The Causes of Depression
What causes depression? In the first chapter I talked about the three types of depression — endogenous, from within the body; exogenous, from without; and neurotic depression. In this chapter I want to consider the major causes of depression, with particular emphasis on the concept of loss and how we must all learn to deal with life's losses.
Life is full of potential for loss. From the day we're born, we begin to "lose" things. With the passage of time, we grow older and leave behind (a form of loss) the safety of our homes, parents, and secure childhoods. We launch into marriage and soon discover the loss of our independence and autonomy. When we reach the final stage of life, not only do we lose friends through death, but we also begin to become acutely aware of the loss of our own faculties and the inevitable final loss of our lives.
All of life, therefore, is full of losses, and along the way we have to learn to deal with them. If we don't, we become depression prone.
CAN YOU DESCRIBE THE KIND OF LOSSES YOU'RE TALKING ABOUT?
Let's take a look at some of the many losses you may have experienced. Perhaps you grew up in a dysfunctional home and never really had a good childhood. That's a loss. Perhaps a friend has moved away from your hometown and
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now lives in some distant area. You've lost a friend. Perhaps a son or daughter has become a missionary and serves in a foreign land. While a part of you rejoices in your child's service for Christ, another part longs for the companionship of your child. That's a loss.
Perhaps you're a student, and that term project you turned in to your teacher or professor didn't earn you the expected A. That's a tremendous blow to your self-esteem. You might even feel a little unsure of yourself as a result. That represents even more loss.
Perhaps you're a business person who has invested in the stock market. Suddenly the market plunges, and you go from feeling fairly secure to facing financial disaster. The loss of financial security can be devastating in our world, because we depend so much on money to survive.
Perhaps you're a mother who has discovered her son is a drug addict or that her daughter's marriage is on the rocks. These are major losses. Or maybe your heart aches for your grandchildren, and your own emotions suddenly take a plunge into dark despair.
Perhaps you're a young man who has had an eye on a particular girl in your college group at church. You keep hesitating, wondering how to find the courage to ask her for a date. One day you learn she is dating another young man in the group. You've lost an opportunity to get to know her, your heart is devastated, and you go into a deep funk. For days or even weeks, you find yourself unable to concentrate or take any interest in your usual activities.
Perhaps you're an older person, and just the other day you took a good look in the mirror under a bright light. The years are beginning to show deep crevices and sagging skin, and you suddenly realize how much older you're getting. The thought doesn't please you.
Getting older is a form of loss. You have a birthday coming up, and you almost dread the day, because it will remind you once again of how quickly your life is passing.
What do all those experiences have in common? They all produce reactions of sadness, because they all represent experiences of loss, and there is little we can do to avoid most of them. We just have to muster the courage to face and accept them. The more effectively we do, the less we're likely to struggle with depression. When we don't adjust to the losses, we become depressed.
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WHAT FORMS CAN LOSS TAKE?
Loss can take many forms. It can be the loss of a loved object, or it can be the loss of something as abstract as self-esteem or ambition.
Sometimes loss takes the form of separation or change. I recently counseled with a pastor's wife whose oldest daughter had just married. The mother and daughter were very close. Although the marriage was exciting, it represented a significant loss for the mother. Not only was her daughter moving away from their hometown, but she was also beginning to build her own family, becoming less dependent on her mother for support and love. It's not surprising that the mother went into a temporary deep depression.
Moving from one job to another can also represent loss. We develop relationships in our work experience, and even when there's the joy of promotion or the excitement of a new challenge in a new job, the separation from those we've worked with can represent a significant loss. It's losses of all sorts, often subtle or complex, that underlie psychological forms of depression.
EXACTLY HOW DOES LOSS CAUSE DEPRESSION?
A universal reaction is built deeply into every human mind and body that responds to loss with depression. It is automatic and natural. In fact, we also see it in various animals, though to a much lesser extent. It is the mind and body's way of coping with loss, and in that sense it's a protective mechanism. It goes into action to help us into a sort of hibernation while we deal with the loss.
In other words, depression has a purposeful function. It's designed to help us come to terms with the loss and to force us to adjust in such a way that we release the lost object.
