Depression or Dilemma? How Context Makes the Difference Between Feeling Stuck and Empowered

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 a Victoria BC therapy session) 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.

Why Understanding Context is the Key for Effective Therapy

Do you ever have the feeling that something isn’t right in your life, but you can’t quite put your finger on what it is?  Or maybe you know very well how things aren’t working, but you struggle to see why?

When people first sit down to with us to talk about the challenges they’re facing, it’s not uncommon for them to say, “I feel this way for no reason”, or “I don’t know why I feel this way…I just do”.  When you feel stuck and are struggling to make sense of why that is, talking with a counsellor who can help you see the bigger picture can make a world of difference.

Why Context is Crucial

Reasons are important.  For better or for worse, how we make sense of the problems we face directly informs how we deal with them.

Examples of this are clear throughout human history.  Just look how far we’ve come in the field of medicine!  For instance, have you ever heard of bloodletting (apologies to our squeamish readers)?  This was a practice used over several thousand years to treat illnesses, which were thought to be caused by people having too much blood in their bodies.  When people got sick, medical professionals would remove blood in attempts to restore equilibrium and good health.

If you’re alive in 2017 and have ever seen a doctor, you know that bloodletting is not considered a standard (or even remotely appropriate) practice.  Instead, we treat illnesses with things like antibiotics, probiotics, vitamins, immune boosters, and specially developed interventions that directly target the problems our bodies face.  Because we know more about the context surrounding particular ailments than we did 3000 years ago, we can address them more effectively in context-specific ways.

Why the Big Picture Can Be Hard to See

That’s all fine and good when it comes to issues around our physical health, but what about the kinds of problems people bring to counsellors like us?  These are often issues that have more to do with emotions and experiences than the nuts and bolts mechanics of our bodies.

As social beings, the popular ideas of our societies and cultures inevitably make their way into our thought processes and lead us to think certain things about how we respond to our experiences.  Here’s an example of how we see that in our work as Victoria BC counsellors:

After her health declined significantly over the course of several months, Sam’s mother was diagnosed with both cancer and an auto-immune disease.  Sam found this profoundly upsetting, and put forth all the effort he could muster to support and care for his mom, as well as his father and sister who were also struggling with these developments.  The weight of the situation was tremendous for Sam, and he experienced a decline in his appetite, more frequent moments of irritability with his partner, and wakefulness at night when he was trying to sleep.  In counselling, he lamented that although this was the most difficult period he and his family have ever faced, these feelings were out of character for him, as he’s usually a happy and carefree person who rarely feels upset when the going gets tough.  Coming in to counselling, Sam had the idea that his despair was unacceptable and invalid, which added another layer of distress to his situation.

Because no one lives outside the influence of culture, we have to consider how ideas about “appropriate” experiences and expressions of emotion inform someone like Sam’s understanding of their responses to what they’re dealing with.

Ideas that suggest “being strong” means not feeling profoundly upset when hardship strikes (or not showing that we’re upset when we are), or that we should just be able to “carry on like normal” can lead us to believe that there’s something wrong with how we’re feeling.

This places the emphasis on “fixing” our emotions rather than exploring what we need within the situation we’re dealing with.  By doing this, the context surrounding our distress is made illegitimate and we’re left scratching our heads as to why we’re experiencing things this way.

The Cost of Easy Answers and Quick Fixes

Simple, individualistic explanations for why we struggle can be both appealing and troublesome.  It can be easy to think about the issues people bring to counsellors, like feeling unhappy or experiencing a lot of worry, as problems of the mind.  Period.  Just like with Sam’s situation above, this leads us to see our responses to the adversity we face (like our emotions) as the parts that need fixing.  We believe there’s more to it than that.

There’s a sea of information on the internet about how to address so-called problems of the mind, and more often than not that’s where people begin their journey of trying to make things better.  “Strategies to not feel anxious” or “ways of not feeling depressed” can be really helpful in some practical ways, but they may not address the reasons behind the feelings you’re experiencing.  In short, they look at the small picture – the emotion or behaviour – but not the bigger web of relationships between the emotion or behaviour and other important contextual factors.

