Our knee-jerk reaction to the idea of being depressed is that it is a terrible state in which to find ourselves: sad, discouraged, stressed out, fatigued, puzzled, hurting, lonely, afraid. It sounds pretty awful. So why is it that some doctors and philosophers put a positive spin on depression, saying that it can frequently be good for us?
Why is it that most psychiatrists today would not regard the experience of depression as an illness in and of itself?
Depression normal? That’s right, and often necessary. There are times when you and I should feel depressed, and there may be something wrong with us if we don’t. That is because what we call depression, with all its accompanying distress, is a particularly human way to react to many adversities, especially those that involve the loss of something or someone we value greatly.
Someone you loved died in the attacks of September 11th, and the grief you experience is a form of normal depression. You’re one of the thousands who lost jobs and financial security in the wake of the Enron scandals; the agitation, anger, and sense of futility you feel is depression. Any number of scenarios can push us toward the brink, bringing on frustration, tears, or just a pervasive numbness and fatigue.
Depression becomes an illness when it is too severe, considering the circumstances that have provoked it; when it so overwhelms a person that he or she is extremely disabled and may give serious thought to suicide; or, most commonly, when the depression doesn’t go away: when we linger in a bleak no-man’s-land, persistently anxious, worried, pessimistic, not operating to our full capacity, irritable, fatigued, sleep disordered, or with any number of vague physical complaints.
Whether an episode of depression remains healthy and manageable or takes any or all of these unhappy routes depend on a set of variables that can be summed up under the term “resilience”. Resilience comes in three parts: psychological, biological, and environmental.
Psychological Resilience is a matter of certain personality traits or characteristics. Resilient characteristics make a person less vulnerable to depression and more likely to cope with it effectively. These include flexibility, courage, insightfulness, humility, faith, a sense of humor, forgiveness, generosity of spirit, and a reasonable strong sense of self.
A person with non-resilient characteristics tends to be more vulnerable to depression and less likely to cope with it effectively. These characteristics may include rigidity, fearfulness, denial, serious self-doubt, narcissism or pride, selfishness, over-dependency, lack of assertiveness, resentfulness, and a tendency to carry grudges.
Closely related to these are the circumstances of one’s upbringing. For example, childhood abuse or trauma, if not adequately dealt with, makes it harder to cope with episodes of depression in one’s adult years.
Biological Resilience is something about which very little is known, but what we do know is extremely helpful. In some people there seems to be a genetic predisposition to being unable to cope effectively with normal depression and consequently they are prone to convert it into a depressive disorder.
Scientists think that chemicals called biogenic amines that transmit information throughout the nervous system-serotonin, epinephrine, dopamine, and a host of others-are involved and that that is the reason why antidepressant medications, such as the serotonin reuptake inhibitors that promote greater levels of serotonin at nerve junctions, are thought to work. Hormones, like thyroid and estrogen, play a role, as do electrolytes like calcium. And regular exercise, a time-tested approach to strengthening physical resilience, has now been shown to have a beneficial effect on depression.
Environmental Resilience has mostly to do with the kind of people who surround us. It is hard to manage normal depression if your family, friends, or coworkers keep putting you down and discouraging you. It’s like struggling to stay afloat in rough water, but every time you come up for air someone pushes you down under again. A resilient environment is made up of people who truly understand and empathize with what you are going through and can offer you proper doses of intelligent support.
There is no way to totally avoid depression. Nor should we try. But we can take steps to be better prepared to deal with depression. Becoming more resilient should be high up on our list of priorities.
Frederic Flach, M.D.
This article first appeared in the March 2009 issue of The Phoenix Spirit