I view depression as an affliction of despair. One which is often held in place by the twin pillars of helplessness and hopelessness. And while it sometimes reflects a purely biological problem, often--with the people I see for counselling--the roots are psychological or existential. For example, if you had a father who constantly criticised you, or a mother who undermined you, you may have developed psychological patterns which lead to depression: perhaps deep down you feel fundamentally bad, or that you are unable to stand up to life's demands. Or, speaking existentially, perhaps your depression is a result of having lived too long without an adequate direction or purpose in life, such that despair has overtaken you, or has taken you by the shirt collar as a way of demanding that you change.
This is a brief reflection on depression from a philosophical and counselling point of view. I have just suggested that depression can have different causes, which is true. And often there are a variety of different causes within the one person. At a general level depression also has different forms, but I will not discuss that today. Furthermore, this is not a psychiatric reflection, but I will briefly address the issue of anti-depressants, for I am often asked about them. I should start by saying that counsellors are not medical professionals. I am trained to help people with life's big and common challenges, rather than with psychiatric disorders. What do I think of anti-depressants? I have seen many people helped by them, and others harmed by them. I think they are clearly necessary for some people, and have saved many lives. I also think that there is too much profit-incentive and dishonesty surrounding their manufacture and prescription. It appears to me that the benefits or costs for an individual of taking them can be hard to predict, and so people should do their own research and make their own decisions. They should do so in conjunction with a responsible, thoughtful doctor. I will talk through the issues, but I will never try to sway a person either way (with the exception of people who appear to be at serious risk of suicide). During my early 20s I suffered depression, and anti-depressants helped me get to a place where I could then help myself. At the same time, in my case, I would have been better served by counselling, but when I sought a referral via my GP I was instead directed toward medication.
The reason I would have been better served by counselling was that my issues were psychological and existential. Leaving a rural town at 17 to escape an emotionally-abusive step-father, and then losing my first relationship, all in the context of old childhood issues which, like most of us, sorely needed attention, were the ingredients which led me down that hole. I needed to heal and to grow with respect to a poor self-image, a sense of distrust, fear, and abandonment, and I needed to examine and change the defence mechanisms which had developed during my childhood to protect me emotionally, but which now undermined me in getting the good stuff from life. A counsellor at that time could have been both a guide for me to understand and change these wounded emotions and negative patterns, and also the confidante, mentor, and ally--an elder--which as a young man I sorely needed.
Those issues were psychological, but they were also existential or philosophical. For they were also about life--about what good there is to be found in it--and about what person I needed to become in order to possess an adequate sense of purpose and direction. These are philosophical problems, but not in the university sense of abstract, intellectual questions, but rather they are questions about living meaningfully. We need to experience the world as a place where meaning and goodness are genuinely on offer. And where we can have hope, and a sense of capacity, with respect to gaining that from the world. Without that, we are in danger of despair.
I just spoke of direction and purpose. Direction is about what you will do with your life and how it will look in general. This includes such things as what relationships you will create, whether you will have kids, and what work you will do. Of course there is much that you cannot predict or control, but nonetheless you need a sense of direction, a concrete future which is good, which you want, and toward which you are making. In short you need to be able to make life work. And to make it work both in a practical, effective way, and in a way that is meaningful and gratifying.
Purpose is about having meaning beyond what practical and concrete direction your life will take. It is about the deeper values you will live by, regardless of what in particular you do. These values include such things as love, truth, decency. For many people it is also about the big philosophical or spiritual questions—what is life all about? What is it to be a true human being, a good person? Of course, despite these distinctions, purpose intersects with direction. If for example your direction includes being in a committed relationship, your purpose may include serving those you love.
Oftentimes when I have helped people with the existential side of their depression or despair, the focus has been on addressing a lack of purpose or direction, and building these. At the building block level that has been as simple as coaching people in taking care of their health or appearance, creating a relationship, finding basic work for the sake of income and independence, determining their career direction, discerning whether they want to have children, or coming to terms with what they have missed in life and building a good and gratifying life nonetheless.
People can fall into a depression because they have not achieved important things at the level of direction and purpose. Or because they lack direction and purpose in the first place. We need to make life work in order to feel hopeful and in control—as opposed to those twin pillars of depression: hopelessness and helplessness. That is, we need to have direction. And we need to have genuine purpose if we are not to feel that, despite our success, it is all pointless, and so to fall into despair. This is why philosophical reflection on your life can be such an important part of counselling, including counselling for depression. Of course such reflection is not enough on its own--psychological work is also often necessary--but then again no one element is enough on its own.
Sometimes counselling helps free a person from depression. This is especially the case if the depression is unusual for that person. If it is part of a person's make-up, perhaps having ongoing biological causes within them, counselling may help instead to diminish the depression, and/or help to live better with the affliction--after all you are more than your depression, but it can be easy to despair over a life afflicted by despair, so it is important to find hope or endurance in the face of it. I guess it's a matter of having the courage to change the things you can, and the ability to live well with what you cannot: to find all the meaning, direction, purpose, and joy that life offers you, alongside and despite your suffering.