So What Is Depression?

Edvard Munch, Melancholy

So what is depression?

It is not an illness, so far as we know. All we really have is a set of symptoms. See the Diagnostic and Statistical Manual to make this clear. It is a bulleted checklist. Check off five or more, and that’s your diagnosis.

And it may be an arbitrary list. What we call depression may, like fever, or a skin rash, have a variety of different underlying causes. Or it may be that one cause is behind both the symptom list we call “depression,” and another currently unassociated symptom list: “anxiety disorder,” or “narcissistic personality disorder,” or “autism,” or something else. Or all of them.

In fact, I submit that this is certainly the case. Depression can have a variety of causes, and it shares the same causes with other currently unrelated “mental illnesses.”

I think we can, however, talk about an essence of depression. It is not “sorrow.” The current label is misleading.

If you scan the official list of symptoms, it is not hard to guess. “Depressed mood.” “Diminished interest in activities.” “Loss of energy.” “Lack of movement.” “Indecisiveness.”

Bingo. The essence of depression is a lack of direction or meaning. One has lost one’s sense of purpose. One just can’t get that motor in gear. Or, one is in a kind of maze of thoughts, and cannot find the exit.

That tends to cause low spirits; not vice versa.

Cheering you up is not the issue, and is not going to work. You have to find direction.

You can actually see this happening to entire cultures. Jung observed it in Africa, and called it “loss of soul.” Back in the 19th century, when first contact with isolated cultures was still often recent, Darwin puzzled over it. He observed in The Descent of Man that when isolated cultures first encountered Europeans, they tended to stop marrying and having children. They stop working, whatever their work had been, and become deeply involved with alcohol or drugs. Their tightly integrated word view had been shattered by this intrusion of something vastly alien. They no longer understood the point of anything.

I have seen a similar reaction on a smaller scale among expatriates, on integrating with an unfamiliar culture. They retreat to their rooms, or to expat bars and alcohol. Some even begin to have fully delusional thoughts.

So the various symptoms we clump together as depression come from a feeling that nothing makes sense. We no longer know what to think.

Losing one’s sense of meaning can, in turn, have a variety of causes. It may be that some dramatic life experience, like going to war, or the arrival of aliens in some great ship, has challenged all our previous certainties, and we have found them not to be true. You can even get the effect from some sudden new idea, either something you learn or something you figure out for yourself. For a while, it can be deeply disorienting. This is one reason why, as Aristotle observed, learning is painful.

We generally derive a huge amount of our sense of meaning and purpose from our relationships: from family and social group, community and nation. We live for our lover, for our children, for our parents. We are prepared to die for our country.

So one inevitable major cause of depressive symptoms, probably the most common, is having come from a family in which one was rejected, devalued, unloved.

Psychiatry and psychology have been vaguely aware of this; but they see the critical factor as childhood abuse, usually physical or sexual. This is not the key; it is the devaluation of the person, or, conversely, the devaluation of the family or community relationship, however this is expressed.

This can explain another symptom labelled as depression in the DSM: a low sense of self-worth. You get this, most obviously, from living with others who tell you you are worthless.

But the same sorts of families or communities also tend to systematically lack or overturn more generally any sense of values. Parents with their own values in good order do not reject or abuse their children. This lack of values growing up may still be the most damaging thing.

If this is right, the cure is obvious. Pills aren’t going to do it. Pills can’t give you meaning. Many early psychiatrists themselves saw it, and said it: Frankl, Maslow, Jung. The solution for depression is to somehow find new meaning and direction.

Some find their new meaning and direction in psychology and psychotherapy. When it works, this is why it works. And this is why people today, who have been psychologized, tend to cling to their particular school with a fervor you would expect for religion.

But psychology and psychiatry are not very strong vessels for this. They are not intended for it, are new and untested, and are critically limited in scope.

The classical place to find meaning is, of course, religion.

The decline in organized religion in North America and Europe, not surprisingly, tracks exactly to a rise in depression and other psychiatric diagnoses. At the same time, people have tended to stop marrying and having children, they have become more inclined to retreat to drug use.

This is not a coincidence.