Tags: depressed

Working With Clinical Depression (part 1)

Most often people have an adversarial relationship with their depression. Once we see any hint of depression in our minds, we often become reactive and judgmental about why we are depressed. Sometimes our reactions to our depression (judging ourselves and self-medicating) often become more problematic than the depression itself.

First, it should be clear from the start, not all depression is "pathological." In fact, there are perfectly appropriate times when human beings are supposed to feel depressed. Significant psychological trauma, the loss of loved ones, and the diagnosis of a terminal illness are among the legitimate reasons that human beings become depressed. In essence, depression is a natural part of our trauma and grief processing.

Having said that, there are many people with a biological predisposition to clinical depression. For these people, depression is a reoccurring obstacle in their lives, making it tough to thrive and grow. This kind of clinical depression is called "major depression," and if left untreated, it can be quite destructive and dangerous.

Therapy does not seek to eliminate depression. As we said before, depression has its place in the pantheon of human emotions. Psychotherapy seeks to help the patient change their relationship to their depression.

Depression is almost always supported by a narrative. Like two by fours in a solid foundation, a good depression narrative upholds and supports a depressed mood. A depression narrative is also pretty easy to spot in that extreme words are used with great frequency – words like "never," "always," "all," and "nothing." In essence, while reality is actually very nuanced and relative, a depression narrative is very simple, extreme, and full of black and white thinking.

My depression narrative goes something like this:

"I am the unsung hero of an unfair universe, and despite the fact that I try hard and do the right things, I never seem to get ahead! I am always blamed when things go wrong, and I get stepped over and I’m deprived the good things in life. I deserve good things too! Basically life is rigged, so what’s the point?"

My narrative is projecting blame outside of me and onto the people, places, and things around me. This is an "angry depression." Many times, however, the depression narrative will be internal, blaming oneself for all the trouble and difficulty experienced. This is a "self-loathing depression" and it’s this type of depression that is typically associated with suicidality.

Working With Clinical Depression (part 2)

Questions to Answer:

What is your depression narrative? Do some writing about the story of your depression.
How do you judge yourself for being depressed? Do you blame yourself, or do you project blame onto others, or both?

How we internally react to our depression is also crucial. As a depression patient myself, I notice that I typically get reactive to my depressed moods. At the slightest hint of a depressed mood, I will typically tighten up and armor up. I think that depression means I am weak, that I cannot handle my life and my responsibilities – so I hate it. But my reactivity and hate (instead of helping) only fuels my depression, making it deeper and tougher to work with.

Because this is true, working with depression is typically counter-intuitive. In essence, fighting depression doesn't work. Depression will not be intimated or scared away. Getting mad at yourself and the world because you are depressed only deepens and strengthens the depression. This has the net effect of placing me at war with myself – and when that happens, I lose.

So what's a more useful reaction to depression? Let's start with an analogy: working with depression is like falling into quicksand – the more you struggle, the worse things get, and the faster you sink. On the other hand, if you can just slow down, become mindful and grounded, and place your arms and legs away from your body, then you begin to float, then you can very slowly begin to inch your way out of the quicksand.

Here is another analogy I use with my patients: working with depression is like being in a Chinese finger trap – the harder you pull, the more you panic, the worse you are trapped. Just as in the quicksand analogy, the solution lies in relaxation and acceptance of the present moment as it is. The solution lies in making friends with your depression; in making your depression an ally in your evolution. In the end, I had to make friends with my depression, I had to "invite the demon in for tea" (to borrow a Zen phrase), and only then, once I had the courage to stay and connect to my demon of depression (without adding or subtracting), only then do I have the chance to dissolve it or transform it into a more useful emotion.


After relaxing for a few minutes with your eyes closed, in your mind's eye, call forth your depression and instruct it to take a shape (e.g., an animal, a person, a thing, etc). What shape did it take?
If you could speak to this creature "Depression" – what would you say? If it could reply, what would depression say in return?
If you could touch your depression, what would it feel like?
If you could smell and taste your depression, what would it smell and taste like?
After doing steps 1-4, have you noticed any change in your depression? Has the depressed mood increased or decreased? Is it as solid and heavy as it was before, or have things shifted a bit somehow?

After making some room for depression, indeed after inviting it in for tea, the depression typically decreases in intensity, or is dissolved altogether. This occurs because the questions you asked of your depression – they are mindful and curious questions. They were not blaming, judging, or insisting – only curious and grounded. And in response, the depression must weaken, for you are no longer fueling it.