“Every man has his secret sorrows which the world knows not; and often times we call a man cold when he is only sad.”Henry Wadsworth Longfellow
While some people might feel “down” occasionally, such feelings do not describe the intensity of negative emotions and debilitating effects of depression. Clinical depression (major depressive disorder) is a serious condition that affects 17 million adults in the United States each year, 2.8 million youth and about 2.5% of children. These are startling statistics and indicate the frequency of this mood disorder. Living with this disorder is difficult, but the good news is that normally, treatment can help if the depressed person will commit themselves to working with a mental health professional on a regular basis. My discussion of depression will span two essays, the first essay provides a brief description of the depression and describes the difficulties a person faces when depressed. It concludes with a narratological treatment of the condition. In the second essay, I will look at the other side of the issue: the difficulties a depressed person’s support group experiences when trying to live with a loved on who is deprssed. Living with depression is difficult for everyone involved and often alienates loved ones, family and friends leading to feelings of hopeless loneliness all too often ending in intense suicidal ideation.
While Major Depressive Disorder (MDD) can develop at any age, the median age at onset is 32.5 years old. Of those suffering from MDD, almost 49% of adults receive no treatment. NIMH: Major Depressive Disorder.
The client sat pitifully in my office. She was a Caucasian woman in her mid-50s who could barely speak a complete sentence much less give me an accurate account of her history and life problems. She was referred to me by her PCP, but she was not sure that seeing a mental health professional would be beneficial. As far as she was concerned, the best parts of her life had been lived, and now, her support structure in disarray, she felt that the future was hopeless. There was nothing left for her. We struggled through this first session, sometimes in painful silence. My goal was not to “fix” her depression. My goal in that first session was to help her believe that someone cared even if that someone was me, her therapist.
This woman suffered from major depressive disorder. While some medical professionals think that depression is “caused” by a lack of serotonin, one of the brain’s important neural transmitters, I don’t fully prescribe to this explanation. I think that the etiology of major depressive disorder is all too often located in a person’s life circumstances that are traumatizing and tragic, the interpretation of “traumatizing and tragic” being relative to the person and the makeup of their subjectivity. When the focus of life leads one to deep despair erasing their hope for a meaningful future, the brain responds with a depletion of serotonin thus intensifying the anhedonia that accompanies this debilitating disorder. The symptomology experienced by the woman sitting in my office was a classic case of major depressive disorder: She felt down most of the time, in fact almost every day; she found no interest or pleasure in doing the things she at one time enjoyed; her appetite was almost nonexistent and though she wasn’t dieting, was losing weight; she found that she often had difficulty sleeping at night but during the day that was almost all she did; she moved about as if she were in a daze; she was fatigued; she felt worthless and was wracked with guilt; she could not think clearly enough to put together a coherent sentence; and she was having suicidal ideation wondering whether her life was worth living. I was quite concerned about her well-being and scheduled her for another session the next day after making sure she would not be alone since she was now living with her mother.
The rates of depression have been rising among adolescents in the United States. Greater than 1 in 20 children aged 6 to 17 in the United States, in 2011-2012, were found to have current anxiety or depression by parent report. Current reports indicate depression among youth increased by 197,000 last year alone. Mental Health America
The good news is that depression can be treated if the depressed person stays in therapy. This woman did, and I was able to help her find renewed meaning in her life and a purpose for future days. She was one of the lucky ones because she followed her PCP’s advice and sought help. Unfortunately, this is not always the case and people embrace the “boot strap” cure for their mood disorder. They think they can just pull themselves up by their bootstraps and get over it. While seeking the aid of a professional may help alleviate their condition, the bootstrap treatment fails in almost every case and people who rely upon it find that they are alienated from their support structures, turn to self-medicating with alcohol or drugs sometimes leading to the most tragic of solutions, suicide. Let’s take a journey into the life of a depressed person and see why depression is so debilitating.
Living is tough. The many challenges that life brings and the ways we choose to respond to these challenges says a great deal about the persons we become. But when these challenges go unresolved or they pile up on us making any type of meaningful resolution seemingly impossible, then our emotional center, rather than empowering us to meet the challenges, begins to work against us by disempowering us and leading us to a subjective place of helplessness. When helplessness predominates and we lose our hope, we find ourselves in the throes of depression. Depression is not something we choose but is a psychophysical response to the overwhelming events of life.
According to the World Health Organization, the COVID-19 pandemic triggered a 25% increase in the prevalence of anxiety and depression worldwide (World Health Organization). According to some reports, cases of depression tripled in the United States during 2020, and now they are even worse jumping from 8.5% before the pandemic to 32.8% today, which is 1 in every 3 Americans (The Brink).
