Three Stages Out of Depression
“Every depression is caused by something depressing that has happened, with no exceptions.”
– George E. Atwood, The Abyss of Madness, p. 166
The title of this article is very alluring for someone who struggles with depression. It promises that there is a way out of depression and that depression has a cure. I do believe there is a way out of depression and that depression, on many levels, has a cure. The cure may not be an easy one, but there is a cure.
Depression is the product of a lack of individuation. Individuation is the ability to recognize yourself as a unique entity apart from others while still in relationship with others. Individuation is the ability to recognize that your life is your own despite what others believe, believe about you, or have done to you. Individuation is the ability to say to yourself, “This is who I am regardless of what has happened or will happen to me.”
Depression occurs when we believe, falsely, that our most fundamental need – human connection (see Change, Part I) – can only exist if we are or behave in ways that other significant people in our lives accept or accepted. When we feel as if there is no hope in ever being what we believe other people in our lives want us to be we become isolated, hopeless…depressed.
To state that depression is the product of a lack of individuation is dangerous. It’s dangerous because it puts the responsibility of depression on the depressed person’s shoulders. And if there is one thing a depressed person doesn’t need while in his depression it is to believe that his depression is his fault.
I am and I am not saying that depression is the depressed person’s fault. I am saying that it is his fault in that I believe that depression has a level of choice to it, a choice to individuate. I am not saying that depression is the depressed person’s fault in that there are millions of factors that have gone into a person becoming the person he is which had nothing to do with him or the decisions he has made in life. Life is complex. But again, this gets back to choice. Wondering and marveling at life’s complexity instead of trying to control it is a pathway to contentment.
Stage One – Depression
A big debate among clinicians who treat depression is how much of depression is a product of genetics and how much of it is a product of circumstance. How much of it is a matter of “nature” and how much of it is a matter of “nurture.”
What biopsychologists are discovering more and more these days is that nature and nurture are not mutually exclusive. Our genetics, the traits that are handed down to us from previous generations, aren’t necessarily set in stone for ourselves or for our offspring. The choices we make during our lifetime have consequences for how our cells reproduce now. This area of study, called epigenetics, suggests that depression, while something that can be genetically inherited, can actually be altered by the choices we make and how we chose to live our lives.
One theory of depression is the monoamine theory of depression. This theory suggests that the cause of depression in many people is the way in which the depressed person’s brain handles two important neurotransmitters that maintain a sense of emotional balance and wellbeing – serotonin and nor epinephrine. Certain pharmaceuticals have proven effective for treating depression because they aid serotonin and nor epinephrine in reaching their receptor sites.
Medication is an example of choices the depressed person can make to begin to alter his experience and begin to rebalance his biochemistry. Stabilized, the depressed person can engage in the two most transformative experiences there are for someone struggling with depression: the interaction with unconditionally loving others and the individuation process itself, which is a psychological journey.
Easy to say and write but not easy to do.
The insidiousness of depression is that when you are depressed you don’t even have the perspective to register how badly it sucks let alone that medication may prove helpful. To be able to register that it sucks and to seek help is to be able to recognize that the depression is temporary. The nature of depression is the belief that it isn’t temporary. Your present condition is the only condition that exists. It is reality. It is permanent. It is eternal.
William Styron explored this experience in his work Darkness Visible: A Memoir of Madness. He wrote, “Most people in the grip of depression at its ghastliest are, for whatever reason, in a state of unrealistic hopelessness, torn by exaggerated ills and fatal threats that bear no resemblance to actuality.”
Styron, who struggled with depression throughout his life, concluded, “It may require on the part of friends, lovers, family, admirers, an almost religious devotion to persuade the sufferers of life’s worth, which is so often in conflict with a sense of their own worthlessness, but such devotion has prevented countless suicides.”
It is a sacred space to be with someone who is contemplating suicide. I have been on both sides of this experience. I have been suicidal, turning to the people closest to me for help, even calling a suicide hotline once. And I have also sat with many friends and clients who wished to end their lives.
In all of these instances it was human presence that made the difference. Someone who didn’t judge but sat with the pain and demonstrated that they were there. A picture I saw years ago of a man on the Golden Gate Bridge using a suicide hotline always brings tears to my eyes. The man needed human connection and there was another person on the other end of that line.
