Depression Part 2

Okay, let’s get a little more deep into the topic of depression; what causes one to be depressed? Also, what is behind the rising rates of depression? (an increase the likes of which has never been reported before). This can be complicated because of the sheer complexity of our brains, our individual personalities, our personal experiences, etc. Is it a chemical imbalance issue? Is it a spiritual issue? Some kind of combination? 

Empirically, it is most likely NOT due to a chemical imbalance. I know. This is hard to take in since according to recent surveys 80% of the public believes depression is caused by a chemical imbalance. However, in July of 2022, the University College London published their large-scale review of  various studies involving tens of thousands of participants, to determine if serotonin levels (high or low) have any influence on being depressed. The study’s lead author states “It is always difficult to prove a negative, but I think we can safely say that after a vast amount of research conducted over several decades, there is no convincing evidence that depression is caused by serotonin abnormalities, particularly by lower levels or reduced activity of serotonin.”

Let me be clear, I am not saying that our emotional struggles/depression have nothing to do with chemicals in our body or other biological factors, rather I just wanted to highlight that relying on the “chemical imbalance” theory as the go-to/main cause for our depression is narrow minded and may blind us from other things that may better explain the cause and/or continuation of our depression more accurately.

So, if it can be reasonably argued that depression is not correlated with serotonin levels, then what might be causing this spike in depression? 

Once again, as often is the case, we can turn to the past for answers/insight. Viktor Frankl, in his book The Unconscious God, writes of what causes a societal uptick in depression.  What Frankl believes is that a societal shift in depression would be the result of an “existential vacuum”. An “existential vacuum” is defined as “not only a sense of meaninglessness but also of emptiness” (90). What leads a society to feel this sense of meaninglessness and emptiness that arguably has more of an impact on our depression than a chemical imbalance? Frankl lists 3 causes:

1. A loss of traditions and values

2. Reductionism (the view of human beings as being nothing more than primal drives and instincts

3. An obsession with the self

All 3 of these causes can begin to feed into themselves and create a deadly feedback loop. If we do not have spirit in us, if we are nothing more than another animal in this world (reductionism) and our spirituality is nothing but a culturally conditioned response to events or a mere firing of neurons in our brain, then there is no deep meaning in our traditions and values. Our traditions and values are no better than any other set of belief systems; so why hold onto them? Why not just give into our animal desires? If there is no meaning to be fulfilled in following our set of traditions and values then we naturally turn inward. Why not look out for me and my own? If there is nothing calling to me, outside of myself, of value and meaning, then hyper self-interpretation and analysis follows.  Frankl states:

As the boomerang returns to the hunter who has thrown it only when it has missed its target, so man returns to himself, reflects upon himself and becomes overly concerned with self-interpretation only when he has, as it were, missed his mission, having been frustrated in his search for meaning. (97)

Have certain traditions and values caused harm to individuals or sets of people at various times in history? Of course. But there is a difference between the innate goodness of the value, the meaning that can be had if we fulfill that tradition or value and our human proclivity to fall short. We have to, of course, switch out the bath water from time to time (re-evaluate our value system) but that is different than abandoning the entire system as a whole (throwing out the baby with the bath water). When that occurs, we are on our way to an existential vacuum. 

So what might be done about this? Might there be a turnaround in the depression levels in our society if we return to a set of traditions and values that offered us a way out of ourselves/our own hyper self-interpretation? If we start to view ourselves as not only biological in nature, but also spiritual, might we begin to feel our life has purpose and meaning? If we are spiritual creatures who have a responsibility to fulfill a set of values in this world, might we start to look outward for ways to fulfill that purpose? Yes. Yes. and Yes. 

I tell my clients frequently that we all need something to do. We need a quest or ideals to strive for (much like the ideals found in traditions and values). Stories, movies, and video games that are predicated on a quest are widely popular. There is a reason for this. To live our life as if it’s a quest; to live and pursue a mission is how we ought to live. When we live as if we ought to live, fulfillment follows. Living as we want to live, to pursue what we think is “freedom” (turning our back on tradition and values to live unencumbered by moral rules/guidelines), to satisfy our physical desires (reductionism), leads to an obsession of the self; If that occurs, misery is what follows. 

So, pursue what is meaningful. Pursue something that will place a demand on you. Pursue something that is focused outside of yourself. Have patience with yourself as you attempt to discover that meaningful pursuit in your life…what else are you going to do that is more worthwhile than that? 

Depression: Part 1

This topic, depression, will be broken into two parts. Understanding depression, treating it, managing it, etc. can be approached from so many angles. This post will be more looking at depression on a surface/practical/lifestyle level. The next post will go deeper into the realm of meaning and purpose and how the lack of, can lead to depression. But for now, let’s not go too deep, let’s keep it practical, and start by looking at our everyday choices and what they could be doing to contribute to our overall mood. 