A middle-aged man sat in my office. He presented with major depressive disorder, and he wanted me to fix it. As I spoke with him over the course of several sessions, it became clear that he meant what he had said in the first session. He wanted me to fix it. He was simply a passive observer to his own life. He had therapy before; he had a prescription for an SSRI (Selective Serotonin Reuptake Inhibitor), a medication to increase the depleted Serotonin in his brain, and none of these efforts had led to a fix of his depression. He still lacked motivation and found no pleasure in his job, his longtime relationship with his girlfriend and he had few friends. Now, he wanted me to fix his motivation and do what was necessary so his life would once again be pleasurable. He didn’t want to help in this; he wanted me to do it.
Often, when I work with depressed persons, I draw upon a technique used by Narrative Therapists called “externalization.” Making a diagnosis is often problematic due to its ontic implications. If I were to tell a client “You are depressed,” I make an ontic association between his state of being and the client’s existence. To be this person is to be depressed, a thought that makes one feel as if they have no choice in the matter. This leads to a fatalistic and vicious cycle. A person feels helpless and believes they can do nothing to improve their situation, a condition upon which depression feeds thereby increasing their sense of helplessness. They become a victim of their own life. However, if I use language that places the depression over and against the client, this language leads to empowerment because it gives the person a choice. “Instead of saying ‘you’re depressed’” I say to the client, “let’s instead say ‘the depression is visiting you.’” The depression is not the client but is like an unwanted house guest that we can ask to leave.
Depression can affect any person regardless of their gender, age, race or background. However, some risk factors for depression connect the illness to a person’s gender or age. Of the 17.3 million people in the US suffering from depression, about 11 million were women, young adults between 18 and 25 have higher rates of depression, and in every age group, females were more likely to struggle with depression (The Recovery Village).
Now while this sounds simple, it takes time to change the client’s language about themselves and hence their thoughts about the power of depression. “If you don’t listen to it and instead listen to yourself,” I would tell them, “you rob the depression of its power. It is not powerful without your consent.” And then I follow this statement with a question, “Do you like the depression? Do you like the way it makes you feel?” to which I receive an almost universal “no!” “Then,” I say, “let’s work on talking as if you wish to close the door to the depression and open the door to yourself.” At this point, depression is externalized and if done effectively, the client begins to believe that it is possible to send depression packing.
Now, the client no longer has to be a victim; they do not have to be passive spectators of their lives. At the core of most people’s subjectivity is a desire to find purpose and meaning in life, and purpose and meaning brings hope. The best cure for depression is recovering the hope that the depression has hid from them so they can begin to dream positive dreams about what the future holds in store. The problem is that too often life hides the hope that lies within, and the depression convinces its victim that the hope simply does not exist. If a person can sift through the circumstance of life so that they are not so overwhelming and begin to feel the power of hope, then it is a short step to excluding depression from their lives.
The prognosis of the illness is usually very much associated with the presence of triggering factors. When the depressive disorder appears totally spontaneously, the prognosis is usually better. On the other hand, when it is associated with some precipitating event or with personality traits of the patient, it usually has a tendency towards becoming chronic (or put another way, a poor response to the treatment). (Clinic Barcelona)
The young man I spoke of earlier simply gave in to the depression and became a victim of life. He was prisoner to “can’t” and felt a type of cynical comfort in it. His person became one of not caring and this hemorrhaged into all aspects of his life causing him his job, the relationship he had with his girlfriend and pushed all of his friends away. Solitude became his ontic reality, a situation upon which depression loves to feed. There is a perverse type of safety in not caring but the result is the deadly silence of worthlessness and boredom that manifests itself in deadly behaviors such as alcoholism, drug addiction and suicidal ideation. When the ontic reality of solitude and apathy is heightened by the hopelessness of depression and lives with a person too long, it is difficult for them to believe that wellness is a choice, and they suffer through a meaningless life that sometimes leads them to believe that the world would be better off without them. Death in either prolonged addiction or suicidal ideation is too often the end of this lifeless journey. I don’t know what happened to the young man. He rejected therapy and one would hope he launched into what Carl Whitaker calls a “flight to wellness,” but I fear that is not the case. Listening to the depression leads not to wellness but the death of hope and sometimes the death of its victims. Fortunately, most of my clients, were able to seize the reins of their lives and find the magic wand of choice, choosing not to listen to the depression and finding their hope within, a hope that guided them much more successfully through life.
The depression that visits so many creating helplessness, alienation, feelings of worthlessness and a loss of hope is a serious and debilitating condition that can be treated. We all have the ability to choose life. Finding the empowerment to choose, however, is not something easily done by oneself. A trained professional can help and when help comes, people often discover how possible it is to filter away the negatives, find hope for the future and choose life.