Thoughts on Depression

If you know someone who’s depressed, please resolve never to ask them why. Depression isn’t a straightforward response to a bad situation; depression just is, like the weather. Try to understand the blackness, lethargy, hopelessness, and loneliness they’re going through. Be there for them when they come through the other side. It’s hard to be a friend to someone who’s depressed, but it is one of the kindest, noblest, and best things you will ever do.

– Stephen Fry

 

Depression is one of the things that many people go through. I would even say many of us go through it, because I have, and I am sure that at some point in your life you will have had too.

And if you have not suffered from it before, perhaps it is hard to imagine what it would feel like. Sometimes you may even be dismissive of depression and its existence, you may – as I have been guilty of in the past – even think that sufferers are merely malingerers, unable to work and simply finding an excuse not to go to work or to get out of bed.

Depression is crippling. Those suffering may find that it gives life a somewhat negative filter. You look through it through a dark lens, and unfortunately when you are in that funk, it is very hard to get out of.

How does one lapse into depression? There are many reasons, but one of them is the result of going too hard, too long. Life has its various stresses, such as financial, family, work, and while at various points in life one of these stresses may surge and grow out of proportion in comparison to the others, and when you are under this stress and your attempts to initially fight it are rebuffed, then not only is it physically tiring, it is also mentally tiring as it sends your mind into overdrive, which tires you out, so eventually you may find that even though you may know what you need to do, you may actually lack the energy to do it, and the disconnect causes you depression, which becomes only sapping in itself.

Depression is something that must be worked through. It is a cycle of incremental gains, slow positivity, that helps one out of depression. And sometimes we find that the thing that has been causing us depression, is removed through time. For example, many men report depression in their thiries and forties, at at time when they have young children, when they experience life stresses of having to be the breadwinners while not being at home to see their child grow up, being away from home while wanting to be home, yet returning home only to have their spouses, tired from the stresses of looking after children, snap at them when they return. And they wonder why their wives suggested having children in the first place …? Do you know someone like that? This can easily cause someone to lapse into depression. But when children grow up, and these stresses are removed, the depression is lifted with time.

Perhaps it is worth considering the thought that depression is the disconnect of an overworked mind and a physically tired body. The mind has been going into overdrive and the body is tired, and the soul is unhappy because the body has no energy or mental will to do the things that need doing.

So whenever you encounter someone with depression, don’t offer advice. Don’t give them more mental triggers that tax their minds, and your advice, no matter how well-meaning, only drains their mental energy. Listen if your friend needs a listening ear, because in the course of talking through their troubles your friend may be relieved of them, and all the mental associations they spin off. You can help your friend mentally filter out the mental thoughts that cause depression. Help them do something physically active to work off the depression when they are ready.

To paraphrase Stephen Fry, if someone you know is feeling cold because it is snowing, you can’t help them by asking why it is snowing. Just huddle with them, keep them warm, until the snow passes. It is truly a noble thing that you can do.

Physical activity and depression

How do you deal with depression? How does it creep up on you? While the causes vary from person to person, it is certainly no argument that depression is a bad mental state to be in. Personally, I feel one of the reasons that depression happens is that there is a great disconnect between reality and expectation. And this gulf – and thinking about it constantly – is one of the reasons people get depressed.

One problem is that society builds us up to think that things should be rosy and ideal. We have sayings like “the world is your oyster”, we talk about loving your work and doing the things you enjoy as a career, and generally promote the that disconnect. For many people, especially young people, there are many things they would like to do – such as to travel, to work less, to enjoy life – but unfortunately reality and rising house prices means that they often have to do the opposite. We are often told that education improves your job prospects, yet the current market means that not only do you get deep in debt with a degree, but the lack of availability of jobs means that your degree not only does not count for much, but may work against you because you are overqualified.

And for many people, one of their rosy expectations of life is to be a blogger, one who earns money by writing, while going on holiday, living the dream by surfing. Unfortunately, like every other job, probably a small minority can manage that, while for the rest of us the income from that is unsustainable. But we are led to think this is possible, and by whom? Usually by those who have hidden agendas and can benefit from leading us down such paths – the travel industry, and the travel bloggers themselves (who usually make income by selling you ‘How I Made It as a Travel Blogger’ courses).

In my younger days I used to think I wanted to make a living from writing, and got hooked into the make a living from writing scene. The problem I found was that writers usually were trying to sell me courses, with actually no means of guaranteeing I would be successful or be able to make it as a career based on that. And the longer I got drawn into it, the longer I realised this was unsustainable and I would have to stop in order to prevent myself from harm.

