What is depression? Is it a mood? Is it a disease? Is it a disease of mood? What do you do about it? Take medicine? Use willpower? Get therapy?
Depression is a common and debilitating affliction amongst humans, which makes it tragic that we know so little about it. We know that depression can arrive seemingly out of nowhere. We know that it can be driven by hormone shifts or brain injury or nutrient deficiencies. We know that medicine really does very little to help it, despite the millions of people taking such medicines. What do we know that is helpful to you when you feel depressed?
On one level, I admit we know next to nothing about depression. It is one thing to try medications, perform brain scans, and test your blood. It is quite another to really understand the human condition called depression.
I like things simple. I like the utter simplicity of Rational Emotive Therapy, for example. I also like simple explanations for human problems. What follows is my very simple, though speculative, explanation.
First the obvious: Humans are mammals. We have more complex brains and more complex emotions. We can think. Thinking is a great advancement in the evolution of animal life. It is also a burden. Humans are uniquely able to think themselves into a tailspin in the light of uncomfortable realities. So how do these facts fit together for me when I treat depression?
What if depression is a defense mechanism? Powerful animals such as bears hibernate in the deep of winter to stay safe from the elements. They fatten up first. Their vital signs depress, and they basically sleep off the inhospitable conditions, consuming all that stored fat.
The diagnostic criteria for depression include depressing of bodily functions and lack of engagement in life, in addition to the depressed mood. Depression has many of the characteristics of hibernation. Many people who experience depression overeat. What if they are storing fat in the light of perceived long-term danger? Similarly, people who are experiencing depression tend to sleep a lot and avoid fun activities. What if this represents a symbolic hiding from danger? Additionally, some individuals lose weight while depressed. Are their bodies already hibernating and burning fat?
In many theories of psychology, depression is a response to perceived danger. Whether there is a biological basis, such as a hormone swing or brain event, or a life event with unpleasant implications, a person experiencing depression feels as if the world is not safe. If a client is deficient in vitamin D or other important nutrients, or has a severe hormonal deficiency, medical intervention that seeks to restore balance, rather than altering basic neurotransmitters, can be invaluable. I often wonder at how long it has taken us to notice a correlation between vitamin D and mood. This sunshine vitamin turns out to relate to how we feel, and, since when we feel depressed, we hibernate, we become even less likely to restore needed levels. The same applies to other aspects of body chemistry: In light of a nutritional deficiency, a body might attempt to hibernate to survive the perceived food shortage. I conclude that depression is a biological state of retreating to safety. The causes can be varied, but they all contain a perception of danger.
Psychotherapy offers significant help in this picture because the first order of treatment in depression is determining what feels unsafe and how to change the perception. A psychotherapist is the right professional to help a client work though the perceptual aspects of his depression by teaching him to question and dispute the thoughts and beliefs regarding lack of safety that are part of nearly every depressed mood. I believe this connection to be hard-wired in many people. If we feel unwell due to a lack of nutrients, a brain injury, or a hormone problem, the body signals a hibernation-like behavior. If, on the other hand, we feel unsafe due to circumstances, experiences, or basic beliefs, we can receive that same strong signal to hide and stay safe. Rational Emotive Therapy is based upon the concept that making substantial changes in such thoughts will change the mood state of fear, and help an individual to re-engage in life. This is not about willpower, but about finding the thoughts or beliefs supporting the sense of danger and changing them.
Depression is a complex of chemistry as well as thoughts and beliefs. It is not as simple as "you are short on serotonin; here is a pill." The biochemistry of a human mind is much more complicated than that. We return to the question of "is depression a disease?" My conclusion, based upon years of practice, observation, and reading, is that depression is a biological state with a complex set of possible causes, but a common theme, that of perceived danger. I submit that this does not qualify it as a disease, but rather a natural defensive state of the organism, which needs to be addressed at its causes.
Your depressed mood can be helped. If you are feeling stuck, think outside the box and try Rational Emotive Therapy, the effective and simple precursor to all the modern cognitive therapies. Change your thoughts and beliefs; change your feelings.