Can you imagine what it would be like if we couldn't "let go" of what we've lost? Some people whose loved ones die are unable to bury them. They embalm them, encase them in glass, and do everything they possibly can to keep the presence of the loved one with them. That's very sad. Such people never really come to terms with the loss and end up being miserable. God's order is that we experience losses with maturity and be willing to let them go.
This purposeful nature of depression is perhaps easier understood when we talk about the loss of a loved one, but it's the same for other losses as well. It applies, for example, to being criticized by a friend or hearing your husband suddenly announce he's having an affair and wants to leave the marriage.
In many respects, all losses are similar. It's just a matter of degree, and even
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though some of our more-complex losses are more abstract, they are nonetheless still significant losses for the mind to cope with.
When someone criticizes us, the loss is usually a combination of the rejection we feel from that person and the loss of esteem we feel for ourselves. The criticism implies that the other person doesn't accept us totally or finds fault with us, and we tend to accept a part of every criticism as valid, so we reject ourselves as well.
All this is to say that loss can be a complex experience. It can take the form of concrete losses, like losing your wallet or purse, or it can take the form of such subtle and abstract losses as the loss of love, esteem, ambition, ideals, and various forms of disappointment and helplessness.
IS IT ALWAYS NECESSARY TO BE DEPRESSED AFTER A SIGNIFICANT LOSS?
Always. If you don't experience some depression, something is probably wrong. The depression may be slight, but it should be there. The only point at issue is its intensity. While depression as a response to loss is always legitimate, you don't have to be as deeply depressed as people often are. Many of our depressions are unnecessarily severe because we value the wrong things and don't trust God. The more we trust, the better we're able to appropriate the resources He has for us, and the less intense will be our depression.
CAN THESE LOSSES BE CATEGORIZED?
It's helpful to put our losses in one of four different categories, because that gives us a better handle on what's happening. The four basic categories are:
1. Concrete losses: These involve the loss of tangible objects. They include having an automobile accident, dropping and breaking a camera, or having our dog die. Life is full of such losses.
2. Abstract losses: These can be just as real as the first category of losses, but they're made up of intangibles like the loss of love, ambition, self-respect, or control. Many things we value are abstract in nature. Abstract losses are not always the creations of our own minds; they can achieve reality in themselves. I may not be able to see love, but I can certainly feel it.
3. Imagined losses: These come from our active imaginations. We can imagine
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both concrete and abstract losses. We imagine that a friend has snubbed us or that someone dislikes us. We think people are talking about us or that we might lose a job. These imaginations set us up for loss and depression just as if the actual loss has occurred.
For instance, let's suppose you suddenly discover you have a lump somewhere in your body. It concerns you, so you want to see your doctor. But you can't get an appointment for two days because she's so busy. So for those two days your imagination goes wild. You begin to suspect that all sorts of things are wrong with you. You play out this imagination to such an extent that you create losses that are as real to your mind as concrete ones. The resultant depression is exactly the same as if you had experienced some actual loss.
Sometimes the depression we experience from imagined losses is even greater than that for real losses, because we can't set adequate boundaries. Imagination can't be contained. It goes far beyond reality and triggers depressive reactions way beyond what's reasonable.
A vivid imagination, therefore, is a serious handicap when it comes to depression. You have to be careful not to let it take over whenever you feel the threat of a loss or you anticipate some experience that has the potential for loss. Imagined losses are difficult to deal with simply because they haven't actually taken place.
We can often resolve imagined losses by testing the reality of our imaginations. Have those things actually happened? Just realizing our imaginations have been faulty can clear up the depression.
4. Threatened losses: The fourth category of losses is threatened losses. Because no actual loss has yet taken place, the grieving process cannot be completed. Imagine having an elderly parent who is on the verge of death. You start feeling depressed, and the grieving process begins, but until the actual death takes place, you can't complete it. You will continue to feel depressed as long as the threat of loss hangs over your head.
WHY ARE IMAGINED LOSSES SO EASILY CREATED?
For two reasons. First, the human mind is capable of such rich thought. It knows no limits. Second, we live in a society that doesn't communicate clearly. Both contribute to feed our imaginations.
We play lots of games with each other. We send hidden messages, and we're
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not honest, so we leave people guessing. Nor do we understand what others are saying. The result is that we're left to imagine all sorts of losses, and often we imagine much more than is really true. Our fertile minds can feed off the littlest things — a gesture, a hint, or mistake — and turn them into big losses.
