Rainy again this morning — the Great Dane digging holes around the garden, unearthing a small Greek origanum bush of which I am very fond, barking loudly and aimlessly at the back wall. He’s bored, ignores me when I call to him.
A friend calls from the city to say she is surfacing from seasonal depression now that winter is nearly over, a mild enough winter on the balmy bay lined with palm trees, not balmy enough for her though. What causes depression? Is there any explanation that really fits across the centuries and cultures? I’m reading a Rumpus history of depression and wondering what novel explanations might appear next month, next year –
The next great theory of depression belonged to Freud. To him, depression (he used the Greek term, melancholia) wasn’t an aesthetic mode but a state of feeling, an emotional reaction caused by loss. The loss could be of anything: a relationship, a possession, even a long-held hope or cherished belief. Often the loss wasn’t conscious, but the feeling was. Melancholia felt like grief, with the addition of bitter feelings of anger, guilt, and reproach heaped upon the self.
Freud didn’t think that melancholic reactions were healthy, per se, but he did believe that they were widespread. Vulnerability to depression was one of the hazards of loving and connecting, and particularly of over-identifying with the things one loves. Anybody could fall into melancholia from time to time, but particularly at risk were those who find their self-worth in attachments and achievements rather than inside, and of eager-to-please individuals who keep their aggressive feelings pent up inside. In an increasingly individualistic society, Freud gave us a vision of grief whose roots were interesting and personal, springing from the bonds and experiences that make us who we are.
And as with theories of alcoholism, the discrepancies, similarities, contrasts go on in their own mysterious way. Sometimes medication helps, but we don’t know why. Some of those in recovery find anti-craving medications work like a charm; for others the urges go underground, switch focus or simply persist. Might the answer lie in a theory of chemical imbalance, like seasonal affect disorder, something external, not originating within at all? We simply don’t know.
Yet despite the promise of definitive, modern understanding conveyed by the chemical imbalance account, the biological reality of depression still floats away from our grasp. Twenty-five years later, scientists still haven’t achieved a satisfying explanation of just how or why antidepressants work. No benchmark for a normal level of brain serotonin has been established, nor have depressed people been shown to have less serotonin in their brains than the non-depressed. Antidepressants are effective for many, especially in cases of moderate to severe depression, and we understand the brain better every year, though an unfathomable amount still remains to be learned. But on close inspection, “depression is a chemical imbalance” turns out to be is every bit as much a model, a metaphor, a story, as “depression is an excess of black bile.”
Outside the dog jumps up and down, barking himself hoarse. I must get up from the keyboard and go and play with him. It is too rainy for a walk and his small dog companions are fast asleep. Is he developing a bad habit? Or just, like all of us, prone to irritability and grumbles on Monday mornings? Perhaps the cat from next door is teasing him again, perhaps he hears something I can’t hear with my dim human hearing. Is he suffering the pangs of delayed spring?
The stories we tell ourselves, the stories that change over time. Snow fell on the mountains above the village last night and is powdery light- blue, a child’s paintbox colour. Loss moves back and forth inside my mind like the passing of winter, but I do not suffer from depression. I’m lucky. Elsewhere the snow is still falling, black clouds gathering in the valleys.
You are always thoughtful and non judgmental. I don’t have depression either, but like you, I’m fascinated by research and theories. My own (limited) experience has been that people are too quickly medicated after coming off long drug/alcohol binges. Getting through the post substance abuse period is difficult, but many of those symptoms do go away with time.
Certainly a history of abuse complicates the picture, masking and exacerbating symptoms.
Lou, I agree people in early recovery are not only too quickly and heavily medicated but often misdiagnosed so that they internalise labels or pathologies that are not accurate. The therapy/ medical businesses are as rushed and hurried and impatient as any other business and understanding takes time.
