Authored for Psyched in San Francisco by Marty Cooper, MFT. Marty helps clients gain insight but also practice skills for overcoming depression and anxiety. Marty answered your questions live about depression in an online question and answer which you can view here.
As a psychotherapist in San Francisco, I've worked primarily with chronic depression for more than a decade, and maybe another decade or two of my own history with these "Wild Moods," and so wanted to write here as distilled a summary as I can of what I've learned so far. So here goes:
The two (non-negotiable) principles of curing depression are:
Self-regulation:
You have to learn through practice how to more skillfully, precisely, and consciously regulate your nervous system. This means studying yourself to see where you leaves what the neuroscientists refer to as the "Window of Tolerance" (the "not to hot, not too cold" state of our nervous system, in which we feel safe and not threatened), and changing your behavior/choices to stay within that window. This self-regulation is the realm of the "tools" of therapy, the "doing stuff" of healing, which is necessary but not sufficient, because cure requires:
Mindfulness:
You can't control your way out of depression, because, in a way, depression is what happens when we fail to control. The trouble is not the failure to control -- most of life is uncontrollable -- it's the inability or unwillingness to let go of that control. Hence mindfulness, defined as "paying attention in a particular way: on purpose, in the present moment, and non judgmentally" (Kabat-Zinn), which is to say, the practice of accepting things just as they are. This is not a trick, or strategy, though; mindfulness is really the deep displacement of our cherished fantasies of life, with life. Without self-regulation, we can't practice mindfulness (try taking a clear photograph in an earthquake). But without mindfulness, you stay attached to false views of life (such as, "If I'm only more successful, everyone will love me"), and therefore keep triggering depression. Which leads us to:
The ten (non-negotiable) realities of depression:
1. Depression pivots on the experience of futility.
When your mind starts registering that something you're attached to is futile (the goal or object is unattainable or determined to be too costly), your system has the natural tendency to want to let it go. When this happens, depression comes online; it is cued to respond to futility. Specifically, when something is registered as futile, depression is cued to ask: "This futile attachment, can you accept losing it?" If the answer is yes, it is satisfied: no depression. If the answer is "No" (or, "No!"), then depression starts revving up, because:
2. Depression monitors for dangerous energy expenses.
If we keep giving energy to that which is futile (say, "I have to keep getting richer!" when we're not actually a very good business person), then depression views that attachment as a wound that won't stop bleeding. Worse, depression looks at you and says, "Apparently you're not competent to close the wound, so I will have to," which it does by shutting down your ability to attach. Not just the futile attachment, but all of life starts feeling grey, undesirable, uninteresting... futile. For depression, job done. Yes, life-energy is suppressed, but the wound is closed and life is preserved. This means:
3. Depression acts as the backup for grief.
Grieving is the emotional process of letting go of that which is already gone. If you can tolerate the loss of the futile attachment, then you go through the emotional process of reconciling to reality without what you were attached to (whether a beloved person or cherished idea). That's what we call grief. But if you don't allow, or can't tolerate, that process, then depression registers that as an endlessly, and lethally, bleeding wound. Depression monitors for futility, sees that we are unwilling or unable to let go, and so, through shutting down your ability and desire to connect forces you (like prying glass from a baby) to let go. It does it brutally and categorically, without mercy, but, from its perspective, it does it to save us. Towards this end, it lies, because:
4. Despite its own propaganda, depression has a structure.
Depression is very powerful because it "convinces" your mind-and-heart-and-body that, yeah, actually, life is essentially futile and worthless and should be avoided. It pretends towards a kind of omniscience and omnipresence, but actually, it has a definite logic -- saving you from a futility you won't grieve -- and towards this, it obscures its own purpose behind an assertion of the "obviousness" of life, well, sucking. Therefore:
5. Depression is not stupid or random.
It serves a particular function, and comes from somewhere; it is not simply a "derangement" of the psyche any more than a histaminic reaction is a "derangement" of the skin. It is ugly and brutal, unapologetic and dishonest, but not meaningless. Therefore healing cannot be just about medicating (as important as actual medications can be for self-regulation), because has to address the meaning, both of depression, and in how you actually make meaning in your life. But because your meaning-making system is so intricately wound up with what defines you, then:
6. Depression requires the transformation of your self.
Like a monster with a jewel lodged in its stomach, depression can't see or know that it is the carrier of incredible riches, but nonetheless, is. If it is a very structure of your self -- the way you identify yourself, and how you attach to life -- that is producing the sense of futility, without grief, then it is only by transforming your self that you'll uproot depression. (I call this depression's "transphilic" nature: its healing "draws for transformation.") The grand project that depression forces on us is transforming the "depressive self" into the "non-depressive self," which inevitably gets us to:
7. The transformation of depression requires mindfulness.
Einstein said, "Problems cannot be solved with the same mind set that created them." With your depressive mind/self (which attaches to futile pursuits, and then refuses to let go), you cannot produce a non-depressed life. You need a "non-depressed" mind for that, and that's exactly the mind that mindfulness practice develops. Instead of clinging to dead ideas of life, mindfulness is the practice of looking objectively at what life actually is, objectively, rather than how it looks as filtered through our depressive mind and self. This is not easy, because:
8. Curing depression requires sacrifice.
You don't get to become non-depressive, and keep the beloved depressed parts of you. You can't cherish hopelessness and not nurture depression. Most potently, unless you are really good at control, you can't maintain a controlling stance towards life, and not summon depression. Even harder, you don't get to control this process, because:
9. Healing depression moves through stages.
These stages are also non-negotiable. You have to learn skills of self-regulation, so you're not perpetually overwhelmed. You have to learn to experiment and accept your failures. You have to learn and practice self-reflection (mindfulness), so you can disidentify from depression, and transform your self. You have to learn to grieve, which requires both self-regulation and self-observation to be strong enough to tolerate the pain and mess of healing. You have to reach a stage where the grief (letting go) is for the part of you that has failed to control your self, your life, your world. It's not pretty and it's not easy. But, if you let this process transform you, what you come to see is that:
10. The incredibly hard work of healing from depression is utterly worth it.
The jewel in the belly of the monster of depression, claimed and owned through this transformation of the self, becomes for you the path to the emergence into life as it is. Which is not the grim bleakness that depression, with its mono-focus on survival, says it is. Rather, what you discover when you allow yourself to grieve losses and accept life in all its painful and funky and exquisite qualities, is that the monster that seemed to imprison you within itself, has actually been the force that has delivered you from grimness to aliveness, that forced you to learn what life, including yourself, is, and to surrender to it. You become, bizarrely enough, profoundly grateful for the monster. Seriously. That's what happens.
There is a tremendous amount of detail and nuance in this process of emerging from grimness, in healing depression, in terms of techniques, theory, how and which supports to get when, etc. Like describing, say, swimming laps in a pool, you can accurately say that you get in the water, learn to float, paddle your arms forward, and do that till you reach the other side of the pool. There's a lot of detail within that, but at a macro level, the description is true. So too, here, with depression: so far as I can tell, at the macro level, what I've put forward here describes the whole nature of depression and its healing, within which all of its dynamics and weirdness and potential can be found. I hope it is helpful in your path of healing.
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If you -- or someone you know -- need help, please call 1-800-273-8255 for the National Suicide Prevention Lifeline. If you are outside of the U.S., please visit the International Association for Suicide Prevention for a database of international resources.