I’ve never publicly written about this before. What made me think about publicly writing about my depression is that I’ve noted several DUers express feelings in recent weeks and months that border on or are precursors to depression. Our current political situation is certainly something that any liberal/progressive minded person could get depressed over.
Two of the hallmarks of depression are helplessness and hopelessness. Having elected a Democratic Congress and consequently been so disappointed over their failure to achieve or even attempt to achieve what we thought we elected it to achieve, it is natural that many of us would feel helpless to control the events that affect our lives. A feeling of hopelessness follows from that feeling of helplessness. The recent FISA vote, which suggests to many of us (including me) that our Constitution is for sale to the highest bidder, was the last straw for many of us.
Depression is a terribly painful illness. It is also very common in our country, and probably in most countries. What worked for me may not work for most people. But if this post helps anyone to overcome or significantly ameliorate their depression, it will have been worth writing it.
Before getting into my own personal experience with depression I will say a few words about what depression is and what causes it. But before doing that I need to describe my professional background in the subject: I completed four years of medical school in 1975. As part of my medical school training, I took a basic course in psychiatry in my second year. In my third year I took a month of practical training in psychiatry in a psychiatric ward for psychotic patients. And in my last year I took another month of practical training, as an elective, in a mental health clinic.
None of that qualifies me as a psychiatrist or psychologist. For a time I did consider making a career out of psychiatry – which is why I took that elective in my last year of medical school. But in the end, I decided that it wasn’t for me, so I made my career in public health, preventive medicine, and epidemiology instead. My main reason for deciding against a career in psychiatry was that it seemed too complicated of a subject for me. Psychology and psychiatry are not rocket science. They are, in fact, a great deal more complicated than rocket science – which is why we understand so much less about them than we do about rocket science. I found that disagreement on basic fundamentals of the discipline among its professional practitioners was severe and commonplace, so I gave it up for something that was much easier for me to grasp.
Because of my continuing interest, I have read dozens of books on the subjects of psychology and psychiatry since I graduated medical school. However, I’ve read very little on the subject in the past several years (My main reading interests have turned from psychology to history and politics.) So my knowledge on many of the specifics of the subject is a few years out of date. Nevertheless, I doubt very much whether the
general principles that I discuss in this post are significantly out of date.
DepressionHere is a pretty good
basic description of depression from the National Institute of Mental Health:
Everyone occasionally feels blue or sad, but these feelings are usually fleeting and pass within a couple of days. When a person has a depressive disorder, it interferes with daily life, normal functioning, and causes pain for both the person with the disorder and those who care about him or her. Depression is a common but serious illness, and most who experience it need treatment to get better.
Many people with a depressive illness never seek treatment. But the vast majority, even those with the most severe depression, can get better with treatment. Intensive research into the illness has resulted in the development of medications, psychotherapies, and other methods to treat people with this disabling disorder.
Very briefly, depression is a mood disorder that can cause severe emotional pain and render a person virtually non-functional. But like most other illnesses, it is not an all-or-none proposition. There are varying degrees of depression, from relatively mild to severe and psychotic.
Some of the main symptoms include persistent sad, anxious, or “empty” feelings, feelings of hopelessness, helplessness, worthlessness or guilt, difficulty concentrating, insomnia, fatigue, loss of interest in normally pleasurable activities, loss of appetite or overeating, and thoughts of suicide.
To give a more personal idea of what depression is, I’ll give you an excerpt from the first paragraph of my now deceased father’s (unpublished) autobiography. My father suffered periodic bouts of depression through much of his life. I cried when I read his book; I had not previously known about his depression:
Help is coming. The thought was comforting… Why didn’t I take some concrete steps before this? Well… I was coping, after a fashion, and my emotional state was not that critical until Joe’s (his brother) death. Then was when I felt the threat of becoming unhinged. Then was when I knew something absolutely had to be done. Strangely, nobody suspected there was anything wrong. Not my friends… No, not even my children. Nobody knows yet – except my wife.
