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The Depths of Depression

When setting out to write about depression, I find myself apprehensive. This is not due to writer’s block, or to a lack of clinical information or personal experience in treating my clients that suffer from the disorder. I hesitate out of concern that I will not do those who have been diagnosed enough justice. I have great respect and admiration for my clients who struggle with depression as I imagine the weight they bear in layers of compounding thoughts. It is unknown territory for those of us who have never experienced it.

Too often, clinical diagnoses such as Bipolar, OCD, and even PTSD are thrown around as casual commentary to express a fleeting emotion, often devaluing the reality of those who struggle with these disorders. Depression is no different. Depression is not sadness. It is not a bad day. It is a clinical disorder that must be revered and respected. This is especially true if we wish to apply proper healing support to our loved ones who suffer. We must work in unison to lift the weight. To appreciate depression as a clinical disorder is not to add to the inherited societal stigma but to empower and aid in undoing the consequences of depression—mainly guilt and shame.

What often lies at the root of depression is a strong attachment to the feelings of guilt and shame, causing one’s emotional reality to be pushed further and further from recognition. Those who experience depression often describe the guilt they experience for feeling the way they do. They begrudgingly speak about the ways they are disappointing their loved ones, themselves, their community, etc. Being the epitome of burden on others seems to be embedded in every thought during a depressive episode. The ever-present team of guilt and shame has set the trap, often in a time and place or by people no longer relevant. The difficulty, unwillingness, and of course “guilt” itself associated in accepting this fact is what I believe keeps one feeling stuck, varnishing the misguided perceptions of themselves over and over again.

Every clinician knows that depression often works in tandem with other diagnoses. Whether it is panic disorder, generalized anxiety disorder, obsessive-compulsive disorder, drug and alcohol dependence, post-traumatic stress disorder, or a personality disorder – depression can be a loyal companion. Engaging in the therapeutic process often leads toward an attempt to discover whether the chicken or the egg came first. Sometimes there is a clear answer. More often though, the thickened layers of circular thoughts have clouded everything to gray. To decipher which symptom was the predecessor seems aimless, leading to stronger feelings of defeat.    

So, what do we do when the web appears so tangled? When we are not sure which side of the string we should pull on? From a humanistic, person-centered approach, I believe that every client is the expert of their own reality. More importantly, I believe that the client must come to know this fact. When I sit with a person who struggles with depression, I ask them to describe the feeling, to give me a visual. As they let me in, I feel the pulling downward from the center of my forehead. My shoulders and breath wanting to follow. It is the massive cloud above, the fog within, the drowning weight, the pulsating struggle inward, the immobility, the cold isolation, the seemingly insurmountable terrain they allow me to attempt to see and feel. We let go of the chicken and the egg. We acknowledge that these feelings are very real, and I work to empower them to find acceptance so that they may begin to move within it.

A common concern of those with depression is their lack of motivation. No kidding. The very real feeling they are experiencing, described above, so deep and heavy, would make any well-meaning, usually giant, to-do list seem damn-near impossible. The list is so distant and necessitates so much energy they simply do not have to expend. We must look at the list and maybe burn some of it for a while. And instead, work on self-compassion. 

I usually have my clients pick three things that are “enough”. It is enough to take a shower. It is enough to eat. It is enough to text a friend. The sooner we accept that this truly is enough because we appreciate the emotional environment they are functioning in, the sooner “enough” can start to become more. In the meantime, we must address the birth of guilt and shame so that we can acknowledge the depth of their influence, build an awareness of their current presence, and begin to release them.

As an unprecedented winter approaches, I can’t neglect to say that what we are doing now is enough. We are surviving a global pandemic, perhaps personal loss, exhausting social conflict, likely familial strains, and a lack of light. My message to you is that what you are doing is enough.

Stephanie Gibart is a mental health and art therapist at Elle who works in tandem with Kristen Pesature-Olds in MindBody Therapy to treat symptoms of depression. Learn more about her work and the ways in which we work to build further coping mechanisms from within the body at Elle.