Managing Sadness and Depression - Blog#20 - 7 July 2019
Sadness and depression are two different entities. Sadness is an emotion, as are guilt, shame, loneliness, irritation, and feelings of helplessness, hopelessness, and worthlessness. Such feelings are the most prominent emotions present during depression. Clinical depression goes well beyond mere feelings, however, and is better viewed as a syndrome that includes cognitive, behavioral, and physical ("vegetative") symptoms in addition to mood symptoms. Beyond the negative moods noted above, depressive symptoms also include a loss of capacity to experience pleasure during activities that have typically been enjoyable in the past. Thus, the mood symptoms of depression involve both the presence of negative feelings, and the absence of positive feelings. Physical symptoms of depression include loss of energy and loss of (or sometimes an increase in) appetite and sleep, while cognitive symptoms include loss of concentration and short-term memory, confusion and slowed thinking, and increased difficulty with decision-making. A common behavioral symptom of depression is withdrawal, which sometimes involves wholesale retreat from life, via reduced involvement in pleasurable, productive, and social activities, and retreat from consciousness by escaping into sleep. As feelings of hopelessness escalate, it is not unusual to experience at least fleeting suicidal thinking when depressed, though we can distinguish between passive suicidal ideation (e.g., wishing you were dead or wouldn’t wake up), and more active suicidal planning or consideration of methods. Suicidal risk is associated with hopelessness more that just depression. Withdrawal and suicidal thinking reflect the flight side of our fight-or-flight defensive maneuvers, while the fight shows up in the irritability that often accompanies depression.
So how do we cope with depression, or for that matter, with persistent down moods that are not frequent or intense enough, or accompanied by enough additional symptoms, to meet the criteria for clinical depression? Antidepressant medication may be helpful, particularly if your depression is severe or even moderately severe, especially if you have a past history of pronounced depression. While medication may not be necessary for milder forms of depression, antidepressants are usually helpful in reducing the intensity of severe depressive symptoms, thereby making it easier to access your internal resources, and to take initiative to use external resources. Typically, medication is a temporary crutch, used to reduce symptoms for a number of months or perhaps a year, until you are able to access, activate, and further develop your skills to counteract depression. Medication does not address the sources of your depression, except in the atypical situation in which strong genetic or other permanent organic factors drive a primarily biologically-based depression. Most depression is associated with losses, rejection, failure experiences, or abuse and neglect, and is driven by our thoughts, self-criticisms, interpretations, behaviors, and preoccupation with these experiences. Psychotherapy is designed to address the psychological sources of your depression, and both the cognitive and behavioral habits that maintain depression.
From a behavioral standpoint, it is particularly important to counteract withdrawal tendencies. Such withdrawal is quite understandable. If we feel lousy, have little or no energy, no motivation, and a reduced ability to enjoy ourselves, we are unlikely to feel like doing anything. Accordingly, we are likely to withdraw into ourselves, stay within the safe cocoon of our homes, and avoid social contact or other outside activities. We may further withdraw to sleep, sleeping 12 or 14 hours per day as a means of avoiding conscious experience of our emotional pain. We may also abandon our responsibilities (e.g., housework, paying bills, going to work, or even caring for our children properly), because life sometimes feels too overwhelming to deal with when we are depressed. However, if we are determined to gradually reduce and overcome our depression, it is vitally important that we counteract our withdrawal, since withdrawal often increases depression in the long run, even if it is easier at the moment. Depression and withdrawal often become a vicious circle, in which depression invites withdrawal, while withdrawal further increases depression, etc. Why is this so? Even though we are less capable of pleasure when we are depressed, we are usually capable of at least some pleasure until our depression becomes severe. If we abandon these pleasurable pursuits, we further deprive ourselves of the experience of pleasure, resulting in an even lower mood. If we abandon our responsibilities, we lose our productivity and sense of accomplishment, which typically results in self-criticism and lower self-esteem, which in turn increase depression. And if we withdraw from social contact, we deprive ourselves of the emotional support and social connectedness that is otherwise available from our friends and loved ones, which leaves us feeling more alone, unsupported, and therefore more depressed.
