Yesterday I created a social media post with the quote – “Anxiety and Depression Can Be Reasonable Responses to Unreasonable Circumstances,” along with a short blurb on that point. I decided to write a longer blog post to add to and clarify that point.
As a starting point, I italicized the “Can Be” portion of the quote to emphasize that I wasn’t speaking to all experiences that people have with Anxiety and Depression, that these are essentially “symptoms” that might be attached to a number of things (e.g., these are symptoms that some people experience after a pregnancy and may be attached to hormone changes that happen after giving birth). While there may be some physiological triggers for anxiety and depression, my contention is that it is often caused by circumstances experienced by the individual.
A commonly held belief since the 1980s suggests that reduced serotonin levels in the brain causes depression – the so-called “Brain Chemistry Imbalance” theory. In the decades in which this “theory” has existed there has been no proof to support it, and growing evidence that it is simply not correct. (See e.g. these articles in Nature, Healthline, Neurocare, The Guardian, and Science News).
Another position held by some in the mental health profession and elsewhere – a position consistent with the “medical model” of mental health – labels anxiety and depression as “illnesses” or “disorders,” and emphasizes that they are qualitatively different than the moods of “nervousness” or “sadness.” I disagree. (Some of what I’m saying here is similar to an earlier post about “Disorders.”)
What I am focused on in this post is the experience that many people have with persistent and deeper levels of depression and anxiety. I am intentionally not separating the two as I believe it is very common to experience both together – if a person is experiencing long term depression they are likely to be experiencing anxiety along with it, and vice versa.
When I suggest that depression and anxiety can be the result of “reasonable responses to unreasonable circumstances,” I’m referring to a wide range of experiences that a person might have, whether it is personal and physical (a chronic illness or physical limitation), personal and experiential (living in poverty or experiencing homelessness), interpersonal (situations involving abuse within a family), or social (experiencing marginalization or oppression within the broader society). The experiences that initially trigger the depression/anxiety might be ongoing or they might have been fully in the past, but were significant enough to carry into the present.
The idea of “learned helplessness” might contribute to deepening and/or extending feelings of depression and anxiety. If you experience something very significant, or very long lasting, you might come to believe that you are powerless against it. A person’s individual background might contribute to how weak or strong that response is. More directly, a person’s resources – social, financial, and otherwise – will impact how deeply and persistently they experience depression and anxiety.
What does this mean for therapy? How does a therapist try to address persistent feelings of depression and anxiety in a client? The following are just my thoughts – based on professional and personal experience.
First, we can validate what the client is experiencing and feeling. One of my primary modalities is Acceptance & Commitment Therapy, which includes the idea of “accepting” our thoughts and feelings – if we want the client to accept their feelings then we certainly have to accept their feelings. (Keeping in mind the VERY important point that “acceptance” I only about what has been and what is at this moment, it does not extend into the future – that would be “resignation”). This is what the client HAS been feeling and experiencing, and it is what they ARE feeling and experiencing, what they WILL feel and experience is unknown at this moment.)
Next, we might work with them to identify resources that might help them directly address their circumstances (assuming the “unreasonable circumstances” are still present). This is of greater or lesser value depending on the specific circumstances – if the person is experiencing a chronic illness, it’s likely that only medical professionals can directly address it. If the person is experiencing significant financial distress, there may be more resources available to help (in the form of government assistance, etc.).
We can explore the extent to which the client’s own narratives might be inhibiting action and/or prolonging or deepening their feelings of anxiety and depression. Narrative Therapy is one useful approach for this – exploring the stories client is telling themselves and trying to take power away from those stories by creating some distance for the client from the stories.
Finally, we can help the client identify their own sense of fulfillment and meaning in their life, helping them become more active in their choice making process. No matter what our circumstances, we still exist, and we still have choices to make. Existential Therapy is a good approach for this area of the work. I will often refer clients to Viktor Frankl’s “Man’s Search for Meaning” as a way of reinforcing our ability to make choices regardless of our circumstances. For anyone unfamiliar with this book, the first part is autobiographical about Frankl’s time in a German concentration camp and how he was able to find his meaning even in that horrific environment. (The book was originally recommended to me by my own therapist many years ago.)
When working with client’s experiencing persistent depression and anxiety, we need a certain level of humility, recognition that this is not an “illness,” it may remain with them for a long time, particularly if the “unreasonable circumstance” is ongoing. That doesn’t mean that they cannot still identify and live a fulfilling, meaningful life, it may just come with ongoing periods of depression and anxiety.
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