DEPRESSION DIALOGUES: Tackling depression often starts by facing a future less rosy than we imagined, writes Dr Michael Corry
Depression is an emotional state in which the desire for life is the primary casualty. This is one of the most debilitating states, since it is human nature to have desires. To wish, want and hope to have our needs met.
Isn't every child's game plan to be successful, contented, loved and secure? From an early age we look forward to Santa coming; to being popular at school; to getting on a team; passing our exams; finding a job; falling in love; having a good lifestyle.
This roadmap keeps us motivated, giving us the willpower and eagerness to continue. If it doesn't happen, there is a sense of loss when our dream dies, as if something concrete has been taken away. In fact, it is our illusion that our future should turn out rosy which has been removed. Our sense of loss is very real and as much a bereavement as any other.
Now we are confronted by future scenarios which are painfully less desirable than those we'd planned. Life has been fired at us point-blank. Who anticipates rejection, sexual abuse, bullying, heartbreak, deaths, marital difficulties, failure, financial insecurity, problematic children, disability, chronic illness or lack of companionship?
Unprepared and disillusioned, it can be difficult to find the desire or the will to engage with such hardship. In shock, we wonder what happened to the gameplan. We can't go back, nor can we go forward. Confused, lost and immobilised, the drive to go on dries up: we are depressed and in grief.
As Dante wrote: "In the middle of the road of my life, I awoke in a dark wood, where the true way was wholly lost."
The classic stages of all grief and loss unfold within us. Can this really be happening to me? (Denial and disbelief). It's so unfair, I don't deserve this. (Anger). I'll work harder, I'll turn it around. (Deal-making). It's not working. What will I do now? (Fear and anxiety). It's hopeless, what's the point? I give up. (Depression). If the situation continues, we can choose to bite the bullet and engage with this future we hadn't planned (acknowledgement and acceptance) or continue abstaining from life.
Depression has degrees of severity in the same way that a swimming pool has a deep end and a shallow end.
The less intense variety we've all experienced is often remedied by strategies in our own personal DIY kit. A holiday, a career break, some 'retail' therapy might do the job. Or we might try distracting ourselves with a new toy such as a car, an extension on the house or a new romance. Others turn to their favourite recreational chemical, such as alcohol, cocaine or ecstasy. Many approach their GP for prescribed versions to give them a 'lift'.
If desire cannot be re-kindled, and with it, the will to act, we are in deep water. Lacking motivation, we look to the past, ruminating over mistakes, cataloguing our worthlessness. Feeling overwhelmed and helpless to act, we withdraw our will and energy, and feel unable to engage with the current scenario.
Movement slows down. We distance ourselves from others and find it hard to cope with the basics of living.
Simple tasks, such as washing, dressing, preparing food and facing the public become increasingly difficult.
It's a misnomer to medicalise this emotional state by calling it a chemical imbalance. All emotions, whether fear, anger, love, or joy, rely on shifts in chemistry, which are always secondary to alterations in our consciousness. It is changes in our own thoughts, beliefs and meaning systems - the software of the mind - which are the primary cause. To see it otherwise is to place the source of the problem in our brain matter or hardware. Who would leave the TV in for repair if the programmes were not to your liking?
There's many a 'chemical' depression that a Lotto win, a proper home, a new partner would solve instantly. In the same way, the implications of telling a depressed individual that they have a chemical imbalance which may be lifelong, requiring the long-term use of medication, and intermittent hospitalisation, can be as damning a diagnosis as an incurable cancer. News of this bleak scenario can itself be a trigger for suicide.
Some severe depressions can be triggered by a source which is not visible, giving rise to dubious diagnoses such as "endogenous" (having no apparent external cause) or "clinical" (needing the attention of a doctor).
Many individuals have experienced deep hurts and wounds from very early in their lives, which remain un-healed and buried, and which they have been unable to bring into their awareness or been too afraid to verbalise to others.
These can range from childhood emotional deprivation to physical and sexual abuse. In such cases, a present-day setback may re-ignite these past emotional traumas. As they begin to surface, no current cause may match the depth of the response they provoke.
Many individuals treated for years with anti-depressants may have been harbouring such old emotional pain. The medicalisation of their depression passes up a valuable opportunity - which counselling and psychotherapy might provide - to permanently heal these old wounds.
Even with less serious forms of depression, the use of the popular psychic energisers (Prozac, Seroxat, Efexor, Lexipro and so on) may jump-start sufferers back into the fray. With this boost, they may be able to interact again with the details of their life, but it may be at the cost of reflection and insight.
If sufficient attention has not been given to uncovering the source; changing belief systems; learning new skills and re-kindling desire for life, the sufferer remains as disempowered as before.
Inevitably, relapse is on the cards, with cocktails of medications in increasing doses being prescribed, many with serious side effects, some lethal.
In this way, sufferers can become trapped in a cycle of remission followed by relapse, otherwise known as the revolving door phenomenon.
• Dr Michael Corry is a consultant psychiatrist and co-author of Going Mad? (Gill and Macmillan) with Dr Áine Turbidy
• Depression Dialogues meetings, faciliated by Dr Michael Corry, are held on the first Thursday of every month. The next meeting is scheduled for this Thursday, from 7.30 p.m. - 9 p.m. at the Royal Marine Hotel, Dún Laoghaire. All members of the public are welcome. Donation: €5. Tel: 01 280 0084