Redefining Depression
For a couple of months, two years ago, I was depressed. A profoundly rainy San Francisco winter, coupled with the heartbreak of yet another failed relationship, just left me feeling blue. Three-thousand miles from my family and my closest, oldest friends, it also left me crying in jags, with a lonely, nagging ache inside.
This time in my life would have been relatively unremarkable (in the sense that I wouldn’t otherwise feel inclined to blog about it two and a half years later) if it weren’t for the fact that I met my partner, Chris, during these months. Because I happened to meet him during a time that can be legitimately referred to as a “depressive episode,” it’s part of our story that it was not love at first sight, and I sometimes reference it that way in conversation. “Sparks did not fly,” I jokingly say to my girlfriends. I like telling people this version of the story because I think it speaks well to how love can sneak up on us when we least expect it. I got the love sneak-attack in that instance because I was … distracted.
What makes this story blog-worthy, in my opinion, is actually the way people respond to me when I “admit” that I was depressed. People’s faces always light up a little bit – not in a sadistic way, exactly – but in a way that seems to say, “You get depressed too? Oh thank God you’re admitting it! I’ve been depressed too. I feel so much less alone now.”
My question is, what’s up with that? Why do we feel like depression is this shameful thing that we shouldn’t talk about? I don’t doubt for a second that they feel doubly relieved that I’m admitting it because I’m a shrink, as if therapists don’t get depressed too. Well, I do get depressed sometimes, and I’m going to tell you why – it’s actually the same reason why almost everyone else does from time to time:
It’s because I’m human.
I have a bone to pick with my own profession. I think that we have done society a major disservice by medicalizing depression and calling it a “disease.” We have taken a normal (albeit very unpleasant) part of the human condition and encouraged people to see it as an aberration. We did this, in large part, so that insurance companies would be required to pay for its treatment, and unfortunately in doing so we’ve changed the way that people look at depression entirely.
I’m not saying that depression isn’t problematic, and I’m not saying that it isn’t something that needs to be treated, but this change in the way that we think and talk about depression has a way of robbing us of something that is vitally important: our ability to use our own internal experience as a source of information.
There are different levels and types of depression and, accordingly, there are a variety of tools that we as mental health professionals have in our tool boxes for it. While my own experience with depression has not been particularly severe, I’ve worked with individuals who have been so profoundly depressed that they’ve undergone ECT (electroconvulsive therapy, or shock therapy — yes, we still use this, although it’s come a long way from what most of us imagine) in a last-ditch effort to try anything that will pull them up from the depths of despair. I’m thrilled to report that I’ve seen that intervention successfully restore people’s functioning, but in my personal and professional experience, most of the time that people are depressed it’s because there’s something happening in their lives that needs their attention.
In my clinical work I help my clients to understand how their depressive thoughts and feelings are related to underlying issues in their lives. Sometimes those issues are current, and a course-correction is in order. At other times there’s something bubbling up from deep within, and I’m able to be helpful by listening empathically, connecting dots, and providing a human connection; I remember how invaluable it was for me to have that myself. Sometimes people need a little extra support, and anti-depressants can be helpful, but above all I believe that our feelings are never, ever random.
So, do I know what it’s like to feel depressed? Of course I do. I’ve had to course-correct. I’ve had to face the skeletons in my closet, and I don’t mind admitting it, because going to see a therapist who’s never experienced psychological suffering would be like going to an auto-mechanic who’s never owned a car.
This is what makes us human, and unfortunately it’s a problem that’s getting more pervasive as we become increasingly isolated and individualistic as a culture. By calling depression a disease, and by focusing our attention on the faulty wiring in each individual, we fail to respond to what elevated rates of depression are saying to us about our society as a whole. We are beings built for human connection in an increasingly isolated world.