The causes of depressionGenerally speaking, there are two major categories of causes of depression. There are life events, such as the loss of a job or a loved one. And there is the biochemical composition of the brain. In general, when life events are the cause, psychotherapy is likely to be the more successful treatment. When the cause is biochemical, drugs are more likely to be the more successful treatment.
However, these generalities greatly oversimplify the issue. Many cases of depression, probably most, and possibly all, are caused by a combination of life events and biochemical factors, and it is often quite difficult to determine which is the more important in an individual case. Furthermore, these factors undoubtedly interact with each other in ways that we don’t fully understand, thereby making treatment even more difficult.
Depression as a thought disorderAll through medical school, it was stressed to us that depression is a mood (that is, feeling) disorder, rather than a thought disorder. But later in my life, in attempting to deal with my own depression, I came across a book by David Burns, a psychiatrist, titled “
Feeling Good – the New Mood Therapy – The Clinically Proven Drug-Free Treatment for Depression, from the University of Pennsylvania School of Medicine”. That book challenged the traditional view of the causes of depression, claiming that it is primarily a thought disorder rather than a mood disorder. That is not to say that the primary symptom of depression is not a dark mood. It is. When Burns talks of depression being primarily a thought disorder, he is talking about the underlying
cause of depression.
I do not know whether Burns’ claim that depression is
primarily a thought disorder is correct. He did present a good amount of scientific evidence to that effect, and I have little doubt that a great many cases of depression do in fact have a disorder of thought as the root cause. I have almost no doubt that that was true of
my depression, because I used Burns’ methods to successfully treat my problem 15 years ago, and it has never returned.
To the extent that depression is caused by a thought disorder, that means that cognitive techniques can be used to treat it. If a person’s faulty thought processes are the cause of his depression, that means that he must learn to correct those faulty thought processes in order to cure the depression. I’ll get into that in more detail shortly, when I discuss my own depression.
The status of my depression 15 years agoIn the early 1990s I was in my early 40s, and I had suffered through periodic bouts of depression throughout my life for as long as I could remember. Sometimes it was relatively mild, and sometimes it was severe enough to cause great emotional pain, though I don’t believe that it was ever severe enough to be classified as psychotic – which indicates a severe break with reality. I had tried drug therapy, and I had tried professional psychotherapy. Both may have worked to some degree, but not very much. Then I came across Burns’ book. After using his methods and internalizing them into my personality permanently, I overcame my depression and have since remained relatively depression-free for the past 15 years. Prior to that time my bouts of depression had come and gone, but never had I been without it for so long a time.
Recognizing my depression as resulting from a thought disorderI don’t feel comfortable going into all the details of my depression, nor do I remember them all. Suffice it to say that the underlying cause was lack of self-esteem, as is often the case with depression.
When I first read that lack of self-esteem is primarily a thought disorder, it didn’t make any sense to me. Throughout Burns’ book he repeatedly says stuff like, “You’re better than you think you are” – the kind of stuff a doting mother would say. I thought to myself, what a bunch of bullshit! How can he say stuff like that to me or any of his other readers? He doesn’t even know us. But I kept on reading because … well, I can’t remember why.
Then suddenly I achieved an insight into what Burns meant. What he was trying to tell us is that we need to think of ourselves differently. Our depression is caused by a failure to think of ourselves in a realistic manner.
Some general principles for treating depression with cognitive therapy So how does one straighten out their thinking to overcome their lack of self-esteem, feelings of worthlessness, and such? It’s very difficult to explain, but I’ll try. First, you have to look deep inside yourself to identify why you feel the way you do. Often you will discover that there is no discernable reason. Or alternatively, you will see that it has to do with how you believe society perceives certain things about you.
If you believe that society perceives certain things about you in a very negative light, then you will have a tendency to be ashamed of those aspects of yourself. And being ashamed of them, you will have a tendency to deny them, even to yourself. If you deny aspects of yourself you thereby deny yourself the chance to think about them in a realistic light. There is then no chance to rid yourself of the shame that you feel about them. And that often leads to depression.
