Lifting the Burden: Notes on Overcoming Depression
It is estimated that 18 million American adults suffer from depression every year. The suggested origins of the disorder vary from genetic predisposition and neurological anomalies to inadequate diet and poor quality of sleep.
The domineering theory about depression in contemporary psychiatry is that those who suffer from depression have a chemical imbalance in the brain. This theory was supported by research demonstrating that the brain chemistry of those experiencing depression was different from the brain chemistry of those that do not experience depression. Further research has showed that this “imbalance” could be corrected by giving patients medication that would alter their brain chemistry and make it more “normal.” Thus ushered in the age of medications like Prozac, Paxil, Effexor, Lexapro, Celexa, Wellbutrin, Zoloft and the like.
There is no question that the brain chemistry of a person who is depressed is different from the brain chemistry of a person who is not. However, what is less talked about is that this “depressed” brain chemistry has not always been there. Most people are not born with this chemical imbalance— it develops over time for an array of reasons. Depression is a disorder that is experienced by people at different stages of their lives. People may have lived for twenty, or thirty, or forty years without feeling symptoms of depression, until they wake up one day and realize their brain chemistry has — suddenly or gradually— flipped. They feel that their emotions went haywire as they find themselves feeling like they are swimming up river — feeling sad, unhappy, apathetic, remorseful, guilty, chronically exhausted, and hopeless.
As a clinician and social worker Wirth over 40 years of experience, my belief is that there is no such thing as a chemical imbalance. The brain chemistry is not primary but secondary to our emotions. Our brain chemistry is always in proper balance, or, to say it more accurately, in perfect correspondence with our emotional state.
Imagine for a moment that as you are reading this page your telephone rings. You are informed that you just were given whatever dream opportunity you may have, or that you have just have won ten million dollars. Or, think of the thing you desire the most. What happens? As you visualize these things, your brain chemistry changes instantaneously— as a response to this emotional reaction. Therefore, your brain’s reaction is in perfect balance with, or it is perfectly appropriate for, the state of elation that you experience.
Now, imagine you get some bad news about a great misfortune that happened to someone you love. Once again, upon thinking about this great misfortune, your brain chemistry changes — but this time it corresponds with the feeling of emotional pain, loss, and helplessness. The brain chemistry may also change slowly, as a consequence of continuous dissatisfaction, feelings of guilt, remorse, helplessness, hopelessness and the like.
Note that in all cases above, the brain chemistry change is appropriate, not inappropriate! Your brain chemistry changed directly in tandem and as a consequence of the experiences and feelings you were having, good or bad.
Most people, after having gone through what commonly would be called “hard times,” go back to normal functioning and their usual mental and emotional disposition. However, some are unable to “shake it off” and return to their regulated state of homeostasis. These are the people who are diagnosed as depressed. Having received a label of being chemically imbalanced, they begin to take chemicals that artificially change their mood. After taking medication, people indeed become chemically imbalanced, meaning their brain chemistry no longer corresponds to state of affairs in their lives. Nothing in their environment, circumstances, and overall life has changed. They did not cope with sadness of not having achieved something they wanted to achieve, or the pain of loss, or the feeling of hopelessness about the situation they are in. They did not learn new tools of dealing with their life circumstance. All that happened was that their feelings were numbed as their neurological processes were altered by an external force— a chemical.
Note that drugs, of course, do not have intelligence of their own— that is, the drug does not arbitrarily choose to numb “bad” feelings. The drug numbs the ability to feel. And to the degree that people on medication no longer feel pain; they are not feeling joy either. Once one stops medication, feelings of pain can come back. However if you keep people on medication, you have also taken away their “awakenness” to life— you have taken away the normal reaction they may be having to real negative conditions and circumstances, and dulled their emotions.
The answer to depression is not to “knock” people out of their depressive state as quickly as possible. The answer lies is in helping them find new and affective ways of coping with life’s challenges— it lies in guiding them to make peace with their losses and find meaning to their lives. The answer lies in assisting them in the development of tools and strategies that they can use in pursuit of their goals.
If faulty brain chemistry was responsible for causing depression and not the other way around, psychotherapy would never work in the treatment of depression. Yet, numerous studies have demonstrated that Cognitive-Behavioral Psychotherapy is just as affective in treating all forms of depression, including severe depression, as medication. So, let us now set aside the theory of chemical imbalance and consider other possibilities of treating depression.
What is depression? First, let us consider the term itself, as this is important. Language evolves slowly over hundreds, sometimes thousands, of years. At the base of most words are verbs carrying a particular pictorial meaning. These pictures — the images rooted in words themselves—have deep connection with the original human observations that led to the development of the initial word itself. The word depression comes from the Latin word depressio, which means pressing down.
So, if people are suffering from depression, there is something pressing down on them. Whether it is guilt, remorse, grieving, or longing for something that did not happen, there is always a burden that is weighing upon them. This burden is a feeling of loss that they cannot move through and move beyond.
Feeling sad or being depressed about loss it is a common occurrence in everyday life. We all go through our ups and downs, through our mini-depressions, and mini-rebounds. The majority of people who go through days or even weeks of being depressed about a loss do get better. Their attention is taken by other things in their lives. Daily responsibilities, new goals, new relationships, new opportunities. Shortly, things that are meaningful to them require their attention, and pull them out of their sadness or grief.
