The Education of the Depressive (Part 1)

The cure for depression is much more like the attainment of an education than the acquisition of a state of mind: it moves through stages or grades, it must progress in sequence, and…it’s a lot of work, which results in deep rewards.

If there were a brochure that our culture gave to describe depression and its treatment, it would certainly not say that. Instead, it would say something like, “Depression is an illness which is best cured by medication, like any other illness.” Now, this actually has a deep if partial truth that is a great step up from earlier conceptions of depression. Yet, it provides a very incomplete map, a bit like a hiking trail map which only gives the names of the paths without defining where they are, how they relate, or what terrain you’ll have to pass through in order to get to the end. 

Which is a problem, as, in general, it’s helpful to have as complete a map as possible.

So what I’ll try to present here is the map of the stages of healing depression, not in micro detail (those details are the unique qualities and colorings of your particular experience), but in it’s broad strokes. I’ll use the metaphor of progressing through the educational grades, because such a frame embodies the way in which curing depression (not, I should say, just managing it) unfolds in stages that cannot (as far as we can tell) be skipped. You can’t get into graduate school without having first acquired the skills and abilities of the earlier grades.

So, here’s the education of a depressive:

1) Kindergarten through Elementary

The depressive (that person who has a strong tendency towards depression as a response to life) in their youngest years is mostly unaware of depression as depression. Either the seeds have been sown, but have not sprouted, or there has been a single incident which has not yet showed itself to be a pattern. But unlike the “non-depressive,” the ground is prepared (by character style, past trauma, genetic/family disposition, biochemical predisposition). But depression as a defined experience or identification is not yet online, even though the symptoms may be there. Often, the people in the depressive’s life also don’t understand what is happening, so there’s a kind of lack of self-awareness both in the depressed person, and in their surroundings. At this stage, there is no working with depression because there’s nothing being recognized as depression. But time is passing and experiences are nonetheless building up.

For example: I met a woman in her 50’s, who had had a successful career in the technology field, healthy relationships, a sense of living a good life. Then the financial market crash hit, and she began, despite her best efforts, sliding down the corporate ladder. This would not have been a problem, except she carried a bomb in her, being the training from her father that said if you don’t succeed, you are unworthy of love. As she lost control of the career slide due to the economic circumstances, the bomb went off and she plummeted into a major depression. Even though in her 50’s, she had been living in these early grades, not really aware of the “presence” of depression, and came to me in the transition to Junior High.

2) Junior High School

After elementary comes Junior High, which is where the awareness of depression as depression starts arising. For most (unlike the woman above), this awakening comes slowly and fairly early in one’s life, like waking up from a rather groggy sleep. Often reflections start coming from others and the outside world of peers and school, that something is off, something is wrong. Like the disorientation of this in-between period of one’s actual schooling, this grade is painful, and the task is to try to understand what’s going on, where the pain is coming from, what needs to be done about the pain, and get support. Usually one meets this challenge with some mix of denial and confusion, but dawning recognition. Essentially, this is a stage of survival: we are doing what we can to keep our heads above water.

For example: A man who was well into his “education” as a depressive, reflecting back on this grade, said, “I remember being at my grandparents farm, at about age 20 or so. I was in a deep funk, but what it seemed like to me was that the world simply was grim and pointless. I’m there at their place, swinging in the hammock, looking out over the calm acres, knowing it’s supposed to be beautiful, which, of course, makes me feel even worse. And then something new happened, which was the thought that, hey, maybe it is beautiful and there’s something happening inside me that’s not allowing me to feel it. Maybe it’s how I’m seeing this, not the thing itself. That was a huge fork in the road, looking back, which rang true, and yet also also felt so strange and foreign.”

3) High School

In the high school of a depressive, there’s a lot of work to be done, yet, usually, not enough resources to do it. There’s a lot of stress as one realizes, “Yes, I am depressed and something is really not working,” but the understanding of what depression is and how to manage it is unclear, shot through with shame and confusion and a frustrated desire to control. The progress through this phase, these grades, is the development of a map of the nature and components of depression, and therefore a greater ability to not simply be subject to the depression, at its whim. As with literal high school, we’re deepening into a sense of where we are in the larger world, starting to get a sense of our identity, and developing a sense of mastery over ourselves.

