I’ve had a front-row view of depression the last few years as I’ve watched several people’s lives change and decline as they struggled with the condition. One person in particular, who I will call Bob here, suffers from major clinical depression. He is out of work and his life consists of sleeping and playing video games. To make matters worse, he has the opportunity to file a wrongful termination suit that was estimated to result in a six-figure settlement, yet hasn’t been able to summons the motivation to call the lawyer who was located and prescreened for him. Bob is a wonderful person with a generous soul who has a genius level IQ and is college educated, and accordingly, he has broken the heart of all those who love him and feel helpless to change his demise. Freud famously described depression as “aggression turned inward” and I believe that to be true (as cited in Sapolsky, 2004, p. 299). Bob is caught in a matrix of paralysis that prevents him from trying to improve his situation, and that non-action is a self-sabotaging behavior that perpetually causes self-loathing, which then translates into further inertia.
The hopelessness theory of depression helps explain Bob’s depression when his psychological vulnerability and challenging environmental circumstances collided. He’s struggled with depression for decades but it wasn’t until he was first injured and then laid off recently that he descended to this level of incapacitation. He was neurologically at risk after a car accident in adolescence which put him in a coma and resulted in some brain damage, but even before that he was inclined towards a depressogenic explanatory style. My mom swears he was born that way. So when he lost his job, I think he looked at things like he was being unjustly punished, yet subconsciously felt like he deserved it. He took the one incidence of wrongful termination and overgeneralized it to his entire world. He used global and stable attributions to explain that one negative event: “I lost my job which was beneath me to begin with and now I’m even more of a loser with no money and no career who plays video games all day long” (global), and “Things will never change; my life is doomed” (stable). With such all-encompassing negative perceptions, it’s no wonder he doesn’t feel any motivation to try different coping mechanisms. Instead, he fell prey to learned helplessness when his best efforts to succeed in life failed, which lead him to give up hope (Siero, Bakker, Dekker, & van den Burg, 1996).
In the discussion of how stress and depression are related, Sapolsky (2004) explains that for depressed people everything about life feels overwhelming, this activates the stress response and elevates glucocorticoids like cortisol, which in turn tells the brain to produce more cortisol since it is clearly needed, and these increased glucocorticoid levels create more depression symptoms, and so on. It’s a vicious mind-body hormonal feedback loop that is self-perpetuating. Sapolsky (2004) also talks about how intense guilt plays a large role in depression. He says that most people suffering from depression are aware of how their state has affected their lives and how it has pained their family, and that they feel incredibly guilty about it. They feel guilty for being depressed, and this is depressing so it prevents attempts at healthy coping mechanisms, but then this triggers more guilt and down they descend into another merciless feedback loop (Sapolsky, 2004). This absolutely mimics Bob’s habitual pattern of being withdrawn from family and friends, and then beating himself up over it which consists of alternating long bouts of angry silence and crying fits lamenting over how he doesn’t want to be that way but can’t help it and hates himself for it.
The deeper layer of guilt is shame, and Dr. Brené Brown shot out of the cannon a few years ago researching this deeply embedded, yet rarely discussed, human phenomenon. She’s a research professor and writer out of the University of Houston Graduate College of Social Work, and gained international attention with her 2010 TED talk entitled “The Power of Vulnerability”: http://www.ted.com/talks/brene_brown_on_vulnerability?language=en. It’s only twenty minutes and I highly recommend watching it during a study break or even just listening to it while folding laundry. I discovered her work earlier this year when I saw Oprah interview her on Super Soul Sunday and have since read a couple of her books. She defines shame as “the intensely painful feeling or experience of believing that we are flawed and therefore unworthy of love and belonging” and links it to mental illnesses like anxiety, depression, and addiction (Brown, 2010, p. 39). She’s been studying shame and vulnerability through qualitative research for the last fifteen years and has conducted over 10,000 interviews. She acknowledges the new-agey association with the concept of “owning your story” and yet she insists that this is a crucial foundation of mental and emotional wellbeing in combating the universal feelings of shame that we all experience. Regardless of where people fall on the anxiety/depression/addictive behavior spectrum, her explanation of shame is something that everyone can relate to:
Shame keeps worthiness away by convincing us that owning our stories will lead to people thinking less of us. Shame is all about fear. We’re afraid that people won’t like us if they know the truth about who we are, where we come from, what we believe, how much we’re struggling, or, believe it or not, how wonderful we are when soaring (sometimes it’s just as hard to own our strengths as our struggles). (Brown, 2010, p. 39)
Again, this resonates deeply when I think of Bob. I think he feels like if we knew exactly how deep and gnawing his emotional pain was that we’d lose respect for him, lock him up in the loony bin, or both. But that’s the insidious irony of shame: it blooms in the dark and withers in the light. The more that depressed people can learn to expose their vulnerabilities by talking about their feeling and fears without judgment, the more they make space for new healthier thought patterns to emerge. While I wish I could make Bob read Dr. Brown’s research and get him to see an excellent therapist to help him work through his shame, he’s too depressed to take any productive action; therein lies the ongoing problem which is a debilitating construct for many people suffering with depression. It keeps you on a sad, dim island, spinning in circles while standing in place. Depression is marked by the incredible ambivalence of wanting things to be better and perceiving that notion to be impossible. In addition to standard treatment like the hopefulness approach, educating patients about shame and vulnerability as part of cognitive-behavioral therapy seems like an important piece for long-term healing. Learning how to feel comfortable understanding and expressing the authentic self (in the company of safe, trusting people) bridges the isolation and shame that feeds upon itself and keeps people locked away inside their silent prisons (Brown, 2010). Dr. Brown acknowledges that there are no easy answers or quick fixes, and instead explains the daily grind and commitment to yourself by quoting E.E. Cummings: “To be nobody-but-yourself in a world which is doing its best, night and day, to make you everybody but yourself—means to fight the hardest battle which any human being can fight—and never stop fighting” (as cited in Brown, 2010, p. 51). I hope her research on shame and vulnerability will continue to gain traction and attention from mental health professionals and laymen alike, as it can enlighten and empower us all.
References
Brown, C. B. (2010). The gifts of imperfection: Let go of who you think you’re supposed to be and embrace who you are. Center City, Minn: Hazelden.
Sapolsky, R. (2004). Why zebras don’t get ulcers: The acclaimed guide to stress, stress-related diseases, and coping. New York, NY: St. Martin’s Press.
Schneider, F. W., Gruman, J. A., & Coutts, L. M. (2012). Applied Social Psychology: Understanding and Addressing Social and Practical Problems. Thousand Oaks, CA: Sage Publications, Inc.
TED. (2010, June). Brené Brown: The power of vulnerability. Retrieved from http://www.ted.com/talks/brene_brown_on_vulnerability?language=en
Tags: Applied social psychology, depression, shame