Depression and Its Meanings
1. Someone is referred by a friend because he is drinking a lot and can't stop. He drives a bus and finds his life to be meaningless. When he enters therapy it turns out that his drinking is self medicating a huge amount of depression. In one session he says to me, "So, this is what my life will be, driving a bus?"
2. A state police officer is referred to me. He is a huge man, tall, handsome, extraverted and sought after by beautiful women. He experiences an anxiety disorder punctuated by occasional panic attacks.
3. A college student falls asleep while studying at his desk and dreams that he is on one of those manual railroad flat beds that works by pushing the pump up and down. Suddenly, a fast locomotive speeds toward him and hits the flat bed. He jumps up from the desk as though pushed upward by the collision with the locomotive.
4. Other patients report dreams of drowning or being pursued by someone hunting them with murder as the intent. Others dream of being on high towers reaching up to heaven, and still others dream or have nightmares of Nazis in hot pursuit, animals attempting to capture and consume them, or being trapped in fires that kill them.
5. One young man worries that his deceased mother will never be able to find him now that he is adult and living far away from his childhood home.
While each of these scenarios has individual meanings peculiar to the individuals, they also relate directly to issues of loss, depression and the fear of death.
We label it with names such as Dysthymia, Major Depression, Bipolar, etc. We suffer from it. We attempt to medicate it away. Some of us even attempt suicide because its pain is too much to tolerate and a few of us succeed. But, what is depression? When I ask this question I am not referring to chemical imbalances in the brain (medical view), automatic thoughts (cognitive behavior therapy view), or anger directed inward against the self (psychoanalytic view). What I am asking has to do with the deeper meanings that lie behind our feelings of depression and hopelessness.
There are many excellent articles on the subject of Depression here on Mental Help Net and on other medical news sites. One good article that reviews the topic can be found at the following URL:
While most of the information available is practical and helpful it does not get at the deeper problems that may be at the root of chemical imbalances, sadness, hopelessness and many of the other emotions associated with the different types of depression.
Many of the E. Mails we receive asking for advice at Mental Help Net have to do with problems related to 1. Intimate relationships, 2. Drug and alcohol abuse,
3. Physical and verbal abuse, 4. Loneliness, 5. Job and career dissatisfaction,
6. Fears about the economy, 7. All types and varieties of anxieties, 8. Trauma,
9. Extramarital affairs, 10. Divorce, 11. Anger ...and these are just a few examples.
It is my observation and opinion that vast numbers of people feel the emptiness of depression because, on a basic level, they feel as though their lives are meaningless.
Perhaps the infamous totalitarian dictator of the Soviet Union, Joseph Stalin, said it best when he stated: "The death of one person feels like a tragedy but the deaths of millions is meaningless." He would have known, condemning millions to death in his rebuilding and remodeling of Russian society. Yet, this is also true of each of us. We have become so accustomed to reading about suicide bombers in Iraq, Afghanistan, Pakistan and around the world, that the reported deaths of human beings is now something we are accustomed to. In a similar way, history teachers instruct their classes about the deaths of millions of people during World War II, of which six million were Jews, a mere sample of the overall death rate from that war. Yet, what do these numbers mean to us? Absolutely nothing because we have become accustomed to numbers and they have lost their impact!
Is my life meaningless?
In my opinion, it is in the meaninglessness of huge numbers of deaths, that root of much of our depression lies. It goes something like this. Whether we think it consciously or it lies there, just under the surface of our full awareness: "If millions die with nobody to weep or care about them, what can my life possibly mean? Who will think of and care about me when I am gone?"
Searching for meaning:
It seems to me that many people struggle with the question, "Does my life mean anything," more today than ever before. Part of this search and questioning has to do, I believe, with the deterioration of spirituality and religion in our lives. One of the components of religious and spiritual conviction that gives believers a lot of comfort is the belief in the value of individual life, particularly in the notion that each life is the result of the creation of the Lord and is answerable to that "higher authority" after we stop living. In this is communicated the strong belief in an after-life in which we retain our consciousness and awareness. In this belief, there may be eternity but it is in the context of another form of living.
However, today with all of our scientific knowledge, along with the growth of wealth, power and technological sophistication, the universe feels less like a scary place where we need a religious set of convictions to help us feel safer and more secure in life. There is much less about life today that feels random. There is much less that makes us feel the passive and helpless victims of natural events over which we have no control. This is true with one single exception: We are all going to die and we know it.
Today ,along with the awareness of the inevitability of death, there is a deep seated doubt about the existence of an after-life, even among the religious. For example, it was discovered after Mother Teresa's death, when her private notes were found, that she had deep seated doubts.
What all of this means, in my view, is that in this modern world of ours, there is an existential crisis the likes of which has never been seen before.
