Depression

Depression

Last week, 11-17 May, was mental health awareness week and in the USA it is a whole month of awareness. It is necessary because of the stigma attached to mental ill health. Also, I find that there are ‘sunny’ people, Christians and others, who can’t see what it is all about. I have come across folk who are very dismissive of the mentally unwell or who cannot see that inward pain is a very real and profound affliction which afflicts the sufferer and those near and dear to them.

I usually find the winter most difficult but depression, for example, can strike out of the blue. At such times I find it helpful to take walks, read, generally slow down and avoid potentially stressful situations at least for the time being. I also get myself ticking along by making to-do lists with simple tasks as well as bigger ones. At one time the antidepressant fluoxetine helped to numb emotional pain. On Sunday, 11 January, 2015, there was an interesting programme on R4 about 'Mindfulness' which seems to be a recent development and is being promoted this year by the Mental Health Foundation. It was said that CBT (cognitive behavioural therapy) helps people with depression but ‘mindfulness’ enables better functioning afterwards. When I asked a psychologist friend about mindfulness he said it was a very good thing so it’s worth following up but he pointed out that it helps some people more than others.

In 1975 I came across a book, Overcoming Depression by Paul Hauck. I must have given it away because I can’t find it anywhere now. He traced depression to three main causes and fortunately I have his later book, How to be your own Best Friend (1988), which outlines them briefly.

[1] Self-pity. We may well feel sorry for ourselves at times and justifiably so but obsession with self-pity will most likely end in depression. Hauck says we should challenge the idea that it is awful that life doesn’t treat us as we want it to. It’s time to count our blessings.

[2] Other-pity. Compassion is an excellent trait but being incessantly involved in other people’s troubles can be overwhelming and result in burnout and depression. People in need may require our help but if we break down emotionally over them we will not be able help them. So the motto is to do what we can.

[3] Self-blame which Hauck later called self-hate. Whereas self-pity often involves blaming other people for our troubles the opposite, self-blame, is a potent source of depression. Again it is good to be self-aware and to put our hands up when we are wrong but when the whole thing becomes obsessive or out of proportion the spiral of depression can begin and swallow us up. Hauck says that we should learn to forgive ourselves for falling short over things we are not really gifted at anyway, for not getting everything right first time (parents need to accept that they are on a learning curve) or things we do when highly disturbed, ‘there is no way we can be fully rational when very upset.’ [Best Friend p. 42]. And it’s worth basking in the realisation that there are people who really value us.

It’s all a form of cognitive behavioural therapy that was refined by Albert Ellis who called it rational emotive therapy. Basically it involves straightening out irrational thinking so that the sources of depression don’t get out of hand or even get a foothold.

In my opinion there is plenty of good, practical, common sense in this and clearly thoughts can affect emotions and sometimes a lot of straightening out is needed but I’m not entirely convinced. It seems to me, for example, that conflict over equally balanced alternatives can spin into depression. Furthermore, I’m not sure that it recognises the sheer depth of the black hole of despair involved in this affliction. Also, our varied temperaments and personalities pitch in to varying degrees so ‘depression stories’ and their outcomes are likely to be diverse. Finally, brain chemistry seems to contribute as well which is where antidepressants play a part.

A few years ago I attended a lecture by Professor Lewis Wolpert, a medical biologist, who was struck down by depression to the extent of being suicidal. He wrote a book about it. Perhaps not surprisingly for a biologist he brought in such factors as genetics and concluded that a mixture of drug and cognitive therapies is the best treatment at the moment. It’s complicated, there are seldom quick fixes and I am very suspicious of some treatments but that’s another story. Sometimes we just have to grind our way through depression.