Shortly after the death of Robin Williams I wrote a post called What I Wish People Knew About Depression. It was a small effort to chip away at the stigma associated with depression and to raise awareness of the complexities inherent to mood disorders. I have expounded on those statements here and rearranged them to read as a summary of what I believe about the condition. I still wish for a lot of things, but I realize I can’t make anyone understand depression. All I can do is share my perspective and hope that my words open a few minds, promote healing, and lead to more support for those who suffer.
I believe depression is complex. I believe it is a physiological condition with psychological and spiritual components, and therefore can’t be forced into any neat and tidy box. I believe depression is part of a intricate web of biological systems — nervous, digestive, endocrine, respiratory. I believe it is about the gut as well as the brain, the thyroid and the nerves. I believe healing needs to come from a variety of sources. I believe every person’s recovery is different.
I believe untreated depression can increase the risk of developing other illnesses. A 2007 Norwegian study found that those participants with significant depression symptoms had a higher risk of death from most major causes, including heart disease, stroke, respiratory illnesses (such as pneumonia and influenza), and conditions of the nervous system (like Parkinson’s disease and multiple sclerosis).
I believe depression deserves the same compassion offered to people with rheumatoid arthritis, lupus, breast cancer, or any other socially acceptable illness. I believe persons who struggle with depression aren’t lazy, uncommitted, and weak. I believe they are not trying to get attention, that they are ill. I believe the best thing you can do for a person who suffers from depression is to believe her.
I believe gratitude can coexist with depression. I believe a person can be grateful and depressed at the same time. I believe she can be fully aware of the blessings in her life even as she is crying at the dinner table. I believe depression isn’t so much the refusal to see the positive in one’s life, rather the inability to enjoy it. I believe that while depression symptoms may look like a cup-half-empty perspective, the negativity is more a result of the struggle to engage with the goodness that a person clearly identifies in her life.
I believe a person can’t un-think herself out of depression. I believe that despite impressive research on neuroplasticity and our brain’s capability of changing, a person can’t undo depression solely by shifting the focus of her thoughts. I believe while he can be mindful of forming new neural passageways, he can’t reverse a severe depressive episode with visualization and mind control alone, just as he can’t un-think a tumor from happening. I believe that depressed persons can benefit immensely from mindfulness exercises, from concentrating on the present moment, from watching one’s thoughts with some awareness, and from applying some self-compassion to ruminations. However, I believe that a person can suffer from depression even years after developing a meditation practice, that mindfulness is often not enough by itself to treat a mood disorder.
I believe medications are important but don’t provide all the answers. I believe they can begin the healing process and allow the other hard work to be done, but aren’t capable of fixing everything. I believe many depressed persons live better, fuller lives as a result of taking antidepressants, mood stabilizers, antipsychotics, and tranquilizers, but that these medications should be regarded as only one tool among many in the pursuit of wellness. I believe that millions of people are treatment resistant and don’t respond to medication. While brain stimulation technologies offer some hope for them, I believe persons who have failed to recover after trying several types of medications and alternative treatments should be met with compassion and not be blamed for their lack of progress or told they don’t want to get better.
I believe depression isn’t caused by demons, a lack of faith, or constipated energy in the seventh chakra. I believe neither reiki nor an exorcism is likely to cure depression. I believe pastors and religious leaders would serve their congregations well by educating themselves on the facts of mood disorders so that they can offer compassion, instead of judgement. I believe Jesus can heal depression just as He can heal cancer. However, when he doesn’t, I believe no one should be blamed. I believe prayer and faith can bolster recovery and promote healing — that it is helpful to design a regular prayer practice and try to grow in faith — but that depression is no more caused by a lack of faith than is leukemia.
I believe exercise, yoga, and the right diet can mitigate symptoms but aren’t a cure-all. I believe the endorphins from aerobic workouts are as close as a depressed person will get to an anesthesia for pain, but it’s possible to swim 5,000 yards or run seven miles a day and still be suicidal. I believe a sad swimmer can fill up her goggles with tears. I believe while yoga is helpful for many, a person can walk out of the studio just as depressed as she was before Namaste. I believe eating right can facilitate healing, but a person can eliminate gluten, dairy, caffeine, alcohol, and sugar from his diet—he can exist on green smoothies–and still be depressed. I believe fish oil, vitamin B 12, and a good probiotic could very well improve the mood, but that they aren’t magical elements. I believe that exercise, yoga, diet, and all efforts at healthy living can absolutely promote emotional resiliency, but that none of them alone is the panacea.
I believe the worst part about depression is the sheer loneliness, the inability to express the anguish that rages within. I believe the smiley-face culture we live in worsens that loneliness because depressed persons are scared to tell the truth. I believe most people with depression deserve Academy Awards for outstanding acting. I believe it can be very difficult to pick up on the desperation and sadness in a person who is suffering because chances are she is the one cracking jokes in a crowd. For this reason, I believe people with depression require the support of each other, a safe place where they can be understood and appreciated for who they are. I believe there is immense power in community, that there is healing energy in the togetherness.
I believe depression is a serious brain disease. I believe it is associated with the loss of volume in parts of the brain, namely the hippocampus, which belongs to the the emotional center. I believe the more severe the depression, the greater the loss of brain volume. I believe depression can inhibit the birth of new brain cells, or neurogenesis. For this reason, Peter Kramer, M.D. believes that depression is the “most devastating disease known to mankind.”
I believe depression can be genetic. I believe there are many genetic variations than can increase a person’s vulnerability to depression and other mood disorders. I believe studies of identical twins and research of genomic biomarkers underscore the fact that depression is a legitimate, medical illness. I believe they also provide hope for more targeted treatments of mood disorders in the future.
I believe depression is aggravated by stress because stress taxes every biological and emotional center of a person’s being. I believe that stress-reduction strategies like deep breathing techniques and time in nature can help reduce the fight-or-flight responses that promote disease, that depressed people would help their brains by working less and relaxing more. I believe listening to music, visualizations, bubble baths, and massages can begin to prime the parasympathetic nervous system and foster calm, that relaxation techniques are often a forgotten part of recovery.
I believe depression isn’t always triggered by an event. I believe that it often is, but that sometimes it’s not. I believe depression can and does occur out of the blue. I believe that it’s sometimes rooted in trauma, but not always. I believe sometimes one small thing is needed to pull a person out of darkness, and sometimes everything is unable to.
I believe depression isn’t a permanent condition. I believe it comes and it goes, and in its ebb and flow are found pockets of peace that can sustain a person for the journey. I believe sometimes the only thing a depressed person can do is to wait for symptoms to subside.
I believe there is hope for depression. I believe the way out of darkness is as varied as the causes. I believe recovery comes from medication and psychotherapy, from mindful meditation and green smoothies, from running and brain stimulation technology, from deep breathing techniques and self-compassion exercises, from cognitive behavioral strategies and painting, from hikes in the woods and coffee with friends. I believe hope is born in sharing the familiar yet unique story of one’s illness, and in finding a purpose to live for — in attaching every piece of the heart and soul to some meaning in this world and in gently turning the pain and the bitterness to love and service. I believe healing happens with faith, open-mindedness, community, and perseverance.