Through the month of September 2017 I fought a small scale conflict, against an army of negative thoughts and emotions that had claimed the territory of my mind. I recognised this mental state well. It was what we commonly call depression.
To win this fight, I needed strategies. I went back and reviewed the best thinking on depression that I have found over the years. And with that work under my belt, I want to share one insight into depression that I find very useful to know.
Like many people who experience childhood depression, it began for me with a parent. My mother had all the symptoms of severe depression, and in my early teens I experienced severe depressive episodes. I went from an A student to a school dropout, and by age eighteen I was was living alone, working minimum wage jobs, struggling with drug addiction, and caught in a trap of poverty and zero self esteem.
The path out of the place was long and tough. It involved many insights and changes, too many to talk about here. By 30 my life had improved a lot. I had returned to my life’s passion – writing. A stroke of good fortune had sent me to America for a summer writer’s workshop. I enjoyed the experience hugely. One morning I woke up to the bright San Diego summer, looked into the mirror and thought.
This is what it’s like to not be depressed.
My second thought was…I will not go back to being depressed again.
I had many more life changes ahead of me to make good on that promise to myself. But, with some lapses, it’s a promise I have kept. I just turned 40, and for almost all of the last decade, I have been depression free. When I have had minor relapses, as occured last month, I’ve been able to go back to the ideas that helped end my depression. And in particular, one idea that I want to share with you.
“Once we recognise the state of depression, the next step is to understand it.”
Depression is a subtle and complex opponent, with many causes. But the experience of depression is quite consistent. The mind falls into a negative state, it becomes hard to see anything positive in life, and an overwhelming feeling of “depression” permeates all of our experiences. Depression, while it may be a slightly vague word, is about the best term we have for this state.
It’s my personal belief that many people, perhaps even a majority of people, live with depression without ever recognising it. Many people self medicate their depression with alcohol, or over eating, or other coping strategies. Others angrily deny that depression even exists. These people, in my experience, are victims of the worst forms of all engulfing depression.
So, a happy thought for those people honestly and openly talking about depression…you are ahead of the game. You recognise the problem. However severe your depression is, once you see it, you have everything you need to escape it.
Almost. Once we recognise the state of depression, the next step is to understand it. I did a lot of reading to try and understand the causes of my own depression. I found compelling arguments for the physical causes of depression. And I found equally compelling arguments for the psychological causes. Both are useful. Then I found one idea that, for me, pinned together both – physical and psychological – into a unified model of depression. That’s the idea I want to talk about.
Among the most established treatments for depression is Cognitive Behavioral Therapy. CBT is a solution for many people. But it is also controversial. CBT trains people to examine their thought patterns, and to change or stop negative thoughts that might cause depression. I’ve never done CBT. I know some people swear by it. I know for others its ineffective, and can sound like a kind of “brainwashing”.
One issue with CBT is relapse. People often experience a cessation of depressive symptoms, then some weeks or months later, the depression returns. In an attempt to tackle this issue, a scientific study was conducted into combining CBT with Buddhist “mindfulness”, also an established treatment for depression. The approach proved successful, and Mindfulness Based Cognitive Therapy or MBCT is now a widespread treatment.
This post is not an advertisement for either CBT or MBCT. I have done neither. It’s also not an argument for Buddhism, mindfulness, or meditation as the solution to depression. I am a Buddhist practitioner, but I don’t believe it’s a path for everybody. Instead, this is about one idea, that I first encountered when reading about Mindfulness Based Cognitive Therapy, that I believe is very useful in understanding depression.
Anti-depressant drugs are the most widely used treatment for depression. They work, in many cases. I have never used them, but I am absolutely not here to argue against their use. Anti-depressants work by replenishing chemicals in your body and brain which, when their levels drop to low levels, seem to be associated with the depressive state. Topping up those levels can provide some level of relief from depression.
There is an ongoing debate about whether depression is caused by the negative thought patterns that CBT treats, or by the chemical imbalances that anti-depressants treat. The research into Mindfulness and CBT revealed a third possibility, that I find most useful. It’s the idea I’ve been working toward. It’s a little hard to explain, not because it’s complex, but because it doesn’t quite fit with how we think about thinking. In a single word the idea is.
Imagine a motor car, left switched on, with its engine running. With enough petrol the engine will run indefinitely. That is until it burns through its supply of oil. With the oil gone, the pistons and other moving parts in the engine begin to grind against each other. When that happens, the engine quickly starts to damage itself, becoming less efficient, and finally breaking down.
On the chemical level, your brain ia a little like this car engine. Your brain has chemicals that work a bit like oil, easing the connections between brain cells. In normal operation your brain can produce these chemicals at much the same rate it burns them. But when you start thinking really hard, you burn these chemicals at a faster rate than you produce them.
