DEPRESSION
By Dr. Daniel A. Bochner
Depression touches us all. It is so common that it really should
be better understood. When a person is depressed, they typically
experience several of the following symptoms: poor sleep (including too
much), poor appetite (including too big), decreased interest in life or
activities, worry and/or guilt, low energy, poor concentration, and
thoughts about death or even suicide. The experience of these
symptoms is often associated with anxiety and tension as well, although
such symptoms can lead to a completely separate diagnosis of anxiety
disorder if they are relatively disabling.
All kinds of depression have similar symptoms, and all kinds have
similar dynamics, but there are two basic causes of depression. These
two separate causes can often occur simultaneously. Depression either
comes from a basic lack of internalized love and/or it comes from
feelings of helplessness, hopelessness, or loss in the face of bad
circumstances. By “lack of internalized love” I mean that some people
have never experienced enough consistently positive feedback and
affection to become confident about positive feedback or affection
continuing into the future. Such people devise various personality
strategies aimed at securing love which are typically controlling,
manipulative, or desperate but can seem powerful, self-assured, and
seductive. When such people do not get what they want, at first they
might become more aggressive in their style. If that does not work,
however, they become depressed, with relentless feelings of emptiness
and dread.
Feelings of helplessness, hopelessness, or loss, on the other hand,
can be a primary cause of depression in themselves, even when they
occur in the life of someone who is relatively healthy. Mentally healthy
people feel responsible for those close to them, and struggle to balance
that responsibility with taking good care of themselves. When
something horrible happens to such people, whether that horrible thing
involves a traumatic experience in the life of a loved one or to
themselves, they can become depressed as they struggle with feelings
of guilt or wonder about how they could deserve such experience. On
one hand, such people feel the need to care for those they love, and
when others are suffering or when others leave, they feel at fault and
typically associate the cause to their own selfishness which then leads
to guilt. On the other hand, when bad things happen, relatively healthy
people often feel like they have been cheated or betrayed, since they
think of themselves as deserving happiness in return for the good they
have done for others, and because they have tried as hard as possible
to be good. They simply cannot understand how they could deserve
such heartbreaking and agonizing circumstances.
Regardless of the cause of depression, the dynamics and
symptoms are typically quite similar in all cases. The depressed person
undergoes a transformation from a state of relative emotional freedom
and ability to withstand the daily pressures of life, to a state in which all
of their energy goes into squashing their emotions as though all
emotions are “bad.” A person afflicted with depression wallows in
feelings of inferiority, weakness, and guilt, but they try to control the
expression of these feelings for fear of hurting others or burdening
others. They often feel that the world is caving in on them, that
responsibilities are overwhelming, and that if anyone knew how they
were truly feeling, they would lose all positive affection and love from
others and be rejected. Thus, depressed people tend to feel extreme
loneliness and isolation since they feel no one is connected with them
or in touch with how they feel.
Paradoxically, depressed people typically do the opposite of what
is necessary for them to recover. Since depression is so related to
being accepted by others (even in cases of loss), an afflicted person
needs to share feelings and be active in exposing their experience to
others. Most typically, depressed people isolate their feelings and
themselves, and quite often their activity level decreases due to how
hard it is to tolerate the vulnerability of feeling exposed. However, if
the depressed person does expose their true feelings to loved ones with
whom they can feel safe, they typically start to feel better relatively
quickly.
This process allows their assumptions about how unacceptable
their feelings are to be contradicted both in the real world and in their
minds. The need for reassurance and a non-judgmental attitude from
those who could be close to the depressed person is therefore crucial.
All too often, depressed behavior results in rejection from others who
are afraid of being “brought down” or who feel vulnerable themselves
when they don't know what to do. However, if the depressed person
can see that they are still acceptable and loved, even when they have
terrible feelings, a big part of the depression is lifted, since the
depression brings with it a feeling of being unacceptable, unlovable, and
worthless. Activity itself can help create greater exposure. If a person
is active, doing things, and getting things done, feelings of
worthlessness are contradicted by that activity. Thus activity results in
exposure and likely a feeling that one is acceptable even when the
depressed person is not revealing their true feelings.
Psychotherapy works in a similar way. Although most patients
do not feel that their therapist is a “loved one” as mentioned above,
they do hopefully feel that the therapist is a relatively non-judgmental
and open-minded person, who is not directly involved in their lives, and
who is professional. When emotions are exposed within the context of
psychotherapy, the same kind of process occurs as was discussed
above. When the depressed person exposes their true feelings to the
therapist, and the therapist does an adequate job of making them feel
that their feelings are acceptable, the depressed person can generalize
that feeling to their experience outside of therapy. They can start to
feel that their emotions are okay, and they can start to regain some
semblance of spontaneity in their lives.
The question of chemistry is also important. No one really
knows whether or not depression is caused by chemical changes in the
brain or whether the brain’s chemistry changes when someone
becomes depressed. Really, that question is not very important to the
depressed person who is simply desperate to feel better. The fact of
the matter is that brain chemistry does change with depression,
regardless of whether the changed chemistry or the depression occurs
first. The dynamics and precursors of depression as outlined above are
also a matter of fact, whether or not chemistry is involved. The human
emotional system works by certain rules that make the depressed
person react and think as has been discussed above. The truth of the
matter is probably that some people are more prone to depression at
the chemical/physiological level, and thus are more likely to see the
world in the ways outlined.
Finally, there are two things I always recommend to depressed
clients. The first is, be really, really good to yourself (please see
article, Be Your Own Best Friend). The second is, tell that nasty,
nagging, critical voice inside your head to “SHUT THE HECK UP!!!”
Most people say things to themselves that exacerbate their depression.
They tell themselves they are not strong enough, that other people will
think horrible things about them, that they are not worthy, or that they
are worthless. Being kind to yourself, however, means to treat
yourself like you think a kind and loving mother should treat a small
child who is hurt or scared. Would you scream at, or criticize, a poor
vulnerable child? I don't think so. So, don’t do that to yourself. Tell
that voice to SHUT UP!!! Defend yourself against it fiercely. At the
same time, tell yourself it is okay to be hurt, give yourself an emotional
hug, and do anything you can to comfort yourself.
If you are feeling depressed, open up to loved ones, get active, be
kind to yourself and, if you are having trouble beating it on your own,
go see a psychotherapist. Research indicates that you will benefit most
from a combination of medical intervention and psychotherapy.
Understanding the patterns that get you thinking in negative and self-
defeating ways is important, but do not underestimate the importance
of simply feeling better, even if you need to alter your brain chemistry
to do it. Sometimes, feeling better in itself, regardless of how you do
it, is necessary in getting you growing in new and healthy ways. No
matter how you view it, however, you cannot recover from depression
unless you see that you are an important and worthwhile person, who
obviously deserves to be loved.