When first diagnosed with depression fifteen years ago at the age of 40, I thought I would recuperate and, more or less, go back to my busy life as a lawyer and husband with a young family. It didn’t work out that way. I soon found out it was going to be a long haul. And I’m still truckin’.
What’s changed in my experience of depression over the past decade and a half? A lot.
I know much, much more about the illness; it’s contours, triggers, and wily ways. I know what will help when I’m in the thick of it, more often than not. I also accept there will be times when there’s little I can do to make a dent in depression’s cold armor.
My depression doesn’t last as long as it used to. Nor is it typically as deep. In the early days, it seemed like it went on forever. I couldn’t remember a time before it when I’d been happy. And couldn’t envision a future of being anything other than depressed. I felt I was barely living. Nothing gave me pleasure. Even eating good food, one of my favorite things. Everything tasted like ashes in my mouth. Death felt preferable, at times.
I didn’t feel much compassion for my depressed, younger self. I’d slap myself in the head and say, “What the hell’s wrong with you?” I had my own inner medieval-like inquisitor ready to burn my soul at the stake for some unknown sins depression’s twisted thinking had convinced me I’d committed.
The verdict: my depression was my fault.
I don’t believe that anymore. I now understand it’s a bunch of hooey cooked up by my depressed head. After all, depression’s a terrible liar. There’s a cruel irony to all of this. We need our minds to recover – but sometimes it’s this very organ that’s turned against us. Depression isn’t who we really are, but we can feel that way. As Parker Palmer once wrote about his experiences with this affliction, “I wasn’t walking in the darkness, I had become darkness.”
I have the upper hand on depression now. It isn’t the giant that once pummeled me. It isn’t as scary. Because I know know that depression will, yes, always be a part of my life, but it isn’t my life.
I am more than that.
And I have a good and full life that I’m determined to live.
Why do people become depressed? A popular theory is that it is the brain chemistry that is in disarray. But this way of thinking often obscures the issue.
Depression rarely comes out of nowhere. It almost always has an explanation, even if it is not apparent to us. Also, read “What is Your Depression Telling You?”
A better explanation for why many people become depressed is, in my opinion, that we develop vulnerabilities earlier on in our life that predispose us to live a life that is lacking in zest, enjoyment, and meaning.
Oftentimes these earlier vulnerabilities point us to experiences of trauma, neglect, or interpersonal disappointments that may or may not be fully apparent to us.
We almost all undergo some kind of trauma, neglect, or serious interpersonal disappointments at some point in our life, and how we deal with these events can prepare the ground for a later depressive episode. To understand why this is is to understand how humans function.
Responding to Trauma by Losing Ourselves:
When we go through difficult events that we don’t know how to deal with, our psyche responds just like a lizard that loses its tail because it is afraid of a predator. It helps us make an adaptation out of fear, but always at the cost of making us a little less human, or little less ourselves.
Overwhelming shame, for example, might make us abandon a piece of who we are, or in the worst case, our entire person.
How Sexual Abuse Can Lead to Depression:
If I was sexually abused, for example, and didn’t know how to deal with my conflicted emotions and loyalties, it might make me feel bad about wanting and desiring. I might be confused about whether I myself sent out the wrong signals, and might question if the sensation of pleasure I felt, really meant that I desired the abuse, or that my desires are bad.
The psychological compromise I can make to rid myself of my shame is to begin to live a passive life where my awareness of my desires and wants is dimmed, or totally banished. This might mean that I get involved in relationships that are not particularly good for me, that I put up with mistreatment or one-sided relationships because I am reluctant to say “no”, or that I unconsciously seek out bad relationships because I at some level believe I should not get what I really want, or deserve to be punished in some way to atone for my badness.
This compromise I have made to deal with the unbearable experience of sexual abuse has now prepared me for life of lackluster results and lack of enjoyment.
If I become depressed, this is therefore not because there is something wrong with my brain. It is because some part of me doesn’t want the life that I have. My depression is like the last call to me deep from within that indicates that I need to make changes to my life situation because the status quo is antithetical to life. My adaptations to a difficult situation, have now become destructive to what life is really about. Life has turned against life, and my depression is thankfully alerting me to this fact.
