Sadly, some people seem at risk of certain types of depression, and we now know that genes appear to play a role. However, while I do not want to underplay the biological dimension of depression, some forms are surprisingly common and genes probably play a major role only in a minority of cases. Life events and early childhood experiences seem by far the more common sources. I suspect this was true for me. My early years were spent in West Africa. It was a place of tremendous freedoms and I would roam happily in the outback. For nearly a year we lived in the ‘bush’ with no running water or electricity – and no school! My memories are still vivid of that time and when the skies are dull and cold I remember with great fondness the excitements, the blue skies and expansiveness of Africa. When I came home to England to go to boarding school I found the confinement and harshness of it difficult. I also found that I was behind in my education and had serious problems with the English language. To this day I do not like confinements and can easily feel trapped in places. The life events that triggered my depression were all related to feeling trapped and failing.
I see depression as a state of mind that we have a potential for, just as we have the potential to feel grief, fear, sexual arousal and so forth. And like any state of mind, depression is associated with very real changes in the brain. In my own work I have explored the reasons for this by thinking about the typical things that tend to trigger depression. This led to a consideration of whether the capacity for depression might be something that evolved along with us as we plodded the conflict-ridden trail from reptiles to monkey to humans. I won’t go into the details of that except to say that depression probably affects animals. As with humans, depression seems to strike mostly when an animal loses status (is defeated), loses control and/or is trapped in adverse environments. When these things happen the brain seems to switch into depressed-like states. In humans, signals of being valued as a person have evolved as important mediators of mood states.
The other thing to consider, if we stay with an evolutionary view for a moment, is that although the brain is a highly complex organ it is also something of a ‘contraption’. Deep in our brains are structures that evolved with the reptiles. Neuropsychologists even called this part of the brain ‘the reptilian brain’. Evolution does not create totally new designs. Rather, old designs are adapted, added to or altered as a species evolves. It is rather like developing a car, but each new design must include the old – you can’t go back to the drawing board and start afresh. So the brain has various structures within it that stretch way back many millions of years. This is why we can see the brain as a cobbling together of different bits that do different things. We have the potential for great violence, terror, lust, love and compassion. We are a mosaic of possibilities arising out of this jerry-built brain of ours.
Provided these various parts of the brain work together then it functions reasonably well, but if they get out of balance then it functions less well. Due perhaps to childhood trauma or difficulties and later stressful life events, we sometimes find it difficult to keep this mixed array of possibilities under control. They start pulling in different directions. The brain may tell us that there is far more danger than there is, and we panic; it may tell us that we are inferior, worthless and to give in, and we feel depressed; it may tell us that we need to get our own back, and so we seethe with the desire for revenge. Each of these parts has its own job to do, but they must work in harmony. In depression we lose this harmony and have thoughts and ideas that lead us to feel more defeated, inferior and worthless, and thus more depressed.
What we find in depression is that people experience all kinds of thoughts and feelings coming from different systems within the brain, and these can be difficult to control or make sense of. Another way to think of this is that we have different parts to ourselves and can play different roles, e.g. child, hero, lover, parent, friend, enemy, helper and so on. Evolution has provided many brain systems that enable us to enact different roles. Each part tends to see the world in its own way. For example, the hero part strides out and risks all. The coward part says, ‘You must be joking. I’m not going out there.’ Now if the two work together then they will make a sensible compromise and evaluation of risk. But if the hero does not listen to the coward then the hero puts the self in danger. On the other hand, if the coward does not listen to the hero, the coward just hides in the corner. In reality, of course, there are no actual ‘parts’ as such; what we experience is the activation, to a greater or lesser degree, of different brain systems. When we pay attention to our thoughts and feelings we can actually recognize which brain systems are turned on. Our thoughts and feelings are windows on these different systems in us.
So what to do if you feel depressed? The first thing to say is that the thoughts we have when we are depressed tell us that the depression system is switched on. That may not seem very helpful, until we realize that there may be ways to turn it off again and bring ourselves back into balance. For example, when we are depressed we may think in ways that seem right ‘to the depression’, but which may seem very wrong to other parts of ourselves. The rational and compassionate parts of ourselves may have a very different view of things. The more we can say, ‘OK, my depression is a part of me; one of my many brain systems, but it can’t be relied on to be accurate or helpful’, the more we can step in to try to take control of it.
Second, as we get depressed the depression system tends to throw other systems out of balance. For example, we may become more irritable or anxious. And as a result we may judge ourselves and/or others more harshly, which feeds the depression. Typical of depression is to devalue things, usually ourselves and accomplishments, but we may also devalue others. We may start to believe that things are darker than they are.
Third, depression is about how the brain is operating at any particular time. So depression is very much felt ‘in the body’ and is about feelings. Depression was designed (evolved) to slow us down, to weaken self-confidence and make us more sensitive to possible social losses and threats. It does this by changing the way our bodies work. However, if we can get other systems to challenge the depression, by learning how to think differently about ourselves and events, then we have an opportunity to get things back into balance. This book will discuss how to recognize important depressing thoughts to work with and how to challenge them.
This book is for people who would like to know more about depression – what it is and how to help oneself. It is not a cure-all, nor a substitute for therapies like drugs or psychotherapy, nor can a book like this change the painful realities of living. It is simply one approach. Each person’s depression is, in part, similar to other people’s and in part unique to that person. What understanding can do is to offer a way to move out of depression rather than plunge further into it. There are many ways to challenge some of the negative thinking of depression. I will try to point out some pitfalls to watch out for and suggest some methods that will enable you to develop a more rational and compassionate approach to yourself.
The book is divided into three parts. The first is the most technical. I have included this because many of the depressed people I see say that they would like to know more about depression itself. If it seems too technical, you can skip those bits you find difficult to follow; in fact, you can skip the whole of Part I if you like. Part II outlines some basic approaches to self-help. Here we will explore the role of thoughts and feelings, and how to challenge some of the thoughts and feelings that lead to a downward slide. There is a chapter devoted to how depressed people treat themselves (which is often very badly) and how to treat yourself more kindly. The more you learn to value yourself (or at least to stop devaluing yourself), the greater the chances of turning the depression system off. Each chapter in Part II is followed by a series of exercises you can try. In Part III the basic approaches covered in Part II are applied to special problems. These include the need for approval, anger, shame, lack of assertiveness, disappointment and perfectionism.
You will read of many other people’s depression. All names have, of course, been changed. Also, to avoid any chance of identification, the details of all the stories have been altered. Sometimes two or three cases have been rolled into one, again to avoid identification. The focus of each problem is on the specific themes that reveal the dilemmas and complexities of depression.
Our journey together may be a long one, but I hope it will equip you with some ideas of how to move out of depression. Recovering from depression usually requires time, effort and patience, but if you know what you are trying to achieve, and have a way forward, you are likely to be more successful in your efforts. So let’s begin.