Depression is a many-headed beast. Though the symptoms and expressions can look similar person to person, the root causes are many fold. In fact, someone very smart person (I can’t recall who at the moment) through research found there to be approx 400 distinct root causes/major contributors to depression. How about that?
The mainstream medical-psychiatric pathology model tends to reduce depression to mere biology and genetics, while the bio-psycho-social person-in-environment model (such as I was taught in grad school) looks at socio-cultural factors, psychological strength vs deficit factors, as well as interpersonal and family history. This model is more holistic, and less pejorative, for sure. Yet, the spiritual/psychospiritual domain of life is not much considered through either of these frames. So if, for example, what you’re really experiencing is a purely spiritual/existential Dark Night of the Soul (which I’ll surely write about in future posts) the chances of it (and you) being misunderstood, medically misdiagnosed and mis-treated, are great.
After 20 or so years talking with people experiencing various degrees and expressions of depression, and having been through at least two notable bouts (and one recent profound and life-altering Dark Night experience) myself, I’ve come to see depression as an infinitely complex, meaning-laden response condition; one not reducible to any one factor or cause. Because even if we’re heavily genetically loaded for depression, as the old saying goes, “genetics may load the gun, but trauma (environment) pulls the trigger.” Meaning, we are inseparable from the culture we live in and all the ramifications and manifestations of being a person embedded in and affected by our social environment. As such, one’s personal, idiosyncratic experience of depression, and the manner in which we endeavor to understand its meaning and therapeutically respond to it should be as nuanced as the person is [understood to be] a unique individual.
And how do you measure that? Because we are all unique (paradox: just like everyone else!).
So how do we know if we are truly depressed— clinically, medically, to the degree that it needs clinical, possibly even medical attention, rather than a just little down for longer than usual, more sad than not, appropriately grieving, or otherwise exhibiting a perfectly rational response to a crazy world?
"It is no measure of health to be well adjusted to a profoundly sick society.” said Krishnamurti
Personally, I would argue that modern society, today, is perhaps no more “sick” than it ever was. Rather, a convergence of things seen and unseen has our collective ills on full display, flushed up to the surface, and into the cold, hard light off day. So if we feel depressed right now in the context of a sick society in full focus, I ask you this:
Who is the patient? Us, or our culture itself?
COVID-19 is putting constraints on—and changing— us all. Even if you believe it to be a “hoax,” or overblown, you still have to interact with others that are responding as if its a worldwide crisis. Institutions are changing, and day to day living is markedly different. Nothing is quite like it was. Now some folks are constitutionally rolling with it better than others. And some, especially those that were struggling emotionally, psychologically or relationally before it hit, are very well seeing an exacerbation of signs and symptoms of depression, to say nothing of those thrust into a survival mode due to having lost their income, or housing, and the immediacy of the all out crisis state this produces.
Political views aside (though we cannot entirely extract belief and conditioned perspectives from the equation) our baseline response to the pandemic and all the “new normal” adjustments are impacting all of us in some way or another. And our mental health, collectively and individually, is on the line the longer it goes on.
Let us apply the Goldilocks Principle here. If your response so far is “too cold” (i.e. I don’t care, not affecting me at all, nothing I can do about it), then you’re probably not depressed in the slightest. Great. But, on balance, you might have some work to do on cultivating sensitivity, compassion, empathy. Some personal growth-oriented therapy work might come in handy there.
If your response is “too hot” (i.e. You’re cripplingly depressed— don’t want to eat, get out of bed, feel utterly terrified and/or hopeless), then that depression—situationally triggered as it might be— is most likely hooking into and magnifying predisposing factors, be they genetic, environmental, and/or previously un-examined, unhealed trauma. If this is the case, I hope you seek immediate attention, and I’d be glad to offer you a Free 20 Minute Consult to assess your needs and help you make some decisions (whether or not that involved working with me).
If your Pandemic response is “just right” (i.e. You’re affected, you feel it, you might get anxious or even dispirited about what’s going on, you’re concerned for others as well as yourself, and you recognize the rather dystopian flavor of it all while maintaining a sense that this too shall pass and you’re hopeful at to what’s to come), then you’re probably alright. Probably “Pandemic Blues,” and nothing more. My guess here would be you’re someone with good, as they say “pre-morbid” functioning (i.e. you were doing pretty well in most domains before all this) and you’re probably generally worldly, reasonably psychologically-minded and emotionally intelligent, and tend toward a big picture view of yourself, others, and the world.
This might even be your awakening time. Good for you.
In the end, there’s no “wrong” response to what’s happening out there. How we see it, what meaning we make, and how we cope and respond says as much about who we are (the sum total of our genetics, history, and each and every culture-bound experience that’s shaped us, consciously or unconsciously) as anything else.
Often it’s those among us that care the deepest, that are the most sensitive and empathic, and that have been hurt the most, that experience the most severe impact, but also stand the greatest chance of thriving on the other side of crisis—be that world crisis, or the more personal Noonday Demon that is depression. Especially if we rise to the challenge of seeking and accepting help, including for our mental health, if and when we need it.
If YOU are struggling, feel depressed, or aren’t sure if you are, but recognize the need for experienced assistance, my Integrative Counseling specialty might be worth considering. Available to Tennessee residents via Secure Video/Telehealth from the comfort of your home, or in my home office in Franklin, TN on a case by case basis.
Visit me at Therapy Outside the Box to learn more about why I believe there’s an outside the box solution to every problem. Or send me an email at Chris@therapyoutsidethebox.com or call me at 615.430.2778.
Peace to you and yours,
Chris Hancock, LCSW, ACMHP