Perspective: How we can move beyond the depressing story about depression
People with depression have long been told their condition is permanent. What if they heard a more hopeful story?
Human beings can endure a lot — especially if they know their suffering won’t last forever. That resilience can wane or dissipate, however, if they are led to believe the pain won’t likely ever go away.
When it comes to serious pain, clinical depression deserves to be in a category all of its own, as anyone who has faced it can attest. One young woman compared her prior experience with serious physical abuse to what depression felt like. Pointing to her chest, she described to me a pain that was “every day, just right here … like this thing that wouldn’t come off — that made it hard to breathe ... like, I would rather have people beating me than to have been where I was just inside. It hurt that bad.”
Each time I’ve interviewed a person who’s experienced this intensity of pain, I marvel at their strength and emotional depth, even sometimes reminding them, “Homer Simpson doesn’t get depressed.” We don’t often have a public conversation about the depth of feelings that predispose some kinds of depression. But we should.
When depression does come up, it’s usually in the context of a loved one who is suffering, and how we can help. In the past couple of decades, there have been many research studies exploring creative ways of bringing more relief, and even more investigating the wide variety of risk factors that can set people up for depression.
None of the factors that increase the likelihood of depression should surprise any of us: chronic stress, abuse and trauma, sleep deprivation, lack of sunlight or physical activity, nutrient deficiency, lack of meaning and purpose, relationship strain and isolation.
Nor should it surprise us that people who find more lasting healing from depression tend to make adjustments in many of these same areas.
All in all, this amounts to an encouraging and hopeful understanding of depression, supported by the latest research. In combination with new appreciation of the plasticity and changeability of the brain, the collective impact of these lifestyle adjustments point afflicted individuals to what one neuroscientist calls an “upward spiral” that is possible.
This really isn’t really how we tend to talk about depression in America today, though.
The common view
Martin Seligman, the psychologist famous for introducing “learned helplessness” to the world, once proposed three characteristics that fundamentally differentiate between pessimism and optimism:
Personalization: Seeing deficiencies as coming from inside oneself, rather than connected to the circumstances of our lives (“I’m just messed up”).
Permanence: Believing that difficulties will largely remain unchanged throughout one’s life (“It’s always going to be this way”).
Pervasiveness: Considering difficulties as permeating all areas of life (“Everything is awful”).
These mindsets sum up remarkably well the predominant American narrative of depression and other mental health challenges — that they are rooted in the brain, enduring throughout the lifespan, and touch virtually every aspect of life.
I first started noticing this pattern after my own in-depth study of depression more than 20 years ago. Among the many findings, one in particular stood out. Above and beyond the acute, raw pain of depression that many people carried, there was another kind of burden that many carried, related to the beliefs and interpretations they carried about depression — what it was, where it came from and what their future likely would be.
How your body ‘will always be’
Perhaps the most noticeable feature of the popular American narrative of depression is the belief that emotional pain arises largely (and almost unilaterally) from one’s internal physiological makeup — a body that is fundamentally deficient, disordered or defective in some way.
For at least a decade — up until the turn of the century — many brain scientists believed a “chemical imbalance” might explain what is happening. While there’s no question that configurations of chemicals play an ongoing role in our mental health, current neuroscience understandings have gone far beyond these early hypotheses. This was underscored by a seminal University College London study, as reported by Lois Collins last summer in the Deseret News.
Still, this is a belief that has persisted for three decades. One individual I spoke with defined depression as “missing the chemical that lets me be happy and content.” And my friend Thomas McConkie once recounted being told by a professional when he was 16 year old that his “brain was like a car engine without oil.”
His response: “I remember feeling dismayed — a little bit crushed that all of a sudden this brain that had made such a good companion to me for 16 years of my tender life, that it was deficient, that it was kind of broken.”
Rather than this difficult period being simply a “tough go at it,” or “just this season of challenge and unrest,” this crude diagnosis left this young man with the impression that “this is your brain, kid — this is how things are going to be.”
