminished levels of interest or pleasure when engaging in all, or almost all, activities most of the day, nearly every day (as indicated by subjective account or observation)
  3. Significant weight loss when not dieting, or weight gain or decrease, or increase in appetite
  4. Sleep disturbance
  5. Psychomotor agitation or retardation nearly every day (observable by others, not merely subjective feelings of restlessness or being slowed down)
  6. Fatigue or loss of energy
  7. Diminished ability to think or concentrate, or indecisiveness
  8. Feelings of worthlessness or excessive or inappropriate guilt nearly every day
  9. Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide

I include these criteria not only because I want readers to know that depression can manifest in many ways but also to underscore the importance of seeking professional help if they apply to you or a loved one.

Over the years I have diagnosed, hospitalized, and treated many patients with the full range of the symptoms described above. But there are also many who qualify for an “almost diagnosis”—not mentally ill by clinical standards but lacking positive mental health.

When I first opened my private practice, most of the new patients I took on were at an inflection point. They sought help to assess a life-changing decision or to understand a relationship, or they were in the midst of a significant transition, often following a loss. The chronic issues in their daily lives did not take center stage. Today more and more patients come to see me because of the ups and downs in their daily lives. They are feeling worn out and worn down by the daily grind.

Women seem to feel it the most. Almost half of the women surveyed said they frequently experience daily stress, and more than 40 percent said they feel as if they don’t have enough time. Their lives are nonstop, with a to-do list that seems bottomless. Often a lack of vitality only amplifies their stress. Patients often just give up and sigh, “I guess that’s just life.”

The hassles of day-to-day living— the annoying, anxiety-provoking, and frustrating experiences that are embedded into everyday life— are a significant source of stress. Seemingly minor occurrences—an argument with a child or partner, an unexpected work deadline, arriving late for an appointment, missing a train, or dealing with a malfunctioning computer—all contribute. One study’s results indicated that watching the news and losing your cell phone are among the top ten daily events that stress people out. Even a long line at your local coffee shop or not having hot water for your morning shower can be enough to put you in a terrible mood. We know it’s absurd to allow something minor to ruin a minute let alone a day. We try to dismiss these daily irritations as irrelevant or as the “first- world problems” they are. We tell ourselves that they don’t matter in the long run. But they do.

Many assume that major life events like divorce, the death of a spouse, and the loss of a job are the most virulent causes of stress, but a University of California, Berkeley study confirmed that so-called microstressors are the ones we need to watch out for: “[T]hese kinds of stressors have been taken for granted and considered to be less important than more dramatic stressors. Clinical and research data indicate that these ‘micro- stressors’ acting cumulatively, and in the relative absence of compensatory positive experience, can be potent sources of stress.” The impact of challenges that occur during everyday living on both a person’s physical and mental health cannot be underestimated and are, in fact, better predictors of health than major life events.

This excerpt is from Everyday Vitality by Samantha Boardman, published by Penguin Life, an imprint of Penguin Publishing Group, a division of Penguin Random House, LLC. Copyright © 2021 by Samantha Boardman. 


Dr. Samantha Boardman is a Positive Psychiatrist with a private practice in Manhattan. She is a Clinical Instructor in Psychiatry and Assistant Attending Psychiatrist at Weill Cornell Medical College. She received her B.A. from Harvard University and a Medical Degree from Cornell University Medical College, where she was awarded the Oskar Diethelm Prize for Excellence in Psychiatry. 

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