IS THIS TRUE OF CHRISTIANS AS WELL?
Absolutely. It's a sad fact that Christian people are not always honest with each other. Sometimes we don't want to reveal ourselves because we're afraid others will reject us, so we avoid being open. That feeds a lot of imagined losses in others.
IS "TRANSPARENCY" A GOOD GUARD AGAINST THIS KIND OF DEPRESSION?
I think so, assuming that acceptance goes along with the transparency. Generally, the more transparent we are and the more accepting we are of one another, the more we can be honest in love. That reduces a lot of imagined losses. We may experience some real loss as a consequence of this transparency, but real losses are always easier to deal with. They have clear limits, whereas imagined losses have no limits. Personally, I'd rather deal with one real loss than have to live with ten imagined losses and all the depression they could trigger!
WHICH CATEGORY OF LOSS IS THE HARDEST TO DEAL WITH?
Threatened losses are perhaps the most serious of all and create the most debilitating type of depression. We can't prevent the depression completely, because there is the possibility of a real loss. On the other hand, we can't complete our grieving and resolve the depression, because the loss hasn't actually occurred yet. So we're caught in a sort of "suspended" state that prolongs the depression as the threat of loss continues to hang over our lives.
WHAT DETERMINES THE INTENSITY OF A DEPRESSION?
The intensity of a depression is determined very much by the significance or meaning of the loss. Sometimes a loss is relatively minor, so the sadness that follows it is mild and short-lived. Most of us probably don't even notice those minor depressions.
Not long ago, I found myself speeding down the road on my way to work.
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Before I realized it, a big, black car with flashing red lights appeared in my rearview mirror, and I had to pull over. The police officer was very polite as he wrote out the traffic citation. It was no big deal. Five miles over the speed limit is hardly anything to be broken up about.
However, I did feel some humiliation, and the waste of the money I would have to cough up to pay the ticket irked me. For the rest of the day, I felt mildly down, even sad. Fortunately, by the time evening came the feeling had passed. Many minor depressions resolve themselves automatically like that and do not require any special attention or adjustment.
But not all losses are minor. And the more meaningful the object lost, the deeper will be the depression, and the greater will be the adjustment we have to make to accept the loss. This is why perhaps the deepest form of reactive depression follows the loss of a loved one in death.
Frequently, many minor losses can accumulate to become big ones. If on my way to work I get stopped for a minor speeding offense, I may feel a little depressed. If, after having just left the august presence of the policeman, I suddenly feel my car shaking and pull over to discover I have a flat tire, I might begin to feel even more depressed.
Now imagine that when I open the trunk, I discover my spare tire is also flat. Then I check my appointment book and realize I have a meeting starting in five minutes, and I'm still 20 minutes' drive from work. Now I have five losses. Furthermore, nobody stops to give me a ride as I stand on the side of the road with flat tire in hand. You can see how this accumulation of losses, even though each is relatively minor in itself, is beginning to create a significant reaction in me.
One of the key principles we need to learn, therefore, is not to allow our losses to accumulate. We need to deal with each loss separately or, at least, not allow self-talk to encourage them to pile up on each other. When I had the flat tire, if I had told myself this incident had nothing to do with my getting a ticket, I might have broken the connection. Discovering the spare tire was flat and that I was going to be late also needed to be kept as separate issues by healthy self-talk.
HOW DOES OUR HISTORY SENSITIZE US TO LOSS?
The tendency to accumulate smaller losses into a bigger one is often the result of having experienced many losses before. The more losses we've had earlier in life, particularly during childhood, the more likely we are to react to later losses with an exaggerated response.
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I experienced several major losses when I was about 12 years old. My parents had decided to divorce, which by itself provoked some significant anger and depression. I soon discovered, as well, that my mother intended to move away from where we had been living, so there was the threat that I would also have to change schools. The thought of losing our home, my friends, and familiar play locations was devastating.
For several years following my parents' divorce, other significant losses also occurred. As a result, I became very sensitive to losses. I came to expect, almost daily, that something terrible would happen to me. With that mindset, of course, every little disappointment and every minor rejection became a big issue in my mind. One loss seemed to come on top of another, and in my young mind I wasn't able to separate them. As a result, depression came easily and often. Only later in life did I learn how to correct my thinking and stop the overreactions.