Trauma Comes in Many Forms:
Trauma does not have to imply a big dramatic calamitous event, but can refer to any moment when we felt overwhelmed with painful or distressing emotions we did not get the help to deal with. Sexual abuse, physical violence, or growing up with alcoholic parents are some of the more apparent reasons why a person might get exposed to emotional overwhelm, but there are many others.
One of the more frequent causes of adaptations out of fear is the fear of losing love from the people we depend on. In Alice Miller’s book “The Gifted Child”, she describes how this can happen due to growing up with narcissistic parents.
A child, she says, has the need to look into their parent’s eyes and see themselves reflected. If I cry, I need my parent to validate that I am feeling sad, and if I am happy, I need my parents to be happy for me. Unfortunately, some of us look into our parents eyes, and see our parents feelings, not our own. When we are sad, they feel inadequate and get annoyed with us. When we are excited, they are too busy watching TV, and tell us to shush.
These kinds of experiences when they accumulate over time can create serious distortions to our self-image, and can make us abandon ourselves in a pursuit to become more acceptable to our parents.
Research has shown that threats to our sense of safe connection with a caregiver register in our brain as panic, and that losing our connection completely registers as pain. To avoid feeling these unbearable emotions, we will do a lot, even if it means ridding ourselves of our natural spontaneous desires and feelings.
Other ways to deal with the threat of loss is to become numb, or to become what the psychiatrist Karl Jaspers has described as a “dead person with wakeful eyes”.
What Does Depression Have to Do with It?
When we pay too big of a price to stay safe early on in life, we enter into adulthood ill prepared to deal with life’s challenges.
If we have gotten used to numbing ourselves to unpleasant emotions, we will likely also find it difficult to feel joy and excitement.
If we have learned to live our life in an effort to please our parents, our accomplishments won’t really mean much to us, and we will pursue goals that are not aligned with what we really want.
If we had to abandon ourselves because of shame about our needs or our feelings, we will forever have a sense of emptiness inside because we aren’t fully honoring and accepting who we are.
In many cases, when we really look at the reasons why people become depressed, we find a childhood history of trauma, abandonment, or neglect that has resulted in adaptations that are currently getting in the way of living a meaningful life.
Depression is often simply telling us that we are not really living our lives as ourselves.
To resolve this situation is to confront the underlying reasons why we make the choices we do, and to see to what extent we are really living a life based on avoiding shame, anxiety, guilt, and pain, and not a life based on our genuine feelings, needs, and aspirations.
Rune Moelbak, Ph.D., is a psychologist and depression specialist in Houston, Texas. He is the owner of Better Therapy, a therapy practice for people who want to discover the underlying roots of their current psychological problems.
Some people who experience a single depressive episode will fully recover, never to experience another. (Sign us up for that, right?)
For about 40-60% of us, however, depression is a chronic illness that will come back. By the time most people get treatment, they have experienced multiple depressive episodes already.
Good news: with treatment, recurrences can be less severe, occur less frequently and not last as long.
So why does depression seem to rear its ugly head over and over again for most of us?
Saying you have depression is like saying you have a terrible headache, in that you have disabling symptoms, but it says nothing about the cause of those symptoms.
For instance, in the case of a headache, you may have a migraine, a tension headache, a stroke, a brain tumor, a concussion, or something else. The underlying cause informs the prognosis and treatment of your headache, whether it will come back and the best course of treatment.
With depression, we are just beginning to understand the underlying causes and contributors – which could be medical, neurological, psychological or social – many of which are ongoing and lead to a propensity for depressive episodes.
Depression has a genetic basis, but whether that’s because of biological differences in brain chemistry or temperament or something else, we don’t know yet.
We do know that people in stressful situations or lifestyles have more depressive episodes. This could be stress brought on by work, it could be relationship-related, a traumatic or neglectful childhood, or an unsafe living or work environment.
Recurrence can be caused by psychological makeup – much of which can be based in how we view ourselves, others and everyone’s place in the world. Studies have shown that psychotherapy can change this brain makeup to positively influence our outlook.