I have frequently been depressed (small d) by how little medical experts know. I’ve suffered from Depression since I was in my early twenties but I’ve never found doctors or psychologists of much good. For me antidepressants help at the start once I’ve decided to give into the depression and seek help; they numb me. But the real cure is to get away from the root cause which in my case has always been overwork so really the depression is a symptom of burnout which is why talking to psychologists has never been of much help because the answer is obvious: don’t work so damn much. But when it came to the drugs it bothered me that their approach was along the lines of we’ll-try-this-one-and-see-if-it-works-and-if-not-we’ll-try-one-of-the-others; it was all guesswork, educated guesswork perhaps but guesswork nevertheless. I’ve never felt confident that any of them knew what they were doing and, to be honest, rather sorry for them too because they had to give the impression that they did.
The problem with language is that it takes something extremely complex and personal and reduces it to a string of letters: d-e-p-r-e-s-s-i-o-n which makes us think that it is something simple like toast or a pencil. And it’s anything but.
Jim, I was just reading an article in the Guardian about the writer AL Kennedy who suffered terribly from exhaustion and depression because of overwork. James Hillman says that depression may be the psyche’s way of telling the person to slow down — but inertia feels unbearable in depression, and overwork has another cause or reason lying behind that too — why overwork? To escape, to win approval, because of obsession, to keep busy as a distraction? But you would know more about all this than me. I agree so much is guesswork on the part of doctors and psychiatrists, like many other emotional difficulties. And many patients respond so differently to differing medications, little varieties in Zoloft or Prozac or whatever else has just been fine tuned. A nascent science perhaps or improving guesswork –
Aha! So it’s Freud’s fault! If depression were sadness, it would just go away. All nice and neat. I was sad for a while and now I’m not.
I have frequently wished Major Depression had another name. “xyz disease” would be nice, it wouldn’t be confused with being in a “bad mood.”
But the naming of that disease would bring with it other perjorative labels and misunderstandings, wouldn’t it? I track popular or notable articles or mentions of theories on depression, Mary Christine, but old misunderstandings persist and those suffering from varieties of depression are at a loss to explain themselves often.
James Hollis and his ilk say that depression is a symptom of a soul/psyche that needs to be paid attention. That seems to make sense for me.
Cleo I think that may be true for some kinds of depression or depression addressed early enough — but for some it is intractable and they have no energy to address what might have caused this — a vicious cycle, isn’t it??
I think that there are the walking wounded and there are those who truly have a biological depression. I can tell you that the depression my mother had would not be “cured” by talking or reasoning or even medication. ECT was the only thing that worked to bring her back from the brink of being lost.
Syd I think the different kinds of depression are linked and I wonder what might have happened if your mother’s depression had been treated much earlier, if she had not lived many years with an alcoholic, if more sophisticated medications had been available. We use ECT out here but the consensus is that the relief is temporary and symptoms return within weeks or months.
The sad thing is that she gave no inkling that she was depressed until she simply fell apart after my father was put in the hospital for cellulitis. She decompensated quickly. It was truly like the old term “nervous breakdown”. And she did have to have recurring treatments. But I just know that they worked to bring her back to enjoy life.
As a long time student of depression it still catches me by surprise. I agree that for me it is always about loss especially the loss of some long time belief. The perfect relationship or job just fill in the blank. I didn’t realize that I had so many of these untruths to wade through. When I am ready to give one up I am sad but once I identify it I can move on.
Grace, that multilayered idea of losses and illusions may be closer to what happens over years — a friend of mine who is a skilled physician believes that depression changes and harden or lightens over years — he sees it as lifelong but with lengthening periods of remission for some lucky people.
The stories we tell ourselves. It is very easy to listen to my sponsee talk of her self loathing and what a pitiful character she has become and realize oh the story needs food. In other words for her story to continue there is low self esteem that needs it’s daily dose to keep going.
But I dont have that clarity often in my own life. I suffer from anxiety and it creeps up on me for no reason sometimes. It’s random what ails me with this little gem. Is this my gate to go deeper into self discovery…not sure…
I am lucky I don’t have severe depression it has taken some of my family. Alcoholism acted as a mask for some of my ails that is certain.
Dee, yes, when we listen we can stand back from the story told by someone else because it is not our story — our own stories need their own food and that may be harder to see. I battle with anxiety that occasionally slips into a numb and paralysing depression but passes after a while — and alcoholism not only msks but distorts so much.