Depression is not very well understood, even by those who live with one of the forms of clinical depression and regrettably by many therapists themselves. I believe it is this reason that depression is poorly treated.
The misunderstanding about depression lies in its confusing resemblances to what we often refer to as sadness. Depression is frequently seen as another word for sadness. The idea that someone is afflicted with mere sadness when they are depressed may even lead others (family, parents, friends) to think they can simply snap out of it. On the opposite end of the spectrum, we have those who think depression is merely a disease, a biological disorder no different than diabetes or heart disease. Depression, for sure, has a biological component to it, but it is about much more than biology. Seeing depression solely this way is to miss the deep psychological components of depression. As with everything, the truth lies somewhere in the middle.
Sadness and depression are very similar in that sad people happen to withdraw from others, cry, and lack interest or energy. This can be said of people who suffer from depression as well; however, the important difference is that the sad person knows what they are sad about, whereas the depressed person does not. A sad person will have no difficulty telling us what is troubling them, the death of a relative, losing a job, etc. The depressed person cannot easily do this.
The depressed person is indeed sad about something, but it needs to be brought out. They are depressed because what they are sad about has been forced out of their consciousness. I have been studying more into Internal Family Systems Therapy (IFS), and part of the modality makes sense to me regarding how I view the person. IFS would see depression as a part of the persons’ natural defense mechanism, an effort to cope, stay safe, and survive, as do I. It would not see the depression as merely a pathological symptom that is bad per se. The part helps you unconsciously choose to be dead to everything opposed to your good because remembering may bring about unbearable thoughts of pain and loss.
Unfortunately, with depression, you also become dead to the very things that aid your flourishing and good as well. This is why it is good to know and determine what values you find important, as you will see and understand better below. The depressed person then spirals into a self-conscious loathing of shame and guilt. On the other hand, the sad person is not affected by their feelings and emotions on a personal level.
There is a reason you are depressed, and that reason needs to be assessed in the therapeutic process, whether that be insight on the client’s behalf aided by the therapist or a direct access approach by the therapist. Understanding is the cure; if not a good part of it. A depressed person may not feel they lack insight and often think it is merely physiological. Still, as they come to a better understanding of what may be eliciting their depression, the better they can begin to address it so the depressed part (so to speak) does not have to work so hard to protect the person. The person will then be free to begin to feel better about themselves because the depression will not bog them down. Addressing unresolved issues and experiencing them in light of your natural coping responses can help the depression not work so hard to protect and turn in on the self.
Also, to have proper insight, it is good to understand how we define happiness, a life worth living, self-worth, and a purposeful life. Sometimes parts of us work harder than necessary precisely because of the way we define these very things. We can do this by clarifying our values by looking at those we admire the most in our family and society. Grandparents are good for this. For instance, I had a 13-year-old girl who was still grieving the death of her grandmother. We made a list of the things she valued and admired most about her Grandmother’s character and personality, and we set out a plan on how she can embody and live those values herself. We did this in light of the 4 levels of happiness.
Lastly, that leads me to the positive psychology movement (the branch of psychology that studies well-being), which is interested in fostering virtue as a vital part of leading a happy and healthy life. It has found that it is not only beneficial to deal with the reduction of symptoms but to balance therapy with aiding the person in developing character strengths and virtues that constitute a life of flourishing and happiness. Our happiness is dependent on how well we live out our natural inclinations towards the good, truth, and beauty. Fostering those virtues and not actively working against them will help tremendously in regards to depression. For instance, it is common for those suffering from depression to withdraw, but this does little good when we have a natural desire for connection with others. Identifying important values and working on a few goals related to these values will go a long way. Our natural and basic moral inclinations to the good do not limit our happiness. The more developed they are, the happier you will become!