How I overcame my depressionWhat I felt I had to do was make an intense conscious effort to acknowledge whatever I saw as my faults, and not try to hide them. For example, if I had an opinion that I thought might be looked upon negatively by other people, rather than try to hide that opinion I should discuss how I feel about it. If I didn’t understand something, rather than try to cover up that fact I should ask someone to explain it to me. If I had a particular vulnerability, I should acknowledge it rather than try to hide it or overcompensate for it. Once I did those things on a regular basis, it was like lifting an oppressive burden from my shoulders. I felt much better almost immediately.
I realize that what I wrote here doesn’t sound very specific. But the truth is that there was no one specific thing that I did to deal with my depression. Rather, it was a matter of changing my thought processes and actions with regard to a great many little things, and making those changes part of my routine life style.
To be a little more specific: Consider a discussion that I’m participating in. It could be with a single person or it could be a large group. It could be a work-related discussion or a personal one. The principles are similar in either case. Suppose that I have an idea or a personal revelation to contribute to the discussion. But the part of me affected by low self-esteem – the part of me with the thought disorder – is afraid to speak up about it. Maybe people will think I’m stupid. Maybe they’ll think I’m “different”. Maybe they’ll think I’m “bad”. If I give in to that part of me – simply keep my mouth shut because of my insecurities – I reinforce that part of me. The low self-esteem is confirmed and the depression remains or even gets worse.
The other option is to search for the other part of myself and reassess what I want to say in the light of my clearest thinking. Doing that may not help me predict how people will react to what I have to say. But at least I can reassure myself that it reflects my true thoughts and feelings and that it is important to say. Once I do that, I should go ahead and say it. If the reaction is negative, at least I can weigh my thoughts against the negative reaction in an attempt to understand them better. I might change my opinion on the matter, or I might realize that what I had said was better thought out and more constructive than the negative reaction. It could lead to further discussion. Or the reaction to what I said could be very positive. Whatever the reaction to what I said, I have challenged myself. I have therefore given myself a chance to learn and to grow. The likelihood is high that I will feel better about myself and my depression will improve.
For a person to do that kind of thing on a regular basis, one needs to be constantly aware of why it is necessary. It is necessary because there is rarely any productive purpose to be served by pretending to be something you’re not, because nobody can grow as a person as long as they do that, and because it almost invariably comes back to haunt those who try.
ExceptionsI don’t mean to say that one can always safely do this kind of thing. There might be real practical reasons why a person has to pretend to be something he is not. He could lose his job by admitting to certain things, for example. But at least we can admit to ourselves when we are pretending.
I can give two recent examples from my own life. One concerned a recent plane trip, on which I brought along the book by Vincent Bugliosi, “The Prosecution of George W. Bush for Murder”. My wife noticed the book as I was reading it in the airport, and she strongly suggested that I take off and hide away the book jacket with the title on it. My fear of being snatched up and carted away to Guantanamo Bay caused me to quickly agree with her (I’m serious).
Then there’s my current job, which bores me to death. In the presence of my boss and co-workers I strive to hide the fact of my boredom and utter lack of enthusiasm. I do that partly for reasons of job security and partly because I don’t want to spread my poor morale to other people. Undoubtedly, it would be better for my mental health if I felt free to discuss the issue with these people. But for the above stated practical reasons I keep my mouth shut. Maybe I shouldn’t.
Depression due to our current political circumstancesDepression due to political circumstances is somewhat different than the issues discussed above, mainly because it’s hard to see how this could lead to low self-esteem. But perhaps it can.
It is depressing to see our chances of replacing our current fascist government with something better (i.e. an Obama/Biden administration coupled with a heavily Democratic Congress) stymied by election fraud, a corporate news media in bed with its Republican benefactors, and racism. It often seems to me that the task of overcoming such problems is insurmountable, and my own contributions relatively miniscule. Yet, there is only one way of overcoming depression caused by this sort of thing: Talking about it and
doing something about it. Exactly what we as individuals can or will do varies tremendously from one person to the next, depending upon our individual capabilities and interests. There is little or nothing we can do about the fact that our individual contributions very well may not succeed. But nobody can stop us from trying. As long as we give it our best shot and don’t give up we are likely to feel much better about ourselves and our situation.