It seems that there are three main points of view about the causes of depression. Most commonly held is the view that it is generally some combination of these three. (The Australian Editorial 18 Feb. 2006 Health Section.)
1. Depression is a medical disease caused by a neurochemical or hormonal imbalance
2. Depression is caused by certain styles of thinking
3. Depression is a result of unfortunate experiences
The article goes on to say that although depression causes physical symptoms and on rare occasions, has physical causes, it is not a disease.
A core aspect of depression is thinking styles but does being a pessimist inevitably cause depression?
Trauma, upheaval or sad experiences seem to trigger depression but why in people whose circumstances are similar, do some suffer from depression and others don’t?
It is only when we consider all the aspects surrounding depression that we can truly see how the pieces fit together, giving a real understanding of the causes of depression and, therefore, the best way to beat it. According to this article – much of depression is about how we interpret reality.
In the ABC radio’s Health Report of 30 Jun 1997, called Recognising Mental Illness a psychiatrist from the ANU Canberra had carried out a study and said they looked at how people’s beliefs clustered together. They found that people tend to have general belief systems. Some tended to go for medical interventions of all sorts and they would go for ones that were supported by evidence, like antidepressants for depression but they’d also go for silly ones like antibiotics for depression.
We found that there were three clusters of beliefs systems. One Medical, one Psychological and the other was Lifestyle. The psychiatrist suspected that where people don’t have specific knowledge about what works, then they fall back on their general belief systems about health.
So people went for help from counsellors, psychologists, psychiatrists, hypnotists and so on. He went on to say that health practitioners need to be aware that the belief systems of their patients might be quite different from their own. He thought that there needs to be some sort of improvement in mental health literacy in the public because they seem to either believe that all drugs are good or that all drugs are bad.
Another psychiatrist, Dorothy Rowe from Britain says that depression is an intolerable prison we build for ourselves but we can escape by choosing to change the way we interpret our lives. (ABC Radio All in the Mind 11 Feb. 2006) She is sceptical about the idea that drugs are the only answer. There was depression in her family and she says that what happens in families is that we learn our parents’ ideas and then we go along with some of them and do the opposite in others. Her work has been about ‘Why do we all behave as we do?’
Rowe said that what she saw was, that with the pills, the anti-depressants, people would get a bit better and then they’d be back again six months or even six weeks later. What she saw was, the psychiatrists were not interested in these people as people and weren’t interested in the person’s life. Time and time again she’d hear the patient say something which she knew was significant and the psychiatrist ignored it. She kept meeting people who had been treated for depression with, apparently, no external reason – for 20 or 30 years – and they must have been interviewed by hundreds of doctors and nurses and yet not one of them had ever just told their story. When, of course, they told their story, there were so many things in the life of that person that were tragic, often not huge things, but the private disasters we all suffer when we know that we’re not loved or our hopes can never be fulfilled.
Rowe said that we as human being are meaning, creating creatures. It’s not what happens to us that determines our behaviour but how we interpret what happens to us. One person can win the lottery and interpret it as ‘great’, I’m going to spend, spend, spend. Another person interprets it as ‘oh, I don’t deserve this, this is terrible, I feel guilty’. She goes on to say that emotions are meanings. Fear is the meaning ‘something terrible is happening that is a threat to me’. Anxiety is the meaning ‘something terrible is about to happen’. Anger is a wonderful emotion because it brings out our personal pride, anger is ‘how dare this happen to me’ and we fight back. Or we should, but nicely though.
We turn these emotions into depression by blaming ourself for what’s happening, or hating ourself. She says we must get away from the idea of good/bad and thinking along the lines of behaving responsibly. The other idea we need to change is the idea of a just world. No amount of goodness prevents disaster and she’s seen so many people who are shocked when something terrible happens to them and they say ‘but I’ve been good, why has this happened to me’. Well, what made you think you were an exception? Anything can happen to anybody and it takes a lot of courage to recognise that.
Like much of the medical profession she sees a place for both medication and talking therapy.