These setbacks and rebounds happen to many people, but not all people. Some do not have rebounds that are strong enough to bring them back into the flow of everyday life. Why do some people rebound, while others do not? This question, while tempting to ponder in the therapeutic context, is not fruitful to explore with a client—because an attempt to answer it may take the clinician away from helping a person, because it may take the clinician and client into an abyss of infinite guesses.
We all have different genetic history, different physiology, different health history, and different individual life experiences. The list of differences among people is endless, and all of these things could play a role in why two people respond differently to the same events. But no matter what, if we try to understand the “why,” we will emerge only with intellectual guesses. The reality is some people “get over it” and some do not.
In some cases, the event or circumstance that originally triggered depression may no longer exist or become irrelevant. However, for people who are experiencing depression, the focus on negativity and sadness becomes a deeply engrained habit. From the moment they wake up, the “doom and gloom” of the present, the bleak events of the past, or the grim perspectives for the future, become an unavoidable focal point of their attention. But is it really unavoidable?
Let us consider a hypothetical situation. A depressed man is sitting in his room, feeling sad and hopeless. Suddenly he smells smoke. The next moment, he sees flames coming up from under the door. What are the chances that after noticing the flames, he would go back to his gloomy thoughts? More than likely, he would act to escape from danger. For however long he is fighting for his life, for however long he stays in the “what is” of the present moment, he would not be depressed. However, after the danger subsides, in the absence of another powerful stimulus, this man might very well back to his depressive thoughts and attitudes. Or not. Some other powerful jolt could shake up his perception of reality, and he could develop new attitudes and new goals. He could get absorbed by the excitement of new possibilities in his life. It would all depend on how powerful this jolt is, whether or not he could afford to go back into the slumber of depression, and what kind of new possibilities would open to him.
Mahatma Gandhi said, “Every night when I go to sleep I die, and in the morning, I am born again.” Every morning we have 24 brand new hours to live. The way we go through these 24 hours largely depends on our thoughts. Our thoughts affect the way we feel, and the way we feel determines our behavior— and the consequences of our actions have an impact on our thoughts. It is a cycle, and every day is an opportunity to redefine that cycle. People who are depressed may not choose to have sad thoughts from the get-go. Depressed thoughts just come. People often just wake up and find themselves overcome with sad thoughts.
However, although we may have no control over the particular thoughts that appear in our mind, we do have control over what we do with those thoughts once we become aware of them. The way out of depression is through becoming aware of thought patterns so that we can interrupt the pattern of negative thinking. Only then can one begin to release the guilt and /or regret about the losses in life, create a new vision of life, and move towards fulfilling possibilities and a new vision.
The following is the ten-step process of overcoming depression. Note that in order to succeed in the following process, in order to implement necessary life changes, you may need assistance of a mental health professional trained in cognitive-behavioral psychotherapy. Each of the ten steps is a creative and deliberate process requiring knowledge of therapeutic specific tools.
1. If it is possible, connect with people you trust— people with whom you can share your pain, if you are able and willing to do it. Inform them that you do not need them to solve your problems, and that you just need their attention.
2. Connect with your feelings but without judgement. Ask yourself, “what do I feel?” Do you feel lonely, scared, hopeless, desperate, emotionally tired and wanting life to be over, disconnected from people and/or life itself? Allow yourself to feel whatever you are feeling without making any judgment or interpretation about the feelings you identify. Know that as you stay with and name your feelings without resenting them (or yourself) for having these feelings, the feelings themselves will subside in intensity. Do this for as long as it takes to truly connect with and name how you feel, whether that takes 1 hour, one day, or more.
3. After this step, you can now look at the content of depressing thoughts. Ask yourself this: “Do I feel this way when I think about something that actually happened? Or, do I feel this way because I just have negative thoughts, self-blame, regrets, guilt or fears?” Then ask yourself: What issues can be addressed and resolved through deliberate action, and what issues are products of cognitive errors?” (Follow up question: how do you know if you make cognitive errors, and what these thought errors are? This is where the help of a professional or insightful friend might be useful, so that you can run the previously identified thoughts by them).
4. Do the work of clarifying or finding meaning for living your life.
5. Identify and learn the tools you need in the pursuit of that which makes your life meaningful.
6. Make an absolute commitment (a written statement) to do all that is necessary to fulfill your intention. Write about the price you pay now and will pay in the future (1 year, 5 years, 10 years) if you are not totally committed to succeed. Write the rewords of succeeding (1 year, 5 years, 10 years).
7. Develop or strengthen your voluntary will, so you could follow through with your commitment. Start practicing the WIT (Will Integration Training) techniques.
8. Keep weeding out negativity and depressing thoughts from your mind.
9. Consult a naturopathic doctor (ND) or a qualified nutritionist for a nutritional program that may help to improve the symptoms of depression. Further, take stock of your sleep hygiene and water intake. Studies indicate that removing toxins from food, eating a nutritionally balanced diet, drinking 2-3 liters a day, and getting 7-9 hours of sleep are essential for reducing symptoms of depression (as well as anxiety).
10. Find a highly qualified Yoga teacher who teach you individually some techniques for mastering negative feelings.
