When 2 years ago (almost to the day) I received a message to tell me that one of my most charming, beautiful, intelligent and star pupils had been found dead I was profoundly shocked and saddened. He had ended his own life and I had not seen it coming. I could not believe it. I felt so guilty. I am a psychologist, specially trained to deal with Depression and Mental Health and this one came as a huge shock.
I did not know what to think, feel, or say to myself about this. I was just devastated. I found myself thinking of him for days and days, wishing I could have done more. For months and months I found myself having ridiculous thoughts. A feeling that, this can’t be right. He’s staged it. He is faking his own death. I had absurd thoughts. Of course he hadn’t. This was me struggling to confront the existential void of what it means to choose to exit.
I kept thinking I saw him when I’d walk up to the university I taught at. It was a very alienating experience and what it revealed to me is that often when a person has decided to end their life they can be so relieved with having made this decision, they seem fine. Also if they are determined to do so, they will ensure nobody realises, so that their attempt can’t be sabotaged. In fact some people report that they seem a little happier.
I look back on the email he sent me a few weeks before thanking me for everything I had taught him and realising that this was a very quiet goodbye. Tears always flow. It is distressing for me to bear the realisation that for some people the option not to be feels safer. I don’t know what choices he made and why he made them. But I so often wish I’d had a better connection with him to help him out and help him have hope. I don’t judge his choice. I am just so sad about it. I am sure I am not alone in having been impacted by Depression.
'However, no matter how many categories and lists we make to diagnose the symptoms of Depression, there are no two journeys into Depression that are identical. Just as grief is always personal so is Depression.'
Depression is today’s leading cause of “disability” and a spreading epidemic across the globe. 1 in 5 adults in UK suffer from Depression, with women in middle-age being at highest risk. About 55,000 suicides occur across Europe every year, which means that a death occurs by suicide every 2 hrs in Europe alone.
Globally (according to WHO) 360 million people of all ages are suffering with Depression and the statistics do not include attempted suicides. Death by suicide is the UK’s leading cause of death for men aged between 20–34. The recent deaths of Kate Spade, Avicii, Antony Bourdain and Sophie Gradon show that depression is indiscriminate. Everybody has their breaking point and unless we expand our understanding of it and review our treatment plans for it, then I fear the figures will just get worse. We have a huge problem people and we need to break through our blind spots.
I am compelled to do something about it and this is why I am writing this article. If you are reading this, you may be too. I really want to help people suffering with the impact of Depression; either because they are coping themselves with a diagnosis or someone they love is.
This is not an altruistic thing. It is because the opportunity to do so will imbue my life with meaning and with a little bit of support from the right people I may leave this earth feeling like I actually did my bit to make a difference. This is my investment in hope. Finding hope and a way forward is vital. Please reach out or share this article if you want to show me your support. The more of us actively spreading a new voice the more chance we have of helping people coping with Depression. So here goes…
What is Depression?
Depression is a Psychiatric Condition diagnosed when a disruptive mood occurs, which is persistent. The DSM-5 (Diagnostic Manual Psychiatrists and Psychologists use as their Clinical Bible) includes a number of Depressive Disorders; such as Disruptive Mood Dys-regulation Disorder (DMDD), Major Depressive Disorder (MDD), Pre-menstrual Dysphoric Disorder (PMDD), Post Natal Depression, Substance/Medication Induced Depressive Disorder, Unspecified Depressive Disorder and Complex Bereavement Induced Depressive Disorder. There are long lists delineating diagnostic features and possible causes for each one of these.
However, no matter how many categories and lists we make to diagnose the symptoms of Depression, there are no two journeys into Depression that are identical. Just as grief is always personal so is Depression. I have never met 2 people, in my clinical practice, who have the exact same journey into Depression. Some symptoms will be similar but the actual lived (inner-felt) experience of the symptoms, how they are understood, what attitudes emerge in response to these symptoms and how they are handled is 100% unique. Nobody has the same Depressive experience. We are all individuals swimming in deep waters and for each one us the waves and currents are different.