There’s evidence to suggest that those who embrace a view of their own brain as deficient end up seeing their own prognosis as worse and feeling more pessimistic about the potential effect of other nonmedical treatments. As psychologist Elisha Goldstein told me, “Our brain really runs us in a lot of ways. And if something’s defective about it and we can’t change it, that would make it difficult for someone to feel a lot of hope.” Neuroscientist Amishi Jha agreed: “if someone didn’t understand that the brain is capable of changing, it could leave you in a very suffocating, constrained feeling.”
If permanent internal deficiency lies at the heart of depression, it’s unsurprising we would see the illness itself as enduring. In my study, I asked participants, “Do you ever talk about ‘getting better’ from depression?”
One woman said, “I don’t think that’s possible. I want to, but a couple years ago, I just faced it, that I’m always gonna have to have something.” Another woman said, “They told me in the beginning this wasn’t possible. But I’m hoping that I can make improvements that are permanent. ... I am getting better than I was, certainly.”
I followed up with this second woman, asking, “Who told you that you can’t ever get better?” She responded, “Well, my initial diagnosis — they said this is something permanent. They told me, ‘This isn’t something that you’ll ever not have.’”
Parents have recounted similar conclusions about their children. One parent of a 16-year-old girl struggling emotionally told me: “You bring them home from the hospital, nurse them and dream that they will be successful ... but then they come down with a mental illness that is there to stay lifelong. Your hopes and dreams die away.”
Dreams and hopes about your child’s future dying? What are we teaching these parents?
Yet these are not uncommon views; they come up over and over again in hundreds of conversations I’ve had with afflicted families over the years. One mother told me about her son: “His brain is wired in a way that his mental illness will be a monkey on his back the rest of his life.”
Needless to say, this can be pretty discouraging to those who embrace this mindset without question. One woman who experienced remarkable healing from painful mental illness told me, “When you are already feeling hopeless and in despair, to have someone tell you that what you have is a condition that you’re going to have to live with the rest of your life, it makes you feel even more hopeless, more in despair, and more worthless, and like, ‘Why even try? Why even try? This pain is going to last forever.’”
These are clearly serious and sensitive matters, especially with the suicide rate being what it is. And that’s precisely why it feels important to shine a light on the potential inadvertent influence of this despairing narrative. As another young woman remarked during an interview, “My suicidal thoughts started the same day my doctor told me my depression would be lifelong.”
A better story
Once someone is persuaded of both enduring impairment and lifelong struggle, it’s only natural to then conclude that a corresponding lifelong need for outside intervention and ongoing support exists. As one father told me about his daughter, “I don’t think there’s going to be a time that she’s going to be well. We’re going to have to stay on it, stay on it, stay on it forever.”
McConkie, who has long since found vibrant, emotional healing in his own life, further reflects on his experience: “I was disposed to believe this doctor, that my brain was like a car engine that didn’t have oil in it. Which brings up this natural question, ‘Where do I get oil? And how much does this oil cost? And where can I get a reliable supply, because the last thing I want is to break down.’”
Few dispute the benefits that many have found from pharmaceutical support — especially in the short term. But the evidence for benefit over the long term is far less clear — and deserves more attention in a time that long-term usage continues to increase. According to a New York Times analysis of federal data from 2019, more than 15 million Americans have now taken antidepressants for at least five years — a rate that has more than tripled since 2000.
Some people clearly do benefit from ongoing treatment and they should be supported in getting whatever help they need. The point here is simply to highlight how, when combined with a narrative of intrinsic deficiency and long-term illness, this conviction about long-term treatment can feel a little heavy.
It’s a depressing story about depression, if you will. But thankfully, it’s not the only story we have to tell.
Jacob Hess is a founder of Public Square Magazine and a former board member of the National Coalition of Dialogue and Deliberation. He has worked to promote liberal-conservative understanding since the publication of “You’re Not as Crazy as I Thought (But You’re Still Wrong)” with Phil Neisser. With Carrie Skarda, Kyle Anderson and Ty Mansfield, Hess also authored “The Power of Stillness: Mindful Living for Latter-day Saints.”