Focusing on the small picture, and the small picture alone, can lead you to feeling more upset, frustrated, and discouraged that things aren’t improving despite your best efforts.

Focusing on Context Makes for More Effective Therapy

The field of psychotherapy has a long history of trying to get to the bottom of things as simply as possible.  Over the decades, this has involved reducing the reasons for the problems we experience to singular origins.  For example, someone might say they struggle with confidence because their parents never encouraged them enough, or they feel unhappy because their self-talk is negative.  Period.

While it’s nice to have simple and straightforward answers to things, perspectives like these leave out more aspects of your experience than they actually take into consideration. They may be relevant pieces of the puzzle, but they probably don't account for the whole picture.

When people come to us, we find it really helpful to not just focus on their feelings, behaviours, or pain, but to expand the scope and explore their place in the tangible world they live in.  We invite people to get out of their heads and into the broader realm of their experiences.  One way we do this is by asking questions that go beyond your thought processes and feelings.  You can read more about that here.

This is a good time to revisit Sam.  If we were using a more traditional, less contextually-focused approach to our work, such as Cognitive Behavioural Therapy, we might guide him toward monitoring his thoughts and practicing private interventions when he notices himself feeling low or anxious.  That would, in all likelihood, be helpful to some degree, but may also fall short at addressing other important aspects of Sam's situation.

A more contextually-focused approach, like Response-Based Practice, allows us to help in even more tangible ways.  Here’s an example of what that might look like with Sam:

• Asking Sam questions about how he’s managing the complex situation he and his family are facing:

  • “What do you worry about the most throughout the day: your mom’s health or your own responses to the situation?”

  • “What’s more stressful: not knowing whether your mom will be ok or trying to ‘hold it together’ for her, your dad, and your sister?”

  • “Who would you worry about the most if they were to know that this has been so hard for you to deal with?”

  • “Who do you imagine would worry most about you if they knew how much you were struggling?”

-Questions like these can shed light on Sam’s awareness of the social dynamics between himself and the others involved, and how he’s navigating those factors.

• Asking Sam questions about the meaning behind his emotional responses:

  • “If your despair could speak for itself, what would it say about what your mom, dad, and sister mean to you?"

  • “What do your worries and fears say about the care you have for each person in your family?”

  • “Who in your life would be most concerned if you weren’t feeling much of anything about the situation at hand?  Why would that be cause for concern?"

-Questions like these can clarify Sam’s values and show how the feelings he’s concerned about are expressions of love or care.

• Offering questions that help identify Sam’s needs or longings behind his responses:

  • “If you could absolutely trust that someone in your life would be ok if they knew how hard things were for you right now, who would you want that to be?”

  • “How much pressure would be released if you knew you didn’t have to hide the extent to which you’re struggling on top of the worry about your mom?”

  • “What do you like most about being a support to the people you care about? Who in your life do you think would be most grateful for the opportunity to support you at this time? How would you let them know you value that support?”

-Questions like these can help reveal practical solutions that can actually make a tangible difference for Sam’s wellbeing.

Our hunch is that a conversation like this would help Sam go out on a limb and recruit more support for himself, thereby reducing the strain he feels from having to “be strong” in such an understandably difficult time.

Using Questions to Better Understand the Context Around Your Own Problems

We hope this gives you an idea of how response-based, context-focused questions can help draw your attention to pieces of the big picture that are totally relevant in understanding your struggle, but which are also often left unexplored.

You can use questions like these on your own to shed light on the big picture of struggles you face:

• When did you first notice that things took/were taking a downward turn?  What was different between this time and before things got bad?

• Who noticed that things took a turn for you in this way?  What was their response like?  Did their response help or did things get worse for you after?

• Is there anyone you’ve been careful to keep out of the loop regarding how you’re doing?  Why is that?  What difference does self-censorship around certain people make for how you’re doing?

• Who is most worried about you and how do they let you know?  What difference does their concern make in terms of how you’re doing?

• If you could imagine removing or adding certain “key ingredients” (contextual factors) to make things better, what would those be?  What difference do you imagine that making?

Are there any particular ways that you use to see the bigger picture of what you or others are dealing with?

If you think it could be helpful having these kinds of conversations, feel free to drop us a line.