Depression

Depression is one of the more commonly named mental health concerns individuals may have. Usual statistics indicate in the general population here in North America (aka Turtle Island), usually one out of four individuals will experience at least one major episode of depression in their life time. Add to this factor issues of marginalization in terms of gender identity, sexual identity, race, ability, illness, incarceration, and employment/finances and the likelihood multiplies. Generally speaking, people tend to understand depression as an acute episode to an event involving some loss in a person's life: a loved one, job, marriage/partnership/lovers, death etc. There seems to be an image that in order for someone to have depression, they must feel very sad and spend a lot of time in bed for days or weeks on end. However, the true picture of depression is much more nuanced and individual than this. In my trauma work with adults young and old, quite often depression does not fit the mold of what one might expect in terms of mood, functioning, source, and duration. Many of the folks I work with have longstanding issues around grief and loss, quite often related to early familial relationships, particularly with parents or caregivers. As adults, we may find that surviving our childhood meant we found ways of coping and distancing ourselves from the pain and neglect of our youth and upbringing. However, what is not identified quite often, are the emotional distancing and cognitive strategies that we engage in order to maintain a level of functioning in our daily lives. Everything may "look good" on the surface in terms of keeping a job, school, relationships, activities, yet there may be a longstanding inability to connect deeply with feelings of joy and appreciation. The relationship with joy may be severed or weighted down, thus making it difficult to relate to others and form deeply meaningful bonds even when surface bonds exist. An individual may simply come to understand that their life feels void, and that they carry with them a generalized, widespread sense of disconnect, greyness, dullness, or numbness that inhibits their motivation and enjoyment of things. This experience may feel less acute at times if the stressors in one's life are addressed, and if one has support for any barriers they may face. However, when stresses permeate or there is an acute loss of some kind, or an abrupt change in one's daily life one has no power over - a deep seated sense of emotional disconnect may intensify and rear itself, causing a cascade of grief and aggravation of critical thoughts focussed on a sense of futility, detachment, numbness, and loneliness. This may look like gradually withdrawing from social engagements, staying at home, not calling or communicating with friends or loved ones, not completing assignments or tasks, and finding everyday minor activities such as getting out of bed, dressing, dishes, making a phone call, sending an email, or buying groceries feel insurmountable. Exhaustion, fatigue, loss of appetite/binge eating, and insomnia or hypersomnia contribute to a disruption of one's sleep/wake/energy cycle and ability to maintain routine or self care. When depression is longstanding, deepseated, and connected to early loss or emotional trauma, the journey to awareness and caring for oneself is multilayered, complex, and takes time. Reconnecting with one's self, their ability to experience relief, joy, a broader, deeper range of emotions, energy and motivation can involve doing early grief and trauma therapy work. It can involve evaluating and renegotiating commitments. It can involve considering making major changes involving daily stressors. It may mean addressing issues in relationships that may be impacting one's mood. It may involve a change in nutrition, exercise, and socializing. One's goals for themself and their expectations around their own functionality may have to be reduced and cushioned and focussed more generally on working on letting go of critical, self defeating inner dialogue. Naming and recognizing the source and impacts of internalized shame and deflated self worth become key. The process of reorienting oneself to their full capacity for emotionality is individual and holistic. For some medication may be useful to facilitate an immediate energy shift to work on other areas of their life and connections to the past. What I have described above are but some details of a potential life cycle of depression. When we think about longstanding depression, we often overlook a much neglected or negated connection to grief and loss of aspects of our own nurturance. Finding our way back to self compassion may involve a longer journey of reorienting oneself to a relationship with self and others and finding support around this.