I have worked with many patients who suffered significant losses in childhood that now affect them in adult life. One young man, who admits he is not intellectual, experienced a number of failures during childhood. His father was forceful and pushed him into activities at which he was not good. He was required to take subjects at school he knew he couldn't master, and as a result of those failures he is now very sensitive to any form of defeat.
Even a simple task like changing a flat tire can be stressful for him. He always feels that if he doesn't do the job in under one minute, he's unsuccessful. He views everything through that one filter: failure. He constantly judges his every action as either a success or a defeat. Most of the time, he judges his actions as failures and so accumulates many losses. Not surprisingly, he is frequently depressed.
Losses need to be kept separate, therefore, if we're going to be emotionally healthy and build a happy life. We must also be able to receive the inevitable losses of life with grace. While the reaction of sadness is natural and inevitable, there are many things we can do to recover more quickly from our depressions. The more efficiently and speedily we come to terms with our losses, the happier we'll be.
God understands the role losses play in developing our sadnesses. Even Jesus became sad. Remember how He cried at the tomb of Lazarus. He had lost a dear friend. He cried with real tears because He felt sad about what had happened, even though He knew He would restore Lazarus to life. There are times when we may have to cry as well; crying can help us to grieve our losses.
CAN OUR ATTITUDES AND BEHAVIORS CAUSE DEPRESSION?
Very definitely. For example, examine the following list, and see how many of these issues have caused you depression in your past:
Discontentment: a tendency to envy others and be dissatisfied with what you haven't got or to resent what you have got.
A faulty set of values: misjudging what's important in life, and a tendency to focus too much on petty issues.
Faulty beliefs: a tendency to believe everything should go your way or that life should only present you with its blessings.
Faulty reactions: to be overly sensitive about what is said or done to you, or to be immature and not able to put things in proper balance.
In addition, many of life's circumstances can give rise to losses that can cause depression. These include:
Financial difficulties
We live in a money-dependent, materialistic society. Money is our symbol of value. We work for money, not food or clothing directly.
The more materialistic we are, the more likely we are to experience reactive depressions. The more we value the material things of this life, good as they may be, the more we will experience loss and therefore depression.
With the instability of the world's economy, more and more people have less and less to survive with. That represents significant losses and can be a major cause of depression.
Problems at work
Since we all have to earn our keep, relationships in the workplace become a major source of tension and disruption. We have to learn how to work in increasingly crowded conditions, as well as how to relate to many people we would not normally count as our friends. These problems can be a significant cause of depression.
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Problems with family and children
Those closest to us are often the cause of our deepest pain. Parents whose children aren't turning out quite the way they wanted can experience significant losses. And in almost every household, there's conflict over discipline. Sometimes this conflict is between parents, but more often it's between parents and children. This is a serious source of depression.
Problems with habits
Many become addicted to certain behaviors and develop habits that can be a source of depression. Addictions such as smoking, alcohol, and drugs can cause serious biological disturbances, and they can be the source of other trouble as well, including family discord and marital breakup. People who get hooked on thrilling or exciting behaviors have their letdowns eventually. Even workaholics can find themselves prone to depression.
Low self-esteem
For many, low self-esteem is both the source of depression and a symptom of it. As I said before, low self-esteem can cause you to become depressed, but it can also be the consequence of your depression.
Growing old
For many of us, growing old will be a traumatic experience. When we're young, we hardly ever think about death and dying. But as we get to the middle and then into the final stages of life, the realization that we have only a limited life span becomes very real. It's at these times that both men and women start to think about what they haven't achieved or what is still left to be done. That can be the source of significant depression.
Loneliness and boredom
We have increasingly become a lonely society. The more we're crowded together in our cities, the more likely we are to be isolated in our little cubicles, cut off from other people. I know many large churches where people feel lonely and isolated despite being surrounded by so many other worshipers.
Loneliness and boredom, therefore, can be serious causes of depression. If you don't have a clear sense of God's purpose in your life to help overcome such depression, or if you don't have a clear sense of how God is working to make
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you the sort of person He wants you to be, loneliness and boredom can be overwhelming.
