In today’s culture, mental health concerns have become more prevalent than ever before. In a recent study carried out by the Harvard School of Education, 39% of young adults reported that they had experienced recent feelings of anxiety; 29% reported recent feelings of depression. This is the bad news.
The good news is that there’s also less stigma associated with living with mental health concerns than ever before. There is significantly less shame and guilt associated with experiencing depression and anxiety, or with seeking professional treatment for these conditions. Depression and anxiety are no longer thought of as evidence of being broken, sick, weak, or a person of lesser value. What’s more, help for mental health concerns is more easily accessible than it has been in the past.
But what is depression? What is anxiety? How are they related, and why does it matter? This article will attempt to answer these questions from a practical perspective.
Dr. Ed Hammer (Professor Emeritus of Texas Tech University) once said that those who suffer from depression feel as though they don’t have choices. Dr. Paul Douthit, also of Texas Tech University, has stated that those who battle depression feel as though they do not have hope. Let’s think about that for a moment. What would life feel like, absent choices and hope? It sounds like it would be an incredibly dark place.
What’s worse is that our instinctive response, when we feel depressed, is to isolate and avoid. Isolation and avoidance tend to shut down our choices further, and shut down our opportunities to create choice, and certainly do not encourage hope. The Existentialists might argue that when we choose not to make any choices, we are neglecting to fulfill our primary purpose as human beings.
Dr. Hammer has also suggested that the purpose of emotions is to communicate something to us— a sort of coded message from the unconscious. So, what might depression be trying to communicate? Perhaps the feeling of depression— or even its lesser cousin, sadness— could be taken as a sign that our life has become too predetermined, too devoid of decision points. Either we are failing to see all of our potential options, or perhaps we are dismissing them prematurely. It then becomes the job of the therapist to give us back our feeling of agency and choice, and by extension, our hope. Dr. Douthit once said that his job as a psychologist was to be a “hope broker.”
The other great obstacle to choice and hope, of course, is anxiety. Anxiety is fear, and fear may lead to paralysis— when we are really afraid, making even a very simple decision may seem impossible.
Of course anxiety, like depression, can serve a productive purpose. If we are confronted with a clear and present danger, such as a tiger, the appropriate response is to feel fear. It may be perfectly appropriate in that setting to avoid the thing you fear. Even the “paralysis” (or the impulse to “freeze up”) might be a useful instinct, from an evolutionary standpoint. After all, a predator is less likely to spot us if we don’t move. But most of the things that make us anxious are not tigers. They may be mildly adverse situations, or low-probability dangers, or even everyday situations which offer a dubious potential for distress. And unlike a tiger, these situations do not lose interest and walk away from us when we freeze and pretend to be invisible.
The trick is knowing when to avoid our anxieties and when to engage. A great man— I think it was Kenny Rogers— once said that “you have to know when to hold them, and know when to fold them”.
The anxious person’s thought process may sound something like this: “I can’t do this or do that because if I do, then something bad will happen.” Anxiety also gifts us with a feeling of energy— when we are anxious our body wants to move, to respond or solve the problem. However, when that energy is unacknowledged and unused, one remains in a prolonged state of heightened physiological arousal, with no outlet for all that energy. And as anyone with anxiety might tell you, it is a very uncomfortable place to be.
What, finally, can do we do about this problem? In general, the tools of therapy— which include reality testing and systematically exploring the patient’s options or choices— are designed to thwart the feeling of choicelessness and hopelessness. It is designed to remind us of the fact that every day, however constrained by responsibilities and routine, is filled with an endless number of small choices and decision points— even if we do not always recognize them as decision points. For example, most of use language every single day, and language is full of choices. The words you choose to describe a problem are not the only words you might have chosen. (Most therapists would agree that this is a particularly important area of choice).
Research shows us that depressive disorders and anxiety disorders often co-occur. How is it that these two mental health concerns are so often found together? Already, we have seen that these disorders share a common theme: both involve the theft of hope and agency. In fact, one disorder tends to beget the other. Severe or long-term depression tends to induce anxiety; conversely, long-term or severe anxiety may induce depression. Either way, there tends to be a profound loss of hope of better things or days to come. It’s often valuable to know which emotion came first, so as to better approach a solution. If the depression provokes anxiety, then treatment for depression should be addressed first; if anxiety invokes depression, then treating the anxiety will also treat the depression. In other words, addressing the underlying causes tends to offer the best relief and restoration of hope and choice.
The task for the therapist, and for the client, is to listen to what the emotions are telling us: perhaps they are clues about what we want for our lives, or what we don’t want for our lives. We can start to see our emotions not merely as “symptoms” to be controlled or neutralized, but as questions to be answered.
Joel T. Meyer, MA, LCPC
Disclaimer: This article is for informational purposes only and not intended to give advice, diagnose, or substitute for treatment provided by a licensed professional.