So why does the medical model hold on to the pretence that it is predictable and knowable? Unfortunately I fear it says more about the need to find certainty in lived distress and to commoditise recovery than our actual ability to heal Depression. The cynic in me can’t help recognise that of course billions are being made through medicalising this issue. I am sorry to be such a cynic but children as young as 8 are on anti-depressants and in some cases Psychiatrists – especially outside of Europe – make a lot of extra money when prescribing anti-depressants in the form of bonuses, holidays and cash payments.
What we do know for sure is that Depression is terribly frightening. Exhausting. Overwhelming. There are good days and really bad dark days. In many cases it interrupts the sufferer’s ability to function and cope with life. It is crippling. It is not just feeling down. Or sad. It is an incredibly difficult psychological experience, which paralyses the person in it and throws them into a dark, hopeless place. So the fact that huge numbers of people in Mental Health units report feeling de-humanised and not actually accessing full recovery is like throwing oil into the fire. So many people are medicalised, drugged up to their eye balls and sadly in some cases – unfortunately – the concoction of the drugs actually prescribed cause increased suicidal ideation. So what is going on?
The medical view on depression is complex and it baffles most people. The key ideas are all regularly being debunked and these are: (a) Depression is a genetic issue (b) Depression is a Dopamine issue (c) Depression is the result of Immune System Problems.
So which one is it?
Unfortunately nobody can say for sure. Could be all of these. Or one of these. Or it could be that these are just the physical neurological manifestations that emerge in response to lived experience in life. Nobody can offer a definitive clinical cause of Depression.
The dominant hypothesis is gradually being debunked. This was that Depression occurs because of a faulty gene which disrupts serotonin transporters and this makes people more susceptible to developing Clinical Depression when distressing life events occurs. The point of this view is that this faulty gene increases production of serotonin transportation and that is how SSRIs (antidepressants) work by slowing down the transportation of such a neurotransmitter. And indeed people on these drugs do experience an alleviation of symptoms.
However a recent study in the US including more than 40,000 people who were diagnosed with Clinical Depression found that there is no significant relationship for the link between stressful life events and the particular gene coding for serotonin transporter. This may explain why some people don’t respond to SSRI meds. These are many! I guess it may be that in those patients it is a dopamine production malfunction which is connected to reward and motivation experiences. But again, the evidence for this theory is being debunked too. And doctors never know when they prescribe medication whether it is one or the other. In some instances, meds for both are offered in the hope that one of them will work.
In all my years as a Psychologist, I have never yet met a client who fully recovered and healed from Clinical Depression as a result of taking medication. What the drugs seem to do is numb the symptoms and this feels like progress to the depressed as the ferocity of the symptoms is reduced and, of course, it does mean that they can cope with life.
I am not knocking that at all and it is possible that the subsequent positive experiences of life that follow because of the alleviation of symptoms can help to assist recovery from Depression; so long as the sufferer is engaging in self compassion and authentic engagement with themselves. Anything that helps them get through the day is important. However in my experience, the way in which a person habitually relates to themselves doesn’t change with meds and without the reflective process permitted in compassionately focused therapy then recovery doesn’t really happen.
Why is this important?
It is important because there are deeply held misunderstandings in society which promote the idea that recovery from Depression is medically based, as it is always seen as a Disease. This forgets to address the wider picture here – that we are more than just neurochemistry.
We are mind, body and spirit always interpreting experience through our own special lens; thus affecting our intentions about life, our self worth and our openness to feeling valid and hopeful. So seeing it just as Disease misses the complex nature of what Depression reveals about humanity. We are not just what we think. We are what we experience, feel, think (both consciously and unconsciously) and do.
We are so complex that in my opinion the Medical Disease model is absolutely narrow. Having said that, more recent research within the Medical model is now suggesting that Depression may be the result of Immune System errors. The argument goes that when you are depressed, or stressed the stress hormones released cause an inflammation in the body and the brain and this causes Depression. This is a new idea coming out of Cambridge University and merits further investigation.
Nevertheless, I am still left wondering about the merits of the human brain and am aware that the lived inner experience that happens unreflectively or unconsciously in our minds determines what we tell ourselves about ourselves, about our life and about any meaning we feel we can experience. We are meaning seeking, interpretative and energetic beings aren’t we?