There’s still so much to learn about the disease. We need to recognize that for many, it’s a biopsychosocialspiritual illness with multiple contributing components that must all be addressed to create the highest likelihood for treatment to work.
Psychotherapy remains the most effective treatment for depression, and should be part of every patient’s plan for recovery.
Someone with chronic, disabling depression may also benefit from a comprehensive evaluation at a center that respects all contributors to the illness to treat the whole person in an individualized, comprehensive way. One place to do this is at The Retreat at Sheppard Pratt, which also specializes in treatment-resistant depression.
Depression is an intensely personal experience. When pursuing treatment, be sure that you are being understood, and obtaining the level of support you need. For some, particularly those working in a highly stressful environment, that could mean getting away for a short time to focus on recovery, even though it can be a tough decision to make. Be open to all levels of care.
It can be disheartening to realize that your depression will likely come back. Know that you’re not alone, as about 6.7% of the U.S. population have had at least one depressive episode in the past year.
Keep working on your recovery, talking about it to reduce stigma, and supporting those who are studying mental illness. One day, we will know more.
Dr. Thomas Franklin is the medical director of The Retreat at Sheppard Pratt. He is a clinical assistant professor of psychiatry at the University of Maryland School of Medicine and a candidate at the Washington Center for Psychoanalysis. He is Board Certified in Addiction Medicine and Psychiatry and has extensive experience in psychotherapy, psychopharmacology, and addictions and co-occurring disorders. Dr. Franklin previously served as medical director of Ruxton House, The Retreat’s transitional living program, before assuming the role of medical director of The Retreat in 2014.
Elizabeth Wurtzel, in her her best-selling book Prozac Nation, wrote:
“That’s the thing about depression: A human being can survive almost anything, as long as she sees the end in sight. But depression is so insidious, and it compounds daily, that it’s impossible to ever see the end.”
We can’t imagine a future without depression. When we’re in the thick of its slimy grasp, our deadened and bleak state seems to go on and on and on. Days become more about survival and meeting our most basic obligations. And nothing more because we don’t have anything left to give. Our life becomes smaller. We’re treading water because there doesn’t seem an end in sight. We’re hit by the stun gun of depression.
Our most urgent hope is . . . the absence of depression.
But the absence of pain isn’t the presence of joy and all that makes life worth living. As Richard O’Connor, Ph.D. wrote in his book Undoing Depression:
“We confuse depression, sadness, and grief. However, the opposite of depression is not happiness, but vitality – the ability to experience the full range of emotions, including happiness, excitement, sadness, and grief. It’s not sadness or grief, it’s an illness.”
Amanda Knapp writes eloquently of her own experience:
“Depression, for me, is a miles deep crater that I believe I will never crawl out of. It’s disillusionment born of an unfulfilled longing for peace. It’s fear that hope will raise me up just to drop me even further down. It’s a cocoon of despair snuggled all around me doing its best to keep me from breaking when the inevitable fall comes. The irony in all of that is that it precludes me from living and dreaming and hoping and praying. But I hold on to it so strongly at times, as if my life depends on it. Because sometimes it feels like it does. But I sit here today, decently removed from the worst of those moments of despair, and I feel myself longing for hope.”
It’s critical that we deliberately nurture a hope better than just relief from our melancholy. We need to rise up out of the dust of our suffering. It’s not enough to exist. Our existence must matter. Living a life with meaning and purpose give us hope because it brings out the best in us – even with depression. And it’s a heroic journey.
“In my view, folks with depression are not so much hapless, as they are heroes.What’s a hero after all? Someone who has a great challenge to confront? Check. Someone who must confront great adversity? Check. Someone who must get up every day and do battle with a formidable foe? Check. You see, for those of you who are struggling with depression right now, YOU ARE THAT PERSON. You’re the person who has to get up every day and cope with your depression. Others can help and support you, but it’s ultimately your walk to walk. And what a courageous walk it is; every single step of it.
