two views of depression

the other day, marc challenged me with this idea: can depression, or any other challenge such as alcoholism or bipolar disorder, be an entity of its own, with its own agenda and will to survive?

i’ve been familiar with this concept for quite a while but it’s never really grabbed me. that’s why i’m grateful for marc’s challenge – i always welcome a chance to expand my mind, think differently about things.

let’s use depression as an example and compare two theories:

one: depression is an entity of its own. let’s call that the 12-step perspective. in AA, for example, alcoholism is seen as a “cunning, baffling and powerful disease”.

two: depression is a poorly executed coping mechanism. that is a systems view, advocated, among others, by psychologist virginia satir; for the sake of argument, let’s call it the “systems” view.

what would be advantage of adopting the 12-step perspective? contrary to what is the received wisdom, there is research that shows that people who attribute their misfortune to outside sources tend to be happier. viewed from a certain perspective, that makes intuitive sense, too: the opposite of attributing misfortune to an outside source is often a guilt-infused attribution (“it’s all my fault”).

in therapy, we often spend lots of time helping people dig themselves out of guilt. if i say depression is my fault because i’m too lazy, unmotivated, or passive, or because i’m not smart, attractive or all-around “good enough”, i can feel totally helpless. if, on the other hand, i believe that depression is a disease “out there”, then the enemy does not come from within. at least i’m whole at my core. personally, i remember very well the first time i realized that my depressive episodes were at least partly rooted in my body chemistry. i felt so relieved. there wasn’t something wrong with who i felt to be “me”; it was just some chemistry gone awry.

now let’s look at the advantages of taking the systems view. depression there can be taken to be a coping mechanism, an activity that one unconsciously feels driven to carry out in order to deal with frightening feelings such as fear, anger, loneliness or helplessness. it is almost a form of self medication. one “chooses” depression; of course it is not a conscious decision; it is a choice almost in the way a tortured man makes the choice to lie to his oppressors in order to save his life.

the advantage of this approach is that if the depressed person can see depression at least as partly as a choice and if she can do so without feeling guilty, then she can feel a tremendous sense of control: “i got myself into this, i can get myself out of this.” not long ago, i had a client for whom this worked very well; once he realized that depression was something he had “chosen” (the quotation marks are important!0, he decided that it was a difficult but important place of rest for him. he chose to explore depression as a space within himself that needed to be respected and integrated. when he got out of it he was much wiser and more whole.

of course, as always, these thoughts are really just thumbnail sketches; there’s much more to them. we also need to remember that there are definitely more than two ways to look at depression! having said that, here are two things that come to mind:

first, the two approaches don’t necessarily contradict each other. depression – and any other mental illness – is multifaceted. one could easily say, okay, this part seems to be an “outside force” and that part is something that on some level i’ve chosen.

secondly, the systems view can provide deep and long-lasting insight. however, not everyone is ready for that; for that matter, not everyone is interested in it.  it’s also a useful approach for someone who benefits from feeling that he or she is in full control of her or his life.

ah, control.  now there’s another topic …

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