It is my view that one of the initial causes of depression is the disconnect between practicality and dream. And dwelling on that, trying to resolve two impossible ends, is what sends the mind into overdrive and long term unhappiness.

What can you do if you are actively depressed? One of the things you can do is to change your environment. Do something to shake yourself out of the doldrums. Better yet, my suggestion is to do something different that involves physical activity. Why is that so? Because this helps your mind and body realign. You learn on a subconscious level how to realign the ideal and the practical together. For example, if you go for a run, you may initially run out of breath if you are going too fast because you haven’t paced yourself. Doing something physically active bleeds off the mental stress, and also helps you to understand what you want to do and how you have to take it slowly in stages. Physically activity is a great help in dealing with depression.

Did you know Martin Luther (the monk, not the civil rights activist) suffered from depression? He apparently conquered it by working on his garden, calming his mind through the activity. And perhaps one of the best suggestions is to do the task you least enjoy. You may find like many of us that depression arises often out of task avoidance too, of neglecting to do the things you need to do, and …. thinking too much of them.

Thought for the day: Do some physical activity. Bridge that mental disconnect.

And if you are feeling depressed, you can always try speaking to a counsellor, or ringing the Samaritans. It always helps to talk to a real person and get a sense of perspective instead of listening to the same thoughts over and over again in your head.

Recognising trauma symptoms can help deal with trauma

To fully understand the impact of trauma and complex trauma, practitioners will need to familiarise themselves with the primary symptoms of trauma. While each survivor’s reactions to trauma are unique and will vary from person to person and depend on the type of trauma, age, the frequency and duration of the abuse, and the relationship to the abuser(s), there are a number of commonalities.

It is crucial that survivors are helped to recognise that the physical and psychological reactions to trauma are normal responses which serve to protect us, and are elicited outside of conscious awareness or control. These reactions are like an emotional immune system, which instead of fighting invading bacteria or viruses, fights to protect us from harm.

To help survivors understand their reactions to trauma, practitioners need to be able to convey the following information in a way that is easily understood by the client and that makes sense to them. This can be supported with directed reading or self-help books such as The Warrior Within (Sanderson, 2010c). Persistent re-experiencing of trauma can be triggered by both internal and external cues. This means that even if the survivor is currently not in actual external danger, inner feelings and sensations can trigger a range of PTSD reactions. Given that they may already be in an elevated state of anxiety, it is easy to set off an already highly sensitive alarm system on the basis of internal physiological arousal. This is potentially dangerous as it prevents the survivor from recognising actual external danger and makes it hard to assess objectively the degree of safety.

To help survivors understand the neurological and physiological responses to trauma it is helpful to explore their knowledge of how the body reacts to danger. When in the presence of danger primitive biological mechanisms such as the alarm system are activated to aid survival. As a result the brain releases a cascade of neuro-chemicals which start a complex chain of bodily reactions, all of which are designed to protect us from the harmful effects of trauma.

Although the alarm system does not stop the emotional pain, stress or trauma from happening, it does cushion the trauma and helps us to deal with it.

The alarm system acts as an emotional immune system, which like the physical immune system, is activated outside of conscious awareness and is therefore not under our control. It is vital that survivors understand that whatever their reactions during the trauma, these were outside of conscious control and therefore they are not to blame or at fault for how they responded. Recognising this can dramatically reduce any crippling feelings of shame, self-blame, or guilt.

When the body’s alarm system is tripped and goes on red alert it sends signals to the brain to prepare for fight, flight or freeze. This sets off two crucial biological defence systems: the sympathetic nervous system and the parasympathetic nervous system. The sympathetic nervous system mobilises high level energy necessary for fight or flight, while the parasympathetic nervous system slows down the heart and metabolic rate which results in the freeze response.

The two structures in the brain that regulate the alarm system are both located in the limbic system, the amygdala and the hippocampus. The role of the amygdala is to detect threatening information through external senses such as touch, taste, sound, smell or vision. The amygdala is responsible for determining whether incoming stimuli are desirable, benign or dangerous.

To maximise survival, this evaluation is instantaneous but crude and primitive in that it does not use deeper analysis, reason or common sense. This is why it is often referred to as the ‘fast and dirty route’. If the stimulus is life threatening, stress hormones such as adrenaline and cortisol are released, which send messages through the nervous system to the muscles and internal organs to either attack, run or play dead.

