The Common Feature in All Depressions

January. The social and epicurean delights of the festive season are over. The weight piles on; the bank account is empty, the weather damp and cold. New Year’s resolutions have already hit the dust. It’s all so depressing.

Is that the right word though? What exactly is ‘depression’, apart from this vernacular usage? Aren’t all dreary moods in essence the same? In my forthcoming book, Understanding the Depressions: A Companion for Sufferers Relatives and Counsellors, I address the many types of persistent low mood states brought for professional help. I examine possible causations and the treatments available, whilst investigating the personal experiences of sufferers, families, GPs and counsellors.

Reductive arguments are eschewed: counselling versus drugs/ECT for management; nature versus nurture as causation; the individual’s personality versus adverse circumstances inducing the attacks; unresolved old trauma is responsible versus the belief that it’s the person’s lack of resilience, not the trauma itself that’s in need of help; disordered brain hormones produce low mood or vice versa?

There’s no either/or, no absolutes here. We need more research, clinical and scientific, not ideological bias.

In my 50 years’ experience as a psychotherapist, all I can say is that each of these factors and many others too, impact on every case in different combinations at different times. Once in counselling, it’s the job of the therapeutic couple to disentangle their interrelationship.

But there is one common feature.

We were all babies once. Whatever our genetic predisposition, and the functionality or otherwise of those around us, we had to grow up within some kind of interpersonal setting, commonly the family. But we weren’t just empty jugs into which good and bad influences were poured by blame-deserving or praiseworthy parents. We struggled to make sense of the peopled world around us through actively participating in it, avoiding or rebelling against some aspects of it; always learning, watching, processing, theory building, till we taught ourselves to know who we were. In other words we constructed a Self, shaped by ourselves as much as our significant others.

As life progressed into teens, then adulthood, we learned to love, hate, hide, be proud or ashamed of that Self. We valued it or mocked it, kept it under wraps or sent it out toward other Selves. Unawares, it accompanied us into every situation, colouring the way we perceived and interpreted others’ responses to us, skewing our judgement.

No matter the type or degree of any Depression, and whatever other symptoms prevail, this relationship to the sufferer’s own Self is always seriously impoverished and in need of attention by any professional.

In the book I use the analogy of the solar eclipse to trace the path of an episode. Depression is a mood disorder (not a thought or behavioural one) where part of the Self is experienced as dead, extinguished, without hope, black as a shadow across the sun. Though biologically alive and even sometimes continuing to function, the person’s subjective and private experience is of death. This experience is unalterable by any appeal to reason, reassuring evidence of the afflicted person’s worth, provision of a swish holiday, or any guilt tripping advice to “count your blessings.”

As the episode moves on, the shadow of death creeps across the person’s sun to a critical point of darkness before gradually sliding away leaving the light of normality behind. To try and coax or logically persuade someone out of Depression during this cycle is as futile as trying to stop a real eclipse. Untreated, it will run its course no matter what you do. This inexorability is the difference between ordinary unhappiness, however severe, and a Depressive disorder.

So those who are miserable, cold and broke this January can take comfort. At least they are not dead inside. They have hope still, and can anticipate the eventual arrival of Spring without having to first helplessly endure the many phases of Depressive eclipse till the light does return.