Clinical anxiety and depression (“A&D”) are often terrifying experiences, especially when we don’t know what’s happening to us and don’t have support. An overview and relatively comprehensive information guide to self-treatment and professional support can be invaluable and what I will try to share with you here. When I was caught in the vortex of A&D, I searched long and hard for insider information to help me. I couldn’t find very much and the therapists I initially saw didn’t help much either, until I found the right kind of therapists with experience in A&D.
This article shares some of what I learned on my successful journey through A&D out to the other side (which at one time I thought I’d never see). It contains much of what I wish I had known when I was in the midst of that storm. I also share some facts and commonly misunderstood aspects of these conditions. Part of the reason for much of the conflicting information out there is the many ideologies and limited understanding perpetuated by people who had mild events, who haven’t been through serious A&D themselves, and who have not been in close contact with others who have A&D.
I have been through extreme anxiety and depression myself, had A&D sufferers as patients, and lived intimately with sufferers while I was in treatment. With this said, I am a Chinese medicine physician, not a psychotherapist, and this article is not intended to substitute for professional psychotherapy or psychiatry help, which I think are crucial for anyone in severe A&D.
So, I speak both personally and objectively about these extremely challenging conditions. My hope is that you will be saved some of the grief I suffered and this writing will help wisely inform your choices.
The most common mental illness in America is anxiety; this is followed by depression, the latter which affects more people worldwide than any other mental illness. I call A&D “evil twins” because they were nothing short of hell to get through, more so than any experience I’ve ever had, including massive grief and nearly becoming paralyzed as a teenager.
The stigma—a societally perpetuated fear, attack, and mischaracterization—on mental illness has developed because of a lack of understanding, fear, and perpetuating false perceptions that serve no one, especially not the sufferers. When your brain goes out on you, as your knee or hip might, it’s devastating because you no longer can guide your life in the way you once did. Except our brains affect every aspect of our lives, not just gait and movement. When we lose our inner world to A&D, we simultaneously lose our outer world because nothing makes much sense anymore and it can become impossible to navigate the simplest tasks.
Most recover from mental illness, just as we do from other illnesses. In fact, between 70 and 90 percent of the individuals who are treated for their illness have a reduction in symptoms and improved quality of life. So, getting proper and prompt treatment is crucial.
We have a long way to go in our understanding, acceptance, and treatment of these disorders, all of which will undoubtedly help the victims of these hellish diseases receive more compassionate care and financial assistance.
Mental illness is not usually some scary monster that makes us “crazy.” And no, mental illness is not well-correlated with mass shootings; this false meme only increases the stigma on mental illness; insightful and revelatory articles on the subject are here and here.
It’s also helpful not to describe mental illness sufferers with pejorative, vague terms like “crazy” that offer little meaningful information and are more judgmental than anything else. Mental illness is a disease process, like the flu or diabetes. The latter affect the lungs and pancreas, respectively, and mental illness affects primarily the brain, endocrine and nervous system, also parts of the body.
While we can learn from A&D, and important “messages” and psychological growth can be gleaned from them, this may not be the best perspective to take when afflicted. Sometimes we just have to get through them, as we would the flu, and get our physiology balanced again, encompassing both psychological and physiological treatment (mind and body). Most often, some combination of both cognitive and emotional learning, as well as good old-fashioned biomedical help, are in order.
Because of the stigma, we might resist identifying, admitting, and therefore seeking help for mental illness for fear of being marginalized, embarrassed, or ridiculed. But, as with most other disease processes, the sooner we get treatment the better for recovery. So, if you or a loved one is suffering from mental illness, try to cut through the misinformation and fears that sabotage healing and get help. Usually those who have suffered mental illness are able to understand and empathize with other sufferers, as can an experienced therapist.
Yin & Yang ‘Evil’ Twins
There are different types of anxiety, just as there are different types of depression.
In this article, I refer to anxiety primarily as severe anxiety that is more than everyday worry or anxiousness that comes and goes. Clinical anxiety is persistent anxiety that is considered an “anxiety disorder.” It usually doesn’t go away on its own, can get worse without proper treatment, and can be accompanied by anxiety or panic attacks.