The amygdala is highly sensitive to any danger and is easily activated to increase readiness to attack or defend (fight), run (flight) or submit (freeze). In contrast to the ‘fast and dirty’ route of the amygdala, the hippocampus is a much slower route in that it evaluates the external threat through deeper analysis using conscious thought, memory, prior knowledge, reason and logic. The hippocampus is also critical in laying down new memories and experiences. If the danger is truly life threatening, the hippocampus will send messages to continue with appropriate responses. If however the deeper analysis concludes that the stimuli are not dangerous it will send messages to deactivate the responses.

In most cases of threat these two structures work in harmony to balance appropriate responses to the situation. When the trauma is prolonged and repeated such as in complex trauma, the feedback loop that controls these two systems malfunctions and floods the body with high levels of stress hormones.

While these stress hormones are critical for survival, they are highly toxic and only designed to circulate for short periods of time so that the individual can get to a place of safety or remain safe until the threat is over. In the case of certain traumas such as CPA or CSA where the child cannot fight or run to safety, the only option is to freeze. This means that the stress hormones cannot be discharged and remain in the system, which can have a number of negative consequences, not least forcing the alarm system to remain on red alert, or ‘online’(Sanderson, 2010c).

Evidence shows that high levels of cortisol that are not discharged can lead to the destruction of brain cells which can affect the function and size of the amygdala and hippocampus (Gerhardt, 2004; Teicher, 2000). Such malfunction leads to increased arousal, fear and anger responses, as well as memory impairments. When the brain and body are flooded with chronic levels of stress hormones the hippocampus goes ‘offline’and is unable to accurately evaluate the degree of threat or danger. It is also not able to assess whether the danger is internal or external, or whether the traumatic incident is over or on-going, and cannot send the appropriate messages to the amygdala to deactivate the alarm system. This leads to the alarm system remaining on constant red alert and the continued release of stress hormones.

As a consequence the body responds as though the trauma is on-going, even after the threat is over. Over time the alarm system is reset on a default setting of ‘on’, with survivors feeling as though they are being repeatedly traumatised. This leads to a heightened or continuous state of danger, known as hyper-arousal.

This hyper-arousal forces stress hormones to continue to flood the body and brain, and the tyranny of post-traumatic stress responses. Since the hippocampus is not able to regulate the alarm setting, or halt the release of chronic levels of stress hormones, its ability to store new memories is reduced. This means that the trauma is not stored within context or time, making it seem as though it is continuous and never ending.

This in turn prevents the processing of the trauma keeping it ‘online’ with the same vividness and intensity as when the actual assault happened. Not being able to process the traumatic experience makes it harder for survivors to store it in memory or to recall it leading to amnesia, or incomplete or fragmented memories. A crucial goal in recovering from complex trauma is to bring the hippocampus back ‘online’ so that its function can be restored to regulate the alarm system to evaluate danger, and differentiate between internal and external threat.

Prolonged release of high levels of stress hormones impacts on physical well-being leading to a range of physical problems such as hypertension, physical exhaustion, chronic fatigue syndrome (CFS), sleep impairment, and digestive, respiratory and endocrine problems. In addition, chronic fear reactions and high levels of adrenaline evoke waves of overwhelming anger which survivors cannot release for fear of consequences, thereby creating even further stress. Hyper-arousal also affects concentration and the ability to reflect on or process experiences, preventing survivors from making sense of their experiences.

While the alarm system can activate three alternative reactions – fight, flight or freeze – in most cases of complex trauma, especially when it occurs in childhood, there is only one option: to freeze. The freeze response is designed to conserve energy so that the individual can escape when the danger is over. Young children are not able to outrun or fight an adult effectively, and are thus left with no option but to freeze.

While the freeze response protects the individual from the greater threat of the consequences of fighting back or running away, it is often experienced as passive submission. This can make survivors feel as though they were weak in not fighting back or running away, which can lead to shame, self-blame and guilt. It is important to convey to survivors that realistically children are not able to escape, especially if the abuser is a significant figure in the child’s life such as a parent, relative or priest. In that moment they are both powerless and helpless.

However, the sense of submission can often haunt them and leave them feeling ashamed that they did not do more to prevent the abuse. This is also true for adults who are in thrall to an abuser who has power and authority over them. The freeze response also protects individuals from the full impact of the pain of the abuse.

As the parasympathetic nervous system kicks in, a sense of calmness descends on the brain, slowing everything down, and the body begins to feel numb in order to cushion the anticipated pain and the emotional terror of the trauma. Once the danger is over, these reactions fade and the stress hormones are discharged through movement.

Understanding the responses to trauma and conveying them to individuals suffering from them can help them recognise their own reactions and how to deal with them. This will empower them and give them the confidence to break free of the hold traumatic experiences have on them.