Modern isolation is not the sole cause of depression, but if there’s anything that I hope people take away from this article, it’s this: Anti-depressant medication alone is not an effective way to treat depression. Anti-depressants are a boon to the pharmaceutical industry, partially because they’re often prescribed by general practitioners and other kinds of doctors who don’t refer their patients to any kind of psychiatric follow up care. This practice needs to stop. The dirty little secret about anti-depressant medications is that they barely outperform placebo in clinical trials. While they seem to be more effective outside of the lab (about 60 percent of patients respond well to anti-depressants in clinical practice), studies show again and again that therapy increases the effectiveness of these medications.
Have I gotten your attention yet? Please, if you’re reading this and you’ve been feeling depressed lately, know that you aren’t alone. You also aren’t, in my opinion, diseased – but now that you have more information, what are you going to do about it?
For more on optimal living, visit http://lesliecarr.com.
Photo credit: John Davey
30 Comments
Thank you so much for sharing!
Reading this soothes a weary heart, on so many levels. I sometimes get overwhelmed by guilt and shame if dark thoughts and emotions come up. Like I’m flawed, or not entitled to be feeling the way I do. A part of me is affected by the notion that entering a relationship requires already being in a perfect state of inner strength and happiness. Oh, and that sparks have to fly right away … But in my heart I believe there is a whole multitude of ways love can appear.
Of course I want strength and happiness and sparks in my life, and in the lives of everyone else. But it is really good to hear from someone like you that feeling depressed is a normal part of the human condition. It lightens the burden, if you see what I mean.
Great article. I remember I went to the doctor once and said that my heart kept racing. They prescribed an anti-depressant. It didn’t work and I abandoned it. Two years later, I started eating properly and exercising and my ‘anxiety’ lessened. Miracle. Miracle….. or is it just common sense
Thank you for this post. I agree with your criticism of the tendency to diagnose depression, label it a disease and then prescribe. I think that tendency goes beyond depression to many physical ailments. One of the dangers of labeling something a disease is that it implies that it’s permanent and requires a permanent pharmaceutical solution. It seems more likely that physical or emotional symptoms signal that something is out of balance and needs attention. I like the phrase you use, a “course correction” is needed.
I thought that the depression was now called a diease because that would make it “acceptable.”. Depression has been such a blight on families that for years they hid it. Even PTSD has only been recognized in recent years. You were just weak if you came back from war with a problem like that.
As for doctors prescribing without theropedic follow up, I am with you on that. Personally, several years ago my then family doctor gave me a prescription for Lexapro. She told me that it was just a band-aid until I found a therapist. Saved my life. Just wanted to let you know. Thank you for being human.
Thanks for sharing with us! It´s such an important topic.
I got depressed when I had vitamin B12 deficiency -it just shows that the cause might be physical as well as psychological. It´s so important to look into possible nutritional causes before taking anti-depressants. Both B12-, Omega 3- and magnesium deficiency may cause depression.
Unfortunately, most of us are ashamed to talk about being depressed. Because of this, we should always keep our eyes open for signs of depression, -maybe your friend is struggling with a serious depression, while you just think she´s being tired, anti-social, irritated or boring?
Leslie, it is so encouraging and enlightening to see a therapist actually admit to having mental health issues like depression. For a span of 10 years, I lived with severe and chronic and anxiety, and the irony was that I felt alone because of this isolated society we live in. I think the more people come clean about how they feel, the less we will see “disorders” such as anxiety and depression. Being able to relate about these topics to others is really the way to heal!
I am so touched by the comments so far today.
I think you’re making a good point, Barbara, about calling depression a disease in the past so that it was more acceptable. It’s almost as if we’ve come full circle and now need to stop calling it a disease to make it more acceptable (in my opinion), but history is like that – especially the history of psychology and mental health treatment. The times shift and how we look at things shifts too.
Birgitte: Excellent point about the nutrition connection. Funnily enough I have a whole separate blog coming out on that topic soon. It’s a shame I forgot to add that into this article!
For Kari and Hadley and everyone else – thanks so much for contributing to the discussion. It certainly seems like you “get” it! I’m so glad that this article resonated positively. Indeed, feeling depressed from time to time does not mean that something is “wrong” with us :)
Be well, everyone.