I discuss depression primarily in the context of severe depression which is known as clinical depression, or major depressive disorder (MDD). Depression is more than low mood and normal sadness. It’s more than being bummed out that it’s raining or that you missed a movie date, or feeling “off.” In fact, depression causes us to perceive extreme negativity in things that would normally cause us only mild discomfort. This is consistent with the well-known adage among sufferers that “depression lies.” Well, anxiety also causes us to believe the worst, and it also lies. Both evil twins distort our beliefs about most of reality that we otherwise wouldn’t when we are regulated (“normal” and manageable) in mind and body.
Depression and anxiety are neurological partners and often co-occur, just like Yin and Yang. Anxiety is Yang (outward, activating) and depression is Yin (inward, quiescent). True to the interdependence of Yin and Yang, depression gives rise to anxiety. And anxiety can give rise to depression, especially when it begins to exhaust our resources. Both usually affect normal sleep patterns and cause insomnia. In atypical depression, one may actually sleep longer than usual. In either case, these evil twins are a menace and in my own battle with them some years ago I could hardly determine which was worse.
Depression and anxiety also often affect relationships, ability to make even the simplest decisions, ability to work and carry out once ordinary daily tasks, and otherwise live a normal life. Suicidal ideation and suicidal plans are also common symptoms. A&D can become utterly crippling and can totally consume us, especially without proper treatment. Again, the sooner they are treated, usually leads to quicker and better recovery. A more complete list of symptoms for depression can be found here and for anxiety here.
Not Necessarily A Reason
If you are anxious or depressed, you might think there is a reason for this beyond genetics and physiological imbalance, and that this reason can be identified. Like many, you might think there is a psychodynamic reason for this, which refers to some aspect of your psyche beyond its mere physiology. Examples include past trauma, lifestyle circumstances, childhood issues, unconscious forces, or other inter-relational events that affects your state of mind. This is not always the case, and it can be impossible to determine what caused your downfall.
In most cases, focusing on what is going on rather than why it’s happening is more helpful for recovery. In other words, first just try to get better by any means and leave any inquiry into why for later. An exception to this is if your A or D has actually been precipitated by a cause, which I address just below. With this said, recovering from depression often takes action, not a lot of thinking, except to trust what others in the know encourage you to “reframe” (think about from a different perspective). As one good therapist said to me, “Jack you won’t be able to think your way out of this.” Boy, did I learn the truth of that as time went on.
Anxiety and depression, like other mental illnesses, often have a genetic component, meaning you inherit the predisposition (called a “diathesis”). If any, or several, family members suffer, you might carry the genetics, making you more likely to sustain either. Often, a stressful life event can trigger genetic predispositions and even epigenetically activate (alter genetic expression of) these syndromes. Many stressful factors and physiological changes acting together and compounding one another can precipitate A&D episodes.
Once we are more regulated (balanced and homeostatic), we will likely have a clearer perspective on our condition. We may then understand more of the why. With this said, sometimes the primary reason we fall into anxiety or depression is due to an identifiable cause, and learning about and working through the issue(s) can help us recover. It’s best to talk to a good therapist with A&D experience to determine the best course of treatment.
If we are very anxious or depressed, it’s only logical to think that something is making us anxious or depressed. In other words, if I am depressed I might think that I must be depressed about something. After all, our emotions are signals of something, right? Well, sometimes yes and sometimes no, and often some of both. Feeling of anxiety or depression often have no meaning and value other than to make us suffer, so it’s helpful during either to not take our feelings or thoughts too much to heart.
Clinical depression and anxiety are disorders, and there is not necessarily a psychodynamic cause behind them. In fact, depression is thought to be some 50% attributable to genetics, according to studies at Stanford. This means that in many cases it’s truly not your fault (not that it is anyway), and depression is not easy to control or navigate on our own, any more than we would be able to heal from cancer or a heart attack on our own.
