AM I DEPRESSED?

Over the past few months, I have received many letters and e-mails requesting information on depression. Here are some questions that were posed:

• What causes depression?
• How can I know if I am depressed?
• What is the best way to overcome depression?
• Is it better to get medication, attend psychotherapy, become more spiritual, exercise, form better relationships?
• Do most people become depressed at some point in their lives?

In response to these questions, I would like to share some information on this widely-discussed yet commonly misunderstood state of mind.

Depression, contrary to it’s popular connotation, is more than being down in the dumps or feeling a bit blue. Depression is a serious emotional state of affairs that tampers with one’s self-esteem, affects one’s sense of well-being, and even interferes with the ability to work and to love. Common symptoms of depression are difficulty concentrating (inability to focus and remember), difficulty sleeping (waking up in the middle of the night - or in some cases, sleeping all of the time), disturbance of appetite (eating too much or too little), feelings of hopelessness or dread, and loss of interest in usually pleasurable activities.

Brief, reactive depression can settle over a person quickly and powerfully in response to an emotional conflict or upsetting situation. But in most cases, depression builds over a longer period of time.

In 1882, Freud wrote a brilliant little article entitled ‘Mourning and Melancholia’. In the article, Freud compares grief (mourning) with depression (melancholia). In both cases, there is an underlying feeling of abandonment, a resulting loss of interest in the outside world, and a fundamental hopelessness about finding (or re-finding) love. Freud theorized that individuals who are grieving often feel ‘let down’ or failed by the person who has died and left them. Similarly, individuals who are depressed often have had an underlying experience of being failed or ‘left behind’. In the case of the depressed person, however, the failure is often historical (for example, a mother who was cruel, a father who drank excessively, a school-teacher who was mean and exacting, a family member who was distant and cold).

Freud’s ideas have been expanded by contemporary theorists. Here are some current ideas about depression:

• Although the depressed person often feels that a sickness has descended upon him, the depression is usually a product of how he thinks and feels. When depression extends for a long period of time, however, antidepressants can be a helpful adjunct to insight oriented psychotherapy.
• Although many adults experience hardship in childhood, the depressed person unconsciously blames herself for the suffering to which he has been subjected. For example, if his parents were alcoholics he may unconsciously blame herself for the resulting chaos and inattention to which he was exposed. Or if a parent was self-centered and depriving, he or she may blame herself for being ‘unlovable’. The seeds of current, ongoing depression are frequently planted in childhood.
• Self-blame creates a vulnerability to depression, because it makes a person feel defective and unlovable.
• The depressed person is often angry. Unlike individuals who are able to resolve anger directly with others, the depressed individual unconsciously turns his or her anger against him or herself. As just described, this tendency is often rooted in a long history of turning anger inward whenever he or she is mistreated.
• Depressed people often have difficulty sleeping, eating and concentrating (symptoms that mimic those experienced in grief). This is because the depressed individual often feels cut off from love and emotional nourishment.
• Depression can be stimulated by current conflicts that mimic painful past experiences from childhood.

*Linda, who came to therapy because she was depressed, exhibited many of the symptoms and syndromes just described. During the first session, she relayed that she was experiencing moderate difficulty sleeping and concentrating. Over the past two months she had lost five pounds.

When I asked Linda what was making her depressed, this is what she shared: I’m not sure what is making me depressed. I began a new job last year, but I feel I can never please my boss. I work evenings and weekends, but he never seems to be satisfied. I must be doing something wrong.

It was evident that Linda was blaming herself for her boss’s unreasonable demands. Instead of allowing herself to feel angry toward her boss, Linda was turning all of her anger inward. Thus, she was unable to use angry feelings to make constructive changes at work or to protect herself. As a result, she felt demoralized, depressed and cut off from support.

Upon exploration, I discovered that Linda had a long history of blaming herself for mistreatment she received from others. Both of Linda’s parents had been unreasonably critical. And instead of understanding that their standards were too high, Linda had come to view herself as ‘slow’ and lazy. As Linda grew into adulthood, she was plagued with continual uncertainty about whether or not to stand up for herself.

In therapy, Linda learned to respectfully hold others responsible for their actions. This helped her to see others more clearly. This also decreased her anger, boosted her self-esteem, and allowed herself to value her contributions at work and at home. As a result, her depression lifted.

The following is a list of guidelines I offer individuals like Linda who are attempting to recover from depression:

• Become aware of past events and people who have made you angry or failed you. For example, if you had a parent who was unreasonably controlling try to understand the realistic impact s/he had on your life. Strive to understand and appreciate the forces at work in both their life and yours.
• Cease blaming yourself for suffering you may have experienced at the hands of others.
• Try to use anger in constructive and appropriate ways.
• Make sure you are in charge of your own life.
• Make sure you are surrounded by people who offer love and care.
• Keep your schedule structured and routine. Resist the urge to lie in bed all day or stay home from work. Exercise daily.
• Resolve conflicts with those closest to you (including those who may not be emotionally close but who exert an influence upon your life) and make sure your life is free of resentments and inequities. For the depressive personality, current relationship conflicts can stir up old feelings of depression.
• If your depression does not resolve, seek help from a qualified therapist.

Depression is serious - but not incurable. For many, depression can become a valuable sign-post that points toward necessary changes they must make in their life. If you suffer from depression, learn to use depressed feelings as an important guide to altering and adjusting relationships, coming to terms with the past, and developing a realistic view of yourself in relationship to others.