Dorothy Rowe states that, a lot of therapists in private practice know quite well that their client isn’t going to change because the client just loves having an hour a week of someone listening to them. ‘It’s a lifesaving thing to have somebody take an interest in you and I wouldn’t decry that at all.’ In her book Depression – the way out of your prison she gives practical guidance to people and their families. The first thing you have to do is to decide that you want to get out. A lot of people in the depths of depression find being depressed is safe. It’s horrible, but while they’re depressed they don’t have to deal with the chaos outside their prison. All they need to do is just start to do little things for themselves, it might only be deciding to go for a walk every day or whatever. Then, because you’ve changed your behaviour your ideas change.
She says that often it is difficult for those supporting a depressed person because when they emerge from the prison of depression never to be depressed again, they’ve changed. And that means you have to change too and you might not want that. So be prepared!
In his book Depression – The Common Sense Approach Tony Bates says that one of the advantages of struggling with depression is that you take up a quest to get to know and express your true self. He says that recovery from depression is a journey rather than a destination. According to him expression is the great enemy of depression. The more open we are with ourselves and others about how we feel, the greater the chance we can change how we feel. He talks about the AAA relapse prevention plan.
Aware Know where your vulnerabilities lie and learn to notice how easily they can be sparked into life.
Accept Accept how you feel without being dismayed or disappointed by your reaction.
Action Think about what you’ve learned in your recovery and consider what you need to do in this crisis to take care of yourself. Then do it!
In his summary, Bates says that Strength is about being able to accept how you are feeling at any point in time, including all those times you feel down, and deal with it in a way that is accepting, compassionate and encouraging. Recovery is about allowing ourselves to be human and not expecting something superhuman of ourselves.
Carl Rogers who first introduced the client centred approach to counselling describes what he considers to be the good life. It is not a state of virtue, or contentment, or nirvana or happiness. It is not a condition in which the individual is adjusted, or fulfilled or actualised. To use psychological terms, it is not a state of drive-reduction, or tension-reduction. He seems to believe that many therapists aim towards these goals and even though, for some people, reaching these goals may be the answer, his experience supports none of these definitions. Rogers believes that the good life is a process, not a state of being. It is a direction, not a destination. Like Tony Bates, he believes the process seems to involve an increasing openness to experience. It is the polar opposite of defensiveness. He says that the client needs to ‘own’ their feelings, thoughts and attitudes. The client needs to learn to listen to themselves, to experience what is going on within themselves and accept themselves.
A second characteristic is for the client to learn to live fully in each moment. This means an absence of rigidity, of tight organisation, of the imposition of structure on experience. It means instead a maximum of adaptability, a discovery of structure in experience, a flowing, changing of self and personality.
A third characteristic of the person who is living the process of the good life appears to be an increasing trust in his organism as a means of arriving at the most satisfying behaviour in each existential situation. It’s doing what feels right for them. Rogers says that the person who is living what he terms the good life, is a creative person. They would not necessarily be ‘adjusted’ to their culture and they would almost certainly not be a conformist! They would live constructively, in as much harmony with their culture as a balanced satisfaction of needs demanded.
From a spiritual point of view it is absolutely necessary for psychological ‘health’ that a person be aware of their ‘spiritual’ dimension. Thomas Moore in his book Care of the Soul states that the ‘great malady of the 20th century, implicated in all of our troubles and affecting us individually and socially, is ‘loss of soul‘. He says that when the soul is neglected, it doesn’t just go away, it appears symptomatically in obsessions, addictions, violence and loss of meaning. Our temptation is to isolate these symptoms or try to eradicate them one by one but the root problem is that we have lost our wisdom about the soul, even interest in it. We have today, few specialists of the soul to advise us when we succumb to moods and emotional pain, or when as a nation we find ourselves confronting a host of threatening evils…He says that we can look to the past for guidance in restoring this wisdom. He says that modern psychologies tell us that if we could only learn to be assertive, loving, angry, expressive, contemplative or thin, they imply, your troubles would be over. He has taken the Renaissance approach of not separating psychology from religion. He claims that a spiritual life of some kind is absolutely necessary for psychological ‘health’. At the same time, he says that excessive, or ungrounded spirituality can also be dangerous, leading to all kinds of compulsive and even violent behaviour. He seems to be saying that it is balance that is necessary.
