Depression is a stuck place

Last year I wrote about grace as the infallible pill of recovery. I explained how regulatory systems long present and buried in our human make-up allow us to keep on a relatively even emotional balance. If our parents were well regulated people, their task will soon become ours, as our systems mature. We will not need to apply to others for support every time we feel angry, discouraged, anxious, resentful, or distressed. Nine times out of ten we can deal with these feelings ourselves. The simple way to work with feelings is just to feel them - just to be patient with ourselves, and wait for the anger to pass, the sadness to fade away, the exhilaration to motor down to a level which is no longer disturbing. Trust me, this will happen, with varying degrees of speed, depending on how severe the emotional upset is.

There are two common fears about feeling our feelings. One is that they will never end - that depression, if we allow it in the door, will be a life-time state, that if we acknowledge anger instead of trying to suppress it, we will feel nothing but enraged ever again. This is an unnecessary fear. Feelings are not like that. We cannot sustain high feeling levels for long. We have built-in regulatory systems which cool down our highs and warm up our lows, so there is an inevitable turning in our mood, after a period of either gloom or anger or excitation - and it happens automatically. Desire in all its variety is a classic example - it is powerful in the moment, but we don't carry it around every minute of every day. (It's a myth that men think about sex every minute!) Thankfully, or we would get nothing else done! It happens at certain times and places, hopefully when we can respond to it. If something frustrates us in the need to respond, however, our desire still fades away when it is obvious there is not much we can do about it right now. And its strength varies from individual to individual, just as everything else about us is individual.

However, notice also that if we persistently ignore it, desire can become something we experience less and less frequently, until we feel like asexual beings. My sister once told me she was never hungry, for example. As she doesn't employ me to be her psychotherapist, I usually try to avoid commenting in situations like this, but it made me think. The question is, why not? Given that hunger is central to human processing, and therefore to our survival. There is a powerful SEEKING system (much under-explored) in the brain, not just about sex, which urges us to go seek, go discover, go experience, go try out, go find what we want... (I didn't assume my sister was anorexic, by the way. Anorexics are as hungry as we are and more so, but they cannot allow hunger, it seems, and become expert at denying it. This is what I'm talking about.) Any system will work less well if we persistently behave as though we don't have it. People come to therapy because they fear they cannot allow their feelings to get out of control. But others come because they fear they have no feelings at all. They have often suppressed feelings for too long, until they no longer seem to exist. (The word 'psychopath' lurks in the background, souped up by generations of movies who love them!) We always find out that they do with some careful exploration.

We do have feelings, whether or not we seem to lack them - but often we have not allowed them enough license for too long. Either way, there is nothing inherently wrong with us that a little attention to our emotional states will not help. Do not suppress feeling - better out than in, is my philosophy. Trust your brain to do its job, which is to keep you well regulated, in a reasonable 'calm' mood. And the dark mood will lighten, sure as night gives way to day.

The second big fear of feelings is the one about fear of being unable to control yourself.  For example, "If I allowed myself to be angry I would kill him/her." The chances of this are not high. Murder is still far less common than road accidents! Heart disease is the big killer globally at 31.8% of the population. Homicide comes a long way down the list at .72%. You might say or even do something you regret. This however is part of the learning process of working with your feelings. The first time you tried to ride a bike you probably fell off. You might have felt a fool and scraped your knee, but your recovered, and this is the learning point to take away. With practice, you will learn to feel and sometimes articulate your feelings, and you will be able to tell when each is appropriate.

Our fear of feeling is rooted in modern society in the belief that we must use our intellects to drive our lives and keep us under control. This is the negative legacy of our pre-frontal cortex. Discovering our higher than average intelligence in the animal kingdom was a turning point in human development. With it we began to claim and rule the planet, and this brought us many advantages. However, it also brought the big disadvantage that we began to discount all the other legacies we inherited from our animal ancestry:  like instincts, powerful intuitions, great sensing capacity, the ability to care for and not frustrate ourselves perpetually. The ability to play, to rest, to care for ourselves and others. These are habits which animals possess without even trying, and which we still share with them. But because we have intelligence, we soon began to grossly overvalue it. We now think intelligence is all we need to live the good life. This is far from the case.  Feelings are built into our systems, just as intelligence is, and cannot be erased when we find them inconvenient. The pre-frontal cortex is not all wise, and cannot be allowed to rule every aspect of our lives. (If you don't believe me, read Iain McGilchrist's amazing book 'The master and his emissary', where he demolishes once and for all the idea that the left brain has everything we need to live well.)  The principal function of the pre-frontal cortex, based on neuroscience findings, is actually to give us the option of inhibiting action. It allows us thinking time. Which other animals do not have. When a tiger is mad, it goes for the one who is provoking it. When the dog wants a walk, it jumps up and down and demands attention. It does not have a mechanism like us for thinking,  "Is this a good time for a walk?" The pre-frontal cortex cannot rule our lives on its own. It needs all our other functions as well to do that.

