A Problem With Depression
As therapists, we have a lot of conversations with people who describe their suffering as “depression”. Though “depression” can mean something fairly different from one person to another, there is often a common element of feeling stuck with a sense of profound despair.
If you think about it (or if you’ve actually lived it), feeling stuck can be terribly depressing in and of itself! To feel stuck is to feel constrained from pursuing your hopes and dreams, and there’s nothing cheerful or positive about that.
In the world of mainstream therapy and mental health, it is the experience of despair, along with the associated thoughts, feelings, and behaviours, that get the most attention. When those parts are the focus, we naturally tailor our efforts toward “fixing” them. The body of mainstream psychological literature tells us that that is where the problem of depression both begins and ends. We therefore strive to think, behave, and feel differently, often in spite of relevant conditions of our lives.
As you can imagine, it’s difficult to get very far when that is the case. Folks in situations like these often feel unsure of what they can do, relying on professionals to help “fix” what’s wrong.
Using Context as an Ally
What gets left out of those conversations and efforts is an exploration of the broader context – the aspects of our lives and experiences that the depression is in response to. For many, it’s not just about feeling stuck in a state of profound despair, but about the real world factors that constrain our capacities to make our lived experiences better.
To put it simply, the “stuck” feeling that corresponds with depression is often a response to a dilemma – to negative circumstances that feel hard or scary to disrupt.
But don’t despair, there’s hope in that too! When that is the case, although we may feel stuck between a rock and a hard place, there is an ever-present possibility to take action to change things – even though we may be afraid of the outcome.
A Depressing Dilemma
Here’s an example to illustrate how a person’s depression can be more aptly seen as a response to a dilemma when enough context is given:
When Aryn came into my office for the first time, they described themselves as “struggling with depression”. They described having pervasive feelings of despair, frustration, and great difficulty focusing on their work. I became very curious and asked a lot of response-based questions to help clarify the broader context. They described how they had spent 10 years studying engineering, which they got into because they were told they could get a good job when they finished. That turned out to be true, but after just one day of working for an engineering firm, they had a panic attack in response to imagining spending the next 30 years doing that work. For Aryn, the work left a lot to be desired.
Aryn promptly quit that job and returned to school to pursue a graduate degree in the same field. Unsurprisingly, they struggled to find joy in their studies, and found themselves feeling an increasing sense of despair and anxiety. I asked about their worries around the possibility of changing direction in their career, and they acknowledged their fear of how their family members and in-laws would respond. They feared being coloured as “flaky” (a term that had been used against them in the past), having the legitimacy of their feelings disregarded, and told they were making the wrong decision – even though continuing on along that path felt anything but right. Aryn felt trapped.
Aryn illustrated how the lack of a clear and easy path forward created the very real constraints they were struggling against, which they responded to with a “depressed” mood. If I were in Aryn’s shoes, I think I would too. Acknowledging that all available options posed at least some degree of risk or adversity, we explored what might be the best solution to their despair. While it would be hard telling their family that they wanted to change their career and risk receiving negative, judgmental responses in return, they decided that was better than continuing down the familiar and unsatisfying path they were on. After making that difficult decision and taking the corresponding actions, Aryn felt a huge sense of relief from what they first understood as “depression” – even though they knew they weren’t out of the woods quite yet.
Social Contexts and Depressing Dilemmas
Despite popular cultural narratives that celebrate independence and total self-sufficiency, humans are inherently social beings. It’s therefore not surprising that depression (and most other problems people bring in to therapy) has key social aspects that often get overlooked. This has a lot to do with why most folks who consult with us about depression acknowledge feeling isolated, alienated, mistreated, constrained, or oppressed in their significant social relations (or society more broadly).
This was absolutely true for Aryn, who was in a career that left them wanting more, and who felt constrained by the social responses they anticipated receiving if they were to do what was needed to disrupt their dissatisfaction. When we really got into it, it became clear that their dilemma was profound: continue down a path that is fundamentally unsatisfying and a source of resentment, or make some important changes to their career path and risk alienation, isolation, and disapproval from the people who matter most in their life. That sure sounds like a recipe for depression and despair to me!
Understanding Context is Empowering
If you were to imagine yourself as a helpful friend (which I’m sure you are!) who had two friends in need – one who asked you to help them solve their depression, and one who asked you to help them navigate a dilemma – which one do you think you think you’d feel more confident in assisting?
While I don’t doubt that some folks would say the first one (there are some really clever people out there!), I’m inclined to think that more people would feel better equipped to help the friend with the dilemma. There may be lots of individual reasons for this, but a common one is that problems that are clearly situated in context are more tangible, and therefore easier to wrap our heads around.
This is a big reason why we find a response-based approach to therapy to be so helpful: it helps us take problems that may feel more overwhelming because they’re steeped in abstraction, and really understand them from the most important angles. If you think about it, a statement like “I have depression” doesn’t tell us a whole lot about what’s really going on for a person, whereas “I’m super unhappy and anxious because I feel unsatisfied with my career path and I’m afraid my family will reject me if I do what I need to do about it” does.
Using Awareness of Context to Navigate Social Dilemmas
There can be a lot of unlikely hope in the social dilemmas we face. While it is sensible to fear negative responses from the stakeholders in our lives because they often pose real material consequences (such as the loss of a relationship, a job, housing, income, opportunities, etc.), there are many nuanced ways we can navigate those situations to try to maximize a positive outcome. I make a point of never underestimating a person’s intimate knowledge of their relations and their ability to use fancy footwork to safely strive for what matters most to them.
While every situation and social dynamic is at least somewhat unique, the crux of how risky taking a chance and doing a hard thing is lies more in how you do it than if you do it. What I mean here is that we can often get discouraged and hung up on what might happen if we do a hard thing. While there may be some good insight informing those fears, it’s also important to remember that we’re capable of a wide array of communication styles, and the delivery of a message can make a significant difference in terms of how it’s received.
For example, Aryn probably knew that their parents would be more understanding if they arranged a time to meet with them and illustrated just how thoughtfully they’ve navigated the decision-making process around their career and education path. They almost definitely knew that would go over better than just sending them a text message saying “Hey I decided to quit engineering and drop out of school forever lol”.
My point here is to encourage you to remember that even though you may not always feel it, you are a social genius, capable of using thoughtfully chosen actions to address dilemmas, which can bode well for things turning out much better than you might fear.
Facing Depressing Dilemmas
If you read between the lines, the fact that we feel depressed when we feel stuck in a dilemma can say a lot about our values and what matters to us in our lives. When our freedom to make choices and take action in what we know to be our best interest is compromised, we protest on a deep emotional level. Although expressions of those emotions are often framed as mental health problems, we see them as signs of good mental wellness, and an implicit concern for our quality of life.
When you find yourself feeling depressed or in despair amidst constraining circumstances, we invite you to consider how those feelings make sense in relation to those constraints. What do they say about what matters to you? If they could be expressed as an “I wish…” statement, what would that statement be?
By being able to identify the dilemma behind the depression, you can then work more easily with the tangible factors that have made that a reality.