Moore says that the emotional complaints of our time, that therapists hear every day in their practice, include:
- Vague depression
- Disillusionment about marriage, family and relationships
- Loss of values
- Yearning for personal fulfillment
- Hunger for spirituality
All of these symptoms reflect a loss of soul and let us know what the soul craves. We yearn excessively for entertainment, power, intimacy, sexual fulfillment and material things and think we can find these things if we discover the right relationship or job, the right church or therapy. But without soul, whatever we find will be unsatisfying, for what we truly long for is the soul in each of these areas.
Moore goes on to say that care of the soul doesn’t concern itself so much with ‘fixing’ a central flaw as with attending to the small details of everyday life, as well as to major decisions and changes. Tending the things around us and becoming sensitive to the importance of home, daily schedule and maybe even the clothes we wear.
He says that the ultimate cure comes from love not logic. He goes on to talk about the importance of being our true self – self acceptance, because a façade of normality can hide a wealth of deviance.
John Powell is a Catholic priest and in his book The Secret of Staying in Love says that human beings are not simple. We are a composite of body, mind and spirit and have needs on all three levels. We have needs and appetites that are physical, psychological and spiritual. Frustration at any one of these levels can produce agony in the whole organism. According to Powell there is one need so fundamental and so essential that if it is met, everything else will almost certainly harmonise in a general sense of well-being. This need is a true and deep love of self, a genuine and joyful self-acceptance, an authentic self-esteem, which result in an interior sense of celebration ‘It’s good to be me…I am very happy to be me!’
Powell talks about depression, anger, addiction, insanity and physical sickness. He claims that Depression spares the person from the agony of his deeper pain, it protects him or her from the full impact of his or her unbearable situation. In his conclusion of this part of his book he says that pain in itself is not an evil to be avoided at all costs. It is rather a teacher from whom we can learn much. Pain is instructing us, telling us to change, to stop doing one thing or to begin doing another, to stop thinking one way and begin thinking differently. He believes there is one really meaningful distinction and that is between those who are open to growth and those who are closed. Open and growing people are willing to try change. They will initiate appropriate responses and adjustments. Others, for reasons we do not know, simply will not address themselves to the lessons of pain. They rather seek a narcotised and tranquillised existence, a peace without profit. They are willing to settle for 10% of their potential. They are willing to die without have really lived.
Finally, a brief look at my favourite form of help for depressed people, which is GROW, a world community mental health movement, originating in Sydney in 1957 when a number of former mental patients, who had reaped great benefit of organised mutual help while attending AA meetings began to meet together and work more directly on their problems of rehabilitation after mental breakdown. They were first known as Recovery Groups.
They follow the 12 Steps of Personal Growth. The third step says ‘We surrendered to the healing power of a wise and loving God.’ GROW is not a religious organisation in any way – and yet – it has only been when the depressed or mentally sick have admitted their need for a power outside of themselves, that they have been able to complete most, if not all, of the twelve steps to personal maturity. On page 104 of the GROW handbook they talk about breaking free from addictions and compulsions. It says the spiritual convictions and motivation of the GROW programme may enable you to do this all at once; and for the first time in years you will realise what it is to be free. But you still have to show you can stay free. The reason is you are dealing with long-standing and therefore, deep-rooted habits. There is an old saying; Sow an act and reap a habit; sow a habit and reap a character; sow a character and reap a destiny. That is the ordinary process of development. Mental illness is an advanced stage of that same process gone wrong!
To answer the question then, ‘Is Depression an Illness?’ seems to have a lot to do with our belief system. For those who believe it is, the medical profession with their prescriptions is more than likely the answer. For those who believe it is tied up with ‘maladjusted’ thinking, to use one of GROW’s terms, or that it is because of unfortunate experiences, then psychiatry or counselling is likely to be the answer. I am no expert in this field and it is certainly a complex area to look at but I believe there are times when a course of anti-depressants can help us through a really bad patch but if we believe that we need them forever, without looking outside of the medical profession, then, as Dorothy Rowe says ‘we will stay in our prison forever.’
Maureen McKenna © 2006