We need help, and in a fiercely independent culture where we think we are supposed to be able to manage everything on our own, we might try to go it on our own, which can compound our distress. It’s especially important to have support through mental illness, not only from professionals but from supportive family and friends. This necessity poses a bit of a catch-22 because depression and some forms of anxiety cause us to want to retreat and isolate ourselves. While this can feel good in the short-term it’s often not advisable, which is why in A&D we often have to act counter-intuitively…to go against what feels good in the moment in service of what is going to help us heal little by little for the long run.
Feeling understood, accepted, and genuinely supported are crucial for healing from A&D. It’s just as important that we treat ourselves with ultimate kindness, that we become our own best friend.
Very often, and more commonly among some popular online psychology gurus, unconditional acceptance is offered as a way out of any troubling psychological dynamic. Some even promote shadow work as the proper psychological medicine for such ails. While I consider shadow work crucial for becoming a human being of integrity, it’s not necessarily the best way through clinical anxiety and depression, or at least not initially.
Some degree of unconditional acceptance is helpful in any therapeutic process, but it must also be carefully integrated with tough love when it comes to healing from mental illness. This is because healing from mental illness often requires what’s called opposite action: that we do the opposite of what seems intuitively right, that we do what we don’t feel like doing. Opposite action is usually what is counter-intuitive. Opposite action is doing what we don’t feel like doing, or don’t think will help, but which indeed is helpful. For example, unconditionally accepting that a depressed person doesn’t feel like exercising, and therefore won’t, may not help him get better. This is because exercise is considered important medicine for recovery from anxiety and depression and it’s usually best to get some, any, exercise even though a depressed person—and less frequently, an anxious one—doesn’t feel like it.
Weaving compassion and tough love together, we might respond this way, in a compassionate yet clear tone, to someone who is depressed: “I hear you don’t want to exercise and you feel that you can’t do it, but it’s important that you try to move around, even for a few minutes.” We can also speak to ourselves (self-talk) this way if we have depression. If anxiety is predominant, we might legitimately need to rest (possibly in addition to exercise), because anxiety taxes our resources and tires us out. So does depression. Please remember to speak gently and kindly, even when firm, to anyone with A&D; you just can’t imagine how horrendous it is if you haven’t suffered it yourself.
Curiously, and contrary to popular belief, stress hormones are usually raging inside someone who can’t seem to get off the couch. Because depression causes real biological fatigue, a person with severe depression may truly not be able to exercise at all. In this case, pure unconditional understanding is helpful. Maybe the next day, encouragement to walk even a few steps is a good idea, and the next hour or day, a few more. When I was in recovery, I began with 3 minutes of walking, which I increased from there. Prior to falling ill, I was exercising every day and could hike for hours. When I feel into depression, 3 minutes seemed like a marathon. Often, a depressed person needs to override real or perceived inertia in order to feel better in the long run, while not overdoing it. Slow and steady usually wins this race.
While anxiety or depression might cause us to feel like we’re going to die, it’s not a good idea to freak out about this feeling, which is to become “anxious about being anxious.” Feeling as if you’re going to die is how the brain automatically interprets intense fear. Again, these diseases “lie,” making us believe a reality that is not real except in our temporary perception of it. And this is key: the perceptions and imaginations we have while ill are temporary, just like it can feel like we will never get better, or that we will be forever bedridden, if we have the flu. We can and do get better. Life can turn around on a dime, and we need others to hold this hope and reasonable reality for us if we are unable to, which is often the case because it’s very, very difficult to believe this when in the midst of severe anxiety or depression.
While empathy can be generated, only those who have been through the gauntlet of A&D truly know what it’s like. If you have not experienced them, trust me, it’s virtually impossible to fathom, and it’s worse than you can imagine. Prior to my bout, I worked in a medical clinic treating people with these disorders. While I sensed their distress, as I do with anyone suffering, in hindsight I see that I could never have truly understood their experience. After having passed through them, I am back at work in the clinic and my empathy and compassion are much deeper, and I can relate on all levels to the utter confusion and terror of these states. While I can never know precisely what another is feeling, suffering from the same disorder gives a new order of relatability.
