can affect anyone — even therapists. During the weeks after my first child was born I was a mess of emotions. Even now, decades later, it’s still hard to admit. I remember pacing the hallway in my apartment, wishing I wasn’t so tired, wishing my husband understood how I was feeling, wishing I knew what I was doing. I’m not sure who was crying harder, me or my daughter. I was a therapist. Wasn’t I supposed to have all the answers? My feelings of incompetence were overwhelming.
PEP TALK: Depression is not something you deserve. Don’t let anyone — most of all you — tell you it’s your fault!
When my mother-in-law was in palliative care, I experienced mood difficulties again. It was probably while eating my twentieth bag of cookies that I realized it wasn’t just my mother-in-law I was grieving — it was my mom.
You’d think I’d have figured it out sooner. My mother-in-law was in the same hospital that my mom had been in twenty years earlier, and every time I visited I had to walk past the room where my mom had been so ill. Back then, I was too busy being the strong one, the capable one, and the one everyone admired to really grieve my mom’s passing.
Trust me, this is a journey. I’m still learning that experiencing feelings is okay. And I still sometimes turn to the bag of cookies.
PEP TALK: It takes guts to acknowledge you have a problem and work on making things better. You are one brave, smart, and courageous person!
Depression may not be the only thing on your plate. If you have anxiety, a concussion, a learning disability, an eating disorder, or any other physical condition or mental illness as well as depression, you may find it takes longer to feel better. You may also need some extra help from your family doctor, a therapist, or a support group. Think of it as having two broken legs instead of just one. You’ll need some extra time to heal, and a wheelchair, not just crutches. Be patient and you’ll make progress!
Depression definitely has a cultural component. Some languages don’t have a word for depression as we use the term in English; if that’s true of the language you learned to speak first, there’s a greater likelihood that you’ll express your depression physically, as pain, digestive problems, headaches, and more. There may be a strong taboo against talking about mental illness in your culture. It may be seen as bringing shame on your family, as evidence that you’ve sinned, proof you’ve been cursed, or simply that you’re British — stiff upper lip and all that. Be aware that these forces will influence your attitude toward depression and affect who you can feel safe talking to about it.
Depression can be so severe that you feel like harming yourself. First, you need to tell someone how you’re feeling. Then you need to see a doctor. You may worry that you’ll scare the person you tell. You may feel as though there’s nothing a doctor can do for you. But I’m telling you, help is available. Depression is very treatable. Don’t do something you can’t undo. Ask someone for help. Your safety is more important than anything else.
THIRTEEN SIGNS YOU MAY BE DEPRESSED
If you find you’ve been experiencing a number of the symptoms on this list for at least two weeks and they’ve been affecting your relationships and your day-to-day functioning, you could be depressed:
1. I feel sad a lot of the time.
2. I just don’t care about things anymore.
3. I’m overcome with feelings of guilt.
4. I feel worthless.
5. I can’t concentrate.
6. I’ve gained or lost weight (without dieting).
7. I’m having trouble sleeping, or I sleep all the time.
8. My performance at work or school is suffering.
9. Making decisions seems harder than it used to.
10. I’m experiencing physical symptoms that don’t have a physical cause.
11. I avoid seeing my friends.
12. I think about hurting myself.
13. I just can’t seem to see the positive side of anything.
Asking Why
It’s not common, but mood difficulties can have a physical cause, such as a vitamin deficiency, Addison’s disease, multiple sclerosis, pancreatic cancer, traumatic brain injury, or Lyme disease. Depression can even be a side effect of some medications. Ron is still embarrassed to admit that one of his clients, who had been working hard in therapy but wasn’t making any progress, ended up having hypothyroidism. As soon as her doctor started her on medication, all of the skills she’d been practicing with Ron worked like a charm. Visit your doctor to rule out any physical illness or condition that could be causing your depression.
Outside of a biological cause like a disease, deficiency, or medication side effect, no one knows exactly what causes depression. Is it a biochemical imbalance? Is it about serotonin levels? Genetics? Is it something we pick up from our parents growing up? Is it our personality? The reasons for depression are controversial and complex. This is one way depression differs from a broken leg — in most cases there’s no defining moment or single event we can point to as the cause of our emotional pain and malaise.
But that doesn’t stop us from asking why. Many people look at their lives — their family, their health, their partner, their job — and say, “I’ve got it so good. So why do I feel so bad?”
Ana, whom we met in the introduction, wonders why she isn’t over the moon when she has such a healthy, beautiful baby girl. So many couples struggle for years to conceive, with so much heartache and expense. So many babies are born with health challenges. “What’s wrong with me?” Ana wonders.
Kate, the second of the four individuals we’ll follow through this book, is shocked when her doctor suggests she might be depressed. “I know I’ve been feeling sad and low since my husband retired, but I’m so lucky that we can afford to live on one income,” she says. “It’s my friends who worry they’ll never be able to retire who should be depressed, not me.”
Becky, whose brother died of cancer, knows how fleeting life is. “I should be making every second count,” she thinks. “So why can’t I get out of bed?”
It’s also tempting to point a finger at the past. John, the fourth person we’ll regularly check in with on these pages, has spent his whole life feeling inadequate and incapable because of the way his parents and siblings treat him — so it makes sense to him that his depression is their fault.
Do you think your mood difficulties are linked to your childhood, your first romantic relationship, your choice to study one subject in college rather than another, the city you settled in, or your career path? Spending time in the past may help you to answer the question why, but it won’t give you the tools to feel better in the present.
The founders of interpersonal psychotherapy saw a pattern among the people they helped with mood difficulties. Their patients, they discovered, were all experiencing problems in at least one of four different areas in their lives at the time they became depressed: life transitions, complicated grief, social isolation, or interpersonal conflict. These four problem areas aren’t causes, but they are contributing factors to why people feel sad, blue, down, and depressed. At least one of them can almost always be linked to a recent