On this last point, many studies have shown that the sharp rise in the incidence of depression since World War II is largely the result of our society's loss of hope and faith, along with a decline in commitment to religion, the family, the nation, and the community. As modern society abandons traditional values we have held dear as Christians, we can expect a further increase in depression. The modern person is confused, lonely, abandoned, and despairing. Those are all significant causes for depression.
Unconnectedness
People without connections to family, church, and meaningful existence will struggle to find purpose in their lives and will experience more depression. One necessary condition for meaning is to be attached to something larger than yourself. People who don't take their relationship with God seriously lack the chief resource for coping with life's problems and losses. People who aren't connected to a family or find no meaning in their lives will be at even greater risk for depression.
This means, then, that as Christians we have a unique resource for helping people cope with depression. We also have a great missionary and evangelistic opportunity right where we live.
HOW DOES DISAPPOINTMENT WITH PERSONAL PERFORMANCE RELATE TO DEPRESSION?
In our culture, where we prize success and performance so much, anything that smacks of failure is a blow to our self-esteem and is going to lead to depression. Failure represents a deep sense of personal loss, more so than the loss of material things. It's probably the largest single cause of loss leading to depression, and it's also the basis for the deepest forms of reactive depressions.
IS THE SO-CALLED MID-LIFE CRISIS A CAUSE OF DEPRESSION?
Many mid-life crises, especially in men, are triggered by depression, but the situation is much more complex than that. A mid-life crisis is both a cause and a consequence of depression.
Let me illustrate the latter first, because people often don't realize that mid-life
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crises can be precipitated by a depression. Suppose a man reaches the middle of his life and realizes things are not going well. He is failing at his job. He hasn't accomplished his goals, and his ambitions are beginning to fade. He also realizes he's getting older, that youth and opportunity are passing him by. He experiences these as losses and becomes depressed.
This depression can lead to a crisis where he frantically and impulsively tries to replace some of his losses. He looks at his marriage and says, "The first thing I should do is to find another wife. If I were married to someone else, I'm sure I would be able to accomplish my goals." So he abandons his marriage and goes off with another, usually younger, woman. Thus, the depression he felt over job failure led to a larger crisis and started a series of events designed to relieve the depression.
But a mid-life crisis can also be the cause of depression. A woman in her mid-forties goes to work for the first time. Her children are off her hands, and she wants to do something meaningful with her life. But as she builds a career, she begins to think she has missed out on life. She starts to "live it up," has several affairs, and then suddenly comes to her senses. But now she's depressed. She feels stupid and ashamed at having lost her head. Her crisis is over, but not her depression.
It's best, perhaps, to see mid-life crisis and depression as being bound up together interdependently.
CAN DEPRESSION COME "OUT OF THE BLUE," SO TO SPEAK, FOR NO APPARENT REASON?
Depression may seem to come out of the blue, but there is always a cause, either physical or psychological. The problem is that we can't always identify the reason. We don't yet understand the complexity of the body or mind. When a person becomes fatigued, for example, depression can seemingly come from nowhere, but of course it's the result of the fatigue. The body is not able to sustain the person in coping with life. This might be mystifying to the individual. Some endogenous depressions may seem to come on quite suddenly, but here again, there's a real cause for the depression.
WHAT ABOUT DEPRESSIONS THAT COME FROM OUR EXPERIENCES?
Depression arising from past experiences also seems to appear out of the blue. But again, there's always a reason for a depression, even if it's not clear at the time.
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Many of us have unfinished business from our pasts: unhappy homes, abusive parents, disappointments, and failures. They have not been resolved and may at some time or another emerge as depressions whenever we sense the losses associated with them. When that happens, we may need to do some grieving all over again.
AREN'T SUDDEN DEPRESSIONS FRUSTRATING TO DEAL WITH?
Yes, they are. Because they come on suddenly and without apparent reason, they increase our frustration — and our reaction may add further depression.
Unable to see an immediate explanation, we begin to look for reasons. It's common for people to blame their spouses, their children, their parents, or their jobs. A number of my clients have come to me with long lists of "causes" for their depressions. "Well, it's because my husband never talks." "It's because my wife isn't affectionate." "It's because my parents never loved me enough." They all sound plausible, but little of it can be proved.