When clinically depressed and anxious, I responded best to those who spoke slowly and gently and who actually heard what I was saying and were able to understand me. Even if you don’t understand what it’s like to have clinical anxiety or depression, you can still empathize to a degree by remembering times you have suffered greatly. Indeed, part of why I have written this article is to give an outside’s perspective if a loved one of yours is suffering.
Disclaimer: while I have written about the dangers of the happiness and positivity craze and not ignoring our difficult thoughts and feelings, this approach is usually not helpful during the distorted experience of A&D , anymore than it’s helpful to give too much weight and attention to our difficult thoughts and intense feelings when we are upset or melancholy due to a bad night’s sleep, an argument, feeling excessively stressed, being hungry and having low blood sugar, or being sick with the flu, as examples. Hint: Getting poor sleep, common during A&D, can make depression feel worse. So, when I didn’t sleep well, I would remind myself throughout the day, “Don’t take anything you think or feel today too seriously.” I was already not taking things too seriously, and when I wouldn’t sleep well, this was especially the case.
A&D are distorted states and a Catch-22: it’s virtually impossible to think clearly about anything in these states because the very brain we think with is imbalanced, and this imbalance affects the quality of our thinking. But it’s not black and white: there are usually some thoughts and moments of intuition or revelation that you can recognize as more sane than others, that more resemble “the old you.” Attach to these, trust these, even if they are short-lived; use them as anchors.
It’s crucial to leverage any positive experience, any foothold we have, to regain regulation and better functioning, so we spiral upward and not downward. This leverage might be the hope someone else holds for us, the part of our thinking that does realize we are distorted and can let go of these distortions more easily, the ability to exercise, to laugh, to quiet our mind, to do anything rewarding and fulfilling, a medication or supplement that helps us feel and/or think better. Whatever. We use any leverage we can to gain more of ourselves back. During A&D, we try to invest our attention in the things that help us recover in the same way we would invest money wisely in order to grow our profits. Sometimes we don’t have any leverage, which is just one more reason it’s valuable to have others who can hold us (up) and remind us when we can’t.
Meditation & Mindfulness
I have been a meditator for years. However, I found that sitting meditation with eyes closed (mindfulness style) was not helpful for me during A&D. My mind was so disturbed and distorted that I couldn’t help but get stuck ruminating on my negative automatic thoughts and perceptions. Such rumination made me feel worse and is actually contraindicated in depression and anxiety. What I needed was a break from these thoughts, and sorry, but while suffering anxiety and depression I did not have the regulation and mental resiliency to just “let the bad thoughts go.”
Indeed, the vaunted capacity and quality for “awareness” is not constant and immutable; it varies with physiological and neurochemical changes. I was not in a place to be any closer to my negative thinking and feeling; I needed a break from them, as far away as I could get from them actually, so that my psyche could begin to find its balance again by way of the “mind healing the mind,” as I discuss below. For me this meant letting my mind get a break from itself.
So, silent, eyes-closed, sitting meditation just wasn’t my medicine. But it might be yours, especially if you are suffering from mild depression, also known as “subthreshold depression,” and anxiety. Therefore, disregard what I say if it doesn’t fit for you for whatever reason. I just want those who suffer from meditating during A&D to know they are not alone and to feel empowered to ditch it if they want to and not suffer more than they have to.
In researching this topic I came across a bold and helpful article by Therese Borchard, echoing my sentiments about mindfulness meditation. She quotes the work of Jon Kabat-Zinn, the “Dalai Lama” of the mindfulness meditation world, who says in his book:
“It may be wise to not undertake the entire program while in the midst of an episode of clinical depression. Current evidence suggests that it may be prudent to wait until you have gotten the necessary help in climbing out of the depths and are able to approach this new work of working with your thoughts and feelings, with your mind and spirit unburdened by the crushing weight of acute depression.”