In the end, each person’s life is his own and he may dispense with it as he wishes. Many have. They’ve reached the nadir of their existence and have decided, consciously or unconsciously, that their need for human connection and attachment will never be met because of their fundamental worthlessness.
One can equivocate about the causes of depression and suicide but ultimately that is what they boil down to – a profound feeling of worthlessness brought on by other people’s treatment of them, usually in childhood. The perception of human connection, or lack thereof, caused the problem and it is always the perception of human connection that solves the problem.
We need people in our lives. Period. But if one wants to be free of depression, one must get to a point where having people in your life is a fluid process that involves many people, many unconditionally loving people. Depression arises at the belief that there are only a select few people from whom we feel we can gain a sense of connection, and if those people choose not to accept us as we are, and we can no longer accommodate them, we imagine utter isolation, abandonment, and hopelessness.
The turning point out of depression is when we finally, somehow, through some stroke of luck or divine appointment, make the realization that no amount of accommodating to meet other people’s needs is going to make us feel like we matter. There is a rock bottom element to this – a breakdown, a suicide attempt, a loss of someone or something we cared about. When we finally realize that the pain of remaining the same is worse than the pain of change we wake up and decide to take charge of our lives.
Stage Two – Anger
Once a person makes this conclusion anger is usually the result. And to understand anger is to understand depression.
Dr. Susan M. Johnson is the figurehead of a mode of couples therapy called Emotionally Focused Therapy (EFT). While this mode is somewhat awkwardly titled – what type of therapy isn’t emotionally focused? – it aptly uses as its cache the immediate emotional responses between members of a couple in conflict rather than the content of their disagreements or the intellectual insight of why they fight.
In other words, EFT is less concerned about the events of a conflict and much more concerned about the emotions that transpire between partners in the midst of conflict and what those emotions ultimately mean in regard to our most fundamental human need – attachment and connection.
Dr. Johnson refers to a common dynamic among couples where one member will pursue and the other will distance, one will “nag” (for lack of a better word), wanting his or her need to be met, and the other will withdraw in response to the nagging. EFT’s view is that the more couples engage in this negative cycle the more this cycle continues. It is a self-re-enforcing dynamic that requires de-escalation.
To de-escalate the conflict, EFT works to look behind the “nagging” and the “withdrawing” to understand better what the nagging and the withdrawing ultimately are about. Rarely are arguments about bills, clothes on the floor, dishes, vacations, or sex. Beneath all of the “content” they are about Do you see me? Do I matter? Are you connected to me? And often the emotional and physical responses couples have to these conflicts are not about their partner but about how they experienced attachment and connection as children.
Anger is about having not been considered. It’s about not being regarded and not feeling as if we are getting our fundamental need for attachment and connection met. In this way, Dr. Johnson refers to anger as being a secondary emotion, secondary in that it masks a deeper vulnerability – Why didn’t you think of me?
If anger is a product of the belief, I wasn’t regarded and I deserved to be, depression is a product of the belief, I wasn’t regarded and I didn’t deserve to be. The transformation out of depression is the awakening of the soul from dormant vapor lock to active self-agency.
Not all people who have pulled themselves out of depression enter into anger, but that usually is the case. Once the awakening occurs from self-blame to self-agency the once-depressed person begins to reinterpret the events of her life and depending on the amount of abuse or neglect she experienced she is going to be angry at the level at which she was disregarded. And she may even be mad as hell that she allowed herself to be depressed in the first place.
There’s a great deal of work required of this. This may be why so many people either remain depressed or commit suicide. To understand the concept of self-agency, especially emotionally, requires consciousness; to engage in an active exploration of past events with the intent of gaining perspective requires thoughtfulness. Both disciplines take time and effort.
This is the realm of therapy. It is also the realm of support groups, self-help books, journaling, and unconditionally loving friendships. One cannot get out of his immediate experience, especially emotionally, without exposure to different ways of existing in the world from the way he was taught. To journey out of depression and to mature past anger is to take control of your life and shape it in ways that reflect who you feel you are called to be.