Such thinking doesn't do much good, because it externalizes the blame for the depression when the people should be looking inwardly for the cause. We must remember that others don't cause us to become depressed. We allow ourselves to be depressed. And we're the only ones who can unlock the prison door to let us out of our depression. Many circumstances from our past and present can't be changed. The healthiest thing to do is to grieve the losses connected with those circumstances and get on with our lives.
CAN WE THINK OURSELVES INTO A DEPRESSION?
All reactive depressions are a result of thought processes. They arise because we perceive something as loss. That means we think, reason, and process the loss. It's not the loss per se that makes us depressed but our perception of it and the thinking we engage in after we perceive it. If we've been robbed, we probably won't experience depression until we arrive home and get over the shock. At that point our thinking will be focused on our fear and losses, and the depression will be triggered.
But we don't need an actual traumatic event to start the process. We can literally think ourselves into depression by dwelling on little reflections of minor events and interpreting them as catastrophic.
That's why I am strongly convinced that the best way to minimize depression is to modify our thinking — to learn to think clearly and rationally.
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HOW DO OUR "ATTACHMENTS" RELATE TO LOSS?
To understand reactive depression, not only must we understand the concept of loss and see how we're created to respond with a grieving process, but we also need to understand the idea of "attachment." The greater our attachment to someone or something, and the more tightly we hold on, the greater will be the experience of depression.
We form many attachments in life. A mother gives birth to a child, and immediately a bond occurs that is a form of attachment. The young father who sees the baby for the first time also undergoes a remarkable attachment. I remember this experience clearly when each of our three girls was born. It was as if from that moment onward they were a permanent part of me.
When we develop friendships, we also form attachments. When we fall in love, marry, and settle down in a particular neighborhood, we form attachments. Attachments are a necessary aspect of life. God has created us to form them. But we will one day be separated from every attachment, with the one exception of our attachment to God in Christ.
Resolving depression, therefore, is a matter of "disconnecting" from the object to which we have become attached. Some of us are perhaps too attached to life and its material things. Because Jesus understood how we form those attachments, He warned us, "What good will it be for a man if he gains the whole world, yet forfeits his soul?" (Matthew 16:26). The apostle Paul warned us to "set your affection on things above, not on things on the earth" (Col. 3:2, KJV). Those are timely warnings made by a God who knows us well. They need to be heeded if we're going to deal with depression effectively. In other words, it's possible to be too attached to the things of this world for our own good.
The healing of depression ultimately comes when we allow the thing or person to which we're clinging to go free. That's also true for our reputation, our disappointments, and our need to be in control. We will talk more about this in chapter 5.
DO CHRISTIANS HAVE AN ADVANTAGE?
The superiority of our resources as Christians shows clearly in this area. Every disappointment, every criticism, and every person who lets us down or betrays us is an opportunity for God's grace to be at work in us, to produce spiritual growth. We know God is in control! We believe He has a plan for our lives! We've experienced His working in the past. This perspective can help us to release the things of the world and speed up the grieving process.
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Let me hasten to add that this is not cause for anyone who is depressed to feel guilty. We're all at different stages in our spiritual growth. Some, like the apostle Paul, can say, "I consider everything a loss compared to the surpassing greatness of knowing Christ Jesus my Lord, for whose sake I have lost all things" (Philippians 3:8). Others will find even minor losses difficult to deal with. God doesn't judge us for that. But He does call us to grow in maturity so we can come to terms with our losses more quickly.
What's important spiritually is not whether we're free of depression, but whether we use each experience of loss as an opportunity to see God's will for our lives more clearly. The majority of us might well have to struggle with every loss we experience. We're slow learners! At times we may be able to demonstrate monumental faith, and even significant traumas won't phase us. At other times, even petty issues will provoke a significant depression. The key to a happy, healthy, and spiritually mature life lies in being able to receive our losses gracefully, grieve them with God's help, and finally get to the place where we become "nonattached" to much of this world.
The ability to deal with loss constructively is a basic mental health skill that everyone ought to develop. We should teach it in kindergarten, reinforce it in adolescence, and continue to develop it throughout life. Our level of happiness and fulfillment depends on it.
DOESN'T THE DEPRESSION EXPERIENCE CARRY WITHIN IT THE SEEDS OF ITS OWN DEEPENING?
It seems logical to think that depression itself is such a significant loss that it creates still more depression, but that's not the case. Depression is not automatically self-perpetuating but tends to move back toward normality. The mind and the body have a self-healing set. Only when this normal depression cycle is interfered with does it get perpetuated. How people think about their loss is the determining factor, the key to healing.