In response to this statement, and how her depression wasn’t really helped by mindfulness meditation, she reflects:
In hindsight, I wish there was more than one paragraph in Zinn’s book about when mindfulness isn’t the solution, about when it’s better to swim laps or ride your bike into town or call a friend you haven’t talked to in a while. I still would have taken the course — and I do feel like I benefited immensely from it — but I would have been more forgiving of myself that it didn’t “work” like everyone else’s magic.
And in response to her meditation teacher finally agreeing with her, she goes on to say:
“He confirmed what I was thinking during that moment and what has been my experience: mindfulness is better at keeping a person from getting depressed than from pulling a person out of depression.”
Indeed, this is the result of a study that found this to be true: that MBCT (Mindfulness Based Cognitive Therapy), which “revolves around mindfulness meditation,” can help to prevent a depressive relapse. And anxiety too.
We now know that via neuroplasticity (re-wiring the brain) we can use our minds to heal our minds; this happens because the quality of our thoughts affects the biological functioning of our brains to, among other functions, produce a more balanced flow of neurochemicals. The trick in A&D, however, is to have enough good mind (mental leverage) to be mindful enough to affect our impoverished mind back into balance. This is one way that CBT (cognitive behavioral therapy) therapy is crucially helpful in A&D. It’s this good thinking that helps us do the right things for ourselves (self care), such as distraction to give ourselves a break from the onslaught of negative thoughts and feelings that are both symptoms of A&D and causes for it worsening.
Thinking positive thoughts actually has a corresponding positive physiological effect. So does smiling, even if we don’t feel happy. In other words, merely by thinking positive thoughts (very tough during severe depression and/or anxiety) can make us feel and think better. Similarly, the mere act of smiling can make us feel happier by changing our neurophysiology.So, it’s generally a good idea to try to smile during depression, and to do so counter-inuitively and in opposite action to what we feel like doing—namely, not smiling.
Many meditation practitioners might tell you it’s fine to feel worse and this is part of the “meditation process.” When I was not ill (and presently), I agree, sitting with distressing thoughts and feelings is difficult yet still helpful. But not during A&D. I also remember feeling worse about myself because meditation would bring me intimately closer to my distorted thinking (including suicidal thoughts), which was tough to get away from even with eyes open and active. This was not okay, and when I finally gave up trying to meditate my way to health, I felt relieved and fared better.
What I did find helpful, however, was ordinary mindfulness: being mindful of my distorted negative and anxious thoughts. And, I didn’t need to sit with my eyes closed for this. As alluded to above, this is the basis of CBT therapy, which helped immensely. I found it easier to let go of distressing thoughts (“thought defusion“) and feelings (“emotional defusion“) while active. To do this, I practiced not spinning stories or buying into the apparent importance and truth of my thoughts and emotions, which are distorted during A&D. “Distraction,” which I mentioned also helped, is a DBT technique. As for Therese Borchard, walking with friends, exercising, writing, watching TV and listening to music, reading, playing games—anything that took me away from ruminating—was helpful. By giving my mind a break from itself, after some time my physiology and neurochemistry became more balanced and I could see my disturbing thoughts and feelings more accurately for what they were: distorted, unhelpful, and largely meaningless.
In sum, be as mindful as you can and let go of beating yourself up if you can’t or don’t want to sit and meditate—it’s okay. Ironically, this can help your mind heal your mind, which is supposed to be a benefit from mindfulness meditation.
I am a holistic physician practicing Chinese medicine. I and many of my colleagues, even M.Ds, try to stay away from pharmaceuticals. When I was in the early days of A&D, I never imagined I would need to be on anti-depressants. I was mortified by the thought of it and resisted them for months, until it got so bad that I welcomed anything that would help. Lesson: just as Western medicine is helpful for many conditions that holistic therapy cannot tackle, such as surgery and life support, pharmaceuticals can be life-saving to those with A&D. And, yes, I tried just about every holistic treatment available. So did a wise and now level-headed elder friend of mine who said this to me during a recent discussion:
“I tried all the alternative prescriptions for A&D recovery . . . like diet and herbs and acupuncture and supplements and exercise and massage etc., etc . . . and I tried them with enormous commitment and dedication, and yet I STILL had to end up taking antidepressants. I’m sure the other stuff helped . . . but alone it was NOT enough to save my life . . . it was ‘Big Pharma’ and a couple of awesome Psychiatrists who saved my life.”
