The following article is written by Dr Werner Sattmann-Frese, a Senior Lecturer and Program Manager at Jansen Newman Institute.
What is Depression?
Depression is the ‘common cold’ of mental illness.
It is the term used in psychiatry to describe a range of mood-related symptoms that can range from minor symptoms of depression to the emotionally and socially debilitating major depressive disorder or clinical depression that often requires hospitalisation.
Symptoms of Depression
According to the Diagnostic and Statistical Manual of Diagnostic Disorders (DSM-5), depression can be diagnosed when a person struggles almost consistently for more than two weeks with lowered mood and a loss of interest and pleasure in usual activities. A person in the grip of this condition typically also suffers from a persistent loss of self-worth, is far more self-critical than is socially useful, and often struggles with a strong sense of guilt.
The Psychodynamic Diagnostic Manual (PDM) describes people with a depressive personality as those who “find little pleasure in life’s activities and are chronically vulnerable to painful affect, especially depression, guilt, shame, and feeling of inadequacy” (2017, p. 29).
Often unconsciously squelching positive feelings such as excitement, joy, and pride, people frequently show a lack of interest in a healthy diet, exercise and personal hygiene, and a fluctuating or persistent loss of hope.
Biological features of this condition often include significant sleeping disturbances such as insomnia or hypersomnia, loss of weight or compulsory and compensatory eating patterns, and somatic agitation such as compulsive handwringing.
The sense of guilt typical for the emotional state of depression usually manifests as self-blame and strong remorse for past activities that have apparently caused others hurt and grief. Predictably, people who have struggled with this condition for a long time progressively believe that suicide would be a useful solution for themselves and for people around them, which is never a rational or reasonable solution but a clear indication that immediate professional help is needed.
Causes of Depression
The clinical experiences of mental health practitioners and findings of researchers demonstrate that a wide range of complex and interrelated factors may cause depression.
This biopsychosocial view of depression — and many other physical and mental health problems — contradicts the widely held understanding that the condition is simply caused by genetic factors, neuroendocrine abnormalities, and a dysregulation of neurotransmitters (the part of brain responsible for sending messages between nerve cells).
An increasing number of psychiatrists and other professionals now base their work on the integrative model that suggests that stress exacerbates the effects of genetic and developmental factors.
Unlike most psychiatric texts which are first and foremost concerned with managing the patients’ symptoms (Virden, 2009), many clinicians are increasingly concerned with creating a meaningful understanding of the emotional and physical state of depression.
Using perspectivism as a philosophical underpinning, depression is described here by employing social-critical, trauma-related, somatic (factors relating to the body), and functional (life context) perspectives.
The trauma-oriented understanding of depression acknowledges and uses the body of recent research linking depression with early experiences of insecure attachment and, in more serious cases, with abandonment, neglect, and abuse. Using object relations and attachment theory as frameworks of reference, this research associates depression and many other conditions with the self-development deficits resulting from developmental traumas. Research undertaken with almost 10,000 patients in 1998 established that: persons with histories of being severely maltreated as a child showed a 4 to 12 times greater risk of developing alcoholism, depression, and drug abuse, attempting suicide, a 2 to 4 times greater risk of smoking, having at least 50 sex partners, acquiring sexually transmitted disease, a 1.4 to 1.6 times greater risk for physical inactivity and obesity, and a 1.6 to 2.9 times greater risk for ischemic heart disease, cancer, chronic lung disease, skeletal fractures, hepatitis, stroke, diabetes and liver disease” (Van der Kolk in Siegel, 2003).
Psychotherapists and counsellors frequently experience that these results also apply to people who have not been abused or neglected as such, but who have grown up with parents highly stressed from internalised feelings and societal pressures. These insights are now spawning an emotional revolution that is shifting the emphasis from cognition to affect.
Recent research has established that the healthy and loving interaction between the new-born and the mother acts as a regulator of the child’s internal homeostasis. A healthy new-born–mother interaction ensures the normal development and maintenance of synaptic connections during the establishment phase of brain circuits. Thus, early developmental influences may affect our ability to cope in trauma related situations in later life.
Body-oriented psychotherapists integrating talking cures with an understanding of the intimate links between body and mind, acknowledge the relevance of the trauma-related background but also emphasise the role of the body in this condition. Central to this view is the understanding developed by Wilhelm Reich that muscular tensions serve to keep traumatic experiences unconscious, a process he called muscular armouring. We can see this mechanism in action when we consciously or unconsciously brace ourselves on the expectation of pain and discomfort, for example in the dentist’s chair. Muscular tensions, together with armouring of the connective tissues achieve this unconscious repression of feelings by fragmenting the flow of subtle energy in the ‘bodymind’. While this may sound strange to people in Western societies, such an understanding of energy and energy flow has a very long tradition in eastern cultures that use Tai Chi, Yoga, Kum Nye, Chi Gong, and many other ‘energy distribution’ and harmonisation systems to generate and maintain wellbeing and emotional integrity.
Depression, in this view, results from a trauma-based energetic fragmentation that blocks people’s life energy and locks them into the ‘prison of their bodies’. Suitable bodywork exercises are usually able to re-establish energy flow and provide crucial emotional relief in a short time. The outbursts of feelings often associated with this relief demonstrate the strong links between the early traumatic experiences and depression.
In her 2006 book, Listening to Depression: How Understanding Your Pain Can Change Your Life, Lara Honos-Webb suggests that depression is meant to stop us in our tracks when we lead emotionally unsustainable lives. It is a challenge to review our core beliefs about life and to replace unsustainable perceptions, beliefs, and behaviours with more emotionally, socially and ecologically sustainable ones. The fact that many of us may find such a positive and psychologically non-critical view of depression challenging and difficult to embrace, only demonstrates how much our perceptions of dis-ease have been shaped by the current modern paradigm and science that lack an understanding of meaning and purpose.
Political and ecological perspective
In her book Living Under Liberalism: The Politics of Depression, Pam Stavropoulos suggests that “[d]epression might be seen as a powerful sign that ‘something is not right’ more generally, not just within the individual” (2008, p. 48). There is an increasing recognition that the ongoing stress of ubiquitous exploitation in many societal areas and more recently also climate change can lead to depression and anxiety. In a paper referring to a recent APA publication, Zoë Schlanger writes that “[G]radual, long-term changes in climate can also surface a number of different emotions, including fear, anger, feelings of powerlessness, or exhaustion.”
What can we do?
The perspectivist approach described above demonstrates that depression is a complex condition that cannot be sufficiently addressed from within one particular frame of reference.
This also means that there is no single therapeutic intervention that is able to assist people in making the condition redundant in their lives. While empathically attuned counsellors and psychotherapists can assist people in understanding and healing the causes of the condition at a personal level, they cannot alleviate the harmful societal pressures impacting on their lives.
A ‘real cure’ for depression will be dependent on our willingness to create a more sustainable society.