Depression

The lived experience

Depression is a common and highly complex mental illness. It is a universal phenomenon - with many shared experiences between those who suffer from it - and at the same time every human experience of it is unique. We know that depression is an illness of isolation, loss and detachment. To understand it more deeply requires us to look both within the mind and body of the individual and at the social systems they are embedded in.

The two essential elements of depression relate to (1) a person’s view of themselves and (2) their mood (Milrod, 1988). When a person is depressed, they are not simply in a state of sadness where they cannot experience pleasure or joy. A depressed or low mood is more pervasive and gives rise not just to sadness but also guilt, self-pity, hopelessness and anger. It is a mood in which a person cannot access pleasure or gratification in the present, nor remember it in the past or imagine it in the future.

The way people see themselves is also negatively impacted. People with depression have low self esteem, often believing they are incapable of change, unloveable and unable to maintain or create relationships. These perceptions mean that they feel helpless, failing and worthless (Blatt, 1998).

To begin to understand what is going on inside a person, we pay attention to our client’s language, metaphors, silences, physical presence. “To be on the outside looking in”, “to be in the dark depths of a pit I can’t see out of”, “to be alone out at sea” — just a handful of descriptions of the experience of depression -- pull us into the field with the other, so we may be able to bear witness and make contact with what is overwhelming to be with alone.

What makes us more vulnerable to Depression?

Bowlby (1969, 1980) describes depression as a form of distorted mourning, where a person grieves the loss of an attachment figure. Experiences in childhood that make a person vulnerable to depression include insecure early attachment or early loss - for example, having a parent who is either unavailable or critical and punitive, or the early death of a parent. In both cases we may develop the view of others as rejecting or absent and of self as unlovable or unworthy and emotionally, this results in grief - for what I lost or for what I never had.

Neurobiology research confirms a central role of attachment/separation neuro-pathways in people who suffer from depression. For mammals, attachment is critical for survival. When mammals are separated their brain produces chemicals that create panic and distress, they are driven to protest and seek reunion with important others (Solms, 2012). When reunion isn’t possible, the mammalian brain shuts down separation distress (causing them to “give up”) because the energy cost of panic to the body is too high. The result is lowered motivation, despair, helplessness — but this depression-like response serves an adaptive function because it protects mammals from behaviors that are potentially dangerous, pointless and unsustainable over time (Watt & Panskepp, 2009).

There is no known single cause of depression but we know that brain chemistry and developmental/environmental factors all contribute to it. Traditional medical perspectives are “bottom-up” and neglect social stress as a predisposing factor. They also cannot explain why depression is so prevalent or why it has persisted in human evolution (Watt & Panskepp, 2009). While commonly prescribed medications provide some relief for depression and anxiety symptoms, relative effectiveness of SSRI medications is estimated to be around 50%. We know there is more to the story than brain chemistry so there must be more to the treatment.

Healing in Relationship

Because the experience of depression is shaped by both “inner” and interpersonal factors, we can consider that in order to effectively help a person survive the experience we must be working towards repairing what is damaged in human relationships and recovering what is lost.

There is considerable difference in the way therapists understand and treat depression. It can be challenging to distinguish between popular cognitive and psychodynamic models of depression because they both see negative cognitions and emotions relating to the self and other, and both see depression as ultimately connected to attachment and separation, esteem and loss (Zellner, 2012). If we know that early experience of loss makes us more vulnerable to depression and we are evolved to feel bad when we are disconnected from others as a way to enhance survival, we can see the importance of understanding a person’s history of loss in relationships and of creating new patterns of relating in a safe and secure relational context.

Therapy should facilitate grieving or mourning as a way to process individual suffering. the most essential elements of effective psychotherapy for depression involve caring and empathic exploration of losses, which leave humans feeling fundamentally helpless and ineffective or overwhelmed by feelings of rejection and abandonment which lead to shut down. When we are predisposed to “give up” and in the pit of despair, it can be hard to see what is possible without the help of an outside mind.

A supportive relationship may begin to transform the ways a person negatively thinks and feels about the self and others. Relationships are important building blocks of the self and it is in the context of empathic and safe relationships that we can begin to explore and create space for new and healthier self esteem, relationships and world-views.