Depressed, depressing, and depression are all words I hear and use frequently. These terms are so ingrained in our culture, they are used for anything from a disappointing friend to an expired ice cream. It is so common, even people who have no awareness of its clinical meaning, or who consider themselves ‘happy’, brush with it now and then.
Perhaps it is due to the fact that after decades of research, new treatment methods, and numerous approaches attempting to dissolve its grip on people around the world, depression remains an incurable phenomenon. And according to the American Psychological Association (APA), it is “the most common mental disorder.”
The theories about depression can be roughly divided into two groups – those who contend depression is a physiological/biological disease caused by a chemical imbalance in the brain, and can be treated with medication, and those who believe it is a psychological/spiritual problem that requires other forms of treatment. There is a split between the physiological (body) and the psychological (mind) approaches that may be at the root of the inability to find an effective long-term treatment.
But few have made the connection between the physical and the psychological, both in their understanding of the nature of depression, and in the ways to help those who are struggling with it. Looking beyond the symptoms and deeper into the research behind the various theories about depression, its causes, and treatments, could help in finding what’s been missing.
During a debate about depression, Donald Klein, M.D. Professor of Psychiatry at Columbia University argued that “clinical depression, is not unhappiness, it is an illness that is open to medication and can be medicated well.” How well is still an open question. Most if not all the medicine and other medical treatments (i.e. Electroconvulsive Therapy) aim to mitigate or eliminate the symptoms of depression such as lack of energy, a loss of interest in life’s activities, and thoughts of death or suicide.
While empirical data suggest pharmaceuticals help some patients, the danger of psychiatric drugs is in its effect on the person’s inability to feel the body. Medicated people are often seen to have a ‘numb’ quality to their behavior and demeanor. Medication may reduce their symptoms and aid them in performing certain societal tasks, but it brings an onslaught of side-effects, and perpetuates the condition without changing its root-cause. This is one of the reasons many depressed patients are susceptible to repeating episodes.
Klein’s colleague, Fred Goodwin, Professor of Psychiatry at George Washington University said during that same debate that depression “involves a whole bunch of physiological dysregulations [which show] that there are differences in depressed patients and people who are not depressed.” This may be true, as brain imaging shows, but to say that it is the cause of depression is still unfounded.
Countering this argument, Psychiatrist & Author, Dr. Ron Leifer said of those physiological dysregulations: “depression is a spiritual problem…that causes changes in the body. The question is, are they cause or effect. I think they are effect rather than cause, an effect of a spiritual problem.” There are many ways to address this “spiritual” problem, which generally involve psychotherapy, meditation, and other activities. But one must ground the ‘spiritual problem’ in reality, not just in ideas. For most people it’s not enough to talk, analyze, and decide to change. Their behavioral habits are structured in the body, which requires a physical change, not just a mental decision.
More than a decade later, the debate rages on. In his Psychology Today blog, Dr. Stephen Diamond, a clinical and forensic psychologist debated the nature of depression with his colleagues. He wrote that “depression’s roots are more commonly basically psychological than biochemical–though one clearly affects the other… Without aggressively attacking this psychological, spiritual and emotional core or heart of depression, it cannot be permanently dispatched. Only temporarily suppressed. Which is why pharmaceutical treatment of major depression by itself, while invaluable, is no substitute for real psychotherapy combined with psychopharmacology.” So combining medication with psychotherapy is the way to go.
The Missing Part
We had the strict scientist, the devout spiritualist, and the psychologist who is trying to combine the two. All present good arguments and years of experience, but none make the connection on the body level. The level where the chemical and psychological interlinks, where the spiritual and the physiological live.
In Depression and the Body, Alexander Lowen, M.D. writes that the condition of the depressed person is that “he is unable to respond [and] has lost his ability to protest his fate.” This simple concept is also physically manifested in the person’s body, often in the form of shallow breathing, and an immobile musculature.
Dr. Lowen writes further, “For every person the basic reality of his being is his body. It is through his body that he experiences the world and by his body that he responds to it. If a p
erson is out of touch with his body, he is out of touch with the reality of the world.” There may be as many ideas about depression as there are people, but they all share this basic truth.
As for a solution, Dr. Lowen argues that “the first step in the treatment of depression is to help the patient get in touch with the reality of his body.” If when you are depressed, your body is physically depressed, wouldn’t it make sense to mobilize your body, which in turn would mobilize your self?
This is not to say that going to the gym is the cure for depression. But if the depressed person’s level of energy is low and the breathing is flat, popping a pill or simply talking about it is not going to do the trick. Yes, it affects the brain and thinking, but it does not change the fact that the depressed person is unable to feel the body. It does not change the basic condition, it does not treat the root-cause, and thus cannot solve the problem in the long-run.
Obviously, the process of getting back in touch with the body is neither quick nor easy. It involves physical exercises, which help a person release unconscious chronic muscular tensions in the body along side the analysis of psychotherapy. In head-oriented cultures, which emphasise power, success, and the pursuit of unachievable goals like staying young, this ‘undoing’ is even more difficult.
But Dr. Lowen’s premise should raise important questions about the basic hypothesis of anyone involved in studying and treating depression. To uproot depression one must dive deeper than the causal correlations, and the surface of symptoms and excuses.