What I want to make perfectly clear is that I am not suggesting or implying that we all march back to religion as a solution to our problems. I neither believe that would work, nor do I believe that it us a good idea, except for those who are already religious. Yes, those who maintain strong religious values seem to have less of a problem with all of this but, in the end, I do not think religion or even spirituality is the solution to what I am calling an "existential crisis." By the way, just for the sake of definition and clarity, I am defining "existential crisis" as a deep seated anxiety and fear that life is meaningless.
The cases revisited:
In each of the cases cited above, the individual patients were concerned not only about the loss of loved ones but about the meaning of their lives and their fears of death.
1. The bus driver questioned not merely his career as a worker but his value as a man, husband, father and human being. He felt a deep sense of inner emptiness because he believed that his life was worthless. So, he drank himself into oblivion in an attempt to avoid searching for self value.
2. The state patrolman lived with a daily fear that he would one day stop the wrong car and be blown away by some anonymous criminal. He imagined that his body would be found on the highway and his life would have been for nothing.
3. The college student was obsessed by the idea that the draft would be brought back and that he would be drafted into the military and killed on some battlefield before he had a chance to experience life.
4. and 5. The situations in cases four and five also relate to feelings of dread about losing loved ones, especially through the patient's own death. In fact, it was not unusual for some people to have nightmares about getting lost on their way to my office and never be able to find me again.
How can we deal with these latent or manifest feelings of dread?
I don't believe that life is meaningless nor do I believe that we are trapped with our depression or even with the realistic problems with which we live. It is true that some of us are not able to realize the value of our lives until we are faced directly with the threat of death as in a hurricane, tornado, earthquake, diagnosis of terminal cancer, etc. Only then we seem to come to realize the sweetness of life.
I have been reading War and Peace, the great novel by Leo Tolstoy. In the story there are several war scenes in which the main characters, suddenly confronting imminent death at the hands of enemy soldiers, suddenly awoke to the beauty of life and the wish that they could continue to live. Even in the midst of the battle and with death all around them, they became acutely aware of the beauty of the sky above and of the surrounding forest.
As a result of some of these thoughts, I have composed a list of suggestions for living life to the fullest:
1. Realize that each life is important because, in one way or another, it impinges on the lives of others. Having one good friend, helping a neighbor, greeting someone warmly in the morning on the way to purchasing the newspaper, are all ways in which we have an important impact on others.
2. Go for that walk in the park and enjoy the sunshine, flowers, birds and the sounds of children at play.
3. Rather than engaging in self pity for the unhappy childhood you experienced and cannot change, live today and enjoy the moment. One Buddist Monk suggests that, when washing the dishes, do not wish for the end of the task but enjoy the time and experience of doing the dishes because it is part of your life you will never have again in quite the same way.
4. Do not follow my late mother's example of how to live. When I was a child she refused to buy us a puppy. The reason she gave was that it was too sad to suffer the loss of the dog when it had lived out its life and died. Well, should we not live and enjoy life because we will die someday, or not marry and have children because we might suffer loss someday?
5. Eric Erikson, the famous psychologist of the twentieth century who wrote so much about childhood and adolescence, as well as about the stages of life, stated that old age is about reminsicing about life's past and enjoying the memory of one's experiences. In other words, it is better to take risks in life, and live boldly so that there need be no regrets in the future.
6. Live a useful life. How to be useful? Even for those who do not want to change jobs or careers, there are plentiful opportunities for volunteer activities after the work day is over. Help is needed everywhere from nursing homes and hospitals to youth groups and sports activities of various types and these are just a few examples.
7. Remember that your life has value to other people. Dr. Irvin Yalom,a well known psychiatrist and author, talks about what he calls the "ripple effect." The ripple effect is the impact that each of us has on others in ways we are never really aware of, unless someone shows up from the past and tells us.
As an example of the ripple effect, I always enjoy thinking of the classic Christmas holiday movie, "Its a Wonderful Life," in which the main character,played by Jimmy Stewart, faces his existential crisis where he becomes convinced that everyone would have been better off if he had never been born. His guardian angel grants his wish but in a way that allows him to observe how the world would have been had he never been born. He discovers, to his shock, that the ripple effect he had on others made a profound difference in the lives of dozens of people in his town.
I often find myself reminding those of us who participate in our Online Support Community that each member is invaluable to the others. Sometimes, when members seem to vanish and I ask them to return, they are both surprised and pleased to learn that I and others value their presence, even when we may disagree with something they have said. Each of the members have a ripple effect on the other community members, who then have a widening ripple effect on the others in their lives.
Ultimately, for those who cannot find that personal meaning in their lives and continue to feel depressed, I highly recommend psychotherapy. It is interesting to note that the research shows that therapy works just as well or better than medication. However, I am not anti medication. There are many times when anti depressant medications are necessary to help a depressed person make full use of psychotherapy. Later, they may be able to feel stable without the anti depressants.
Your comments and experiences are welcome and encouraged.
Allan N. Schwartz, PhD