HOW DO ENDOGENOUS DEPRESSIONS DIFFER FROM REACTIVE DEPRESSIONS?
As I explained in the first chapter, endogenous depression is caused by a disturbed biochemistry and can be triggered by many factors, including genetic defect, stress, fatigue, illness, or some glandular malfunctions.
Adrenaline letdown is another common cause, varying from a mild weekend
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depression to much-more-serious letdowns. Sometimes the period immediately following a success or victory may trigger this kind of depression. We call it a "postadrenaline" depression, because it occurs when our adrenaline suddenly drops after it has been on a high.
Elijah's experience after his stunning victory at Mount Carmel (see 1 Kings 18-19) is a good example of this postexcitement letdown. When he had defeated the prophets of Baal, he ran into the wilderness, lay down under a juniper tree, and asked God to take his life.
This postclimax depression has an important physiological root. During periods of success, we draw heavily on our adrenaline and arousal systems. The moment excess adrenaline is no longer needed, it's as if our systems say, "Now switch off. We need time to recover." In providing that recovery time, then, postadrenaline depressions are very healthy.
Endogenous depressions can also be the most serious form of major depression, the bipolar disorder, formerly known as manic-depressive psychosis. If treated promptly, these depressions can be brought under control rapidly, and unnecessary suffering can be avoided.
WHAT ARE THE MOST COMMON PHYSIOLOGICAL CAUSES OF DEPRESSION?
Glandular problems, fatigue caused by stress, and many illnesses, including cancer and influenza, can cause depression in both men and women. Many medications cause depression as well. In women, the menstrual cycle is a very important cause (see chapter 3). Some physiological causes are mysterious — we haven't yet discovered what they are, although we can see their effects.
CAN DEPRESSIONS BE TRIGGERED BY DRUGS?
Drugs, or more correctly the side effects of drugs, can create depression. Alcohol, for example, may initially alleviate depression and is used by many people as a tranquilizer. When they feel down, they turn to alcohol. But alcohol is actually a depressant, so after it wears off, the depression is worse than before. Other drugs stimulate the system. They create a feeling of well-being, but not for long. The depression is worse when the drug wears off.
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IS DEPRESSION HEREDITARY?
Some forms of depression are clearly hereditary. That's especially true for the major endogenous depressions. Studies of identical twins, for example, have clearly established a genetic link. Whether all depressions that run in families are due to heredity, we don't know, because we haven't been able to identify the specific mechanism of onset.
Some minor endogenous depressions aren't necessarily genetic but are caused instead by overstress or malfunction in the endocrine system. Some evidence suggests, however, that in people who experience a psychological depression over a long period, the body becomes adapted to that low level of functioning. The biochemical disturbance becomes relatively permanent, but it is brought about by a lifetime of depressive living.
Sometimes parents teach their children to deal with life in a depressive style. Those parents were taught the same patterns by their own parents, so the problem gets passed from generation to generation.
Generally speaking, genetic depressions respond well to antidepressant treatment. My opinion is that it's better to suffer from one of the genetically caused depressions (that can be treated) than from the neurotic forms that are more difficult to overcome.
WHAT IS THE RELATIONSHIP BETWEEN LOW BLOOD SUGAR AND DEPRESSION?
Many people report feelings of depression or low mood some time after they have eaten or, more commonly, just before their next meal. That is caused by a low blood-sugar level, and some are more sensitive to it than others. Low blood sugar disrupts our whole emotional balance. We become irritable, intolerant, or easily angered. Blood-sugar problems can often precipitate depression, too, because our social environment is disturbed.
Consider this familiar scenario. Your husband comes home from work. You haven't been able to grab a bite since early morning because you've been too busy. The low blood sugar makes you irritable. There's a bit of a quarrel, and your husband storms out. You feel a sense of loss, and you become depressed. Your depression is not caused by the low blood sugar, but by the secondary consequences of it. This is the kind of complex cycle that can disturb our emotional balance.
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CAN DIET CONTRIBUTE TO A TENDENCY TOWARD DEPRESSION?
