Depression – An Uninvited and Challenging Guest
Depression is a difficult and painful experience that visits almost everyone at some point. It may be short lived or linger for years. It may come as a mood that interferes with the experience of daily life or be so deep that it defines our experience of daily life. It is uninvited and seems to steal our capacity for living.
Depression varies in its depth and presentation. It is reflected primarily in a sad or flat mood. It is often associated with altered sleep patterns (insomnia, excessive sleeping), eating and weight changes, changes in libido, changes in activity level (agitation or lethargy). Thinking often becomes repetitive, circular, pessimistic or fatalistic, and irrational. Others can generally see the irrationality more easily than we can. Sustained, focused action becomes increasingly difficult. Suicidal ideas and plans may develop and even appear rational in the depressed state. Depression can be deadly, though it generally is not. Even a mild depression steals our vitality. Depression should not be ignored because, at a minimum, it reflects an emotional/cognitive impasse and a loss of creativity.
Depression can be contrasted with emotions such as sadness, anger, or joy. These emotions are clearer and are accepted as a part of life. They change as our lives and situations change. For example, we can be happy right now without expecting to always be happy. In contrast, the experience of depression is more obscure. It often does not reflect specific events. In fact its causes can be hard to identify or define.
When depression is deep, it obliterates our ability to respond emotionally and intelligently. Our capacity to experience joy, beauty or even a clear sadness is diminished or lost. When we are depressed, we tend to equate our mood with the quality of our lives not just the quality of a particular moment or time in our lives. Intellectually, we may know that our lives hold many riches, but emotionally our lives feel bankrupt, hopeless or meaningless. Our understanding of depression will influence our response to it.
Depression is psychological exhaustion.
Depression is best understood as a state of psychological exhaustion. This exhaustion limits our capacity to respond emotionally, intellectually, and creatively to our lives. Just as physical exhaustion prevents an energetic physical response to life, psychological exhaustion prevents an energetic emotional and intellectual response to life.
Psychological exhaustion can have many possible causes. Life situations that are emotionally demanding, long term and seemingly unending can drain us. Each of us must at sometime cope with a painful life situation that is not easily remedied — a painful marriage, no marriage, unfulfilling or stressful work, lack of a supportive community, illness, personal loss, a lack of financial resources. Psychological stress is intensified if we feel powerless to change our circumstances. Over time, a pervasive sadness, anger or loneliness can result in emotional depletion. The situation itself does not cause the depression. Many people live in stressful situations and are not depressed. Beliefs that give meaning and purpose to painful or stressful experiences can sometimes provide an emotional immunity from depletion. Nonetheless, living with chronic situational stressors and emotional pain puts us at risk for psychological depletion and depression.
Mild depressions can be helped by a situational change. A new job, new social activities, new friendships and activities can sometimes give us new energy and a sense of purpose. A greater sensitivity to our personal needs can also help; devoting time and energy to personally important activities can sometimes resolve mild depressions. Often, however, situational change alone is not enough.
The need for greater self-understanding: Confronting emotional reality
The resolution of chronic or moderate depression requires a greater understanding of our selves and our lives. Greater self-understanding allows experience to take on new meaning and purpose. The clues to greater self-awareness are often found in our emotions, particularly painful or somehow unacceptable emotions. Reflection on our emotions requires curiosity, compassion and objectivity; self-criticism is rarely, if ever, useful. We must confront our self-protective attempts to deny, minimize or avoid painful emotions. Avoiding emotional truths is in itself exhausting over time. For example, grief is a normal part of life and yet we often try to minimize or deny it.
Grief is a profound, painful, complex response to a major loss – the loss of a loved one, of a relationship, of physical health or competence, of a life goal, of a community. Grief often involves powerful emotions, e.g., anger, sadness, forgiveness, hatred, confusion, moments of new clarity. These emotions can be contradictory and yet follow in swift succession. Despite rational inconsistencies, each emotion reflects a partial truth. Grief can shock and confuse us. We may have emotions that we did not know ourselves capable of and that may be in conflict with our values and self-identity.
Grief may frighten us because we cannot control the experiences and we may fear they will define us; for example, we might worry that once we begin crying, we will never stop. Grief confronts our deepest values. We must confront who we are now, and what is important in life now without this relationship, or that career, or life situation. We must confront our sense of meaning; what is the meaning or importance of life now? No one likes to go through this process and we may minimize or deny it. But blocking a genuine emotional need does not make it disappear. Furthermore the effort to avoid important emotions, such as grief, will result in psychological exhaustion. Grief, which can be resolved, is replaced by depression which cannot be directly resolved. Ironically, while grief often confronts us with our greatest psychological challenge, it holds the possibility of change and increased self-understanding. Grief can be a royal road to meaning and wisdom.