Stage Three – Individuation
The goal of therapy, in my opinion, is individuation. It is to reach a place where the individual can finally grasp the understanding that his life is his own, bad things have happened and may happen again, life continues, and we all have agency to control that which we have the power to control and also have the power to accept that which we can’t control as just a part of life.
Feeling anger is not a bad thing; in fact, it is part of the healing process. And it can be scary to feel anger, especially if expressing anger as a child was met with punishment. Anger became a dangerous emotion and now part of the goal is to allow yourself the freedom to feel it.
But some people never make it past anger in their development out of depression. They remain firm in blame and judgment. This is ironic because anger, just like depression, is not an individuated state of being. Just as depression is a means by which a person remains connected to people from childhood so too is anger. Among the other things that anger works to achieve is it provides a person with self-definition. It says, I am me because you did this to me. The goal of the self-actualized person is to be able to say, I am me because this is who I want to be.
Accepting one’s freedom can be a very scary place. In many ways embracing our freedom is synonymous with embracing existence itself. If there aren’t any “big people” left between us and the Infinite that means that it’s just us and the Infinite. Yes, if we are doing our work, we have plenty of people to stand along side us as we face the Unknown, but if we chose the right people, they are facing the Unknown just as much as we are.
The vast majority of my clients identify themselves as Jewish or Christian. The vast majority of them believe in God. I would say that all of them are struggling to find God. My answer to them is that God exists in this space between what we can control and what we can’t. And since that space between what we can control and what we can’t is always with us that means that God is always with us. (See God’s Invitations: an Exploration of Christian Spirituality).
Individuation is the domain of our faith lives. Depression is reliance on earthly, fallible people. Anger is reliance on earthly, fallible people. Individuation is an acceptance of the vagaries and uncertainties of life, even the vagaries and uncertainties that were our childhood, and a fundamental trust that things will work out the way things will work out. Sure, maybe we got a bad deal in our youth, but this is the life we have now. What do we want to do with it?
This is certainly in line with Eastern thought, particularly Buddhism. This is about mindfulness, acceptance, and non-attachment. But it is also at the very core of Christian belief.
Christ’s life and death, above all else, is the story of individuation. Christ came from nothing. He didn’t have an easy childhood and grew up in a culture rife with oppression, both religious and political. His parents couldn’t offer him much and even rejected him. He didn’t blame them for their limitations but instead focused on the call God had for his life. Few of us will be called to die in our pursuit of justice. But Christ did. And his perfect individuation provides a pathway to understanding what is in store for us if we truly want to achieve peace, for ourselves and for others.
Christ did get angry. He got angry with the money changers and the religious leaders who took advantage of the faithful and the poor. The difference between Christ’s anger and what is often the anger we carry around inside of us day to day is that his anger wasn’t about what had befallen him in his life; it was about what had befallen others. Sure, it is often anger at those who have hurt us that sparks a desire to change circumstances for others, but that’s about social justice not self-pity.
If you’re looking for purpose in your life often it can be found at the core of your anger, at what made you feel disregarded and unvalued in life, especially as a child. You can either “burn the house down” with your anger, directly or indirectly acting out against people who have hurt you in the past, or you can channel that anger into helping others who have suffered in ways similar to how you have suffered.
Here’s the news, there will always be people who hurt people in this world. That’s just fact. And for many of us it was hurtful people who were entrusted with taking care of us as children, whether they knew they were being hurtful or not (see Dads…). Traveling from depression into anger is a process of accepting that the treatment we received from others wasn’t our fault; traveling from anger into individuation and contentment is accepting the reality that bad things happen and just so happened to us but we can do something constructive with what we have now.
Christ didn’t burn the house down. He didn’t act out in violence and he specifically instructed others not to do so as well. What Christ understood and preached is that all violence leads to is more violence. Furthermore, all violence leads to is your own unhappiness.
Individuation can be accomplished when we recognize that the people who have hurt us have been hurt as well. And just as with the discussion of epigentics – the reality that we can change our genetics for ourselves just as much as for our off-spring by the choices we make – making the decision to stop the chain-reaction of violence within society in general can be very empowering and hopeful. And, furthermore, there is nothing more Christian than to forgive so that you may be forgiven yourself.
There will be more in regards to this topic in my next article, Non-Violent Resistance in Intimate Relationships.
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