Dr. Cesar Vasconcellos de Souza

Depression is the leading mental illness, causing death and disability worldwide. We need to understand the possible psychological causes of depression, and what a person can do to gradually come out of this illness.

John’s mother, whose name is fictitious, had postpartum depression and a new depressive episode 15 years later. His father was a melancholic, always complaining about life. John grew up in a family without major conflicts, but in an atmosphere of sadness and complaints that prevailed in his home. In adult life, after he got married, he had a depressive episode when he was anxiously awaiting a promotion and it didn’t happen. He even missed a few days of work due to symptoms of discouragement, apathy, insomnia, loss of determination to do things, decreased appetite and constant pessimistic ideas. John underwent treatment with a psychiatrist, used some medication for a few months and also underwent psychotherapeutic treatment. That helped him to come out of a depressive state.

Causes of Depression

What do we see in this brief clinical report about the influences on John’s life that favored the onset of the depressive episode? First it has to do with the genetic factor. John’s mother had important depressive episodes. Genetics is not everything, but it biologically influences the behavior of the descendants. The scientist Charles Nemeroff, a psychiatrist and professor at the University of Miami Miller School of Medicine who specializes in treating depression says:

The cause of unipolar depression is about 40% genetic factors and 60% environmental factors.((C. B. Nemeroff, 2003))

A second factor favoring the emergence of depression in John has to do with the family environment, with a strong tendency towards melancholy, complaints and a negative view of life on the part of his father.

Other scientists such as Kenneth Kendler, professor of human genetics and director of the Institute of Psychiatric and Behavioral Genetics at the Virginia Commonwealth University, have verified that, despite the importance of the genetic factor for many mental illnesses, this is not predominant or determinant. And Dr. Kendler is an expert in studies of genetic factors in psychiatry. His studies have focused heavily on the genetic factors in schizophrenia.

For him, the most important predictor for the appearance of mental illnesses is not genetics, but the existence of stressful events in the individual’s life, along with interpersonal problems and a personality with tendencies to neuroticism. The word neuroticism describes people who live cultivating negative pessimistic thoughts, always in a bad mood, too worried and complaining about everything.

So, we can see that in John’s clinical history, all of these factors, including genetics, are present, but one important thing that Dr. Kendler and colleagues found out about the cause of depression was that sensitivity to the effects of stressful life events leading to the depressive state, seems to be under genetic control, that is, genetics does not induce depression, but there is a control made by the individual’s genetics as to how he reacts to the stressful life events.

Research by Dr. Kendler and his team found that in people who had a higher genetic risk for depression, living at that time without major stressors, the chance of having depression was only 1.1%, but in the presence of significant stress at that moment, the risk increased to 14.6%. Do you know what were the most frequent stressful factors as triggers for the onset of depression in this scientist’s study? They were as follows:

1. Death of a close relative
2. Aggression
3. Serious marital conflicts
4. Separation and divorce

These scientists I mentioned admit that emotional distress very early in childhood, the neglect of caregivers to the child or separation, can generate a type of neurobiological sensitivity, which predisposed people to react to stressors of adulthood through depression. The American writer Ellen White already wrote about this at the turn of the 19th to the 20th century:

More than any natural endowment, the habits established in early years decide whether a man will be victorious or vanquished in the battle of life.((Ellen G. White. Child Guidance, p. 202))

So we see how important people’s childhood history is. Some types of abuse suffered in childhood increase the chance of developing depression in adult life. For example, physical abuse, such as beating a child; sexual abuse such as rape, incest, child molestation, the neglect of basic care for them, not encouraging them with hugs, kisses, kind words. All of this creates an emotional climate in the person’s mind, which in the future when some traumatic event in adulthood occurs can trigger depression.

Women who were victims of abuse or other poor emotional care during childhood are twice as likely to have an attitude of personal disrespect, low self esteem and repetition of complicated relationships in adult life, compared to women without these sufferings in the past. Those who have had a history of these problems in childhood are ten times more likely to experience depression in adulthood.((Brown e Eales, 1993; Bifulco et al. 1998))

In the example quoted at the beginning, John had a depressive episode triggered by great frustration at work. However, when we analyze his emotional history, that is, when we understand the history of the family of origin where he came from, we saw that he was born in a home with a predominance of melancholy, sadness and complaints of his father about life, and the mother who went through postpartum depression, and a relapse into depression, years later. In addition, John has a sensitive temperament, which favors melancholy in the face of discouraging situations. His depression wasn’t caused by not being promoted at work. Frustration at the company where he worked was the trigger for his depressive state.