Accordingly, it is imperative that we counteract the withdrawal that often accompanies depression, despite the fact that depression makes it particularly difficult to fight withdrawal. The solution is to be found in discipline, even though self-discipline is particularly difficult to muster when we are feeling low. We cannot afford to wait until we feel like becoming more active, or until we feel like reaching out to others. In life, we often wait for feelings (e.g., hunger, love) to drive our behavior, but sometimes we use discipline to behave in a certain way (e.g., chores or homework) to feel better. Feelings cannot be changed directly, but do change indirectly in response to changes in our thinking and behavior. Withdrawal and passivity are behaviors. Negative self-talk, cynical attitudes, and pessimistic/hopeless predictions are thoughts. We will need to change both, though it is often more productive and easier to change behaviors than thoughts initially. In particular, we need to get off the couch (or bed), out of the house, in touch with supportive friends, and active in exercise. You won’t feel like doing these things, but if you use a few minutes of discipline (e.g., get out of bed and get wet in the shower), the behavior will often flow from there. People seldom get back in bed after a shower, and seldom return home after the first five steps of jogging. So focus on a short burst of discipline to start a behavior. And don’t expect to enjoy yourself as much as you used to – that will take a while. Use a different expectations yardstick – did you feel better after your outing than you would have after staying home in bed? So start fighting depression by focusing on anti-depressant behaviors.
We mentioned both thoughts and behaviors as means of changing feelings, so what about thoughts? Aaron Beck's famous “cognitive triad” is a good starting point. You are more likely to become depressed, and stay depressed, if you harbor and dwell on negative thoughts about yourself, the world, and your future. If you think that you are worthless, that the world is cold and uncaring, and that your future is hopeless, you are likely to become depressed. Even if you don’t typically think these ways, depression (e.g., after a loss or failure experience) will often invite you to think negatively. If you want to think your way out of depression, you must become proactive in addressing the cognitive triad. That is, you must learn how to become self-nurturing and supportive to yourself, in your self-talk, while developing a more hopeful and optimistic, or at least a balanced view of the future. You must also think of the world, or at least your own social world, or perhaps a new social environment that you create, as a potential source of support and connectedness. Cynicism is poison to the mind. It alienates you from your environment, thereby disrupting your external connectedness. Likewise, expectations are thoughts, and we spoke above about new yardsticks when fighting depression. Expect yourself to get out of bed and to activate yourself, but don’t expect yourself to immediately feel better doing so, or to be as efficient as you used to be before your depression. Be patient with yourself, encourage yourself, and maintain hope that you will gradually become more joyful and effective, if you are self-supportive and engage in antidepressant behaviors.
From a different angle, the foundation of depression often includes a feeling of significant loss. This loss may be the loss of loved one, a job, the loss of friends and familiar surroundings after a geographical move, the loss of self-esteem after a failure experience, the loss of health, or some other type of important loss. It is important to address and grieve such losses, and to determine if and how such losses can be replaced as a means of filling the existing void. Grief and sadness must be expressed and worked through before such feelings can be significantly reduced. Time does not heal all wounds. It is what you do over time that heals. Despite the temporarily increased emotional distress experienced when we allow ourselves to cry, it is important to talk about sadness, allow tears to flow naturally, and to otherwise grieve, as such emotional expression and catharsis is necessary to gradually reduce our grief and regain our emotional equilibrium. Some losses can be replaced, though others need to be accepted, while pursuing new meaning in life from unaccustomed sources. Sometimes the problem is not so much immediate losses, but the enduring or residual impact of early losses, abuse or other traumatic childhood events. We typically try to suppress the emotional pain associated with such losses, but the disowned pain nonetheless influences us indirectly from the hidden confines of our subconscious mind. We thereby benefit from suppression in the short term, but continue to suffer in the long term. In these circumstances, we need to muster the courage to face our feelings, memories, and traumas, perhaps with professional help via trauma-focused therapy.
We have only scratched the surface and highlighted a few central themes in the management of depression. For more, check out the chapter on depression in Psychomechanics – Tools for Self-Regulation of Emotions, which I recently published on Amazon. Please note that Psychomechanics is also included in my lengthier book on Secular Spirituality: Beyond Atheism – A Secular Approach to Spiritual, Moral, and Psychchological Practices, also available on Amazon. But there are also hundreds of self-help books that are specifically and entirely targeted at depression. Sometimes it helps to just sit in a bookstore, or read passages online, to see which books speak to you. Or visit a therapist, to see if you can establish a safe relationship where you can work through your losses and other depressing issues. Thanks for listening.