I've been trying to "solve" the mystery of depression for many years. Depression has revealed its secrets to me in three main ways: as a therapist who wants to help people in a way that works; as a teacher of "Overcoming Depression" classes at Oakland Kaiser for 10 years; and through personal experience. Here is some of what I have learned about depression:
1 Although there are many ways that depression is similar across different people, depression is also unique to each person who suffers with it. There is no one-size-fits-all approach that works for everyone.
2 "Depression" is a technical term, a label, a diagnosis, a set of symptoms that describe a mood disorder. A label is useful when it points in the direction of the right kind of help. A label is harmful if it feels permanent or limiting, like it defines who you are or what’s possible for you.
3 Depression is overdetermined. This means that there is no single "cause", but multiple factors play a role. It can be helpful to look carefully and make a list of all the contributing factors because each factor has within it a suggestion for what is needed for healing. Also, making a list has the effect of getting into the observing, analytical part of your brain, which you need to mobilize in order to help yourself.
4 The three main categories of factors that contribute to depression are biological, psychological, and situational.
5 The biological factors that contribute to depression are: genetics, hormones, brain chemistry, nutrition, exercise, self medication with alcohol or "street" drugs, side effects of pharmaceutical medication, side effects of medical illness, the physiological effects of trauma and chronic stress.
6 The situational factors that contribute to depression are: experiences of either powerlessness or loss (and loss is a form of powerlessness). Loss of a loved one, loss of control, trauma, interpersonal disappointment or rejection, illness or injury, injustice, cruelty, to name a few.
7 The psychological factors that contribute to depression are: negative thoughts, feelings, behaviors, and body sensations that all mutually reinforce each other (and usually start as a response to a situation).
8 The negative thoughts of depression are biased towards pessimism, self-criticism, self-blame, self-loathing. These thoughts filter perceptions so that you only notice that which confirms the thoughts - which ends up shaping what we see and experience as "how the world is." Of all of these thoughts, self blame is arguably the most insidious. If you blame yourself for depression, you will think that how you feel is your fault, which can lead to thinking that you don't deserve to feel better, which can lead to continuing to do the things that make the depression worse as well as not doing anything that might help.
9 Sensorimotor Psychotherapy considers that depression can be an ingenious survival strategy that has its roots in trauma or interpersonal wounding. A very brief example: if in a traumatic situation you cried repeatedly for help and nobody came, your initial fight or flight defenses would have ultimately given way to "shut down" - collapse and hopelessness. Staying in the collapsed and hopeless state even after the traumatic situation has passed can become a habitual way of protecting yourself from then on, making sure that you are never that vulnerable again.
10 Depression and grief can have some similar features. Whereas depression is an illness, grief is a healthy response to loss. Grief flows and depression gets stuck. Although grief is painful, there is nothing pathological or "wrong" with it. Grief is greater when we have lost something very meaningful to us - so grief is a sign of how much we have loved. The healthy way to respond when grief comes is to open the front door and let grief in and also open the back door and let grief out. A failure to let grief in or out can lead to depression. So, if you are depressed it can help to find what you are grieving and make sure you have opened the front and back door so the grief can flow through.
11 Depression can be an indicator that something is going on at a deeper level that needs your attention. The following are just a few examples of what depression could be indicating:
Something in your situation is "killing your soul." If you continue to ignore this, or avoid taking action to restore balance, the depression will likely grow more insistent.
You are living too much on the surface - you are too preoccupied with being who you think you "should be" and not aligned with the depth and uniqueness of your essential nature. Depression is trying to "take you down" to a deeper, truer experience of your Self.
You are disconnected from your wild, indigenous Soul.
There is "unfinished business" from your past - unprocessed emotions, unresolved pain.
Your natural impulse to discover, develop, and share your unique gifts and talents with the world is being blocked or thwarted or ignored.
You are holding a grudge and blaming someone or something for your predicament. Blame gives something outside of yourself the power to cause and to fix your experience, which makes you feel powerless. Powerlessness is depressing. You have forgotten that you have the power to let go of the grudge and move on.
You are disconnected from your ability to touch the magic and mystery of life.
12 In an excellent blog post, Steve Bearman, PhD considers depression as "The Shutting Down of Aliveness." He writes:
"Let’s consider some excellent reasons to become depressed, to stifle the flame of aliveness:
Imagine, say, that some of the events in your life have left you with feelings too painful to face. What if you could somehow just shut down the whole feeling mechanism? You wouldn’t be able to feel much enjoyment either, but the trade-off might just be worth it.