Self-understanding: Emotional conflicts and unconscious beliefs
Emotional exhaustion can also reflect personal, psychological conflicts. Many conflicts are partially or wholly unconscious and thus difficult to resolve consciously. For example, a person may have unconsciously learned that his role was to provide emotional support for others and that his own emotional needs were secondary. This situation can occur when a parent is too emotionally needy, self-involved, depressed or absent, or when family or community values assign this role to some family or community members. The child unconsciously believes that his self worth is determined by his ability to care for others and to rescue others from their emotional demons. This unconscious identity may lead to a pattern of taking too much responsibility for relationships, of being excessively self-critical and self-doubting whenever something goes wrong, and of expecting alternately too little and too much from relationships. These unconscious beliefs may result in choosing partners who unconsciously desire to be saved from their emotional demons and who do not take enough personal responsibility for their emotional reality and for relationships. The unconscious beliefs may also underlie a tendency to minimize and avoid our own emotions and needs.
Unconscious beliefs about self and others will not only lead to unconsciously driven behaviors, they may also conflict with more conscious beliefs (e.g., I believe that adults in intimate relationships have a mutual and equal responsibility for the relationship). We may belief one thing consciously and another unconsciously. Our decisions, behaviors and emotions will be influenced by both. This situation will make self-understanding difficult.
Identification of unconscious beliefs is difficult. A full understanding may surface only with great effort and time. Unconscious beliefs are often reflected in our irrational thinking and expectations, our dreams, our emotional responses to our needs and to the needs of others, and our history of relationships. Counseling relationships are often helpful in understanding these responses and can make the process of self-understanding faster and more certain.
For some people, the recognition of unconscious beliefs allows life to make sense again and supports changes in decision-making and action. Others need to examine the unconscious patterns in greater depth. Reflection may lead to further insights about self-identity, psychological reality, our shared human nature and even a greater compassion for human vulnerabilities. The resolution of internal unconscious conflicts provides a broader view of reality and a more coherent sense of self. From this new position, a person can reengage in life and resolve even long-standing depressions.
Self–understanding: Existential and spiritual dilemmas
At times, depression is associated with an ill-defined loss of personal meaning and direction. There may be no obvious situational problems or unresolved emotional dilemmas. We may have achieved a reasonably broad psychological understanding of self and others, and a coherent sense of values and ethics. But there remains a profound sense of meaninglessness; life itself appears pointless and flat. Since there are no apparent rational problems, there are no apparent rational solutions. Old ways of finding personal resolution and direction do not work. This state can be understood as an existential or spiritual crisis. Our personal sense of meaning and purpose is not holding and must evolve.
Resolving these dilemmas begins with the emotional acceptance of our current reality. We need to recognize that rational understanding of self and reality alone will not resolve our inner dilemma. Through private reflection (which can be supported by writing, art, prayer and/or counseling), a dialogue is fostered between our conscious sense of reality and our unconscious processes. We develop a new relationship with our inner reality. The inner life includes our emotional experiences and truths (both conscious and unconscious), our openness to inspiration and creativity, and our living connection to the transpersonal, however, we might conceptualize it.
Depression and the body
Depression is experienced in the whole body. We feel physically different when we are depressed than when we are not. The emotional exhaustion of depression can mimic physical exhaustion. However, physical and emotional exhaustion are different. When we are physically exhausted, rest is the cure. When we are emotionally exhausted we want to physically rest (lethargy), but inactivity makes the depression worse. Physical exercise can reduce the depressive experience. In mild depressions, exercise alone may be enough to reenergize us and allow a reengagement in life. However, be cautious of compulsive, extreme exercise; it may be masking a depression that will have to be dealt with sooner or later.
In part due to the physical changes and symptoms associated with depression, the medical community has reasonably asked whether depression has a physical cause and whether it has a pharmaceutical solution. These topics are reviewed in a separate paper. Regardless of the ultimate understanding of these issues, however, depression is too complex to be reduced to a simple physical process. Ultimately, there is no separation between body and mind. All complex experiences and their resolutions will involve emotional, intellectual and physical engagement.