Dorothy Rowe

February 12, 2001

DEPRESSION ONE

Lewis Wolpert, the scientist who wrote about his own depression in his book Maligant Sadness, and I were taking part in a television discussion about depression. The producer had hoped that Lewis and I would disagree, but when I began talking about how being depressed is far, far worse than having a physical illness Lewis nodded his head furiously and said, 'Yes, yes, absolutely.' Lewis had had more than his share of physical illnesses, but he was in doubt that being depressed was his worst experience.

The fact that being depressed is so terrible makes the news about increasing rates of depression so very serious. Depression is certainly better diagnosed than it was in past years, and more people, especially men, are prepared to admit that they are depressed, but the increasing numbers of adults and children who describe themselves as being stressed at work and at school suggest that there is a real increase in the incidence of depression. We can turn stress very easily into depression by blaming ourselves for our misery.

A World Health Organisation report in 1999 showed that in Europe and America depression is the second greatest cause of death after heart disease. An earlier WHO report looked worldwide at the number of years lost through sickness and death by people aged between 15 and 44 who were suffering from various diseases or injuries. The people who had suffered by far the greatest loss of healthy years were those people suffering from depression. It has been known for some time that stress reduces the effective functioning of the immune system, and so can lead to physical illness. Depression, the greatest stress, is now seen as one of the possible factors leading to influenza, pneumonia, cancer and heart disease.

Suicide rates in young people have increased steadily since 1946. Of recent years rates for young women have levelled out, but rates for young men have continued to climb. Studies of which groups of people become depressed have always shown that the group most prone to depression is married women, but it is now clear that the group which is next most likely to become depressed is single men. Married men and single women fare best. It seems that marriage suits men but not women.

There are two competing theories about the nature and causes of depression. One is the medical theory which says that depression is a physical illness which is caused by a chemical imbalance in the brain and which has a genetic origin. The other is the psychological theory which says that depression is our response to our upbringing, the present circumstances of our life and our sense of being vulnerable and of little self-worth. The first theory is supported by most psychiatrists and by those people who prefer to explain human behaviour in terms of physiology. The second theory is supported by psychologists and psychotherapists and by those people who prefer to explain human behaviour in terms of personal experience.

Like everything in life, these two theories have advantages and disadvantages. The first theory has the advantage that, if you are depressed, you don't have to feel responsible for your depression, but it has the disadvantage that if your treatment is simply medication designed to attempt to re-establish the chemical balance in the brain (though no one knows just what a chemically balanced brain actually is) then, while the treatment might seem to be effective in the short term, depression is likely to recur. Psychiatrists who believe in this theory don't talk of curing depression but of managing the depressed patient. The second theory has the disadvantage that you have to take responsibility for your depression, but it has the advantage that you can change and end depression forever (though the best way of making this change is far from clear).

In all the years when I worked closely with depressed people I often wished for a magic pill which would take away their suffering, but I have seen the evidence steadily mount that depression is something that arises out of the way we see ourselves and our world, and that we are capable of changing how we see ourselves and our world so that depression never again becomes part of our experience.

Discussions about depression are often confused because the words 'depressed' and 'depression' are used incorrectly. People will say that they are depressed when what they mean is that they're disappointed or dispirited. They'll say , 'I'm depressed that my son didn't pass his exams,' or 'I find this weather really depressing.' The word 'sad' is used to denigrate a person, as in, 'He's a sad guy', when in fact being sad or being unhappy is the appropriate response to loss or disappointment.

There is a very great difference between being depressed and being unhappy, as anyone who has been depressed will know. When we're unhappy, no matter what terrible thing has happened to us, other people can comfort us and we feel warmed and supported. When we're depressed there is a barrier between us and other people. We see them doing comforting things, but nothing gets through the barrier to warm and comfort us. When we're unhappy we can comfort ourselves. We speak to ourselves kindly and look after ourselves. When we're depressed we'll do nothing to comfort and help ourselves. We have turned against ourselves and hate ourselves. We find ourselves alone in a prison where we are both the prisoner and the cruel jailer.

The essence of the experience of depression is that we are alone in a prison. All depressed people have their own individual image of this complete isolation. Some people describe themselves as being in some kind of pit; some of being alone in some vast, desolate, dangerous landscape; some of being some kind of sealed enclosure; some of being wrapped tightly in a cloth or weighed down by something immensely heavy and unmoveable.

