Out of the Darkness

“In the midst of winter, I found there was, within me, an invincible summer.” — Albert Camus

Major depression is a serious and complicated condition that should be evaluated by a trained professional.

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Anyone who writes about depression faces the inevitable challenge of trying to present the information in a way that does not become, in colloquial terms, a real downer. According to the National Institute of Mental Health (NIMH), depression is the leading cause of disability in the U.S. for ages 15-44. Knowing that it can result in "severe impairments that interfere with or limit one's ability to carry out major life activities" is enough to give one a serious case of the blues.

Common expressions of the depressive experience include "being in a black hole," "a downward spiral," "a heavy burden," and "the dark night of the soul." People who have dealt with depression not only talk about the psychological and emotional pain of feeling helpless and hopeless but also a physiological pain little understood by those who have not fallen into this dark place. Given its prevalence, it's imperative that we find a way to shine some light on this condition to provide both the hope and courage essential to recovery.

Once known as melancholia, depression has led to many psychological theories on its origins and treatment. Away from the therapist's couch, there is an almost romantic quality when one looks at literature and the arts. It has been suggested that many artists turned their depressive symptoms into some of the world's greatest masterpieces. Additionally, many writers have chronicled the ebb and flow of their inner turmoil, producing profound works of poetry and prose.

Back in the modern world of the wellness paradigm, there is a growing movement toward taking our suffering head-on, thereby finding meaning in depression. Far from being a New Age twist on turning lemons into lemonade, using the down times in life as a method of transformation has deep roots in human development. The poet Rumi wrote, "The wound is the place where the light enters you." For many, the passage through is as much a spiritual journey as it is a psychological trek. Finding that the light at the end illuminates a stronger self is what the Stoic philosopher Seneca referred to when he wrote, "What is hard to endure is sweet to remember."

Regardless of its origins, anyone who has experienced a period of depression knows that, while in its grips, one seldom thinks, "I'm going to be better in the long run for going through this." On the contrary, one of the first things that depression attacks is one's ability to counter the errors in negative thinking that help to grease the downward slide. That being said, many people do turn to introspection, evaluation, and/or altering life habits to decrease the pain. Survivors of depression, much like survivors of physical conditions like cancer, often report increased resiliency and appreciation of life.

According to a study at the Center for the Study of Mind and Human Interaction at the University of Virginia in Charlottesville, the gains from recovering from depression include:

• Higher levels of empathy and awareness
• Increased analytical thinking
• Improved relationships
• Enhanced stress management skills

Whether professionally guided by a trained therapist or through the compassionate support of a caring other, moving through depression can illuminate those hidden mechanisms in one's life that contribute to the spiral of negativity that is the hallmark of the depressed state. As a countermeasure to the happiness addiction so common in Western cultures, working through and with a depressed period helps to avoid the trap of immediate maladaptive coping skills, whose quick relief often rebounds in the form of more pain.

We would be wise to head the words of the poet Rilke, who wrote to a despondent young poet, "Why do you want to shut out of your life any uneasiness, any misery, any depression, since after all you don't know what work these conditions are doing inside you?" Later, he advised, "You must be patient like someone who is sick, and confident like someone who is recovering; for perhaps you are both."

In my work as a therapist and in my own struggles with depression, I've found that living as someone who is ill while also in the process of healing makes depression less threatening. Addressing it as one would physical pain, as a call for attention and action, one acts with self-compassion—itself an antidote to many of depression's insidious symptoms.

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Ultimately, depression teaches us that the very vulnerabilities that create despair, if managed thoughtfully, will expose the opposite energies of endurance, resilience, and even joy. These represent more than just rays of hope; they are the assurance of an invincible summer.

Practical steps for starting the healing process include:

1. Break the silence — isolation only fuels the depressive cycle. One does not have to turn to social media and announce one's suffering to the world to break this cycle. Start by finding at least one trusted family member, friend, mentor, etc., with whom you can share your story.
2. Try bibliotherapy — there are countless books written by others who have come out of the tunnel of depression and can serve as a beacon of hope.
3. Resist the urge to surrender to inactivity — while fatigue and loss of interest in usual activities are hallmarks of depression, challenging oneself to push through this inertia can make all the difference. Don't wait to get motivated; start with the smallest of actions, and the habit feedback loop will bring the energy to keep moving forward.
4. Take a social inventory — make a mental or physical list of the people you routinely engage with. It's possible that they are sucking the positive energy out of you. Limiting your contact with emotional vampires can help you return to the land of the living.
5. Just say "ahh" — many physical ailments mimic depression, so a great start is to see your PCP for a head-to-toe checkup. While psychotherapy has proven effective in treating depression, it falls short when addressing things like thyroid conditions, blood sugar, heart problems, and several other medical conditions. If you haven't seen a doctor lately, it's likely that you will be asked to complete a patient health questionnaire (PHQ9) as part of your intake, a go-to depression inventory—it's a win-win.