Mick Bramham, mental health consultations  

Thinking about depression

So, what is depression?

There are numerous reasons why we might feel depressed, such as the loss of a close friend or relative; the break-up of a relationship; being treated with abuse and injustice (including mental, sexual and physical abuse); painful memories; a sense of hopelessness; or situations or people that seem beyond our control.

In trying to describe how they feel, people may speak of: feeling anxious, uncertain, tearful, lacking confidence, deep sadness, despondency, lethargy, not wanting to face other people, finding life meaningless, or an overwhelming sense of darkness, dread, and despair.  Very often there is a feeling of powerlessness to change the circumstances they are in. For many people their lives have drastically changed; either suddenly, or gradually over months or years, so that they compare how they are now with how they used to be.

        Anne Bronte quote    

When we feel depressed, invariably it is someone or something that is getting us down. It
might be a sudden and overwhelming event or the cumulative impact of people, events and
circumstances over the years (possibly with roots in childhood experiences too). It may
have much to do with how the person feels about him/herself, with exceedingly low self-
confidence and esteem. It could also be a response to despair over the apparent
meaninglessness, uncertainty or insecurity of life. These and many other factors can weigh
heavily upon us, pressing us down, de-pressing us to the very depths of our being. This we
might call “depression”.


There may be memories, circumstances and experiences that weigh
heavily upon us, pressing us down, de-pressing us to the very depths
of our being. This is perhaps what we mean by “depression”.


We tend to use the word “depressed” quite freely. We may use it when we really mean that
we are tired and feeling fed up – knowing that tomorrow we will feel fine after a good night’s
sleep. Others will speak of depression to describe feeling desperate and suicidal. Thus
there are clearly degrees of sadness and despair - ranging from feeling upset and
disappointed - to feeling desperate and even suicidal. For some people the experience can
be short-lived, but for others more enduring. Depression, or melancholia as it has
sometimes been called, was aptly described by Hippocrates as “when fear or sadness last a
long time.”

Not surprisingly, the way we feel and behave when we are down seems to vary somewhat
across cultures too 1. In reality there is no single entity called “depression”; rather, we
use this word to try to understand and/or explain how we feel. When someone tells me that
they are depressed I wait to hear what that really means for them as an individual, as each
person’s experience of feeling depressed is unique.

Is depression a medical condition that needs to be treated?

Confusion arises as “depression” is also spoken about as if it were a medical condition. If
we go to the doctor when we are feeling down we are likely to be told that we have
“depression”; viewed by many doctors as a medical condition caused by chemical
imbalances in the brain, and one that may be corrected by drugs. I am uneasy with this for
a number of reasons. First, I don’t think this is factually correct [more in this web here].
Second, it can have the effect of undermining the link between a person’s experiences (in
this case feeling depressed) and their experiences of life (the factors leading to feeling
depressed, such as the loss of a loved one, injustice, continued distress etc). Sometimes a
significant step towards hope and healing is making this connection: a “now I know why I
feel like this” sort of moment.

Third, antidepressants do sometimes create an emotional detachment that seems to
disengage a person from life - making them less able to actually face and maybe change
the matters or circumstances that are getting them down. In this sense, antidepressants can
be disabling. Fourth, narrowing down a person’s experience of depression to various
symptoms (not eating or sleeping etc) misses the relevance and importance of the bigger
picture. And it is here, within the larger context of a person's life, that clues often lie when it comes to living beyond depression.

Depression from the Latin

It is sometimes asserted that there are two types of
depression - one less severe and in response to known
circumstances or events (such as a bereavement) – and
another more severe depression without a known cause (but
assumed to be due to some brain, biochemical and/or
hereditary disorder). The former has been referred to as
“reactive” (or “exogenous” lit. origins from outside) and the
latter as “endogenous” (lit. origins from within) depression.
I don’t see how this distinction can be helpful unless genuine
physiological causes have been identified. The notion that
unknown causation might indicate an organic basis is perhaps a weak one. It’s not unusual
for people, who at first are emphatic that they have no known reason to feel depressed, to,
given time and consideration, begin to connect how they are feeling with what has
happened or is happening in their lives.

Depression: when hope is sinking

My Oxford English Dictionary defines
depression like this: "severe, typically
prolonged, feelings of despondency and
dejection". This dictionary also points out that
the word "depression" comes from the Latin
verb deprimere, "to press down", "to depress".
In fact, the Latin word was also used to mean
"to sink", and "to keep down". Together these
aptly convey a sense of what we might
experience as depression today; although the
word "depression" is often currently taken to
be a specific entity - something we have rather
than a description of how we feel. In everyday
life there are many factors that can weigh
heavily upon us, pressing us down, de-
pressing us to the very depths of our being.
This is perhaps what we mean by "depression".

Being run down and feeling depressed affects our physical health too. But as there are also
physiological factors that can lead to depression we take a look at some of these here. We
also look at the phenomenal increase in the diagnosis of depression and how this has been
(and continues to be) driven by business interests and the profit motive, here. As cultural
and social factors also have an impact on how we feel, we take a look at some of these
here. Finally, we consider what might help here.

Sorrow comes in great waves...but rolls over us, and though it may almost
smother us, it leaves us. And we know that if it is strong, we are stronger,
inasmuch as it passes and we remain. Henry James

References - Bibliography - Further reading

1 Marsella, A. & White G. (Eds) (1982) Cultural Conceptions of Mental Health and Therapy. US/Holland: D. Reidel Publishing Co.

To home page