In the end, I don’t know if the medication helped me, and I don’t regret taking the pills. Just like Western medicine generally, pharmaceutical companies gets a bad rap, and often for good reason. We therefore might conclude that all their medications are unnecessary and useless. This is not only unfair, but unwise. While many more people are on antidepressants than should be, for many sufferers these drugs offer relief from an illness as debilitating as any around. You can listen to what world-renowned professor and depression survivor Robert Sapolosky has to say about depression. Adding insult to injury, many who take antidepressants are further shamed or stigmatized in addition to the stigmatization they already endure. Alternative medicine’s propaganda and stigmatizing of pharma medications likely causes more damage and additional suffering than necessary.
With this said, I tried every means possible to relieve my symptoms by natural means and none worked well enough, not even close. I felt like a failure for this, which added (unnecessarily) to my distress. Finally—and too late in the game—I had to go to the big guns. So, by all means, give the natural remedies a try. In the case of severe A&D, this decision should be made with the aid of your health care professional/s. But if nothing works well enough, don’t be afraid to consult with a psychiatrist for meds. Antidepressant and other medications, even with their potential side-effects, can provide much-needed relief. Yes, it can get so bad that any relief is desired as soon as possible.
With this said, anti-depressant medications don’t always work the first time around. In fact, for moderate to severe depression, they are effective about 50% of the time. A period of trial and error is often needed to find medication that works best for any individual, and they usually take between 4 and 8 weeks to take effect. I encourage you to partner closely with your doctor and mental health professionals. You are the expert on your symptoms and you doctor needs to hear what you’re experiencing. This will help you work together to find the right medication, or combination of medications.
For some, and by no means all, anxiolytics (anti-anxiety meds) and antidepressants help resolve anxiety and depression, respectively. Remember, there isn’t always a psychodynamic reason why we get anxious or depressed. Medication can also be helpful to help us get a foothold and begin to dig ourselves out of the trenches. They can help regulate us so that our prefrontal cortex (the rational, self-reflective part of the brain that shuts down in depression) comes “back on line” enough that we can absorb, remember, and comprehend crucial information and gain necessary perspective on our illness to be able to navigate it in ways that support our recovery. In these cases, medication does not mask mental illness or act as a harmful crutch, but helps us recover from it. Once we make strides and are able to exercise and function more normally, we may not need the medication. The choice to come off or get on medication, however, should be made with the help of a doctor.
Even if a person’s depression or anxiety is due to psychodynamic issues, medication can help to regulate the mind so that any identifiable issues that precipitated the illness can be productively worked through. Again, in acute A&D it’s difficult, to say the least, to perceive anything clearly enough to make strides. But again, it can be helpful to do so, especially with the help of a good therapist. Indeed, medication in combination with psychotherapy has been shown to be more helpful than medication alone for recovery from major depression (which often presents with its evil twin sister, anxiety).
Again, antidepressants are not for everyone, and the research literature clearly states this. But for some, they are an invaluable component to recovery. Since suicidality is a symptom of depression, medication literally saves lives. With this said, and ironically, antidepressants have been shown to increase suicidal ideation and behaviors in a “small number of children and teens,” so specific precaution and monitoring is needed for this age group. These are specifics to discuss with a qualified health professional.And, if you’ve been severely clinically anxious or depressed, you likely know the desperation to do anything to get out from the dark shroud of severe depression and the relentless inferno of anxiety. From my own experience, witnessing others go through the gauntlet, as well as from researching the subject, I endorse whatever helps someone get through without creating a bigger problem.
Two of the most helpful therapies for depression and anxiety are CBT (cognitive behavioral therapy) and DBT (dialectical behavior therapy). Here’s the classic DBT handbook authored by its developer, though my experience is that the book is not a substitute for working with a therapist, even a DBT-trained therapist. Part of this reason, is that in severe A&D, it can be tough to read a single line, much less a chapter or a book, make any sense of them, identify the proper advice for you and then, after all that, put the suggestions into action.
