Working With Clinical Depression (part 1)

Most often people have an adversarial relationship with their depression. Once we see any hint of depression in our minds, we often become reactive and judgmental about why we are depressed. Sometimes our reactions to our depression (judging ourselves and self-medicating) often become more problematic than the depression itself.

First, it should be clear from the start, not all depression is "pathological." In fact, there are perfectly appropriate times when human beings are supposed to feel depressed. Significant psychological trauma, the loss of loved ones, and the diagnosis of a terminal illness are among the legitimate reasons that human beings become depressed. In essence, depression is a natural part of our trauma and grief processing.

Having said that, there are many people with a biological predisposition to clinical depression. For these people, depression is a reoccurring obstacle in their lives, making it tough to thrive and grow. This kind of clinical depression is called "major depression," and if left untreated, it can be quite destructive and dangerous.

Therapy does not seek to eliminate depression. As we said before, depression has its place in the pantheon of human emotions. Psychotherapy seeks to help the patient change their relationship to their depression.

Depression is almost always supported by a narrative. Like two by fours in a solid foundation, a good depression narrative upholds and supports a depressed mood. A depression narrative is also pretty easy to spot in that extreme words are used with great frequency – words like "never," "always," "all," and "nothing." In essence, while reality is actually very nuanced and relative, a depression narrative is very simple, extreme, and full of black and white thinking.

My depression narrative goes something like this:

"I am the unsung hero of an unfair universe, and despite the fact that I try hard and do the right things, I never seem to get ahead! I am always blamed when things go wrong, and I get stepped over and I’m deprived the good things in life. I deserve good things too! Basically life is rigged, so what’s the point?"

My narrative is projecting blame outside of me and onto the people, places, and things around me. This is an "angry depression." Many times, however, the depression narrative will be internal, blaming oneself for all the trouble and difficulty experienced. This is a "self-loathing depression" and it’s this type of depression that is typically associated with suicidality.