Depression and anxiety are to emotional health
what the coughs and sneezes of common colds are to physical health. They happen often, and yet, with savvy prevention, can be minimized in frequency and duration. At the same time, ignoring small depressive collapses can let them worsen into serious depressive episodes and even morph into life-threatening suicidal
A recent PT posting by Azadeh Aalai shares this view of depression as "the common cold" of mental health, adding that the prevalence rates of depression have been rising steadily over the past century. That post summarized 5 myths about depression . The first of these myths was the mistaken notion that depression stems from a "chemical inbalance."
By contrast,, the writers of an article on the triggers for depression in the most recent issue of Scientific American.lacked Aalai's insight. While the article did specify that life events such as loss of an important relationship or a desired job can trigger depression, they appeared to be trapped in the myth that depression is largely a question of biochemical abnormalities. This misunderstanding may benefit pharmaceutical companies but it can do a major disservice to patients as it is misleadingly points to pills as the best way to lift depression's dark clouds.
The Scientific American article did clarify, and I believe rightly so, that grief and depression are related and at the same time different. Both have low energy negative mood. At the same time, grief is primarily sadness. Depression includes also three additional factors:
Underlying anger, which Freud's contemporary Karl Abraham once referred to as "anger turned inward"
Helplessness, which psychologist Martin Seligman aptly refers to as "learned helplessness"
Negative thinking, which cognitive therapy founder Aaron Beck referred to as "the negative cognitive triad" of negative thoughts about self, others, and the future).
What the article missed however, from the perspective that I first suggested in my 1990 book From Conflict to Resolution, is that depression emerges as a by-product of a problematic conflict resolution event, that is, of a decision or interaction that has been made in a win-lose manner.
Depression is the by-product of giving up in a dominant-submissive interaction.
If I hate my job but feel stuck because I need the money, I will feel depressed. If my wife treats me harshly and I give up on trying to change the pattern, I am likely to feel depressed. If I am grieving the loss of a boyfriend after a relationship break-up, and in addition experienced the ending of the relationship as unilateral, his decision only, then I will feel depressed as well as grief from the loss.
Choice-points, both within an individual and vis a vis other people or circumstances, can be addressed in a manner that leads to win-win solutions. If instead, one side dominates and the other gives up or has no say, depression will be the by-product.
All of us feel a brief spurt of depressive serotonin drop when we lose at a game, when the stock we just bet on slides downward or when our favorite football team loses a game. Losing is depressing. That's because in a loss of any kind, never mind major losses such as the severance of an important relationship or termination of a job, we must submit to an outcome that was the antithesis of what we wanted.
When we get what we want in an interaction, serotonin spurts into our system. When we lose, the serotonin gets depleted, or so I read in more medically-oriented writing. Yet the depression is triggered by situations in living life; the seretronin depletion is secondary to having experienced a dominant-submissive interaction.
This view expands on Seligman's view that depression is a disorder of power. Giving up in a contest between what I want and what someone else wants comes from feeling less powerful. In turn, not getting what one wants creates feelings of diminished power.
How to Reverse Depressive Reactions
The good news is that when depression is understood as having been triggered by giving up, the solution emerges. Identify the problem situation in which giving up was the solution. Then reverse the feeling of submission by understanding the situation in a new way or by correcting the actual outcome. My earlier post on a visualization technique to clarify the triggering problem and then release the depressive reaction offers a how-to you can do with a therapist, a friend, or on your own.
In addition, marriage therapy can be hugely helpful both for ending depression reactions and for preventing further depressive episodes. That's because a significant proportion of depressive collapses occur in response to interactions with loved ones.
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Love relationships are hugely valanced. Attachments to love partners are vital. We generally want to keep them in tact. Many people therefore give up on what they want, and succumb to a dominant-submissive pattern of interactions, thinking that this subordination is necessary in order to keep the relationship going. Giving up on getting what you want in a realtionship, alas, will cause depression. Depression is not good for you, or for your partner, or for that matter for relationship satisfaction for either of you.
Fortunately, marriage patterns are learned, not genetic or chemical. We learn how to interact in marriage initiallly from what we have seen our parents do. Did you learn habits of giving up and assuming you can't get what you want, habits that cause depression?
That learning however is just a starting point. Anyone who chooses to can learn how to have a mature equal-power relationship can learn the skills for cooperative talking together and win-win deicision-making.
My clinical practice is filled with couples who have transitioned from depression caused by having been too submissive to enjoying a fully loving and mutually empowering relationship. If they can learn how to build truly healthy relationships, you can too.
For an indexed listing of Dr. Heitler's PT blogposts, see the drop-down menu under Dr.H's Blogposts on her website, TherapyHelp.com.
Denver clinical psychologist Susan Heitler, PhD is author of From Conflict to Resolution for therapists, the books for couples The Power of Two and The Power of Two Workbook, and the fun interactive website called PowerOfTwoMarriage for folks who want to upgrade their couple partnership skills.