Leslie
This was such a great post. I love when people step out in bravery to expose the parts of themselves we’ve been conditioned to hide at all costs. The best lesson I got from your post is that when we share these parts of ourselves we are not only helping to heal ourselves but we are also offering a wonderful gift to those around us. You create a circle of healing energy and give others permission to embrace all of themselves…the light and the dark. Thank you for your courage.
Thank you so much, Kai. I feel so incredibly honored by how warm all of these responses are!
It really feels like a lesson in how healing it can be when we open up and allow ourselves to be vulnerable. I wasn’t too concerned about anything I was sharing here, but I also would be lying if I didn’t say that I felt a bit exposed! To hear people respond so positively is such a nice feeling.
*Leslie
A fabulous post, which rings so very true for me as well. Depression for me was about isolation, and loss of social supports.
I feel that part of the issue is also our newfound ability to live and move wherever (for the most part) we want to. Families now often span the globe, whereas before you nearly always lived in the same neigbourhood or town as your relatives. That sense of community support and unconditional acceptance can be missing in people’s lives.
Kristina
One of the father’s at my daughter’s school ended up in hospital and we didn’t know why. People kept saying ‘it’s his head’ in hushed tones and we assumed he had terminal brain cancer or something. When finally someone admitted it was depression we were so relieved and then we laughed because there had been such a huge cover up. And the same thing happened – as soon as depression was acknowledged, others came out of the darkness.
Hiding away has never been a good solution to anything. It’s wonderful to see such an honest post shining a light on this very real and prevalent experience.
Hormones!! A big thumbs up for Estradiol and paying attention to what’s going on with your hormones in addition to your brain. Sometimes it’s not all in our heads!!
In that it seeks to label illnesses and not treat underlying cause(s), I think that there is a problem with all medical diagnosis and treatment. However Depression is an illness with physical symptoms and imbalances in the body/mind which is one.
I think that recognizing Depression as an illness makes it more likely that people discuss it.
Thanks Leslie for another good article. I was listening to a discussion earlier today by Dr. Ofer Zur and he also has a good website with a lot of good resources/articles on it. His website address is zurinstitute.com.
Dino R.
My two cents; besides having a lousy childhood, apparently my vitamin D level was non-existent!!! Talk about depressive…. Now, I see a holistic health doc, a counselor and take supplements! Working up to my Vita-mix!!! Aiming to be somewhere in the realm of your sister!! Thank you for the great, wonderful, insightful article!!!
I am a huge fan of Kris Carr as well as Andrew Weil!! I am a FB fan of both of these inspiring people! I wanted to share his ( Andrew Weil) link for the day. I am a Registered Nurse and witness the ” cure” of all symptoms with a prescription of medications! UGH!! I wish we could convince the world to try the holistic approach!! Thank you for your insightful article!!!
Nonfiction Review: Spontaneous Happiness by Andrew Weil, M.D. Little, Brown, $27.99 (320p) ISBN 978
http://www.publishersweekly.com
Really interesting post, and yes it’s actually very reassuring when the “professionals” get depression too (weird I know) I was diagnosed with post-natal depression just weeks before my DX of primary and secondary canser and was prescribed a mild anti-depressant which I did take for 4 months. I weaned myself off them at Christmas time. And knowing what I know now – mainly from reading Dr David Servan Schrieber RIP, I would definitely suggest a mega dose supplement of EPA Fish oils instead of anti-depressants. I have been told that as Stage IV it is pretty certain I will get depressed and will need further medication! No way! My diet and lifestyle will get me through this and I will live with my cancer. Thanks for your article, I was feeling very slightly low and thought I’d log onto CSL to see what came up – spooky!
