What causes depression and what works in its treatment? It depends on what type of depression you are referring to and who has it.
In common parlance the meaning of the term depression can range from a debilitating mental disorder to a passing blue mood. Professionals use a number of terms to describe different forms of depression, including major depressive disorder (a disabling condition), dysthymia (a milder and chronic form of depression), adjustment disorder with depressed mood (a reaction to a stressor), and bereavement. And within these broad categories there are infinite shadings and variations depending on the constitution and background of who's experiencing the depression.
While there is overlap between the different varieties of depression, they do have different causes and call for different treatments. The sort of advice that some give to deal with depression such as: laugh, get a dog, and exercise may be helpful to someone with one of the milder conditions, but infuriating or even more depressing to others who have a more severe form of depression. The more serious kind of depression, the kind that keeps you from getting out bed and can lead to suicide, requires more significant measures, including the possibilities of medication and hospitalization.
So what I have to say in this blog may not resonate for everyone.
Among the many hypotheses about the origins of depression is one which tries to understand the original adaptive function that it may have played in our evolution. This theory has had numerous proponents from Carl Jung to more recent researchers such as University of Virginia psychiatrist Andy Thompson.
Thompson's research has lead him to believe that our thinking and ability to focus is actually enhanced by the sort of rumination that occurs with depression, and that while depression can turn destructive, it originally had an adaptive role. I believe that there is merit to Thompson's ideas, but I'd like to flesh them out based on my own direct experience with patients.
One of the most frequent themes of rumination that I see in patients suffering from depression is a gap between who they feel they should be, and how they actually experience themselves. This discrepancy leads to painful self-attack, which can eventually become emotionally deadening.
This sense of who we should be comes not just from neurosis, but also from a deep, instinctual need to grow and to find meaning. While this too is different for everyone, a sense of growth and meaning is often found in connection with others and contribution to community. The neurotic part comes in when we can't accurately assess whether we have succeeded in connecting and contributing. Sometimes we feel that we've failed these expectations and mount a virulent attack on ourselves. So, something that ideally leads to growth turns destructive.
This self-destructive phenomenon parallels a bio-chemical process known as apoptosis, in which cells that no longer serve a function for the organism die off. This helps the organism survive, but it can also go awry. In some cases it becomes excessive and results in a restriction of the blood supply to specific areas. Similarly, when we feel that we are inadequate and have nothing to offer, we may engage in psychological self-attack, which can shrink or constrict the personality, and possibly lead to suicide.
Our culture is in the midst of an epidemic of felt inadequacy, which leads some to overcompensate in a destructive way. Our natural and healthy need to grow can then get hijacked by commercialism. Just as an example, one new expectation that some feel they have to meet is to have cosmetic surgery on their genitals. Angela Bonavoglia's post, Cosmetic Vaginal Surgeons Clueless About Female Sexuality, shows us how far this has gone.
A New Yorker cartoon by Michael Crawford also demonstrates the self-destructive tendency as a failed attempt at improvement: A man has pummeled and decimated his car with a baseball bat. A woman he knows comes by and asks, "Still won't start?"
It's unfortunate that self-acceptance has become cliche, because it really is essential to mental health. Unless we accept where we are without self-attack, it's very hard to get where we want to go.
None of this is to say that we should give up our goals and dreams of growing and helping. I'm not advocating a world of mediocrity or self-indulgence. I am saying that in order for us not to have depression take so many of us out of commission, we need to look at the underlying dynamics of self-destruction and the cultural aspect in which the profit motive preys on our sense of inadequacy. Accepting ourselves as we are does not preclude "getting better," whatever that might mean for the individual.
For effective treatment to occur in these cases, we need to help the individual develop a more nuanced and specific understanding of his or her instinctual drive for growth and connection, and a healthier relationship to the meaning and purpose that those can give us.