As mentioned previously, acting counter-intuitively, or what is called “opposite action” in DBT terms, can make a big difference. This includes not listening to our warped feelings and cognitive distortions (faulty perceptions and bad ideas). This is also why “intuition” and “trusting our feelings” as guides for how to act during A&D can be counter-productive and outright disastrous. An ordinary example we can all relate to is not wanting to get outside or get out of bed to take a shower or go for a walk. But once we do we feel better. Same for depression, unless we truly can’t get up for physiological reasons not due to an apparent lack of motivation.
As mentioned, psychological depth work is not usually appropriate in severe depression unless a significant cause of the disorder is due to these psychodynamic causes and one is regulated (functional) enough to undergo the process of hashing through past hurts and the emotional upheaval this causes. In severe A&D, depth work is usually not a recipe for success because bringing up more dysregulation and intense emotion when balance and stability are needed can sabotage recovery. Again, it’s difficult to see any issue accurately during A&D. Getting counsel from a good therapist with experience treating these conditions is invaluable and usually best to help assess what is appropriate to guide treatment.
Lastly, I want to mention that when medication and talk therapy don’t help enough, other treatments for depression you can consider include: ECT (electroconvulsive therapy) and rTMS (repetitive Transcranial Magnetic Stimulation). Even psilocybin mushrooms seem to have helped some, but opinions vary and the evidence is yet scant.
Biochemistry shifts with age, stress, diet, hormonal changes, environmental factors, genetic/epigenetic expression, and anomalous brain wiring. All these can cause significant mood changes. So, if you are anxious or depressed, it might not be due to something you are doing or have control over—that you can put your finger on and fix. It might be largely genetic and triggered by a stressful life event. OCD (obsessive-compulsive disorder), for example, is an anxiety disorder that causes anxiety for no logical reason (other than anxiety!). OCD and other anxiety disorders amplify usually mild issues or events and make them seem multiple times worse than for a person with more common responses to everyday anxiety.
OCD, GAD (Generalized Anxiety Disorder) and depression cause us to think that events themselves are causing our distress and they are responsible for our feelings and perceptions. It’s actually more our highly distorted response to events that causes our suffering. Anxiety and depression latch onto whatever we might think about. Our mind is “latches onto” and spins tornadoes from what would otherwise be mildly distressing events. This is why therapy in general, and specifically being able to witness and be aware of our reactions (a key tenet of CBT), is so helpful to recovery; it allows a more regulated and balanced version of us to guide our responses to disturbing thoughts and feelings, rather than being so caught up in our negatively-generated and alarming thoughts and feelings that they take over and own us.
Psychodynamic triggers can indeed trigger unpleasant emotional states but are not the cause of all, or even most, of anxiety, depression, and other mood changes. With this said, sometimes our anxiety and low moods are signals for real-life issues, past or present trauma, lifestyle, coping, and other unhelpful dynamics that need to be addressed. Often, it’s some combination of both real-life events and underlying anxious or dysthymic (low mood) tendencies to which we are genetically predisposed and/or triggered into that cause anxiety and depression.
In cases of mild and even moderate A&D that have their source in life issues, sorting out the impacts of such dynamics with a trained and sympathetic therapist and/or psychiatrist is a good way to learn more. When psychodynamic issues are at the root of depression or anxiety and go unaddressed, chances are that suffering will continue, even if temporarily masked by medication. Again, skillful timing and personalized treatment are key here. If the cause is more biological in nature, medication is a modern miracle that can help recovery.
