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Most people who have had a true experience with depression have no trouble at all believing that something biochemical in nature has happened to them. The change in mood, in how the self and the world are perceived, seems so profound and overwhelming that it makes intuitive sense to feel that the self has been invaded by something alien. We do not feel like ourselves. Something very powerful, something from outside us, has invaded and changed us.
But most people with depression also recognize that this feeling that seems so foreign is also very familiar. They remember many times from their childhood and adolescence when they felt the same way. They felt alone, helpless, and friendless. They may remember their parents as kind and loving, but they wonder why they felt so unloved. They may have believed that they had to be perfect, and they may have tried very hard, but failed, and felt again the futility of their efforts. As adults, they may have thought they'd grown out of it, but here it is again. Winston Churchill referred to his depression as the "black dog"--the familiar beast that quietly pads in in the evening and settles down at your feet.
Depression is a disease both of the mind and of the body, the present and the past. In psychiatry now we have pitched battles going on between opposing camps, those who want to treat the brain and those who want to treat the mind. Both sides have powerful motives for pushing their own theories, some of which are idealistic and some of which are ignoble. Unfortunately, the patient is caught in the middle. The family doctor, supported by the pharmaceutical industry, is likely to say, "Take this pill"--but when it doesn't work, the patient just has another in a long line of failures to add to his baggage. The mental health professional is likely to say, "Let's talk about it"--and the patient is likely to feel patronized, misunderstood, because how can simply talking cure such terrible pain?
It's not an either-or question. Both ways of thinking are true. Both points of view have much to contribute to helping the depressed patient and his family. Both also have a lot to teach people who simply want to raise emotionally resilient children in a difficult world. There is a biochemical process in depression, but the individual has been made susceptible to depression through life experiences. The current episode may be precipitated by an external event, but the event has set in motion a change in the way the brain functions.Undoing Depression:
What Therapy Doesn't Teach You
and Medication Can't Give You
pages 21-22
Depression is a loss of parts of the self. Instead of experiencing our inner selves as strong, vital, and joyful, we see ourselves as weak, damaged, or blameworthy. We wish that others could make us feel better, but we can't usually express such wishes directly; instead we use various self-defeating defense mechanisms to keep our wishes out of consciousness. And even though we try to keep our deepest needs out of consciousness, we still feel guilty and shameful; we consider ourselves needy, unworthy, repugnant. What can we do to reinvigorate the self, to help us capture or recapture a sense of ourselves as a center of initiative, a participant rather than an observer, a cause rather than a victim of life?Undoing Depression:
What Therapy Doesn't Teach You
and Medication Can't Give You
page 172
The depressed person makes himself miserable partly by trying to control things he can't control. Indeed, some researchers feel that excessive worrying is the hallmark of depression. Depressives ruminate on their problems, worrying the same issues around endlessly; we find a counterargument for every possible solution to our problems, and so end up taking no action at all...
In order not to be driven crazy by constantly responding to the demands of the moment, we need to become adept at detachment. Detachment implies a certain objectivity, a certain perspective in being able to rise above a situation and consider its meaning within a larger context than the immediate one. Detachment suggests a certain degree of insulation from contagious emotions--not being caught up in others' panic or anger, but making our own decisions about the emotional meaning of a situation...
Detachment is not stuffing feelings. It is not repression, denial, projection or intellectualization. It is recognizing and acknowledging feelings, but maintaining a certain amount of conscious control over how much they affect us. Detachment comes from being able to get in touch with one's most important values, asking ourselves: Does this situation threaten what's most important to me, or is it merely difficult or unpleasant?Undoing Depression:
What Therapy Doesn't Teach You
and Medication Can't Give You
pages 181-182
[from the hardbound edition]
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