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Depression

When the Bubble Bursts: A New Approach to Depression

A new way of viewing depression may lead to better treatment.

Key points

  • A depressive episode is often the response to an event that shatters what a person once believed to be true.
  • A shattered worldview can lead people to respond by surrendering and giving up.
  • Talk therapy can help people suffering from depression.

The symptoms of depression can dramatically transform a person’s life, daily routine, behavior, and relationships. A depressive experience is common, with an estimated 3.8% of the population affected, including 5% among adults and 5.7% among adults older than 60, according to the World Health Organization (WHO). Approximately 280 million people in the world have depression. Depression is different from usual mood fluctuations and short-lived emotional responses to challenges in everyday life. At its worst, depression can lead to suicide. Over 700,000 people die by suicide every year. Suicide is the fourth leading cause of death in 15-29-year-olds, according to the WHO.

Types of Thoughts Depressed People May Experience

  • “I’m a failure.”
  • “It’s my fault.”
  • “Nothing good ever happens to me.”
  • “I’m worthless.”
  • “Life’s not worth living.”
  • “People would be better off without me.”

Psychological Symptoms of Depression

  • Continuous low mood or sadness
  • Feeling hopeless and helpless
  • Having low self-esteem
  • Feeling tearful
  • Feeling worthless or guilt-ridden
  • Feeling irritable and intolerant of others
  • Having no motivation
  • Finding it difficult to make decisions
  • Not getting any enjoyment out of life
  • Irritable mood
  • Feeling anxious or worried
  • Having suicidal thoughts or thoughts of harming yourself

Dangers of Terminology

While the term ‘depression’ has become commonplace, it is often evoked to describe an array of moods, and experiences. Outside of the DSM or ICD, we should realize that we are confronted with a controversial topic here. The different descriptions or explanations for the experience of depression, from religion to medicine, leave these descriptions open to challenge. These varying descriptions or explanations are neither right nor wrong. We should realize, however, that what matters is the effect of the solutions that flow from these different viewpoints. I suggest that we can only really say we understand a problem if we can create methods to solve it.

Biology or Relationship

From our point of view, a depressive episode seems to be the effect of a person’s reaction to something that occurs in their life that ‘shatters’ what they once believed to be true. Although I think that most of the time, depression has been unhelpfully defined as an illness in a strictly biological sense. Frank Ayd's book, Recognizing the Depressed Patient, (1961), declared the “chemical revolution in psychiatry.” It urged doctors to reassure patients that their suffering was now better understood and that their problems existed because of an organic, physical issue (Kirsch, 2013). Ayd’s book was distributed by the pharmaceutical company Merck to almost 50,000 doctors in the USA and thus, the chemical imbalance myth was born.

However, despite the success of this strategy, the pharmaceutical industry had no way of explaining conclusively how anti-depressants worked at that point and the actual situation was that “just because an S.S.R.I., antidepressant increases serotonin in the brain and improves mood, that does not mean that serotonin deficiency is the cause of the disease." However, now, with nearly 20% of the American population consuming antidepressants and anti-anxiety medication, little is still known about the long-term effects of taking anti-depressants. It is now, however close to a 70 billion dollar industry in the USA alone (Richard Friedman, 2014), but a wind of change is now blowing and neuroscience laboratories and research facilities in companies such as AstraZeneca, Novartis, Pfizer, Merck and Sanofi Pasteur have been significantly scaled back or completely shelved, as it appears the dream of finding a chemical solution to anxiety and depression has not been realized.

Real World Clinical Observation

Through my daily clinical work, I've seen that depression seems to evolve, beginning from a particular belief the person has constructed about a specific event, real or perceived. This belief finds them perceiving themselves to be a victim of something, something which they feel incapable to fight or overcome and so they surrender to it. The belief is a kind of description they hold about themselves, others or their world and is maintained through their interaction with themselves and the world around them. The person begins to assume this belief to be true. This belief or theory about themselves, others, or society, shapes their own unique, subjective, personal vision of their world and their place in it. Most of the time, repetition of these voluntary behaviours and relationships creates a self-fulfilling prophecy that makes their perceived, subjective reality seem to be true.

Beliefs and Experience

A person's belief isn’t created based on a rational idea, except in the case when the belief is the result of a specific ideological or political choice. The reiterations of their behaviours define the relation between the individual and their environment, shaping their way of being. Once such a pattern is established, it will tend to reinforce itself following the Rosenthal effect, where someone persuades themselves that something is true, and they alter their very behaviour to confirm this belief.

You Can’t Solve a Problem With the Mindset That Created It

In the case of depression, there isn’t just a hardening of the underlying belief, but also the destruction of the belief itself. When people are confronted with an unexpected and previously unforeseen event, their fixed belief, due to its rigidity, fractures, and now everything which has worked up to now no longer functions as it used to; everything in which they believed crumbles under the oppressive force of this unexpected event. For example, if someone holds a belief all of their life that ‘friends are kind and loyal’, only to find that one of their closest friends has betrayed them in some way, their belief, that up until now, did not need to be questioned, shatters in an instant and paranoia and suspicion may begin to creep in about the motivations of others around them. Whether the event is true or not isn’t important. Our clinical research has demonstrated that surrendering and giving up are the most common attempted solutions patients adopt. Surrendering seems to characterize the primary response in all the different types of depression that we see. Nevertheless, we realized how this surrendering could be expressed in many ways such as giving up on sports, not caring about how we look or giving up on things we loved doing before.

Surrender, Defeat and Victimhood

Surrendering can present itself as a generalized form and giving up can be expressed behaviorally. It can be achieved by surrendering our ideals, aspirations or previously held desires, or we can surrender in our relationships. Surrendering is best characterized by an image of a person who has been ‘paralyzed,’ refusing to do anything in the belief that nothing will come from anything they might attempt. The person’s physical movements are slowed, they appear demotivated, and their thoughts and ruminations become negative. Their new, rigid belief becomes, "There’s nothing that can be done to solve the problem, so why even try?" Pleasure is, in any of its forms, missing, and their mood is characterised by a general lack of hope, feeling they can now only passively accept their new, painful reality.

It’s the tragedy of impotence, which at times leaves space only for lamenting, rumination, and complaint. The patient becomes the metaphorical 'puppet with broken strings.' This pattern of behaviour and thinking characterizes severe depressive states. These states are most of those we see in clinical practice. Such cases are often ‘sent to therapy’ by others, usually by their loved ones, because the very way in which they have surrendered to life has led them to regard hope that change can occur as futile. These patients readily adopt a pharmacological treatment rather than talk therapy and give up completely. The good news is that help is readily available and professional help should be sought if people recognize themselves in these patterns.

References

https://www.who.int/news-room/fact-sheets/detail/depression

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About the Author

Padraic Gibson, D.Psych, is a Consultant Clinical Psychotherapist and is the Clinical Director of The OCD Clinic®, and director of Training and Organization Consultation at The Coaching Clinic®, Dublin. He is senior research associate at Dublin City University.