I very much agree with a lot of what you are saying. We are taught to see so many emotions as wrong, when they are all normal. However, I do feel compelled to say that another thing this culture does by defining depression this way is start to minimize chronic/clinical depression because people blur the difference between chronic vs acute depression. Acute depressions happen to everyone from time to time and they can be awful. Chronic and clinical depression is a disease that has to do with brain chemistry/genetics (I am talking about true mood disorders: major depressive disorder, bipolar disorder, etc).
Excellent point, Katie – I think you’re right. I’m also quite disturbed by the increasing rates of prescribing anti-psychotic medications (Abilify, Seroquel) to “boost” the effectiveness of anti-depressants that aren’t otherwise working. These medications are intense, and come with serious side-effects. It’s disheartening to see how often they’re prescribed (and pushed, with advertising) to people who fall into the “first camp” that you’re describing (the people who are on the lighter end of the spectrum).
Loved your article! More people of in all careers need to speak more openly and freely about depression. My whole family suffers and I hid it for a long time but now I talk openly and people are so kind and understanding. One important aspect of depression not openly talked about is hormone balancing – I have read and am passionate about the book “hormone hell to hormone well” by Dr. Randolph. It is an often overlooked missing link to mental and physical health. I have been on his safe, vitamin regime and have never felt better – mentally! Thank you for your thoughtful article.
love this Q : “Why do we feel like depression is this shameful thing that we shouldn’t talk about?” it’s been given a bad rap. when we are out we can see how rich it was. I love how Thomas Moore talks about it in Care of the Soul. I find its a creative time that needs to be honored + bliss is right behind the door we least expect it to be. Thanks for your honesty in every way even the bone you have to pick with your profession. :)
Thanks Dr. Leslie for this perspective. I’m a heart attack survivor who has written extensively about my own serious depression following my cardiac event three years ago. Mayo Clinic cardiologists tell us that depression is regrettably common for survivors of cardiac events (up to 65% of women, specifically, yet fewer than 10% are appropriately diagnosed). Regrettable – because studies show that depression increases the risk of poor outcomes in heart patients. And as cardiac psychologist (and more importantly!) a heart attack survivor himself, Dr. Stephen Parker writes: “There are damn good reasons to be anxious and depressed after a heart attack!”
A study on the stigma of mental health diagnoses reported in the British Journal of Cardiology last July followed over 400 London heart patients for two years – of whom at least half showed symptoms of anxiety or depression when first interviewed. But the study authors described their participants in this way:
“Many of these heart patients were reluctant to accept a diagnosis of depression and expressed reservations to the clinical psychologist by rejecting the term ‘depression’ for describing their problems, or by expressing negative views about even attending a mental health service for treatment.” More on this at “I’m Not Depressed!” – And Other Ways We Deny the Stigma of Mental iIlness After a Heart Attack” at http://myheartsisters.org/2010/09/07/heart-attac/
I’m now reconsidering whether the “depression” suffered by heart attack survivors could be a matter of semantics. It’s also been viewed as GRIEF because of the loss of everything normal that came before. Or FEAR because of living 24/7 with the knowledge that another life-threatening cardiac event could hit at any moment. I’m wondering if what you now describe as “depression” was actually more like situational SADNESS, perfectly appropriate for a person facing heartbreak, bleak weather, no close friends around. All of it perfectly “normal” and expected reactions in the human condition.
Precisely, Carolyn. I think you’re making an important distinction here. I think that the people who are rejecting a diagnosis of depression are doing so largely because they don’t want to feel stigmatized or “faulted” for an emotional reaction that they’re having that (I would argue) is perfectly natural. Thank you for adding that.
I think the positive psychology movement and over simplifying genre of books like “The Secret” have stigmatized depression even further. There is this notion that if you are depressed it is your own fault and if you could just be more positive your sadness would go away.
I even hear it in the comments posted here, if you treat your depression with medicine it is the wrong, maybe worst course of action. Just eat better, get exercise, practice mindfulness, consume your flax or or your fish oils and drink green smoothies from your Vita-a-Mix. I am all for each of those scenarios but they may not even budge some anxiety and depression.
