Long-term depression differs significantly from short-term acute depression, therefore making the chronic (long-term) depression infinitely more difficult to control. My personal opinion that the latter (chronic) is incurable, but treatable to the extent that the depressed has an excellent prognosis of living a full life after learning correct coping skills. This solution is most effective for those who have not learned the value of “escape mechanisms.” This ability to justify, substitute, etc. are the mind’s way of coping with situations that the conscious mind cannot bear to confront. Obviously, this does not solve these issues, but merely masks them so the individual can function.

Psychotropic drugs, anti-panic and depression medications again only “mask” the issues and do not solve them. Solutions occur when the “unconscious” mind relays these issues to the “subconscious” mind. The unconscious mind does not address the conscious mind, but needs the intermediary to get the message across to the conscious. When these “epiphanies” occur, it can be extremely profound or extremely upsetting and dangerous to the depressed unless there is a professional monitoring so that the depressed is not so devastated as to harm themselves because of the revelation(s). Catharsis, and thence the healing process, can begin at this time, but I must stress that understanding and addressing these issues can be traumatic without professional guidance. I, personally have dealt with chronic, long-term depression for decades so if “it takes one to know one”, that applies to me.

I no longer am involved with counseling but have many acquaintances who are and I pass this warning on to all. Learning the causal factor is the most important step, but is only the beginning of the solution. Thanks again for the insightful blog. Hope this is of some value. I am currently writing an article on this very subject, maybe a book. Depends a lot on my concentration level and I know you understand what I mean by that.

I was a professional at a major medical center, and I’d done well there for 22 years. But over the last two and a half years, my memory and ability to concentrate have been slowly deteriorating. Depression and a feeling of powerlessness to stop it slowly crept in as I began making bone-headed mistakes. I felt like I was either burning out, or had unresolved issues of some kind that needed to be addressed. I’d had some major emotional traumas in the past, so I tried using the self-examination and coping skills I’d learned from my previous time in counseling to deal with my current situation. I also tried slowing down and “being present in the moment” as much as possible. I kept kicking myself for not concentrating harder and began to feel worthless. In the end, things just got worse and I was terminated a few days ago.

I stumbled onto your site via a link from the NY Times and have spent the morning having my eyes opened by your article and the resulting comments that followed. I’ll take your advice on how to deal with this and I also have a doctor’s appointment today and will insist on having various hormone levels checked thanks to Lucy’s contribution to the discussion.

I think that depression occurs for several reasons, and the best course of dealing with it depends on the individual’s past and present experiences, world- and self-view, and/or biochemical equilibrium. I also believe that in some cases, there is a genetic component. You have a wonderful theory that I think may help many, but not all, people suffering from depression.

Thanks a lot, and good luck paddling upstream against the current paradigm.

Kevin: Best of luck in getting the help you need to feel better!

Alex

Something that persists in many such discussions is the assumption that depression is a single quantifiable illness and all experience it the same way. That seems to be part of the assumption it is caused by our flawed thinking of being powerless.

The advent of medicine to address this has saved many lives both literally and in terms of lost time, wages, etc. Many depressions will simply fade with time. Many have depression that is so extreme it falls into psychosis.

If someone is helped by looking at how they are thinking improperly that is good for them. But it is not one size fits all. For me, looking for the “why” was a dead end. It is a temptation and a habit for many. I try to think of the “what,” as in what can I do to help myself or with patients to help them. Sometimes in the latter case it is simply to be empathic, patient, understanding and supportive. That is a better suggestion to anyone than “you have to change your thinking.”

I once wrote to Dr. Weil for his website post that depression was a problem of “attitude.” We don’t need to feed more judgment to those who don’t understand and who will try to “help” by giving advice to their friend or relative who is depressed and telling them both how they are wrong in their thinking and how to fix it.

One of the only “causes” that seems reasonable to point to is the one of thyroid insufficiency which is measurable. For the rest we really simply don’t know enough.

jt, mft: I agree with many of your comments. I would point out, though, that in putting forth the contention that a belief in one’s powerlessness is the true cause of depression I specifically avoided suggesting I know the best way to change that belief. As I’ve noted in the post itself and in responses to other commenters, I think changing one’s beliefs is one of the hardest things to do in life, especially when we’re unconscious of them or they lie deeply embedded.

You may be right that depression is not a single quantifiable illness and that we don’t all experience it the same way. Psychiatry has attempted to carve out the different forms with different criteria and causes, but it’s done so at best bluntly. Yet there are striking similarities between all forms of depression that vary only in their severity: a feeling of anhedonia (the inability to experience pleasure), a feeling of being defeated, and a feeling of psychic pain. Why couldn’t those things, which seem to lie at the heart of most forms of depression, have a single, common cause? I could certainly be wrong about this (especially, I’m wondering more and more, with regard to secondary causes of depression like hypothyroidism), but I disagree that uncovering the “why” is a dead end. It may not immediately point to more effective therapies, but it very well may in the future.

Alex

They argue that neurochemistry (and whatever caused its imbalance, be that health problems, genetic predisposition of, etc) preceded or caused the depression. You argue that a lack of belief in one’s ability to solve problems preceded or caused the depression which then manifested in imbalanced neurochemistry.

Here is an alternate way of looking at it: See the depression as a circle/cycle rather than as a line. This circle/cycle can potentially be made up of 1) chemical imbalances 2) stressful occurrences 3) negative thought patterns 3) physical illness—add whatever you want to the mix.

Depression occurs when enough of all of these factors—or a lot of even one of them—triggers a certain state in the body/mind. Once that state is triggered, it will take a certain amount of counter-measures to push one out of that state (or not—counter-measures may not be successful).

These countermeasures will depend on what it was that figures most prominently in the depressive state (for one person it may be a preponderance of stressors, for another, a genetic quirk, for a third, a combination of many factors).

One may choose to see these factors as cause, as precedents, as entry-pathways—or more simply (and less linearly) as those things that make-up/maintain the depressive state.

The thing to avoid (no matter how one characterizes those things that are factoring into the depression) is trying to find one factor that explains all manifestations of the problem. For some people it will be one thing, for others it will be another, for others still it will be a combination of many factors.

Likewise with solutions.

In some cases it may be possible to counteract a depressive state (i.e., “break the cycle” or “break into the circle”) from a different aspect than the strongest factor—the “many ways to skin a cat” idea—when for other cases it must be a particular solution for a very particular problem (such as needing thyroid hormone for example, or needing time to heal from major surgery).

In any case, if one looks at depression from a holistic, multi-factor, non-linear perspective, it takes one out of the need to argue a causally linear or even chronologically linear progression.

In any case, the most useful thing to do (from a Buddhist perspective as well) is to approach each situation as an empty cup, not full of theories or opinions, but willing to listen and learn from what each individual situation has to teach us.

I’m writing the above as someone who has both treated and experienced a variety of mood disorders.

Before Pasteur and his germ theory, a prominent German obstetrician who had recently adapted Semmelweis’s widely-mocked chlorine hand-washing regimen became despondent, realizing that his previous unsanitary methods had likely caused the “childbed fever” deaths of many of his patients, including a beloved cousin. He committed suicide at the age of 51. Ironically, he was a pioneer; hand-washing would not achieve widespread acceptance among physicians for another two decades.

http://en.wikipedia.org/wiki/Gustav_Adolf_Michaelis