When I’m treating someone with depression I start by exploring if what they are feeling is typical or clinical. The reason I do this is because all of us are vulnerable to the ups and downs of life. When in graduate school, I was an intern therapist at the university’s mental health clinic (may the good Lord above forgive me for the terrible therapy I provided those people). Before each appointment, the clients would be given a survey to fill out on an electronic tablet. The survey was tracking their mood and overall depression levels, comparing and tracking their progress from their 1st appointment, to each following week of therapy. In order to determine if they are actually depressed, their scores on the survey had to be compared to the general population’s scores. The general population meaning, those who are not in therapy currently but just going about their daily lives. The client’s results/scores were placed on a 0-10 scale (0 being no depression at all, 10 being severely depressed, if not suicidal). Now, if you were to guess what the average score of depression was in the general population; or in other words, the level of sadness that everyone is usually walking around with, what would you guess? The answer is 4-5. Upon seeing this, the clients wouldn’t feel so bad when they would score a 6-8 because compared to everyone else, come to find out, they’re not so bad. The next step I would do with these clients is explore with them lifestyle changes they could make, to take their score from, let’s say, a 7 down to a 6, then over the next few weeks, from a 6 down to a 5, and so on. 

Depression and pain can be lonely, because well, you are the one feeling it. We can’t literally give it to someone else or divide and share it. However, when we know that on average, we are not that far off from the general population’s scores of feeling negative emotion, it can give us hope. That maybe, just maybe, we can make some adjustments in our lives to start to feel better; because very often, if not always, you have to do better before you feel better. 

To “do better before feeling better” is the correct order of operations. All too frequently, we wait to feel better (motivated) before we do better (action/change). We have to be driven by discipline, devotion, and an acceptance of pain (all of which are deeper than motivation). But where do we start? What areas of our life can we begin to explore to discover how we could be doing better?

May I suggest looking at the following areas of your life (almost like an inventory) and look for any ways, no matter how small, you could be doing better. The key to this is honesty; to honestly and openly reflect on how you are living now and if there is any way you could do something differently that would benefit you. If you open your mind and soul to this, you’ll hear that small voice inside you guiding you to clarity and direction.

Sleep - What are my habits around sleeping? Do I/Should I get up at relatively the same time and go to bed at the same time every night? Do I have a nightly routine that helps my body, mind, and soul get ready for bed? (A routine that doesn’t involve screens at least 1 hour before bed). 

Nutrition/Food & Water - How much water do I drink? If I’m being honest, should I drink more? How much sugar am I ingesting each day? Is there a balance (hey, I enjoy a cookie and donut just like anyone else) that is now off? How do I feel when I eat healthier vs when I let loose? 

Exercise - Am I either lifting weights or engaging in cardiovascular type workouts at least 3-4 times a week for 45 mins each time? Where could I start? Could I at least go for 2 walks this week? What support can I ask for to get this done? 

Relationship with Screens/Entertainment - What entertainment am I taking in? Pay attention to how you feel afterwards. Have I consumed too much? What is this time on screens really doing for me in the context of my overall mood? 

Time management & Routines - How do I spend my time? Am I productive at work? What do I do with my free time? Do I live my life with a plan in mind that is fairly consistent? Is my time management too strict and organized? Too chaotic? Do I routinely set aside time to be with people? Do I spend way too much time online? 

Spirituality - Do I feel connected to something bigger than me that leads to positive growth? God? Nature? My community? 

Relationships - What is the state of the most important relationships in my life? While I may not have the types of relationships I want (ex., being single and wanting to be married), do I still take time to nurture the familial and peer relationships that I DO have? Is there a strained relationship that I am avoiding? Do I need to work things out with this person before it gets worse? 

Work/Job environment - Is the work I am doing meaningful? If so, why or why not? Am I satisfied with my work? Would I feel better if I really gave it my all? Do I have a decent relationship with my boss or co-workers?

Cleanliness of living spaces/work spaces - Think of your room, workspace, home and your mind as being reflective of one another;  how are things looking? Can I pick an organizing/beautifying task in one of my spaces and make it better? How does it feel when I do that? How might a cleaner and more beautiful space affect my mental state?  

Values - What inherently good values are important to me? Am I living up to them? For example, Do I value honesty? Do I lie frequently to others? Do I lie to myself? Telling the truth to myself - What do I need to change!? Finally acknowledging the truth-  Do I need to break up with him?  I wonder how I would feel if I really tried to tell the truth for 2 weeks. Hmmm.

Do I value kindness and compassion? I wonder if I would feel better if I made a deliberate effort to reach out and help someone that is in need of help. Or at the very least, look around and seek ways to help others in my neighborhood. Are my beliefs/perspectives/value system bearing good fruit? 

Okay, now that you have a roadmap for a lifestyle inventory, give it a try. There are various ways to look at and treat depression, but this is always a good place to start. It will take effort, lots of reflecting and sometimes some bravery, but I encourage anyone to do this. Yes, it may reveal some failures in our everyday choices. Yes, it may leave us feeling down about ourselves, but that feeling is due to a choice of perspective. You can look at this inventory as a sign of your failures (which, okay, it could be) and/or you can look at it as a roadmap to feeling better. 