Suppose something changes, and whatever has made your life most meaningful is now gone. The work of finding new sources of meaning, purpose, or inspiration might prove too arduous. Better, perhaps, to retreat into a way of being where you don’t have to try anymore. Even if the cost is that nothing motivates you or feels right.
Though people around you seem to be in touch with their desires, perhaps there has never been room in your life for you to discover what you want, or what you like, or what’s worth pursuing. Or perhaps you know what you wish you could have, but you can’t seem to get it, or you think wanting it is unacceptable. If what you want is unknowable, or unattainable, you can always settle for a comfortable, if empty, place to wait out your days.
Consider just how much is wrong in the world, in your world specifically, and consider the significant obstacles to changing any of it. It can seem quite hopeless. Rather than banging your head against the wall of futility, it might be easier to give up."
You can find Steve's blog post here:
13 If depression sticks around long enough it can become habitual. By this I mean that you get used to the depressed way of thinking, feeling, and behaving. You start to think that depression is who you are. You start to think that the bleak world and the hopeless future you see through the lens of depression is reality. You forget that your perception and attitude are colored by depression. This can be debilitating and self-reinforcing because the depressed way of seeing, which is hopeless and pessimistic, often doesn't think anything will help and is therefore reluctant to try to change or will give up easily.
14 The symptoms of depression - namely pessimism, low energy, low motivation, irritability, and feeling undeserving, can make it very hard for a depressed person to reach out for help or to initiate or maintain efforts to help him or herself.
15 The paradox is: turning depression around requires mobilizing your will - your will to live, your will to feel better and to enjoy your life, your will to give and receive love, your will to find meaning and purpose, your will to engage in life creatively and courageously. Yet, depression has zapped your will. What are you to do?
16 The question asked in number 15 above does not have a "quick fix" answer. It is a paradox to contemplate: How do you mobilize will when an illness has taken it away and it is nowhere to be found? A beginning of an answer lies in the creative process, in which something is created out of nothing. Your will must be invoked, evoked, remembered, called, imagined, conjured out of thin air. In order to do that, you must be in touch with how much you want to feel better.
17 So, begin by focusing on your desire to get your life back. The more you focus on it, the more you stoke the fires. Don't let yourself get sidetracked in depressive predictions of failure - just think about what you want. Then, it can help to make a list of all the things (no matter how small - no kidding!) that have helped you to feel better in the past - things like connecting with your pet, getting out in nature, going for a walk with a friend, listening to uplifting music, washing the dishes (one of my personal favorites). Commit to doing one small thing. I remember during a very dark time in my life, I knew that if I didn't very consciously and intentionally "turn towards the light", the darkness would engulf me completely. It was the winter solstice and I bought a strand of colored lights and hung them around a doorway in my living room. Every day, when I plugged in the lights their cheerfulness made me smile and remember my devotion to increasing the light inside myself and my life. It was a very simple action yet it was full of symbolic meaning of self love and hope. And the magical colored lights spoke to the child inside, the one who wants to live. That is not the only thing I did to get help, but it was the first step.
18 Other lifestyle changes that target the connection between body and mood are: antidepressant medication, mindfulness meditation, exercise (this can be simple - start with walking around the block and looking for beauty), nutrition (more healthy protein and veggies, reduce sugar and refined carbohydrates), give up alcohol (it's a depressant!).
19 In sections 9, 10, and 11 above we explored depression as a strategy for coping with trauma or attachment injury, or depression as avoided or stuck grief or depression as an indicator of a deeper issue that needs your attention. If any of these are going on for you, the simple lifestyle changes mentioned in section 18 probably won't be enough to help you feel better. Psychotherapy can help a lot in those cases.
Any discussion of ways to get help for depression can get sucked into the black hole of self blame if you are not doing any of these things. That is the way depression can turn anything into food for itself. My hope is that the above musings will breathe a little fresh air and new possibility into the dark dungeons of despair - because depression is not all there is. No matter how pervasively the darkness spreads, there is light around the edges. I also hoped to show that depression should be treated not just as a painful problem that needs relief but as a way your psyche is seeking to correct an imbalance by getting your attention and your curiosity about the deeper issue that is giving rise to the depression.
There is much more that I could say - and I'm sure there are many more creative and inspiring ways of considering the wholeness-seeking impetus of this illness. Your creative involvement in your depression treatment will greatly enhance its success.