Depression has been recognised throughout the ages. But the beliefs around causes have varied, ranging from physical, mental, metaphysical or spiritual, with treatments ranging from barbaric to bizarre. Today the debate rages on, with many contradictory statements and a plethora of approaches posited. Let’s take a brief look at historical and current thinking, then move onto Freud whose position on it, interestingly, parallels much of the Existential view, which is where we’ll conclude our snapshot
Inevitably, what we believe might cure depression is tied to what we judge to be the cause. Cicero, in Ancient Rome, wrote about melancholia as being caused by the psychological distresses of rage, anger and grief. In the Middle Ages the overarching conviction was that depression was brought on by demons and evil spirits and the concomitant cure included exorcisms, drowning or burning. The medical views of the time noted that depression was a physical imbalance of the humors (bodily fluids) as well as a mental weakness in temperament. Melancholia, as it was called then, was due to an imbalance of the black bile in the spleen, so treatments might include bloodletting, baths and diets.
In the 17th Century, poverty and loneliness were considered as contributing factors to depression and remedies such as exercise, music and travel were recommended as well as other physical approaches such as herbs and bloodletting. In one sense, these cures are not so different to much of the current thinking, which allows for a mix of drug therapy, psychotherapy, exercise and strengthening social support.
And moving on to today, it seems as if the latest thoughts on depression are almost as contradictory as ever. The following links are based on the ‘facts’ as they are variously pronounced and give a glimpse into the continuing ‘to and fro’ debate.
Is everything you think you know about depression wrong?
The Case for Ketamine in Treating Suicidal Ideation
‘Gene map for depression’ sparks hopes of new generation of treatments
For Freud, loss and depression or melancholia were intertwined. The experience of loss could be actual, such as in a death or it could be symbolic, such as not achieving a goal. Here, Freud’s ideas dovetail with the existential view which is that a depressive mood can be understood as a loss of meaning. For instance, the death of a loved one thrusts the survivor into an altered world, presaging the need to shape a new identity and to create different reasons for living. Indeed, most changes in circumstance include a shift in what we had perceived as our identity and a review of who we believe we are (and are not). This can be hugely confronting, with all our relationships coming into question as we navigate our way through the morass of transition. Endings and new beginnings of all types come under this banner of altered meaning. Developmental transitions such as the shift from childhood to the responsibilities of adulthood, changes in job, country or relationships, can all swing us into a place of uncertainty that can be very uncomfortable and lead to a depressive mood.
Crisis of meaning, in the sense that what we believed to be true is no longer true, is another way of understanding what transpires when something takes away the familiar structure of our life and the meaning that we’ve created to make our life as certain as we need it to be. All meaning is intertwined with hope. So, as familiar meaning recedes, hope also seems to dissipate. A sense of hopelessness, perhaps even a lack of any anticipated future, can rush in to fill the vacuum.
The existential lens is averse to labelling so tends to favour the use of descriptions or ‘the opening up of experience’ to reveal a bigger picture of a person’s overall mood and how they exist in their community. Giving a client the space in which to talk about their life with a wider lens helps to remove the belief that depression is a noun or a fixed, immoveable state. The idea that everything changes and is in continual flux can help give credence to the notion that depression is also a shifting state of play. We may experience ourselves as being in a low mood, in the confusion of despair or without hope. But it is not forever. As Sartre wrote, “Life begins on the other side of despair”. Working patiently with a wider perspective can facilitate an awareness that these feelings are on a continuum, helping to open up a space for hope and for new possibilities.