Pathway to Healing

You might ask: what’s the point of understanding all these things? Actually it helps a lot. Remember the words spoken by Christ, “And you shall know the truth, and the truth shall make you free”.((The Bible, John 8:32))

When John understood that: First, that he had an emotional sensitivity that pushed him towards sadness. Second, that he had lived in a family environment as a boy where sadness and the mother’s depressed state predominated, he understood that he would need to fight this melancholic tendency, forgive his father for the pessimistic model he passed on to him, and accept that his mother could not give him the best care in childhood because of the depressive episodes she suffered.

John understood that some things needed to be done about the tendency to become easily sad: First, he would need to observe what kind of thoughts came to his mind most often, and detect the pessimistic negative thoughts of defeat, and thus avoid these thoughts dominating his mind.

He also learned in psychological treatment that he needed to resist feelings of sadness, not focusing on them, but looking at his current life, and seeing the good things in it, the blessings, cultivating an expression of gratitude for those things. If John wouldn’t do that, didn’t work in his mind against the melancholic tendency, not letting himself focus on defeatist and pessimistic thoughts, the antidepressant drugs would probably work for a while, improving his sad mood, but with time it would no longer have an effect. Because he would continue letting sad feelings and negative thoughts predominate in his mind.

So an important question for a person who is dealing with depression is: What are you doing with your mind, with your life, with your thoughts, with your emotions, and with your relationships, without having to take medicine for depression?

Dimensions of Depression

Depression is a mental reaction to loss and frustration, trauma, violence, abuse, and it also has a physical and spiritual dimension. That is, depressed people who eat poorly, do not practice physical activities, are sedentary, live in an environment with a lot of air pollution, may have more difficulty in recovering compared to depressed people who strive to exercise, who decide to use healthy vegetarian food and living as close to nature as possible. Also depressed people who have a religious faith and practice this religion have better internal mental resources to deal with the difficult depressive moment they are living.

Returning to the psychological aspects that contribute to the depressive state, an important thing for us to understand the causes of depression is the way each individual reacts to a stressful event. The same problem – like the separation of parents – hits one child in one way and the other child in a different way. Family members, friends and professionals who deal with the depressed person need to understand that what may seem an easy trauma to resolve can have a very strong meaning for the depressed person, being neither easy nor quick for the individual with depression to come out of it.

How to Treat a Depressive Person

Glen Gabbard is a clinical professor of psychiatry at the Baylor College of Medicine in Houston, Texas. He is also a training and supervisory analyst at the Center for Psychoanalytic Studies in Houston, in addition to directing the Gabbard Center. He comments on how to deal with the depressed patient:

Perhaps the most common mistake by both family members and novice mental health professionals is trying to cheer up the depressed patient by positively focusing on comments such as: “You have no reason to be depressed”, “you have such good qualities” or “Why to commit suicide?” “There’s a lot to live!” probably has the opposite effect than intended. These “encouraging” comments are experienced by depressed patients as profound failures of empathy, which lead them to feel even less understood and more isolated, and therefore more suicidal.((Gabbard G. Psychodynamic Psychiatry in Clinical Practice. Artmed, 2016))

That is, if you didn’t listen to the venting of the depressed person, if as soon as she starts talking about her suffering, you use these phrases right away, even in an attempt to help, it comes to him as lack of compassion, lack of understanding of his pain, creating in him more hopelessness, more feeling of loneliness, which can make everything worse.

If you want to help a depressed person, then let them talk first, let them vent. Just listen carefully, looking at him and not getting distracted by something else, but concentrating on what he says so that you focus on being really there with him. Even Solomon speaks of this in the Bible:

To everything there is a season,… A time to weep, and a time to laugh;… A time to keep silence, and a time to speak.((The Bible, Ecclesiastes 3:1,4,7 (NKJV) ))

Ecclesiastes 3:1,4, 7.

These phrases can be used when a depressed person needs to vent and you want to help him: “Wow, there must be something in your life that makes you suffer like this, right?” You can say, “Tell me how you feel, I’m here to listen.” “It must be so bad to feel this sadness right? Do you want to tell me something about it?”