Neuro-plasticity of the brain shows that when we experience life as good, safe, fulfilling and content we end up having unconscious positive core beliefs and in response to this, we actively stimulate that part of our brain that produces happy hormones. It is confusing and we as a Psychiatric and Psychological community have been obsessed with what comes first. But it seems that this is a naive perspective; as all experience is automatically and simultaneously connected through mind, body and spirit. We are all of it at once and it happens at an invisible level every minute of our life.
We have thousands of unconscious thoughts that go through our mind every day and we don’t even know we are having them. We of course discover these inner experiences when we pause to reflectively engage with what they are telling us. That is what therapy is all about and studies of Mind, Body and Spirit practices like Yoga, Mindfulness, and Meditation show repeatedly the obvious connections between what we experience and what our brain does with it. We are led and coloured by our lived experience and how we unconsciously interpret it.
So the question I am left pondering is whether it may be that what causes Depression is the way in which we relate, connect and understand our lived experience in life.
If you suppress pain, trauma, rejection, abandonment and you stop recognising what your inner experience is like, and what this means about how you relate to you, your friends and family and you start to experience yourself judgementally, critically and develop a self-hating critical inner voice then the brain has to adapt to this and produces the hormones to show you that there is no hope.
I am certainly not suggesting that Depressed people think faultily. Not at all. But what I don’t think Depressed people have had the opportunity to reflect on is the actual lived experience of what being them has been like, what they tell themselves about that, what it has been like to cope with distressing life events.
Depressed people, in my encounter with them, have not had the opportunity to psychologically internalise a compassionate, safe and valid sense of self. They are made to feel problematic, faulty and wrong in their experience of Depression and this is even more devastating; given that they are already coping with a disrupted and despairing sense of self.
Depressed people often hold onto the belief that there is no hope, there is no point, they don’t deserve to feel valid and good, and they have no control or choice in how they find themselves being. This is a devastating experience for them. Further studies into how reflexive compassion heals the brain from Depression are needed.
What I do know is that the only way to help people heal who come to me with Depression is to guide them into an authentic relationship with themselves, with a recognition of what it has actually been like for them, exploring meaningful ways of engaging with life and with developing a compassionate attitude to themselves.
Of course this is a huge challenge as people who are struggling with Depression resist being compassionate and kind to themselves and the journey is often a long one. But with curiosity, an open non judgemental approach and a deepening of the therapeutic relationship we do eventually open up the reflective space for meaning and compassion. It does work!
Meaninglessness and self rejection are at the core of Depression and that is why I believe meaning oriented therapy that engages them in self compassion is a valid antidote. If they feel valid, seen, understood, cared for and supported unconditionally then they recover.
Overcoming Depression is possible. I meet so many people in my practice who find a way to recover from Depression (from mild, to moderate to severe). It is not easy but it is possible.
The key is Self Compassion. Validation. Being heard. Being able to express the inner lived experience of such pain. To be free to authentically express choice. Being free to appreciate and discover personal meanings and purpose. As Frankl and Edith Egger have eloquently shown, human beings have the capacity to meet adversity and the most horrific of situations with dignity, courage and, in that, they can imbue themselves with meaning. Although circumstances of life may be horrendous and devastating, the opportunity to reflect on
what it was like to experience such events
what it is like to reveal such experiences to oneself
what it is like and what it means to own choice in attitude, beliefs and on interpreted meanings
how to move forward in life with self compassion
what it reveals about the energy and attitude of one’s relationship with themselves
..are all healing. Tough. Sometimes enraging as they reveal inner pain and devastation. But ultimately human and focused on discovering choice, freedom to be who you are, authentically revealed and held.
I find it a huge privilege to help people who are facing Depression. It is so hard. But I hope that with this article I have contributed something meaningful to the discussions around Depression. What are your thoughts and more importantly what is your experience?
In response to my original question – I believe there is loads of hope. With openness, compassion and a whole person approach to wellbeing and psychological health we can help everyone.
I really welcome your responses. I’d be thrilled with your support. I am hopeful. I am available. I am here.
With hope and compassion,
Dr Chloe Paidoussis Mitchell is a leading grief and trauma psychologist working in the UK. Most recently she was appointed as the clinical lead for the Overcoming Grief app and has developed strong expertise in delivering digital mental health apps. Chloe is very happy to answer any questions. If you want to get in touch, don’t hesitate.