In a world where immediacy and quick fixes abound, getting back to patiently improving ourselves a little bit at a time can be hard but trust me, it’s worth it. I’ve seen this approach effectively help people not only make positive change but sustainable change! Except for some comfort and perhaps pride, what do you have to lose? We can accept the pain of making necessary changes now, or experience the suffering from not making these changes later. 

“The conquest of the soul is in reality a work of patience, self sacrifice, and devotion.” - Carl Jung

“Straight, not straightened.” - M Aurelius

Part 1 of The Big 3:

Anxiety

by Ron Squire

In my experience as a therapist I have treated a lot of what is sometimes referred to as the “big 3”. The big 3 are Anxiety, Depression, and Trauma. Today’s thoughts will focus on Anxiety (although at times, not always, but at times - all 3 can become connected, interwoven, and start to feed off one another). 

Anxiety can be seen as an alarm system. Anxiety comes from a very ancient and old part of our brain. Its main purpose is to keep us protected and alive. Anxiety is actually what has contributed to us as a species surviving this long. Anxiety overestimates threats and underestimates our abilities to deal with the threats (whether real or imaginary). Think about it, if we perceive a threat, and we don't feel we can handle it, then we run. Running away from something leads to a higher chance we’ll stay alive versus confronting it.

Another perspective on anxiety is that it’s a form of time traveling.Those suffering from anxiety or consistent worry live in “what if land” (future mindset) and not in “what is land” (present mindset). Constantly wondering about the “what ifs” in life can lead us down an endless maze of possibilities with danger and harm lying behind every turn. Thinking about the future is not always bad though. Future based thinking is necessary at times. There is, however, a difference between healthy future thought vs unhealthy future thought. William James in his book The Varieties of Religious Experience discusses this difference as “Fear Thought vs Forethought”. Forethought is good - “What do I pack for my trip?  How much will I need to save up for a new car? How many string cheeses will we need to bring to make sure our children don’t turn on us and lead a rebellion of violence and aggression?” Fear thought is bad. What differentiates fear thought from forethought you ask? Fear thought is thinking about something coming up that may be challenging and feeling incapable. There is something coming up and I AM INCAPABLE of meeting the challenge (remember, anxiety is an overestimation of a threat and an underestimation of our ability to deal with it).   

One well-intentioned goal of many clients is to “get rid of” their anxiety. While I understand their desire, that is something that will never happen. Anxiety is a part of our story, however, it does not have to be the entirety of our existence. Anxiety is not going away, but to what degree we feel anxiety (clinical or typical) we can maybe do something about.

Here are some general things I myself have tried as well as my clients that have been successful in keeping anxiety in check; at least enough to be able to more effectively navigate the challenge ahead:

1)Deep breath, step back - oxygen is fed to our frontal cortex, the analytical part of the brain responsible for taking perspective and navigating our way through the challenge in front of us. Oxygen intake will bring back online this part of the brain that can help keep the anxiety in check. 

2)Ground yourself in the present - check in with what IS, not what if. Then, really take stock of your capabilities to deal with what IS. Talk to your anxiety, thank your anxiety for doing its job. But then you can discard it by gently steering that anxiety in the right direction. Just by slowing down your breath and turning back on the analytical part of the brain (prefrontal cortex), you give yourself time and a chance to make the next best decision/move.

3) Choose your Move - 

But what is the move I should choose? 

To conquer your anxiety it takes voluntary, incremental steps towards the thing you’re afraid of. 

Do you over involve yourself? Are you a control freak? Does the loss of control bring up anxiety? If so, then the conquering of your fear would be taking voluntary incremental steps towards letting go; to remove yourself and just be. It’s not about inaction but rather disciplined inaction. 

Do you isolate yourself? Hide out? Avoid? If so, then the conquering of your fear would be taking voluntary steps towards the very thing that scares you. 

To engage or disengage? That is the question when it comes to anxiety. Which do I do? Well, it depends on what is more scary to you. If stepping forward and engaging is what terrifies you, then that is what you must do. If stepping back and letting go is what terrifies you, then that is what you must do. 

Anxiety is real but not real like a pen or an external object we can touch, taste, smell, etc. Anxiety is experienced within and once we recognize it for what it is (an alarm system that is just trying to protect us), take a deep breath, ground ourselves in the present, and start to bring back online the analytical part of our brain (introduce other perceptions or perspectives), we can choose what we do with it. 

To close I can’t say it better than Marcus Aurelius, in Meditations, when he says this about anxiety:

“External things are not the problem. It’s your assessment of them. Which you can erase right now.” (110)

Today I escaped from my anxiety. Or no, I discarded it, because it was within me, in my own perceptions - not outside.” (121)

Citations:

M. Aurelius - Meditations

William James - The Varieties of Religious Experience