Any quick search online will give you a variety of answers. Broadly, there are two main schools of thought:
In my practice, I find a consistent theme with those who suffer from depression - for the majority of people, along the lines of the second statement. Depression is a feeling we get when a vital aim seems impossible to achieve.
For example, I regularly meet depressed people who are:
In therapy, we come to terms with our past, our present, and our emotions. We work together to look problems in the eye, so that, ultimately, we may gain back precious momentum. The truth is that we usually can find our way back into the world. We usually can begin to change our potential into reality. But even the smartest people get stuck when they try to do it all alone.
Depression can be frightening and disorienting, but you might be surprised at the results when, in conjuction with a therapist, you're able to look beyond the sense of being a victim of a faulty biological make-up. Indeed, for many people, the idea that we are somehow in the midst of an "epidemic" in which human beings, so highly evolved in so many ways, are suddenly biologically misfiring without environmental cause, is highly problematic.
Rather than looking along the lines of "disease" to explain depression, I am more inclined to view most sufferers in terms of health. The person who, for example, has been cheated on in a relationship may feel depressive feelings. But, the person who believes that no relationships can be trusted is likely to experience depression. Likewise, the person who experiences anxiety and stress at work for a week is likely to experience depressive feelings, but the person who sees no opportunity to find meaningful work is likely to become depressed. Again, the person who's confidence has taken a knock might feel low for a time, but the person who has chronically low self-esteem and cannot exert their will (or does not know what it is), long term will be vulnerable to depression.
The idea that a doctor, within a 15 minute window, can know anything about your individual "brain chemistry" lacks both evidential and intellectual rigour. But this is exactly what happens: drugs are being routinely prescribed to "correct" the chemistry of those who are suffering from depression. All the while, it is common for no questions at all to be asked about the patient's life, and the difficulties that particular individual might be experiencing.
One cannot help but think that the current situation is exascerbated by the immense marketing and lobbying dollars of the pharmaceutical industry, which relies upon a dubious formulation of "chemical determinism" for its dominance. But doctors themselves must take some responsibility in the spreading of such dubious ideas. After all, the Hippocratic oath makes it encumbent upon doctors to apply ethical rigour when any person walks into their office.
When a person puts forward the argument that "chemical imbalance" causes depression, they are actually making an assumption: that the brain (which has "chemicals") affects mind (which feels depression). This is a fallacy based upon dualistic (Cartesian) thinking: "mind" and "brain" in fact are essentially the same thing, viewed through different lenses, so saying that "brain" affects "mind" is a skewed picture. One might just as easily say "mind" (feelings) affects "body/brain" (chemicals) - which of course, it does, if we follow the same faulty logic. If you watch your favourite sports team, just like a roller-coaster, your adrenaline and cortisol may rise and fall. If you win the lottery, or a promotion, you can bet your brain chemicals change. In fact, we know through the study of neuroplasticity that the brain is always changing, and always reorganising itself.
It's easy to swallow the "chemical materialist" view. But, we are not just chemicals. We are beings with intent, and when our most important intentions feel unachievable, our bodies often speak in the language of depressive feelings. It is as if we are living in a dark, invisible box, and we cannot get out.
Most people who come into my office have not been afflicted with anything that might realistically be called a "disease". Their emotions are talking a language that can be hard to understand, but it is certainly understandable for most people: it is the language of depression. My job as a therapist is to help both of us understand what is being said.
A worrying end note: in my definition, depression is strongly related to inertia. If we try to eliminate the feeling of inertia (depression) by the use of drugs, how does this affect the amount of energy directed at the improvement of our environments? If, for example, an office executive is depressed, do we treat the isolated individual as sick, or do we listen to them, and wonder whether something needs to be changed in the office? Do we give her pills, or address the rampant sexism that's affecting her? Do we give him pills, or address the racism that's holding him back? Do we address the introvert with anxiety, or address the open-plan office environment? Above all, do we treat people as sick, or insist on giving them opportunities for empowerment and advancement in the knowledge this will help their mental health? Where do we lay the emphasis, where is the problem and the confidence?
Clearly there are plenty of people on anti-depressants who are making positive change happen in the world, but the conclusion remains that there might be more energy devoted to change if we learned our own secret language, and found ways to encourage self-esteem, communication, creativity, determination and momentum. Aren't these some of the core, growth-associated qualities that companies struggle, but need to encourage in their people?
My answer to the question in the title of this article is that we do not ever truly beat depressive feelings, but we do have a choice: we can try to numb them out, or we can learn what they are trying to teach us. Believe it or not, depressive feelings can become a powerful guide to our growth and future advancement.
This is the phrase I sometimes have in my mind when I think about my practice, and about therapy in general. It doesn't describe everyone who comes to therapy, but both the incidence and the suffering involved are considerable. It is deeply instructive to me that so many people facing struggles in life have suffered at the hands of narcissistic parents, and many people bear the tell-tale deep, invisible bruises of what often amounts to a form of emotional (and sometimes physical) abuse.
I thought it might be helpful to outline a few of the dynamics of growing up and living with narcisisstic people:
1. When we grow up, we need to be known, seen, heard, reflected and accepted. Sadly, children of narcissists are forced to know, see, reflect and hear their parents instead. They learn that their own selves are not welcome, and what is inside them is not acceptable.
2. Children of narcissists must serve. They serve another's needs and emotional states. They "parent" their parents, or are regarded as a nuisance. Either they fit into serving the narcissist's ego, or they become "black sheep", forever punished, demeaned and forgotten.
3. Children of narcissists live confusing lives. If they are angry or upset, this is perceived as an attack on the parent. If they pursue an interest or point of view that is different from the parent, they are diminished, ridiculed, "frozen out" or punished.
4. Not surprisingly, children of narcissists can grow depressed. Their every attempt at being loved and acknowledged for who they truly are is met by something that feels false, rejecting or humiliating. Becoming deflated and exhausted internally is natural, but can set itself up as a pattern long into adult life.
5. Like the giving and receiving of gifts, conversation requires a two-way interaction. Children of narcissists have grown up around a skewed communication in which the desire for true exchange is frustrated. Learning to talk, gradually, from the inner self with someone capable of receiving that self is part of the work of therapy. Naming and reclaiming emotions, ideas and a greater sense of selfhood takes time, but a more reliable, solid, vital and creative person can emerge.
Therapy is not top-down expertise; it is bottom-up. We are there to help you grow, to listen acutely, to guide you in exploration and to help you come to know your self in ways you've never been able to. But therapy goes beyond knowledge. We are there to help you claim and re-claim your self. This can sometimes feel like hard work, but it can also feel deeply liberating, exciting and rewarding. In my experience, given time, it is eminently possible to recover what is rightfully yours.
Psychotherapist, working in private practice in the Annex, Toronto.