Anti-depressants are indeed a boon to the pharmaceutical industry but, they are also a boon to individuals suffering clinical depression. I think the stigma related to depression can also be tied to the stigma around taking an antidepressant.
Thank you Katie @ peacebeme for your comment! It was something I had been debating commenting on for a while now. I appreciated that Dr. Carr mentioned there are different levels of depression. I think it’s important for ppl to differentiate btwn what I like to call ‘situational’ depression, and chronic depression. Everyone goes through down/depressed times, but there are also people who have actual mental illnesses. I’ve struggled with depression for many years, not just a few months. I’ve been medication free for 3 years now, but I can tell you that there is no situation or event that has happened that has triggered this or caused this. And for me, that is frustrating – there is no “issue” for me to deal with – things just shut down.
And, unfortunately, abg’s comment does have a solid point – I’ve struggled with following the CSL forums and posts b/c I do feel that somehow I’m just not being healthy enough and this depression is my fault. When I have followed the CSL diet strictly, why hasn’t it fixed things – I must be doing something wrong b/c my depression is still there, my digestive problems are persisting etc… I exercise more than most, and although my diet hasn’t been the best these past few weeks, most of the time it’s quite good.
I guess my point is that it’s very important to distinguish btwn people who hit some down or rough patches (which are awful I know!), and those that suffer from clinical or chronic depression (or things like bipolar etc…) However, I don’t think that society has done a disservice by labeling depression a disease. I think it’s done a disservice by not distinguishing the diagnosis from people who are going through some really awful stuff which has triggered a down/depressed state (and which I am NOT trivializing, just pointing out the difference) and those who suffer from severe medical depression.
(Sorry my comments are always so long)
Dear Veronika,
Hugs to you out there in cyber space.
Veronika,
Thank you so much for adding that. I hear what you’re saying completely, and I appreciate what you’re contributing here. I did, in hindsight after having posted this article, worry that I might come across as minimizing the concerns of people who suffer from severe, chronic, and even life-threatening depression. It wasn’t my intention to do that.
I will say though that the mind is complex, and sometimes we might think that we’re depressed for no reason other than chemicals, when in actuality there’s something deep down that’s gnawing at us. I hope that in addition to everything else that you’ve tried, that you’ve had some really good therapy that could help you excavate all that.
abg: Excellent, excellent point. I always feel terrible when I hear that someone is being hard on themselves because, if they’re depressed, they’re clearly not “doing a good enough job of being positive.” I think that that stuff (the Secret-oriented approach and things like it) has its time and place – there’s a time and a place for everything – but sometimes it can be misinterpreted or abused. Human beings are built to experience a multitude of different emotions for different experiences. We’re not robots.
Thank you for contributing that.
Hello Dr. Carr,
Thank you for taking the time to respond. I never felt that it was your intent to minimize related mental illnesses – I just felt that it’s important to distinguish.
I wanted to include something about therapy but my comment was already so long :) Yep! I have gone for therapy and do continue. I strongly believe that the medical system likes to pump out drugs & leave it at that. Even if someone does require anti-depression meds I feel that therapy is essential!
That being said, my health coverage through work covers 2.5 therapy sessions a year. Yep 2 and a half. At $120/session, I simply cannot afford to go as often as I would like. I could try and find a less qualified therapist as the price would go down, but I finally found a therapist that I feel comfortable with and it’s hard to make a switch. The sad part is, if I went back on medication, my coverage would cover that 100% for the full year! I think something is a amiss there :S
I wanted to say that I really appreciate that we can share different ideas & points of view in an accepting environment in these comment sections.
abg: cyber hugs back to you :) I still struggle & get frustrated, but I TRY & remind myself that every one has a different path to health and what might work for some, may not work for others.
As Charlie Sheen says, this airctle is ?WINNING!?
this is a wonderful article I recommend
http://www.odemagazine.com/doc/70/Your-brain-is-a-rain-forest/
August 19, 2011