Some of the best people that I’ve been privileged to know struggle with depression. While they don’t have shiny medals pinned on their lapels, there is an unmistakable strength in them – even if they don’t see it. I know it’s real because I see and feel it – just like when I am in a grove of giant and majestic pines during a walk in the forest.”
Dr. Anthony Scioli, author of Hope in the Age of Anxiety, writes that one of the things needed to build up our hope muscles is faith and a spiritual foundation (whether it be in God, nature or a higher power) to experience a more open attitude for developing faith in others as well as the universe.
Pope John Paul II once said,
“Do not abandon yourself to despair. We are the Easter people and hallelujah is our hope.”
So, nourish hope in your heart. Surround yourself with hopeful people, places and books.
“While the symptoms used to diagnose depression are the same regardless of gender, often the chief complaint can be different among men and women,” says Ian A. Cook, M.D. Read the Blog
There’s a wretched place depression drags me off to after taking control of my thoughts and feelings. It’s the place where the longing for relief mutes every other desire, even the desire to wake up in the morning. There are days when I wonder if I’ll lose everything: my job, my relationships, my last stitch of sanity. It feels as though I’m breathing hot black smoke.
Yet I believe the same depressions that pin me to the mat so often also serve a bigger purpose in my life. They don’t come empty-handed. I believe the purpose of suffering is to strengthen us and help us understand the suffering of others.
At 16, my first episode hit me hard enough to think I’d literally gone to hell. Now, at 35, when I start dreaming of haunted houses and worrying uncontrollably about the future, I know another episode is looming. I’ve got a week’s notice, maybe two. And then it’s as if I’m drifting off to exile inside myself with only a shell remaining.
It used to be that rising from the ash after the depression cleared was like resurrection. The burial over, I’d catch myself laughing or looking forward to the next day. I’d pig out at my favorite deli. But now, when I look closely, I find mental illness leaving other significant gifts in its wake — things I didn’t discern when I was younger.
The discovery is like that scene fromThe Matrixwhen Neo finally comprehends his identity. Through the whole film, he’s been beaten up by evil agents. But the fighting transforms him into a warrior. And at the right time, he understands and uses his power. He’s peaceful, even when confronting an enemy. I believe my own years of struggling with depression have left me with similar gifts: inner strength and calm I can rely on, diminished fear and compassion.
I believe the painful nights that close in on all of us in some form are the cocoons from which we might shed our weaknesses. I believe pain tells us something critical about ourselves and life: that developing strength and empathy and bravery is more essential than our personal comfort. And when I think of it like that, I’m more willing to accept suffering on its terms.
That’s important, because if my pattern holds consistent, my next episode is due to arrive soon. I live with this reality, but I’m no longer afraid of it. The depression has, in the end, equipped me for its next visit — and that’s enough. Of course, I’ll take my medicine. I’ll talk to my gifted psychiatrist. But when the dark does come, I’ll stand up and breathe deeply, knowing I’m becoming the person I’m supposed to be.
By Andy Blowers.This piece first appeared on National Public Radio’s All Things Considered.
Because it was a natural evolution from the book that preceded it, Callings: Finding and Following an Authentic Life, and because I’m just fascinated by how people manage to hold on to their vitality and life force against all the downward-pulling forces of life and culture.
In the Introduction to Vital Signs, you write that the book is geared towards “being in love with life” versus your first book, Callings, that addressed “doing what you love”. In what ways are the two the same thing? In what ways are they different?
They’re similar in that doing what you love is among the active ingredients of being in love with life, and being in love with life is a mindset that lends itself to looking for ways to stay that way, and doing what you love is one of them.
As for distinctions between them, I look at the two books this way: Callings:Finding and Following an Authentic Life was more about finding a passion, and Vital Signs: The Nature and Nurture of Passion is more about livingpassionately. Developing the skill, the stance, of passion that can inform all arenas of your life, not just the vocational.
In your mind, can a failure to live a passionate life cause and/or contribute to true clinical depression? How so? Can you give us any examples?
