Depression: to medicate, or not to medicate?

Depression seems to have become a go to diagnosis for all our ills within modern society. We see it as some kind of anomaly, a monolithic entity that needs to be gotten rid of and as such requires treatment in returning us to a place of unalloyed happiness.

However, depression can be seen as having several different facets; these being “reactive or environmental”; “inherited” and “historical”. We might experience one, or all of them simultaneously. They are however, often undifferentiated, though have different root causes, as well as asking differing questions of us.


- Reactive or Environmental Depression:

A reactive depression is a normal response to a loss or disappointment. It is understandable to feel a period of depression, following a bereavement or ending of a marriage. The extent to which we are emotionally invested in the world we live in; will determine the pain we experience. With the right support reactive depression will resolve itself. It only becomes a longer-term difficulty if it begins to profoundly affect the normal day to day functioning of the individual.

- Inherited Depression:

Inherited depression derives from biological causes. This kind of depression can be carried genetically through the family. Individuals experiencing this, find a real difficulty in performing the day to day tasks that many of us take for granted. As though they are constantly walking up a steep hill, carrying a heavy weight. This kind of depression can respond particularly well to medication, as this helps to re-balance the chemical make-up of the brain.

-  Historical Depression:    

Depression can sometimes feel like a well with no bottom. However, from a therapeutic perspective, historical depression is a well with a bottom; even if we may need to dive deeply to find it!  We might see this form of depression as a kind of collusion against ourselves. Where we have suffered an early trauma in our lives, such as an emotional abandonment by a care giver. We come to see ourselves as not being worthy of love and care from others in later life. Therapeutically, the task here is to attempt to become conscious of the difference between what happened to us in the past and who we are in the present.   

(Hollis, J., 1996. Swamplands of the Soul. Toronto: Inner City Books)

Depression in mid-life often carries with it a crisis that embodies the conflict between what we have created through this false self of our early conditioning; (the belief we are unworthy of love) and the spontaneity and energy of our true selves. We could say at these times that depression is the individual experience of the discrepancy felt between our false selves and the call of our true self.

Unfortunately, at these times, what can become de-pressed is the space that allows us to reflect on “what is the meaning of this depression”. We might say that the therapeutic process is one whereby we are offered the means, at these times to take a breath and allow ourselves to sit with what is being asked of us.

As such, I am not implying that medication doesn’t have a place in treating some forms of depression; especially if there has been a chemical imbalance in the functioning of the brain. However, depression might also be asking us to reconcile who we think we are, with who we actually are. At these times; in using medication as a one size fits all “cure”, we may be missing an opportunity in coming to know the real self within us.


Understanding Shame

We might define shame, as opposed to other emotions such as guilt, embarrassment, shyness and humiliation. The etymological meaning of the word is “to hide” or “cover up”. The experience of shame isn’t an isolated event, but often becomes tied to a set of destructive emotions. This is because shame is often a difficult emotion to communicate, and masquerades as other feelings. To put this in context, the experience of guilt can often be resolved through some form of practical intervention, which may include confession and making amends. However, the experience of shame is in large part tied to the individual’s experience of self and identity. As such shame is linked to an individual’s self-esteem. This situation can in turn lead to chronic shame, which can begin to take over the individual’s life leaving them with a pervasive sense of fear and terror and the inability to live meaningful lives, and the experience of ongoing feelings of depression and anxiety. 

Shame can often play a dysfunctional role in men’s lives. Evidence in this respect shows that men are often more ready in displaying behaviours to conceal their vulnerability and shame about attachment and caring, with these behaviours more likely to lead to violence. In this respect, the differing varieties of shame can be distinguished between being humiliated and shamed by someone else and those incidents in which the person themselves becomes the major source of criticism and assault on their self-esteem. However, what is clear is that shame is often accompanied by the experience of incompetence and feeling less than; with the associated experience of the individual having no responsibility or control over the circumstances they face. This in turn leaves many feeling they have lost connection with what they consider to be familiar and safe in their lives.

5 sources of shame, including:

  1. Genetic and biochemical

  2. Family of origin

  3. Self-shaming thoughts and feelings orchestrated by one’s own narrative

  4. Current humiliating relationships

  5. Contemporary culture

(GOLDBERG, C., 1991. Understanding Shame. London: Jason Aronson.)

Shame can occur at every stage of development, and we might say that this is an inevitable consequence of being alive; in that as children we are almost entirely dependent upon the exact correspondence of our needs and the attentive nurturing care of our caretaker 24/7, the reality of which unfortunately is impossible to maintain. This process can in turn lead to self-blame and self-loathing, which can lead the individual to seek psychological help. The experience of therapy can be shaming in itself for the client too; as they are often confronted, maybe for the first time in their lives with the realization that they have lost any meaningful control in making changes for themselves. I have found in my therapeutic work that being aware of these factors is an important part of understanding the client’s experience of shame and associated issues around depression and anxiety.