By MICHAEL SHAPIRO, PhD
No blog about behavioral health issues would be complete without a discussion of depression. Winston Churchill (who some think suffered from major depression or bipolar disorder) referred to his episodic dark moods as his “black dog.” He didn’t actually invent this term; in fact, it was a pejorative term used by nannies in the Victorian era to refer to unpleasant or moody children. In any event…we get the idea. Everyone on the planet who claims to be human (which, I suppose, includes pretty much everyone) has experienced low mood, despair, or sadness. If you deny it, you’re either a liar, have very poor insight, are deeply in denial, or literally live in Mr. Rogers’ Land of Make Believe (even then, the rising price of trolley tickets has got to get you down sometimes!).
Sadness is a natural, healthy reaction to loss: loss of a relationship, loss of an opportunity, even loss of physical health. It can even be evoked in response to someone else’s loss. This kind of identification with another person (in other words, feeling sad because someone else is sad) is called empathy: it ties us together as humans and motivates us to help each other. In a way, “normal” sadness gives life meaning by helping us understand our own values. It reveals what’s really important to us. Also, how can anyone appreciate joy and happiness if we’ve never known sadness?
However, there’s a difference between sadness and depression. Typically, sadness is caused by an identifiable event: your favorite team lost in the playoffs, your pet hamster died, or your child went off to college (okay…so maybe sadness and joy can sometimes co-exist). In contrast, clinical depression often appears for no reason. Indeed, people who suffer from depression often feel guilty about being depressed without any apparent cause! The job is going well, the kids are fine, the marriage is solid…what could be wrong? This conflict between a person’s mood and the reality of the situation only makes him or her feel worse.
So if clinical depression is profound sadness that often appears for no reason, what causes it? Excellent question. As with any behavioral health disorder, there is more than one answer. Specifically, depression has four facets: biological, psychological, social, and spiritual.
Let’s start with the biological facet: it is now a known fact that, as with any physical illness, depression is rooted in biology. For one thing, it appears to be hereditary. Since depression runs in families, there must be a genetic predisposition to this disorder. More often than not, someone who suffers from depression has a depressed relative (or relatives) climbing around on some branch (or branches) of the family tree.
It is also known that some kinds of depression are linked to deficiencies in neurotransmitters…the chemicals that allow brain cells to communicate with each other. That’s why treatment of depression often involves medication. Most antidepressant medications cause these neurotransmitters to be more available to the brain (more about that in our next blog!). The important take-away is this: clinical depression isn’t a weakness, a lack of character, or a moral failure! It’s a biological disorder, just like diabetes, hypertension, or the flu!
However, for someone who is biologically predisposed to depression, the first depressive episode is usually triggered by a stressful or traumatic event. Personal catastrophe (loss of a job, financial stress), family stress (divorce, frequent conflicts between family members), trauma (abuse, natural disasters), or any other stressful circumstance can precipitate a depressive episode. Whereas such circumstances would cause anyone to be depressed, the individual with clinical depression doesn’t “bounce back” and may become vegetative (loss of energy, loss of interest in things that used to be pleasurable) or suicidal.
This brings us to the social aspects of depression. This refers to the way you were raised, events of the past, and how you’ve been treated since you were a child. Did you grow up in a “negative,” unloving, or oppressive household where conflicts were the norm, or where certain emotions (like anger) were expressed while others (like love and warmth) were discouraged? If so, you may never have been able to develop the “coping skills” that are necessary to keep minor setbacks from becoming emotionally catastrophic events.
It’s worth mentioning that these social factors appear to have become more prevalent in modern times, such that depression has almost become an epidemic. In fact, it has been shown that at least one out of every five people in the US will experience an episode of major depression at some point in their lives. At least some of this increase in depression can be attributed to the fact that mental health professionals are getting better at describing and identifying this disorder. Also, depression carries less of a stigma than it used to, so people are more likely to admit that they have a problem and seek treatment. However, let’s be realistic: there have been numerous social changes that have contributed to the rise in depression, such as rising divorce rates and the slow erosion of family structure since the 1940s and 50s. Of course, there’s also the impact of social media, which has given millions of people a stage on which to share their sorrow or exploit the sorrow of others. There are even websites and Facebook pages that instruct depressed people on the best ways to commit suicide!
In view of these social aspects of depression, another component of treatment involves individual counseling or psychotherapy. It is the task of the mental health professional (counselor, therapist, psychiatrist, or psychologist) to help the individual come to grips with the social components of depression and untangle the complexities of things like past trauma, abuse, or a fragmented family.
In addition, therapists can be very helpful with the psychological component of depression. This refers to aspects of your own personality…the way you think, the way you view the world, and how you naturally react to circumstances. Have you ever known someone who is a “natural worrier,” or someone who always sees the glass as half empty? These tendencies are part of your inborn personality and temperament, but they can be changed. Therapists use techniques like Cognitive Behavior Therapy to help the depressed person learn how to change those depressive or negative thoughts that lead to depressed mood.
Lastly, although some people embrace it and other people ignore it, I can tell you that there is always a spiritual component to depression. When someone is depressed, their thoughts invariably turn to some of the “big picture” questions that reveal their spiritual convictions (or lack thereof): “Why am I here?” “Would the world be better off without me?” “Why is God letting me go through this?” Several studies have suggested that religious and spiritual beliefs are protective against depression. Also, although there are certainly some people who are “spiritual” but do not participate in an organized religion, the prognosis is better for people who are involved in a faith community like a church, temple, or mosque. As such, a component of treatment should involve either spiritual guidance from a leader in the faith (pastor, minister, rabbi, priest, imam, or monk, to name a few), or cultivation of a more introspective type of spiritual exercise (meditation, yoga, etc.).
So, it is hoped that you now view depression as an actual disorder that is very common but is more complex than you originally thought. If so, good…because we’re about to make it even more interesting by discussing different types of depression and how to recognize them according to their specific symptoms. However, that will have to wait until next month. See you then!