Complete isolation for an indefinite period is the torture which will break the most hardened prisoner. All jails and concentration camps use it. It is this sense of utter isolation which makes depression far worse than a physical illness. When we're physically ill, even though we may be in great pain and discomfort, we can for short periods separate ourselves from our suffering body and enjoy a joke or feel close to others, but when we're in the prison of depression there is a barrier as impenetrable as it is invisible between us and the rest of the world and we cannot escape.

Over many years I have been listening to the stories of their lives that depressed people tell. No two stories are the same, but every story has the same theme, just as the theme 'boy meets girl, boy loses girl, boy gets girl' is a theme upon which many millions of stories have been built. Following is the theme which underlies all depression stories.

The story starts with the kind of upbringing that most of us have. All babies come into the world full of unself-conscious self-confidence, but by the time babies have turned into toddlers they have learnt that as they are they're not acceptable to their families. They have to learn to be clean, unselfish, unaggressive, obedient, that is, they have to learn to be good. Being good means that you believe that you are never good enough. Some of us grew up in families where the adults were easy-going, warm and accepting, and so we learned to think of ourselves as being, not perfect, but basically valuable and acceptable. Others of us grew up in families where the adults set us high standards and inflicted harsh punishments when we failed to meet those standards. Our parents might have threatened us with the loss of their love, or told us we would be being sent away if we weren't good, or they made us feel guilty for not being good, or, if we displeased them, they isolated us, or beat us, or, as in sexual abuse, they treated us cruelly and told us that we deserved this. Growing up in such families we learned to think of ourselves as being unacceptable and therefore we had to work very hard to be good.

Most of us grew up in families where we were taught that we lived in a Just World, that is, that ultimately and invariably bad people are punished and good people rewarded. All religions teach this, though they differ in how they define good and bad, rewards and punishments. A Just World is one where nothing happens by chance. If we believe in a Just World we can answer the question, 'Why did this disaster happen to me?' only with 'It was my fault' or 'It was someone else's fault.' We cannot say, 'That happened by chance.'

Most of us grew up in families where the adults told us that the way they saw the world was the right way and, if we saw things differently, we were wrong. Few of us were taught that what determines what we do isn't what happens to us but how we interpret what happens to us, and that we are always free to change our interpretations. Thus most of us grew up believing that what we saw as the world was fixed and real, and how we experienced ourselves was fixed and unchangeable.

If you believe that you are in essence bad and unacceptable, that you live in a Just World, and that everything is exactly as you see it then you have laid the foundations of the prison of depression. All you have to do is wait for a disaster to occur to you.

This disaster might be something which other people can see, or it might be a loss or disappointment which is private to you. Whatever the disaster, you discover that you have made a major error of judgement. The world and your life aren't what you judged them to be. You feel yourself falling apart, and this is utterly terrifying. Depressed people often speak of the panic which preceded the onset of depression, but others, not wanting to remember this terror, say that depression came out of the blue.

In your terror you ask yourself, 'Why has this disaster happened to me?', and, being a good person, you have to answer, 'It was my fault.' Good people, being experts in guilt, can manage to blame themselves for any disaster, however unlikely. Blaming yourself for the disaster brings a kind of calm for you now have an explanation for what has happened, but it is the calm of the prison of depression.

In blaming yourself you turn against yourself and hate yourself. Believing yourself to be wicked you become frightened of other people in case they see how bad you are, and so you cut yourself off from them. (By 'cut yourself of' I am referring to that sense of being connected to other people, to the world, and to our past and future which we experience when we are happy.) You cut yourself off from your past, for all you see there is evidence of your wickedness. You cut yourself off from the future for all that lies there is punishment for your wickedness. You cut yourself off from society and nature for you are too wicked to be part of that. You have cut yourself off from every aspect of your life and thus, inadvertently, you have created the prison of depression.

There is a way out of the prison. Discover that what you see as fixed and real is actually your interpretations and that you are free to change your interpretations. Now you can see yourself as valuable and acceptable. You can see that events can happen by chance and that you don't have to blame yourself for every disaster. As you make these changes to your interpretations the walls of your prison disappear.

However, making these changes isn't always easy. Old habits die hard, and you may need some help.

Dorothy Rowe

Click here for "Depression Two": Treatments and therapy

Dorothy Rowe Breaking the Bonds: Understanding Depression and Finding Freedom HarperCollins £8.99

Dorothy Rowe Depression: The Way Out of Your Prison Routledge, £10.99

Lewis Wolpert Malignant Sadness Faber, £9.99