This is one reason why intellectual effort is literally tiring. As you exert your brain, these chemicals burn out, and thinking gets harder. Eventually, you have to stop thinking so hard and do something that uses little or no brain power, like watching Game of Thrones. Of course your brain is still doing things, even when you sleep, but at a sustainable level.
The real problems begin when your brain enters a state in which it can’t or won’t stop thinking too hard. One example are states of high anxiety. If you’re really worried about, say, a trip to the dentist, your brain can just kick into a high gear that you can’t switch off with an episode of Star Trek. We’ve all been there, and it can be awful. High anxiety can incite periods of depression. But usually these states are temporary, and the depression often passes with them.
A more dangerous situation arises when the brain begins to obsessively think about an issue on the unconscious level. Maybe there is a difficult situation at work. Consciously, you think about it now and again. But unconsciously, your brain is chewing it over all the time. And it’s burning brain oil* in the process. One name for this persistent, often unconscious thinking, is rumination.
* not actual brain oil, metaphorical brain oil
Rumination has many forms. We ruminate on short term problems. We ruminate on childhood traumas. We ruminate on imagined futures. You name it, your brain has a habit of ruminating on it. Sometimes rumination is conscious. You know you are doing it, but you just can’t seem to stop. Distraction doesn’t work, your mind carries on ruminating behind the scenes. Even when we sleep, the rumination just carries on.
Rumination places your brain into a state of overwork. Hours, days, weeks even months in this state use up the brain’s resources, and it begins to degrade. Like a dysfunctional app on your laptop or smartphone, a ruminative process can eat up all of your brain’s processing power and destroy its chemical balance, leaving you tired, unfocussed…and depressed.
Rumination opens up a different, and I believe very useful, way of understanding depression. Negative thought patterns and chemical imbalance aren’t sole root causes of depression, they are parts of a depressive cycle of which rumination is also a key driver. It’s not what you think that’s the issue, it’s the sheer repetitive length of time you spend thinking it.
Rumination overworks your brain, this depletes important chemicals, without which your brain functions poorly, which create negative thoughts, which you then ruminate on, which overworks your brain, which…creates the negative feedback loop that makes depression so very dangerous.
Rumination is the idea I find very useful to know about depression. It is not in itself a solution to depression. But many of the recognised treatments for depression intervene in the cycle that rumination causes.
- Anti-depressants replace the chemicals that rumination depletes, but they don’t stop the processes depleteing them.
- CBT and talking therapies unpick the negative thoughts that we ruminate on, but rumination will always find a new focus.
- Sleep slows rumination and gives the brain time to recoup, but rumination can keep going even when we sleep.
- A piece of cake, a pint of beer, a shot of heroin, provide a pleasure hit that can disrupt rumination, but it often comes back.
- Distractions like a good book or video game session can push rumination aside but it can, again, keep going in the background.
- Solving the problem that you are ruminating on helps, but a brain trained to ruminate will likely find another fixation to continue ruminating on.
If we can reduce the rumination itself, all of these treatments become much more effective.
I do not present rumination as equally useful for everyone. We all have our own ways of conceptualising the world, and rumination will not fit the model that everybody works with. But. If you do find the idea useful, I think there are two ways that it can help reframe depression in useful ways.
First. You do not have to stop having negative thoughts in order to stop being depressed. Which is good, because we all, however happy we are, have all kinds of negative thoughts. Negative thinking and depression are not the same thing. You can be happy, and yet often worry about whatever it is you worry about. These aren’t mutual exclusive states.
Second. You can’t think your way out of every problem. In fact, there are whole categories of problem that are completely insoluable to thought. When we’re depressed we often believe that if we can just think of a solution to this or that problem, then that will resolve the depression. In fact, thinking too much about the problem, IS the problem.
If rumination is the problem…how do we stop ruminating?
There is no way to reboot the brain. Stopping ruminative thought processes is very hard. I haven’t found an answer to the problem of how. My personal path to escaping the depressive cycle, and limiting rumination, included counselling, meditation, exercise, healthy diet and making important life changes. I don’t believe there is a singular “magic bulket” treatment for depression.
But understanding the role of rumination in the cycle of depression was, in and of itself, an important breakthrough for me. It reframed depression from a scary happening that I had no control over, to a recurring problem that I understood and could begin to control. And learning about rumination lead me to ask, when I felt depression approaching, what am I ruminating on? Identifying ruminative thoughts is, very often, all that is neccesary to defuse them.
The full research on MBCT and its insightful model of rumination and depression is available in a new editions: Mindfulness Based Cognitive Therapy for Depression.
If you’re interested in exploring mindfulness further I recommend reading Thich Nhat Hanh, the Zen vietnamese monk who founded the Buddhist sangha I attend in the city of Chiang Mai.
For a deeper exploration of meditation, I recommend American teacher Jack Kornfield.
I hope this idea is of some use to you as a reader. You can talk to me about this on Twitter @damiengwalter. And you can help reduce my existential angst about turning 40 by backing me as a patron.