So at this level, as a depressive, after having accepted in junior high that we actually do experience something called depression, we focus on the strategies and skills for controlling or managing depression, without a recognition of its depth and span. There is a deep dimension to depression, a transformative pull, but that’s only real or meaningful after we attained some measure of masterly. Having been subjected to depression, we are rightfully enjoying attaining a sense of mastery and control. The relief at being able to get some distance from depression, to start seeing it as an object, rather than “that which I am,” is a huge attainment.

This is the phase where we (often with outside help) learn ways to control our “wild moods,” ways which, as we progress through these grades, get healthier and healthier. Alcohol and drugs, or vigorous intellectualism, can be great survival strategies and resources, but they have a lot of negative side effects. We also develop a deeper understanding of the nature of depression (as in literal high school, we learn about the paths into the adult world, the pitfalls and prizes), filling in our own map of our experience, which is necessary to explore it more deeply and thoroughly. We are learning here to orient and control our experience of depression, which is a huge piece of learning. It also sets us up to be ready for college (if we choose, or if our desires are such that we actually have to continue into the higher grades to get where we want to go).

For example: A man I knew, who was in his late 20’s, was moving towards graduating from his depression high school. When we started working together, he was clearly out of junior high. He’d woke up to the fact the he’d been depressed for years, and trying to survive through being a workaholic in Silicon Valley. Which worked well enough for quite a while. But survival strategies, because they take so much energy, eventually burn out…and then we’re have the potential to graduate to the next grades (though often really not wanting to). So he came to therapy in crisis, unable to manage the depressed moods, his work falling apart, relationships chaotic. Our work fell very much in the high school range: clarify and map what was happening to help him orient and get buoyancy; stabilize his nervous system with medication (we paired up with a psychiatrist, after some work around accepting that he actually needed that support); change behavioral habits (cutting down on drinking, eating healthier, exercise); learn different ways of addressing the depressed thoughts (Cognitive Behavioral Therapy-CBT-is great for this); and developing an awareness, and some practice of, the critical skill of mindfulness, or being able to observe himself in action, opening up whole new ranges of self-control and knowledge. After a chaotic and frightening period of falling apart, he was content to end therapy at the point of stabilizing and learning mastery skills the depression. We mapped the further levels of curing/healing depression, but like many 18 year olds, he was happy to take a break and (metaphorically) travel around Europe.

4) College

The transition from high school to college, literally, or in the education of the depressive, is a big one, entailing more self-determination, more acceptance and navigation of ambiguity and uncertainty, and a deeper look into the nature of this human reality, and into the depths of depression.

So for the depressive, college is where depression has been defined, and where they have learned more stable and reliable ways of managing the moods. Yet, with this stability comes the ability to perceive more subtle ways in which depression is functioning and influencing one’s life. It also is where one begins to see the limitations of our coping skills. Where the powerful CBT technique of “rational response” to negative thoughts has been effective, we start seeing that we can feel depression even when we’re diligently practicing such skills. We start realizing, by practicing our own self-observation, that depression has influenced us in deeper ways than we knew.

As with the literal transition to college, one can experience a big shock: “I thought I knew exactly where I was!” Inevitably, every transition comes with a measure of disorientation.

Here is where control itself starts coming into serious question.

In high school, control over the depression was a necessary attainment. Without it, it’s like trying to learn to swim while still not knowing how to keep our head above water. But when it comes to swimming, trying to control the water itself is going to actually have you swallowing a lot of H2O. Just when you thought you’d learned a complete control, and had beaten the enemy, you start seeing that that very control is dragging you down.

