Depression: Facing up to distress
By Tony Bates,
The Irish Times -
Tuesday, January 12, 2010
What is depression, the illness that appears to have afflicted both Iris Robinson and Marian Keyes?
DEPRESSION IS the most common mental health problem worldwide. And the evidence seems to indicate that it is on the rise globally. It has something to teach all of us about the way we live our lives and relate to one another.
Depression is a very lonely place. For the person caught in its grip, it can feel as though they are under house arrest in an empty drab house, with nobody home. All they see are locked doors, empty corridors, and mirrors that give them painful reminders of everything they despise about themselves.
People may come and go but it’s hard for them to feel connected with them. The well-intentioned advice of friends, although sensible, may feel like just another way of asking someone who is depressed to be different, not to feel what they feel or to think what they are thinking.
It’s equally possible that the people around a depressed person may be oblivious to their distress. Because they hide their feelings from others so well. They greet friends and loved ones at the door with a smile and pretend everything is fine. The effort this takes gradually wears them down.
What can turn depression into despair and engender thoughts of suicide is the feeling that this painful ache at the core of one’s being is a permanent fixture in one’s life.
One feels like giving up; who needs this hell? Feelings of anger boil up inside them, but they know they have to keep a lid on it. So they lock it away. Other bits of their emotional life get locked behind other doors.
Being depressed cuts us off from everything that made it feel good to be alive.
Someone in a state of depression knows they need a plan, if only to put a little structure in the day ahead. There are things they need to do, things that need their attention. But it’s hard to get going. They are all out of “get up and go” energy. Lying there is not making them feel any better. Doing things is hard; not doing things is even harder.
Martin Luther King said: “Everybody is somebody.” When you’re depressed, you lose that sense of being somebody. The most important thing you’ve got to do is to get that back. Current mental health policy underscores the importance for someone who has experienced depression (or any other mental health difficulty) being enabled to recover their sense of self.
People have rarely agreed on what exactly causes depression, and different views have often divided mental health professionals and left sufferers feeling bewildered. What is agreed is that the story behind each individual’s depression is unique, that it is more likely the result of a complex interaction of several factors in their life that can be properly understood only over the course of time. In the cases of Marian Keyes and Iris Robinson, it is naive, if not a little risky, to speculate as to what has tipped them into the clinical depression their personal accounts have implied.
Their openness, for whatever reason, in sharing their predicament with others may make it easier for many people in pain to begin to share the distress that they are trying to conceal from others in their own lives.
Recovery can begin only when a person accepts the place they are in. Wherever they are, no matter how unbearable it may feel, it is the only real ground they have to stand on. It is by learning to look at our distress directly that we can find a way out of it. If we run away from our feelings instead of accepting they are there, we will never have a chance to find our way out.
Once one has worked through depression, there is another challenge waiting. How to stay well and heal the wounds that gave rise to their depression, so that they don’t keep falling into the same old black hole?
There are lessons a person in recovery needs to learn that are essential to everyone’s mental health. We all need to notice the good things that are happening in our lives, and to enjoy moments in the day that could easily pass us by: the smile on a child’s face, the sensation of the breeze against our skin, the way sunlight plays on the water.
We also need to learn to relate to difficult experiences rather than react to them by trying to push them away; to take time to see whatever is happening and to stay with it for a while. Instead of fighting with ourselves, to let ourselves be. Instead of running away from ourselves, we need to come to terms with those darker elements of our personalities that can be destructive.
We need to make friends with the full spectrum of our feelings, to become open to sorrows, and recognise that each of them is a part of who we are.
We need to learn to notice particular negative thought patterns that trigger depression. Those destructive stories that we weave can convince us that there is nothing good in our lives. Relating to these thoughts and story lines with awareness and kindness, instead of panicking and trying to avoid them, can prevent us from getting carried away by them.
This is the practice of mindfulness, which has been formulated into a programme that has been used extensively with people who are vulnerable to repeat episodes of depression.
Several international randomised control trials have shown that mindfulness reduces the recurrence of clinical depression by a factor of 50 per cent. These studies have shown that repeated episodes of depression are not inevitable.
The experience of people like Marian and Iris is troubling, but also sobering for the rest of us. Let us hope we make the most of the opportunity their predicament has afforded all of us to be a little more honest with ourselves.
Tony Bates is founding director of Headstrong – The National Centre for Youth Mental Health and author of Depression: A Commonsense Approach