Anxiety and depression are illnesses like any other biological illness, it’s just that they occur primarily in the brain. We are more familiar with less stigmatized diseases such as diabetes, migraines, or Alzheimer’s and cancer. These are diseases that largely happen to people, just like mental illness. But with mental illness, somehow we have the idea, in whole or in part, that someone with depression or anxiety can just snap out of it and that they have control over their condition. We wouldn’t say this to someone with diabetes or cancer; neither should we address an anxious or depressed person this way. An astute friend recently commented this in response to an on-line post I made about A&D:
“There is a mountain of stigma, judgement, opinionating and misinformation to be overcome by people who are trying to live with and manage their Anxiety and Depression (as though just being afflicted with these dreadful conditions it isn’t hard enough already.) No need to take on the shame or misinformed projections of people who ‘think they know’ what these illnesses are, and where they come from and what you should do to manage them. Beware of rejecting what modern medicine has to offer you, and double beware of people who think they know what is best for you. Take any lifeline that is offered to you, and relinquish your attachments to romantic notions of recovery entirely through excessive self examination and compulsive scab picking of deep emotional wounds (which can be extremely dangerous for people who are very unwell). The causes of your illness might be extremely complex, and your recovery is likely to require a multi-faceted and uniquely personal set of strategies, which may well include medication. Hugs to anyone out there wrestling with A&D.”
Time For Compassion
For all our similarities, we are complex biological organisms with many nuanced differences. Just like other animals have personality types, oddities, seeming imperfections, and unique gifts, so do we. Yet, we seem to think that just because we are conscious and self-reflective creatures that we should be able to fix our anomalies, or even that they are in our control, especially when it comes to the mind. This myth perpetuates suffering, violence, and abuse when we treat others with judgement, condemnation, and meanness according to this flawed perception. People with severe depression and anxiety can’t just snap out of it or get over it, at least not quickly, the way you or I (when well) would normally shift a low mood or worry. Clinical depression and anxiety are different animals and sometimes lifelong events.
If we are significantly anxious or depressed this does not necessarily mean that something is complexly wrong with us, or that we can fix our predicament by digging into our current or past issues or venting our emotions. It might mean we need medicine, just as we would for any other less stigmatized form of physiological illness towards which we are culturally less judgmental. Because mental illness happens in the brain, it effects our thoughts and emotions more than other biological illnesses. Usually it means that we need both medicine (pharma, herbal, and/or nutraceuticals) and the support of caring, informed, and understanding health professionals who aren’t pigeon-holed and attached to a one-size-fits-all approach.
Images and stories of “crazy” and “unpredictable” people with anxiety, or even depression, perpetuate our irrational fears and judgement of these debilitating conditions. Such people are usually not violent unto others. Those who carry unresolved pain and trauma are more likely candidates for this.
Most people with mental illness suffer in shame and silence and are some of the most vulnerable, tender, compassionate and empathic people I know. So, let’s break the mould together, lift the mythic curse of judging mental illness due to our usually innocent ignorance of these menacing and crippling invisible illnesses. We do this in part through opening our minds and humbly learning about them so that our beliefs about these conditions can match reality. This in turn informs how we help sufferers and those who love them.
Some resources for Depression & Anxiety:
The Upward Spiral by Alex Korb, CBT for healing through depression
The Noonday Demon by Andrew Solomon, on depression
The Imp of the Mind: on OCD and intrusive, bad thoughts
“The Refugees” by Andrew Solomon at The Moth
Depression, Too, Is a Thing with Feathers by Andrew Solomon
Depression Talk at Stanford by Robert Sapolsky
Sam Harris and Robert Sapolsky: from 48.00 minutes to the end
Disclaimer: The information in this article is not intended to diagnose or treat any disease, or substitute for professional help. It is based on the author’s personal and clinical experience, research, and direct observations. The author is not a psychotherapist.
Jack Adam Weber, L.Ac., MA, is Chinese medicine physician, having graduated valedictorian of his class in 2000. He has authored hundreds of articles, thousands of poems, and several books. Weber is an activist for embodied spirituality and writes extensively on the subjects of holistic medicine, emotional depth work, and mind-body integration, all the while challenging his readers to think and act outside the box. Weber’s latest creation is the Nourish Practice, a deeply restorative, embodied meditation practice as well as an educational guide for healing the wounds of childhood. His work can be found at jackadamweber.com, on Facebook, or Twitter, where he can also be contacted for life-coaching and medical consultations.