Depression is one of the most common and pervasive mental health conditions. Some people have experienced it at least once in their lives in response to a very specific cause, such as the death of a loved one, the dissolution of a relationship, or the loss of a job. Others may have grappled with depression for most of their lives and are unable to recall a time when they have not been depressed. Yet others say that their depression follows a very cyclical, seasonal pattern, with the winter months being a particularly difficult time.
Despite the pervasiveness of depression, some myths and misconceptions about this mental health issue continue to abound. In what follows, I will identify a few of these myths and attempt to counter these misconceptions with truths using de-identified case vignettes to illustrate some points.
Myth #1: "I don't feel depressed. Therefore, I must not be depressed."
"Ross" is a Caucasian gay male who entered therapy because his 40th birthday was coming up but felt that he had not accomplished much in his life. He had made frequent attempts to make a name for himself in the entertainment industry, but his history of childhood sexual abuse severely damaged his self-worth, self-esteem, and self-confidence. His struggle with depression has also been practically life-long.
When "Ross" first walked into my office, there was no question in my mind that sitting in front of me was someone who was severely depressed. His grooming was sloppy, his posture was slouched, and his eyes remained downcast and averted for the entire duration of the session. He further reported that he would stay in bed for days at a time, had absolutely no motivation or energy level, and had isolated himself from the world. Yet, he was not convinced that he was depressed. "I don't feel depressed, so I must not be depressed," he stated.
The truth of the matter is, as much as a depressed mood is the hallmark of depression, there are instances when the most depressed individual will not feel depression. Especially in the more severe cases, the pervasive feeling is instead one of apathy or not caring. It seems that the severity of their depression has zapped them of all their energy that they cannot even muster up any energy to feel depressed. In other instances, depression may instead present as anger or irritability or feeling very short-fused. Yet in other instances, the depressed person may mask his or her depression through substance use or abuse to anesthetize the feeling of depression.
Myth #2: "My depression is purely biological."
"Bob" is a thirtysomething gay male who was referred to my practice by his medical provider. He was adamant from our very first phone contact that his depression was "purely biological," but reluctantly complied with his medical provider's recommendation that he give talk therapy a try.
When he came in for his first session, "Bob" stood by his story that his depression was purely biological and had nothing to do with the psychological realm. He endorsed the common symptoms of depression—-depressed mood, sleep disturbance, eating disturbance, etc. Then I asked him if the emergence of his symptoms corresponded with any life events or situations that he was undergoing. Reluctantly, he began to disclose that he began to feel depressed shortly after he had ended his relationship with his boyfriend.
As he slowly continued to reveal his life story, a very clear pattern began to emerge: He would stay in a relationship and a job only long enough until he found a better boyfriend or a better job, and then repeat this process all over again. Through the process of therapy, he came to realize that his jumping from boyfriend to boyfriend and from job to job was not so much his ongoing quest for something better. Rather, it was because he could not allow others to know him long enough for fear that others would see him "as he really is" once they really got to know him, that is, as flawed and broken. As part of his belief system that he was incapable of getting hurt and of experiencing pain, he was very quick to defensively attribute his depression to something biological.
The nature-versus-nurture controversy surrounding depression is an ongoing one, and the middle ground position is to accept that depression has both biological and psychosocial determinants. It may be short-circuiting a comprehensive understanding of depression to conclude that it is solely biological in nature and that antidepressants are the only solution for depression. Treating only the symptoms of depression without considering the circumstances surrounding the depression would be akin to putting a bandage over the wound without actually treating the wound.
Dr. Edward Fajardo is a licensed clinical psychologist in independent private practice specializing in gay-affirmative psychotherapy. He can be contacted at EJFajardo@aol.com or 312-623-0502.