Then, after using comments that convey to the depressed your intention to help, you can and need to invite them to participate in the healing process, asking, for example: “I want to help you, so let’s think about what can be causing the emotional pain in you. Tell me a little bit, I’ll listen to you”. This way you invite the person to speak, as only then will it be possible to understand what is happening inside them. A professional caring for a depressed person will try to carefully assess what stressor, or factors, contribute to triggering the depression. Dr. Gabbard comments as follows:

Did the stressor involve humiliation and loss? Did it bring back the losses or traumas of early childhood? What was the particular meaning of the stressor for the patient?((Gabbard G. Psychodynamic Psychiatry in Clinical Practice. Artmed, 2016))

The professional who cares for the depressed person will want to know what the patient associates with the factors that he says seem to have triggered the depressive state. Dr Gabbard, gives an example of a question to be asked to the patient, and that you family member can think and also ask your depressed relative, which would be like this:

Does the event that the person says caused depression recall other feelings, thoughts or fantasies that were present in the patient’s mind?((Gabbard G. Psychodynamic Psychiatry in Clinical Practice. Artmed, 2016))

Then we encourage the person to talk about it. Talking to an attentive person who wants to help can not only alleviate the depressed person, but also bring to light the true circumstances of the suffering, as it serves to reveal that the causes are not the ones that you might have thought they were.

Finding the Meaning

Dr. Constance Hammen, professor of psychology at the famous UCLA or University of California Los Angeles, found that the most important thing to drive a person into a depressed state is not necessarily the event that took place, for example, the death of a loved one, the dismissal of a job, the divorce, but the interpretation that the person gives of the meaning of the fact that occurred.

According to her research, the traumatic events that occurred in a person’s life, if they were linked to what the person felt was his self, were more likely to lead to a depressive state. In other words, Dr. Constance verified that a person whose sense of his self, of being a person, a human being from the psychological point of view, with the sense of being an identity; when this sense of self is partially defined by their social connections, the disruption of an emotional relationship important to that person can trigger depression. And when this same sense of self in the sense of self worth is connected with academic achievements or another work, there is a greater possibility of a depressive reaction to an apparent professional failure.

That’s why it’s important for you to cultivate a sense of personal worth, not based on economic, academic and professional success, but on being a human being, a creature of God. You are the only person in this world with these specific characteristics. There is no one like you, not even if you have a twin brother or sister. Your worth has to do with the fact that the Creator God thought about your existence and allowed you to come to light, and maintains your life every millisecond. Think about that.

So, when a person, from an affective point of view, is overly attached to another, when he becomes too attached to another individual to feel important, he automatically puts himself in the hands of the other to have a sense of personal value. This is dangerous. What if that person leaves? What if the individual you’ve become too attached to dies before you do? So a question that a depressed person needs to ask himself at some point in order to get better is not who he lost that made him depressed, but what he lost in that loss. What is the meaning of the loss he is experiencing?

Conclusion

Dr. John Raymond Peteet, a psychiatrist at Harvard University, USA, commented on depression:

Depression is a major public health problem worldwide, including as a contributing factor to suicide. Compared to simple grief after a loss, it often involves a dynamic interplay between biological and psychological vulnerabilities, environmental factors, and spiritual aspects of the person.

One of the biggest challenges in responding to depression is recognizing how it distorts a person’s view of themselves and the world. For example, a depressed person may feel hopeless and justified in their pessimism and fear, or maladjusted when options seem limited and he feels out of control. If he is insecure, he feels worthless as a person. Severely depressed individuals often feel guilty and are unable to find forgiveness. All of this can make them give up on things we used to find meaningful, feel uncomfortable around other people, and withdraw.

Recognizing that someone is not seeing life clearly because of depression is an important step. Identifying what makes a person vulnerable to depression at any given time can help them re-evaluate priorities. Therapies such as CBT, cognitive-behavioral therapy, can help depressed individuals distinguish what is reasonable thinking and what is not, and take steps to protect against further relapse. Spiritual resources that offer hope, community, and forgiveness can be part of this recovery process.

Rather than thinking of depression as a temporary mood or moral weakness, it’s more helpful to think of it as a recurring but potentially manageable presence in someone’s life. I recommend a short online video from the World Health Organization called: “I had a black dog, his name was Depression,” which offers a number of suggestions for developing a relationship with your own black dogs.