Toronto Psychotherapists


Depression: Is it Really a Disease?

Melancholia, the word written in the engraving by Durer shown here (1514), is an old name for what we now call Depression.  The word originates from the Greek, meaning “Black bile”.  People thought that this “bile” was the bodily cause of depressive states.


But bile was not the only supposed cause of this mysterious disease (Disease is from the old French, meaning a “lack of ease”).  Demonic possession was another historic favourite, alongside a plethora of other things such as witches, spirits, or something in our food.


When we think of depression today, we turn to science in the hope of finding a certainty of cause, and therefore of treatment.  Popular in the modern discourse is the idea that depression, as we now call it, is due to a disease, a chemical imbalance in the brain.


The implication is that the cause of depression is, in the main, a chemical or biological one.


However, Durer’s angel can have two ways of viewing her own emotional and professional state.  She can either say to herself: “my depression means that I feel so awful, so low, that a lot of the time I cannot write.  I cannot even bring myself to pick up a pen.”  Unconsciously, she views “depression” as the biological cause of her woes, and her low work rate as a symptom.


If we reverse the thinking, we can look at depression (depressive feeling states) as a symptom.  In this scenario, the angel’s sense is that she is faced with a great wall of impossibility.  For various reasons, she is stuck, and her potential is going nowhere in the world.  This has a correspondingly great effect on her feeling state, and she feels terribly low.  If she views her condition this way, impossibility causes the symptom of depressed feeling.  From this perspective, some people may be more prone to depressive feelings than others, but those feelings will be activated by a sense of the person’s place in the world.


Well, which version is correct, and does it matter?  What is symptom, and what is cause?




Depression is a disease, caused by our biology


Depression is a feeling caused by a sense of impossibility



Here are some examples, based on real world cases:


  1. I am stuck.  I hate my job and do the same thing every day.  I have no energy and some mornings, I just don’t want to get out of bed.
  2. In the long, cold and dark days of winter, I feel really depressed.  I’d never commit suicide, but dark thoughts come to me.
  3. My relationships never work out.  I can sense my existing one going the same way.  It seems inevitable.  I feel…just awful.
  4. I think I’ve messed everything up.  I’m getting older, and now it seems too late to put things right.
  5. I’m an artist – like in that engraving by Durer! – but I can’t get enough work or money.  Maybe I’m just not good enough.  I am losing hope.


What do these suffering people have in common?  Are they “stuck” because they have a disease, or is their “stuckness” contributing to a low mood?  What a confusing picture!


But can the latter idea be true?  Can we, as people, overcome lingering depression and remain drug-free?


As it turns out, the above examples are all of people helped by working from the latter model.  The office worker was deeply fearful at root, and had hidden in her unrewarding job as a result.  The therapist worked alongside her to work through her fears, which helped free her from inertia.  The seasonal sufferer found that walking every day in the open helped him a great deal; the repeating relationship problem eased when she worked on her boundaries, self-esteem and self-understanding, and so on.


And how about Durer’s angel?  What needs to change?  Can we imagine a scenario whereby she feels possibility in the world, and is thereby less depressed?  Perhaps she works on her confidence, her self-expression, her fears about life and she manages, every day, to write her poem or book – how does she feel then?  Perhaps after resolving some issues from her life, she decides she actually wants to do something entirely different, goes to school, and manages to do find a different route forward.


Of course, we influence how we feel in life all the time, and therapy can help this process in a positive way.  When we change our psychology, what we do, how we feel, we change our chemistry – be that through exercise, therapy, or anything else.


The deeper, involved and collaborative work of psychotherapy can provide people with the tools, the self-understanding and knowledge, to combat their depressive feelings.  In therapy, we call this agency.  Agency is when we have more say over how we are feeling, including the ability to move on from feelings that threaten to swamp us.


So, if you’d like to change your brain chemistry, or to put it another way, if you’d like to change how you feel day to day and gain more agency, therapy can be a powerful and helpful tool.


Our decision to view depression as a cause or as a symptom can have great consequences over our lives, not least because of the implications upon our agency.  But the decision over how you view your depressive feelings is ultimately, and always, yours.




Some Further Questions:



Why do I suffer from more depressive feelings in the Autumn and Winter?  Is this because I have a disease or disorder, or is it because I am naturally (and perhaps too much!) in tune with nature, and the seasonal closing down of light and life?



Why do so many new parents suffer from depression?  Is it because they are suffering from a disease or disorder?  Or, is it because they are people, dealing with great pressures, a lack of sleep, and anxieties about how they will deal with the situation, succeed and thrive?



Why does exercise help combat depressive feelings?  Is it only because of the direct changes it produces to brain chemistry, or does it also help psychological issues, such as self-confidence, esteem and overall, a sense of forward progression?


By: Tom Barwell