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The inner world of depression. (Stresslines).

Depression is the single most common emotional problem with which people struggle. Its symptoms include feelings of listlessness or sadness, sleep and appetite disturbances, and a lack of joy in life.

Underlying these symptoms are often pervasive and profoundly painful feelings of worthlessness. The depressed person often feels burdened, at times even tormented, by thoughts of his or her real or perceived failures.

For some people, feelings of worthlessness are so intense and/or unremitting that they lose hope in their ability to manage their lives. They may resort to abuse of drugs and alcohol to numb their emotions. However, these attempts at self-medication ultimately fuel feelings of helplessness, and render the individual progressively less able to meet the demands of daily life. As the individual becomes less able to manage his or her daily affairs due to substance abuse, feelings of failure and following this, self-blame increase further.

Other people attempt to soothe feelings of self-recrimination by withdrawing from contact with others. Attempts at isolating from, others are sometimes driven by the belief that truly responsible and "strong" people should be able to manage these feelings on their own. Isolation may also follow from shame, rooted in the individual's belief that he or she is a burden on others. However, withdrawal may ultimately leave the individual feeling more helpless and desperate than ever. This is because the individual who isolates him or herself socially is eventually left without the interpersonal support needed to solve concrete problems of living.

Causes of Depression

There are various causes of depression. For example, there is research now underway that will hopefully clarify the extent to which biochemical or genetic factors play a role in the genesis of this disorder. This research may pave the way for promising new medical treatments. From a psychological perspective, we know that adults who, as children, were placed in a caretaker role in their family of origin are more prone to depression because they were usually only rewarded for taking care of others. As adults, these individuals find it hard or, in some cases, impossible to identify effective ways to take care of themselves. They may even feel that they have no right to have their own, separate wishes or needs and may feel profoundly guilty or ashamed for asserting themselves in ways that most other people deem appropriate.

Help Through Psychotherapy

How does psychotherapy help the depressed person? The answer comes in two parts. First, therapists who are successful in treating depression are aware of, and sensitive to, the depressed person's anticipation of rejection for sharing feelings, since expressing emotional needs is a form of self-care running counter to the messages they received in childhood (i.e., to be "strong," to keep personal and family affairs private, etc.).

Second, putting feelings into words can be the prelude to beginning to understand some of the historical roots of current dilemmas.

Talking with a therapist is different from talking with a friend or family member. First, the therapist brings experience to bear on understanding how to help someone struggling with depression. Second, unlike friends or family, the therapist is more likely to be optimally objective about the client's difficulties. Related to this is the fact that the client benefits from the private, protected nature of his or her relationship to the therapist, by the knowledge that the therapist does not feel influenced by the opinions of friends and family.

Garth W. Amundson, PsyD., is a licensed clinical psychologist. Heidi D. Schwartz, is a Licensed Clinical Professional Counselor. Both practice in Chicago, telephone (708) 930-1833. This column is published under the sponsorship of the Quality of Life and Career Committee. The committee's website is at The Quality of Life and Career Committee, in cooperation with the Florida State University College of Law, also has an interactive listserv titled "The Healthy Lawyer. Details and subscription information regarding the listserv can be accessed through the committee's website or by going directly to
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Author:Amundson, Garth W.; Schwartz, Heidi D.
Publication:Florida Bar News
Date:Apr 15, 2002
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