Depression doesn’t mean you’re crazy – it just means you’re human

Originally written for www.independent.ie

One of my first tasks in working with someone who is depressed is to encourage them to talk to the people in their life about what they are going through. This isn’t easy – despite the fact that there has been so much in the media in recent months about depression, anxiety and suicide, the stigma and fear around mental health problems persist. It’s why I was so impressed and encouraged by John Murray’s willingness to be open about his depression on his return to his RTE radio show last week.

Similarly, former Cork hurler Conor Cusack’s honesty regarding his own depression has been very powerful and inspiring.

However, there is one comment John made last Monday that I’d like to pick up on. He said: “One minute I am happily presenting this radio show and enjoying life; the next, I am gripped with dread and anxiety with the simplest task proving beyond me.”

Clearly this is how John experienced it; but I wonder if people will take from this that depression is something that strikes without any warning; outside of their control?

We know depression’s symptoms include overwhelming despair and hopelessness, feeling like you can’t face the day or cope with the simplest of tasks or responsibilities, possible sleep and appetite disturbances and withdrawal from social activities.

As for what causes it, well, it would be so much easier if we could put it down to a biological cause – ie a chemical disturbance in the brain, treatable with pills like Prozac or Lexapro – instead of all the other social, environmental, developmental and relationship factors which are so much more messy and harder to tackle.

I think Conor Cusack hit the nail on the head when he said: “I believe depression is a message from a part of your brain to tell you something in your life isn’t right and you need to look at it.”

Think how much more helpful that definition is – to see depression, or anxiety, which often goes hand in hand with depression, as our body’s rational response to something that is going wrong in our world, instead of some malevolent illness that strikes without warning.

But take it a step further – is it possible that at some level we choose to depress? I believe that, as adults, we are all responsible for who we are, who we become. And sometimes that responsibility can just be too heavy to bear. So our highly inventive psyches come up with ways for us to avoid facing our fears and emotions or simply to give us some time out.

Existential psychotherapist Irvin Yalom says that if we’re responsible for our own happiness, then we are also responsible for our own depression. And Gestalt therapy founder Fritz Perls, a real character in the field of psychotherapy – it’s worthwhile YouTubing the videos of some of his sessions – was an ardent advocate of personal responsibility, going as far as to say that we choose our symptoms. He encouraged patients to look at their own roles in their diseases; and indeed there is considerable evidence now that what’s going on in our minds influences how healthy our bodies are, what illnesses we may develop.

I can’t argue with the many research studies that have found links between depression and chemical changes in the brain. But as Limerick GP Dr Terry Lynch noted in his excellent book Beyond Prozac there is no proof about which comes first – whether the chemical change causes the depression or whether the chemical changes are in fact the effect of being depressed.

What I know is that, without exception, whenever I talk to someone who is depressed, there are clear environmental or existential reasons why they should feel that way. Perhaps it’s an unfulfilling job; an unhappy marriage that the person feels trapped in; unresolved trauma from childhood; a physical injury that has limited social and professional life; or maybe it’s a pervasive feeling of not fulfilling one’s potential in life.

I am not saying that medications don’t have any place in the treatment of mental health problems; sometimes, they may be what is needed to kickstart recovery. But it isn’t drugs that are going to help in any fundamental way. The depressed person typically lacks confidence, self-esteem, the ability to be assertive and faith in their ability to improve their lives, and the way they begin to recover these vital things is essentially just by talking about their experience.

Because it’s by talking – to trusted friends and a good therapist – that you increase your awareness of what has led you to the present point. And with awareness comes a greater sense of personal control. Unexplored feelings and thoughts will tend to be in control of you; but once you become aware of them, you get to turn the tables.

You might, for example, have been called ‘good for nothing’ by your mother as a child. You then become aware through therapy that at some level you’ve continued to tell yourself this and consequently haven’t gone for the jobs you really wanted because you didn’t believe you’d be good enough. Now you are in that unfulfilling job I mentioned earlier, suffering from depression and low self-esteem. But once you become aware of what is influencing your choices and your feelings about yourself, you have the power to change them. You can start, for instance, by telling yourself you are good enough.

I wish John Murray had said more about what helped him – what worked; what didn’t – and my hope is that he will continue to draw from his experience on the show, keep it out there in the open. We need more people in the public eye like him to help us begin to see depression as a normal reaction to the various challenges many of us face in our lives. That it doesn’t mean you’re crazy, weak or in some way defective.

Depression is undoubtedly a bleak experience. But if there is one message I would like to get across, it is that we always have more control over what is wrong with us than we think we do. Whether we see that as a good thing or bad, well, that’s up to us.