Some people contend that diet is an important component in depression. Certainly, if our diets are not well balanced, or if we're deficient in certain essential vitamins and nutrients, our systems are not going to cope satisfactorily with life. The consequence is ultimately depression. Some hold that sugar intensifies the cyclical highs and lows of our emotions with its "artificial highs," but that's an overstatement for those who are not diabetic. On balance, though, good nutrition is important for physiological well-being, so it's probably also good for mental well-being.
WHAT IS THE RELATIONSHIP BETWEEN PHYSICAL FITNESS AND DEPRESSION?
Evidence suggests that physical exercise is very important in maintaining a balanced emotional life. Well-exercised, energetic bodies function much more efficiently than physically inactive bodies, and fit people cope better with stress and are not as prone to illness. Some psychiatric hospitals, in fact, use exercise programs for severely depressed patients, because exercise acts as a stimulant to the system. Thus, exercise is helpful in both avoiding and treating depression. It doesn't replace standard treatment but augments it.
DO CERTAIN ILLNESSES CAUSE DEPRESSION DIRECTLY?
Very much so. For example, depression is a common symptom of influenza. The depression helps the healing process by slowing us down and causing us to be disinterest in our usual activities. Certain forms of cancer create deep depressions, although in the case of life-threatening illnesses, many threatened and real losses must be contended with as well. In those cases, depression is a protective mechanism. It removes us from life, slows us down, and makes us disinterested in our environment so our bodies can have the time needed to fight the illness.
HOW CAN WE DEAL WITH THE DEPRESSION THAT ACCOMPANIES AGING?
Depression does not have to be a part of aging, but many elderly people do get depressed. Not only does your body change, limiting your ability to do the things you used to do, but you also begin to feel a shortness of time; a sense of
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things coming to an end increases your awareness of the limits of life. It hurts to lose your job when you're young, but it's not nearly as catastrophic as losing your job near the end of your working life. So all sorts of adjustments are needed to the losses associated with aging.
Adjusting to the aging process as healthily and realistically as possible involves an acceptance of the facts of aging — that we all have to get old and eventually die. You can't go backward in life; you can only go forward. And again, as a Christian psychologist, I believe we have wonderful resources available to us in this process. Getting old is not as bleak a prospect for us as it is for those who don't believe in God.
The best possible adjustment for advancing age is to be well in the previous stage. If your adolescent years were well adjusted, for example, your early adult years are likely to be well adjusted. If they were not, you'll experience problems in the next stage. Each stage builds on the previous one. It may seem this fact holds out little hope for the older person who has not adjusted well previously. The reality, however, is that it's never too late to begin. Make the most of your present stage in life. That's the best way to assure you adjust well to the final stage.
IS MUCH OF WHAT IS PASSED OFF AS SENILITY IN OLD AGE REALLY DEPRESSION?
Senility and depression are different phenomena, but it's difficult to separate the two. There's no doubt that senile disorders tend to create a lot of depression. How much is physiological and how much is psychological isn't always clear. When someone develops a senile disorder like Alzheimer's diseases, many losses can accompany a decline in mental abilities. These include the loss of friends and the loss of activities. Such losses can cause depression as well as the physical changes that occur in the brain. The two are so interwoven that it's difficult to separate one from the other.
HOW DO NEUROTIC DEPRESSIONS DIFFER FROM OTHERS?
Neurotic depressions are caused by inadequate responses to life's demands. They normally build up over a long period into a life-style pattern, and they're neurotic because they're an unhealthy way of coping with anxieties and pressures. This type of depression has now become known as dysthymic disorder, although I don't like that label.
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WHAT ARE THE CHARACTERISTICS OF A DEPRESSIVE LIFE-STYLE?
Many people retreat into depression to avoid dealing with the pressures of life. After years of this retreating, they develop a life-style of cowardice. Every time they encounter a bit a tension, stress, or anxiety, they withdraw into depression. They wake up in the morning, and the prospect of facing the day is overwhelming. So they retreat and stay in bed all day.
The characteristics of this life-style include a tendency toward depression at the slightest hint of anxiety, a low tolerance for stress, avoidance behavior, and a nonengagement of life. I must sound one important qualification, however. Sometimes perpetual depression is a symptom of a more serious endogenous depression. Before we can interpret persistent depressions as a neurotic life-style, we must eliminate the possibility that the depression is due to physiological disturbance.