I believe so, yes. For starters, if you’re not expressing your passion and vitality, whether in your work or love life, creative or spiritual life, then you’re probably suppressing it, or repressing it, or depressing it, which all mean the same thing: pushing it down. And whatever we refuse to express will either explode or implode, and I think depression is a form of imploding. Here’s an example from my own files:
I’m not generally prone to depression, but a couple of years ago I had a nasty bout of it. I was sleeping too much, feeling lazy, bored, disconnected from everything and everyone, lacking initiative but restless. I just felt profoundly off, and I couldn’t get to the bottom of it.
Until I had a dream of being chased by an enormous black dragon—the size of a T-rex with wings—and feeling like a rabbit who couldn’t find a hole to duck into.
I tried fighting off the dragon with a safety pin, and finally, out of sheer fright (and, I remember, a distinct sense of incredulousness that I wasn’t going to be rescued at the last second, like in the movies), I woke up. Literally woke up from the dream.
My interpretation of the dream was that the dragon was my writing. My real writing. Not the academic-style stuff I’d been doing a lot of at that point, but the freewriting practice I meant to be doing alongside it, and wasn’t. In a sense, I was playing it safe with all that cautious, academic writing—thus the absurdly inadequate safety-pin defense—when I should have been doing more passionate, intuitive writing.
But the dragon woke me up, literally and figuratively, and over the next few months I started doing my real writing again—and here’s the punch line: the boredom and depression lifted.
That experience reminded me how closely related depression and repression can be.
In your experience, what are some of the reasons people don’t follow their passions?
One reason is that people often put security before passion. There’s nothing wrong with security, but when it routinely takes precedence over your passion and aliveness, you’re courting disaster (a word that means “against one’s stars.”) I once heard it said that heroism/heroinism can be redefined for the modern age as the ability to tolerate paradox. To hold two seemingly contrary ideas/impulses/energies/beliefs inside you at the same time and still retain the ability to function. In this case, passion and security. Which don’t cancel each other out. They’re both true. We need both of them. And they both need to be brought to the bargaining table to hammer out a treaty that’s going to serve them both, rather than trying to stuff one or the other under the floorboards just to be rid of the tension.
Another reason involves the kinds of suppression and repression that are common to certain styles of parenting, schooling, gendering, bibling, and corporate enculturation, where you’re encouraged to leave maybe the best parts of you out in the parking lot when you punch in, like your emotional life, your personal life, even your spiritual life. I recently consulted with a woman who told me that when she was growing up, her parents sent her to her room for any displays of “negative emotions,” like tears, anger or frustration. That is, punished her. Banished her.
So it’s no surprise that at 40, after a lifetime of repressing half her emotional
repertoire, she’s feeling blocked from being her full powerful self, the one she’s going to need in order to be the healer she intuits herself to be. She quite rightly refers to her mission at 40 as “soul retrieval.”
What tips can you give our readers about how they can begin to follow their passions?
For starters, it might be useful to begin identifying where you lose it. Where it leaks out of your life. Which routines, relationships, involvements or beliefs drain your energies, and which ones revitalize them. Maybe it’s a job that sucks the life out of you, or a relationship in which you feel like a ghost of your full vital self, or your eager, capable mind being put in dull circumstances, or any involvement that’s literally de-meaning. Lacking in any sense of meaning or purpose.
Maybe it’s socializing out of guilt or obligation, driving in rush hour traffic when you don’t have to, television, letting yourself be trapped by talkaholics, or doing your own taxes rather than farming it out.
Secondly, it’s important to understand that passion can be cultivated.
Turned on as well as turned off. It’s not one from the “either you’ve got it or you don’t” department. And cultivating it happens most readily at the level of the gesture and the moment, not the 5-year plan or the extreme makeover. Though even at the micro-level, action is ultimately required. Especially spontaneous action. The equation is: ready, fire, aim.
I was sitting around with some friends one evening recently when one of them said, “You know what the problem is? We’re not outrageous enough.” When I asked him what he would do if he were to be more outrageous, he thought for a moment, then reached up and swept his hair from middle-parted and slicked back to side-parted with a cowlick dangling from his forehead—instantly transforming him from Richard to Ricardo. And he said, “I’d come into work like this.”