Depression is a typical example. When something bad or disappointing happens to us, we may respond with depression. This is perfectly normal and nothing to be surprised about. It's pointless say, "I should not have been upset."  Your reaction is what it is, and you need to start from there. I've had patients say things like, "I lost my partner last year, and this year I had to move house to a strange new neighbourhood, and now my son has been in an accident and is in hospital. Why am I so depressed!"  To which I will say, "I would be worried if you weren't depressed in the light of those circumstances!" This is a perfectly normal reaction to events. (They don't say it all at once. They tell me about their depression at great length in the first session, and after three sessions may mention in passing casually that their son is in hospital. And gradually we learn more. Fed with little drops of their emotional life, as though it were the most trivial aspect of them, the one I will be least interested in!)

Actually cyclic periods of depression and upbeat mood are common and normal. They are nothing to worry about, and you do not need a pill to take it away. And it is not only life changing circumstances which drive it. Perish the thought. We react with sadness and a sense of loss quickly and easily, even to trivial matters like being unable to attend a favourite football match. What you do about it is nothing. There is no need. Feel it and wait for it to pass. And it will. We find ways of compensating ourselves for disappointment, too. Sometimes it is helpful to say to a patient, "What makes you feel good?" Because the patient usually knows: what they don't know is that it is ok to use that knowledge to help themselves through a bad patch! They frequently disaprove of trying to help themselves, as though it were a sign of character weakness. Some may connect self-help like this with addictive behaviours causing them trouble in the past. Don't indulge yourself, a grim voice whispers, or you'll get hooked on it! But this is rarely the case. Addictive behaviours of all kinds are made worse by not knowing what else makes you feel good. If you have no hobbies that please you, habits that you thoroughly enjoy and can lose yourself in, no other ways to feel on top of the world, you are more likely to turn to the old enemy. 

Does any of this apply to bereavement? Yes. Because bereavement is heavy, painful and prolonged you do need time out for something you can enjoy, like digging the garden or going to the park with the grandkids. However, bereavement, if of a close, intimate relationship, will take much longer to heal, and unlike the loss of possessions or a job, will stay with us probably all our lives. What happens, though, is that the sense of loss will gradually be integrated into our lives so that we can function in many normal ways together with the presence of the loss. 'Integration' is not the same as blending. It is not like making a smooth soup, but more like making a chunky one. Each element of the soup remains available to us as a separate and individual taste - but also it is now part of a larger whole, and can function together with all the rest of the ingredients to bring a combined taste as well as an individual one. Bereavement then is not THE ingredient of your life, but ONE ingredient. The lost one remains as an individual person in our minds and hearts, but is now part of us and not someone that dominates our minds all the time. And we will return to the sense of loss from time to time, and give some due weight to it, by feeling our sadness and loss once again. If we could not bear loss, as human beings, how would human kind possibly have survived? The fact is that the history of our species is fraught with just such loss and the pain and suffering of it.  It is utterly painful, sometimes beyond words, especially at first, but it is endurable as time passes. It is not the time that heals, though - beware of such easy comfort. It is the integration that heals. When we feel it, take it in, and make our sadness an authentic part of our whole character, but not all of it, then we have done the job of grieving. And it will take time - think in years, rather than weeks or months.

Is there a difference between depression and sadness? Yes. Sadness comes to us through events that occur outside of us, and often outside of our control. Depression arises from inside. It is a response to something going in within us, much less to something happening outside of us.  

Such as, you might think? For example, depression arises often from memories rising to the surface of our past. The job I failed to get. The woman who did not love me. The mother who hated me. The way I gave way to criticism of my daughter too often. Essentially, the depressed one is ruminating perpetually upon mistakes and guilt and failures of the past. These are feelings, and what is more, have never been named, and never been made open to processing. The feelings of the past rise up inside us, no matter how hard we have practised intellectual suppression. We don't bury feelings dead. We bury them alive, and they rise up to haunt us, unless we agree to look at them, to do the work of processing them. It is important and valuable to do that work now. This is what your depression is telling you! Find someone to talk to who will be able to listen and understand that you still feel bad about your broken marriage, or your mother's death. Depression is not a visitation from Mars! Trust me, it is about something in you - and your job now is to find out what that something is, and deal with it. Any kind of talking therapy will help and has the advantage hopefully of being with someone qualified for the job, and unknown to you:  who has no previous baggage of a relationship to bring to the task.

Friends and family may help, but not always. They feel anxious about you and want you to be 'your old self.' This is their way of saying, "I can't cope with your depression!" You are best not confiding in them as they will tell you kindly to 'pull yourself together', which is not helpful. Instead, find someone to talk to who has no vested interest in viewing your present state this way or that, but who will, rather, ask objective questions about it. This will be a shorter and truer road, even if more expensive. 

Should I take anti-depressants, people ask. No harm in a short course, in a genuine emergency or to help you over a rough patch. My advice if asked is always, if you've been taking them for a long time, years perhaps, you need to reconsider. But do it with your GP, not alone in a heroic attempt to 'get off' them. The problem is that many anti-depressants create dependency, and that is not a help. But also they work best by attacking the very roots of your capacity for feeling. Which was already in trouble! If you think you would like to try stopping the pills, and the decision is always yours, then do it sensibly, and a therapist will help and support you also, as well as a GP, along the way.