So the “college” of depression starts with a recognition of this contradiction: the control that was so helpful, starts showing up as more and more unhelpful. Then comes the movement through the grades of college, which is the mapping of this deeper aspect of depression, and therefore calls for a different skill set to be developed (earlier on with the real sense of, “like it or not”). This skill is that of acceptance and surrender, which is there embedded in the mindfulness practice that began in high school, but which only shows itself fully as the control aspect of mindfulness starts giving way to the acceptance.

This is not easy.

It’s not easy because the letting go of control is not a choice, but more like the relaxation of a Charley horse: it takes time, massaging, and relaxing of the body. In fact, the thought that we can choose acceptance is itself another attempt to control, because the mind thinks, “I am going to be in control of not controlling!” To lose this can feel like a deep, deep threat to our lives. Letting go is fine if we’re on level ground, but it takes on a different meaning when it feels like we are hanging off a cliff.

So this progress through college is the deepening of our understanding of what acceptance actually is, how to let it arise (rather than make it happen), and especially how our essential self survives even when we are not in control mode. We learn that control, and the attempt and “failure” to control that which can’t be controlled–i.e., life–is the heart of the problem with depression, and that only acceptance and surrender can get at the root issue.

Then what we learn, getting towards graduation, is that actually we do have to control, but only certain things, and only in the way that a surfer controls surfing: by knowing the waves intimately, by accepting their autonomous nature and logic, and by adapting action and response to what’s given by the ocean, and seeing how that is actually what allows the deepest levels of communion and artistry. The notion of control itself goes through a transformation, from domination to responsiveness. Which is only possible inasmuch as acceptance has deepened, and one knows more and more profoundly that who we are is actually magnified and clarified by virtue of practicing surrender.

In the college of depression, we start learning about the way depression has infected our sense of self, surrendered to our powerlessness to dominate it, and started a transformation of who we know ourselves to be at essence (rather than the surface structures). Towards graduation, depression as a syndrome (a collection of closely joined symptoms (negative thoughts, suicidality, hopelessness, etc.) is crushed. This happens because what binds the elements of depression into a coherent whole is the belief in the logic of depression and the identification with that logic: Life is futile, and so am I. When that belief is seen through, and begins to wither, then the “binding agent” of depression is dissolved, such that what arises are the pieces of depression, but not depression itself.

In college, most of us are seekers, but we also come to learn that there is a deep inherent problem with seeking. In San Francisco, there’s a huge culture of seekers, of individuals who have set out on a path to find that which is better, deeper, and often, more spiritual. (In terms of the education of the depressive, you might not actually be able to reach the deeper levels of “school” without having this seeking impulse.) Yet the dilemma is that in developing the force and will to seek, one often (or may have to) identify as the seeker–“I am one who seeks what’s better”–which carries us, at the same time it subtly discourages us from actually arriving, simply because to arrive at our destination is to lose our identity. Which our deeper parts really, really don’t like.

For example: So, John came in to see me entering his “college” of depression. He’d substantially resolved the chaotic or wild quality of his moods, and stabilized his outer life. His happiness with these changes were genuine, and then he started noticing how a more subtle unhappiness still dogged him. He was a Buddhist meditator for five years (he was in his mid-30’s), diligent, and getting a lot of benefit from the practice. Which is why he was baffled that, as committed as he was, the unhappiness hadn’t gone away. He genuinely wanted a better life, and put his efforts towards finding it, and felt somewhat cheated that his path, his seeking, hadn’t definitively secured it.

We didn’t need to spend much time with coping or management strategies, because he’d essentially secured those skills. What we needed to focus on was this “seeker’s dilemma,” and support him in deepening into surrender and acceptance of his life as is, rather than the attachment to his life “as it would or shout be.” This entailed a deepening into the skill of grief (which I’ll talk more about below), and into challenging his deeper ideas and experiences around survival, and the danger of being actually really present in his life. When he left therapy, his graduation, he reported feeling that his sense of himself had changed, even transformed in some ways, as he saw that his subtle commitment to control-as-domination was unnecessary, and was never who he was, at depth, anyway. A much deeper letting go arose, as a result of seeing and experiencing how, actually, truly, it was safe to surrender.

(Part 2 of this essay will be in next month’s newsletter.)