The point is: start with the subtlest impulse to express yourself and act on your passions, and build from there. Begin identifying little moments of choice that lead you either toward or away from your sense of aliveness.
I think it’s important to distinguish, also, between healthy and unhealthy passion. In other words, there’s a difference between being called and being driven, and not all passions should be acted on. There’s something called harmonious passion (flexible persistence toward an activity and more of a flow state) and obsessive passion (persistence at any cost, the passion controlling you rather than the other way around, and self-esteem and identity all wrapped up in performance).
There’s also primary and secondary motivation. Doing something for it’s own sake—for the charge or challenge of it—and doing something for a payoff (whether money, power, sex, fame, or attention).
And there’s a pretty simple test to determine which one is in the driver’s seat: when the payoffs dry up, do you still do the work? Are your passions still intact?
He is a lecturer and seminar-leader in the business, educational, governmental, faith-based and human-potential arenas, and has keynoted and presented workshops at The Smithsonian Institution, the EPA, Microsoft, and Amerian Express, to name a few. He is also a frequent media guest on ABC, CNN, NPR, PBS, and others.
We often mix-up a drive to excel and perfectionism; they’re not the same thing. A drive to be your very best can leads to a sense of self-satisfaction and self-esteem. It feels good to give it all we got. Perfectionism? It’s a horse of a different color. People who feel driven in this direction tend to be more motivated by external forces – such as the desire to please others rather than themselves. Common and recurring thoughts of perfectionists include:
My name’s Paul and I am a recovering perfectionist.
I am also recovering from depression. The two are connected.
I’d been trying to do too much, too well, trying to please too many people, expecting too much of myself for too long, putting too much pressure on myself, creating too much stress. That’s a lot of ‘too muches’ for one person. My self-esteem took a battering, I stopped looking forward to anything and I felt like I was useless and hopeless.”
Psychologist Dr. Gordon Flett has studied perfectionists and found that they set excessively high personal standards for themselves and others then harshly evaluate their performance on these benchmarks. Often, perfectionists believe it’s their parents, bosses, or spouses who expect them to be perfect. They believe that such people will value them only if they’re perfect. The constant demand to appear as if they have it all tougher is draining.
Others tend to see them as harsh and unforgiving – rigid and unkind – though the truth on the inside is they are vulnerable people who lack resilience. Flett fund that physicians, lawyers, and architects, whose occupations demand precision, are at higher risk for perfectionism, depression and suicide.
Causes of perfectionism run from parenting to a genetic link, but whatever it’s origins, try these fixes:
Separate self-worth from the requirement to do things perfectly.
Dr. Nicholas Jenner writes: Perfectionism is addressable by using and applying cognitive tools. Positive change can be had when thinking is changed and self worth is separated from the requirement to do things perfectly. If you constantly hear your inner critic berating you for not getting or doing that extra 20%, you have noticed your perfectionist beliefs. Discrediting and disputing these values and finding realistic evidence to prove them wrong is a key part of recovery. As humans, we are inherently imperfect. We have the ability to fail without ever being a failure. We sometimes just need to think it and believe it.
Put people first.
Before tasks and “stuff,” put your heart into connecting with the people you love.
Come out as a human being.
Authenticity, although messy, is required for the pleasure of love, joy, fun and overall happiness.
Pay attention to your own signs of trouble.
Perfectionists get more anxious and rigid when they are hungry, angry, lonely or tired. Use prevention strategies to manage this tendency.
Let go of high expectations. Try to accept people as they are. We are all unique and flawed as human beings.
The great songwriter and poet Leonard Cohen once wrote and sang, “Ring the bells that still can ring. Forget your perfect offering. There is a crack, a crack in everything. That’s how the light get’s in.”
We’re cracked open when stress, anxiety and depression become just too painful and perhaps begin to see this eternal truth about others and ourselves:
When first diagnosed with depression fifteen years ago at the age of 40, I thought I would recuperate and, more or less, go back to my busy life as a lawyer and husband with a young family. It didn’t work out that way. I soon found out it was going to be a long haul. And I’m still truckin’.
