Human beings can endure a lot, especially if they know their suffering will not last forever. However, this resilience may diminish or dissipate if they are led to believe that the pain will probably never go away.
When it comes to severe pain, clinical depression deserves to be in a category of its own, as anyone who has faced it can attest. A young woman compared her previous experience of severe physical abuse to how she felt when she was depressed. Pointing to her chest, she described pain to me that was “every day, right here…like this thing that wouldn’t come off – that made it hard to breathe…like, I’d rather people beat me rather than having been where I was right in. It hurt so much.
Whenever I’ve interviewed someone who has experienced this intensity of pain, I marvel at their strength and emotional depth, even reminding them at times, “Homer Simpson doesn’t get depressed. We don’t often have a public conversation about the depth of feelings that predispose to certain types of depression. But we should.
When depression arises, it’s usually in the context of a loved one who is suffering and how we can help them. Over the past two decades, many research studies have explored creative ways to bring more relief, and even more investigations into 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 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.
It also shouldn’t surprise us that people who find longer-lasting recovery from depression tend to make adjustments in many of these same areas.
Overall, this amounts to an encouraging and hopeful understanding of depression, backed by the latest research. Combined with a new appreciation for the brain’s plasticity and capacity for change, the collective impact of these lifestyle adjustments points afflicted individuals towards what one neuroscientist calls an “upward spiral” that is possible.
That’s really not really how we tend to talk about depression in America today, though.
The common vision
Martin Seligman, the psychologist famous for introducing “learned helplessness” to the world, once proposed three characteristics that fundamentally differentiate pessimism from optimism:
Personalization: Seeing deficiencies as coming from within, rather than related to the circumstances of our lives (“I’m just messed up”).
Permanence: Believing that difficulties will remain largely unchanged throughout life (“It’s always going to be like this”).
Omnipresence: Seeing difficulties as permeating all areas of life (“Everything is awful”).
These states of mind encapsulate the mainstream American narrative of depression and other mental health issues remarkably well – that they are rooted in the brain, last throughout life, and affect virtually every aspect of life.
I started noticing this pattern after my own extensive study of depression over 20 years ago. Among the many discoveries, one in particular stood out. Beyond the sharp, 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. in regards to depression – what it was, where it came from and what their future is likely to be.
How your body ‘always will be’
Perhaps the most notable feature of the popular American narrative of depression is the belief that emotional pain stems largely (and almost unilaterally) from a person’s internal physiological makeup – a body that is fundamentally deficient, disordered or defective in one way or another.
For at least a decade – until the turn of the century – many brain scientists believed that a “chemical imbalance” might explain what’s going on. While there is no doubt that chemical patterns play an ongoing role in our mental health, current knowledge in neuroscience goes far beyond these early assumptions. This was underscored by a seminal study from University College London, as Lois Collins reported last summer in the Deseret News.
Yet it is a belief that has persisted for three decades. One person I spoke to defined depression as “lacking the chemical that keeps me happy and content.” And my friend Thomas McConkie once recounted how a professional told him when he was 16 that his “brain was like a car engine without oil.”
His answer: “I remember feeling dismayed, a little crushed that all of a sudden this brain which had made me such a good companion for 16 years of my tender life, that it was defective, that it was a bit broken.”
Rather than this difficult time being just a “hardship” or “just this season of challenges and turmoil”, this crude diagnosis left this young man with the impression that “it’s your brain, kid. , that’s how things are.” will be.”
There is evidence to suggest that those who take 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 non-medical treatments. As psychologist Elisha Goldstein told me, “Our brains really direct us in many ways. And if something is wrong and we can’t change it, it would make it hard for someone to feel very hopeful. Neuroscientist Amishi Jha agreed: “If someone doesn’t understand that the brain is able to change, it could leave you feeling very suffocating and constrained.”
If a permanent internal deficiency is at the heart of depression, it is not surprising that we see the illness itself as long-lasting. In my study, I asked participants, “Have you ever talked about ‘curing’ depression?”
One woman said, “I don’t think that’s possible. I want it, but a few years ago I faced it, that I will always have to have something. Another woman said: “They told me at the beginning that it was not possible. But I hope to be able to make permanent improvements. …I’m better than I was, sure.
I followed up with this second woman, asking, “Who told you you can never get better?” She replied, “Well, my initial diagnosis – they said it was something permanent. They told me, ‘It’s not something you’ll ever have.’ »
Parents recounted similar findings about their children. A parent of a 16-year-old girl struggling with emotional issues told me, “You take them home from the hospital, nurse them, and dream they’ll be successful…but then they catch a mental illness that is here to stay. for life. Your hopes and dreams are dying.
Dreams and hopes regarding the future death of your child? What do we teach these parents?
Still, these are not uncommon sights; they come up again and again in hundreds of conversations I’ve had with grieving families over the years. One mother told me of her son, “His brain is wired in such a way that his mental illness will be a monkey on his back for the rest of his life.”
Needless to say, this can be quite daunting for those who adopt this mindset without question. A woman who had a remarkable recovery from a painful mental illness told me, “When you’re already feeling hopeless and desperate, someone telling you that what you have is a condition you’re going to have to live with. the rest of your life. life, it makes you feel even more hopeless, more hopeless and more useless, and say to yourself, “Why even try? Why even try? This pain will last forever.
These are clearly serious and sensitive issues, especially since the suicide rate is what it is. And that’s precisely why it’s important to shine a light on the potential unintended influence of this desperate narrative. As another young woman remarked in an interview, “My suicidal thoughts started the very day my doctor told me my depression would last a lifetime.”
A better story
Once a person is persuaded of both an enduring impairment and an ongoing struggle, it is natural to conclude that there is a corresponding need for outside intervention and ongoing lifelong support. As one father told me of his daughter, “I don’t think there will be a time when she will be okay. We’re gonna have to stay on, stay on, stay on forever.
McConkie, who has long found vibrant and emotional healing in her own life, reflects further on her experience: “I was willing to believe this doctor, that my brain was like a car engine that had no oil in it. Which raises this natural question: “Where can 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 would dispute the benefits many have found in pharmaceutical support, especially in the short term. But the evidence for long-term benefits is far less clear — and deserves more attention in a time when long-term use continues to rise. According to a New York Times analysis of federal data from 2019, more than 15 million Americans have now been taking antidepressants for at least five years — a rate that has more than tripled since 2000.
Some people clearly benefit from continued treatment and they should be supported to get the help they need. The point here is simply to point out how, when combined with a narrative of intrinsic impairment and long-term illness, this belief about long-term treatment can seem a little weighty.
It’s a depressing story about depression, if you will. But luckily, that’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 publishing “You’re Not As Mad As I Thought (But You’re Still Wrong)” with Phil Neisser. Along with Carrie Skarda, Kyle Anderson, and Ty Mansfield, Hess also wrote “The Power of Stillness: Mindful Living for Latter-day Saints.”