This Foreword by Professor Paul Gilbert OBE FBPsS, sourced from the BPS website, for a comprehensive report on depression (2020), helps us to understand depression in a wider context this year. October 2020.
‘Depression’ is not a word that describes just one state of mind, but refers to a whole array of different feelings and thoughts that people experience in different ways in different situations. There are, of course, some common themes to experiences of depression around the world: loss of feelings of pleasure; having a pessimistic view of the future, feeling as if life is too harsh and difficult, often with sleep difficulties, feelings of tiredness, fatigue and/ or in some way feeling ‘ill’.
Many of the people I have worked with also use the term dread – waking up in the morning with a sense of dread of having to get through another day. Dread is not a word that crops up medically but it’s a useful description for how a depressed person feels in struggling to cope with the challenges and tasks of living. Some people also have feelings of anxiety or withdrawal but others can express irritability, anger and aggression. Some people cope with their depression by drinking to numb pain others seek out supplements and alternative medicines to directly change their ‘body states.’ Depression is not just ‘in our heads’, as beliefs and imaginations. Indeed we now know that depression can be associated with a whole range of changes in our bodies. Recent research has shown changes in parts of our brain, in our immune, cardiovascular and digestive systems. There is evidence that our diets may contribute to depression. Increasing evidence is showing that the bacteria that live in our gut can have a major impact on our mood. So depression is not just a psychological state. We are increasingly understanding that depression emerges from complex biopsychosocial interactions and that we must not ignore the body or social and economic contexts. Hence, depressed people would be well advised to be checked out physically in case of undetected thyroid problems, diabetes, anaemia, hormone difficulties, such as low testosterone, indeed a range of physical problems. Physical illness itself can be a source of depression. Indeed, anything that creates pain or disrupts our capacity to live a meaningful and active life can affect our mood. Sexual difficulties and the shame of talking about them can be depressing for both men and women, contributing to unhappiness in their partnerships. They can contribute to the fear of forming intimate relationships and hence contribute to loneliness. Depression has been discussed in different ways in different cultures and at different historic periods. This reflects not only different ways of understanding depression, but also that people expressed their suffering in different ways according to culture and context.
Today we have a growing problem of self-harming, particularly in the younger generations, whereas 200 years ago young people rarely cut or burned themselves. The fact of the matter is that historically human life has often been harsh and a struggle. Fifty per cent of all Romans, for example, died before the age of 10 because diseases were so prevalent and conditions so harsh. We live in a world where we all want to be happy and indeed we expect to be happy, and yet happiness requires certain conditions for it to flourish – it is not a naturally given state of mind. Happiness will not flourish in conditions of social conflict, abuse, violence, neglect, and where we are surrounded constantly by signals overstimulating us and confronting us with how much better and how much more others have than we do. Research has shown that it is not just absolute poverty that is the problem – it is relative poverty. The greater the disparities between the rich and poor, the more mental health problems societies have. Rates of postnatal depression are much lower in cultures where women are well integrated into kin networks. In wealthier countries we live in a very competitive society where we are constantly being directed to self-monitor and judge ourselves in the sense: ‘I’m not good enough; I’m not up to this.’
It is reported that when the Dalai Lama first came to the West, he could not understand how people could dislike themselves and be so self-critical. Having a hostile relationship with oneself is now known to be highly associated with depression vulnerability. Questions arise as to how do people acquire such hostile and critical views of themselves? What can also sit underneath some of our depression is not just anger and disappointment in the self but about the way life is. Many depressed people can be frightened of their anger, worried about expressing it, risking a counter attack or rejection, and upset if they express it to their children. When all you really want is to feel connected, valued, and loved, it’s tough to have to deal with these feelings. Depression is increasing as part of the modern age but we are not evolving genes for depression, we are cultivating lifestyles to breed it. We are living increasingly in an age where we are reduced to objects of competition, despite the extraordinary outpouring of compassion and mutual support generated by Covid-19. It is the role of psychologists to highlight that we are a highly social interdependent species. From the day we are born to the day we die, the kindness and compassion of others will have a huge impact on the quality of our lives – even changing the way our genes work (what biologists call gene expression: epigenetics). Consider that even at a conservative estimate, 5 per cent of us are depressed, then for every million people we have 50,000 who are depressed. In a country the size of the UK we are talking over 3 million people. We’re not going to tackle that with individual therapy solutions.
Countless studies have shown that the more connected and supported we feel in our communities, the lower the levels of distress. Hence building compassionate and supportive communities would be a major target for intervention and prevention. Psychologists have a major role in helping people understand what they are caught up in and to begin to soften the chains of selfcriticism, self-blame and shame. There is increasing evidence that a compassionate focus to ourselves and others has many mental and health benefits. Psychological interventions need to be more social and contextual, focusing more on prosociality rather than just rationality. Our physiologies are co-regulated through our relationships. In this document the British Psychological Society has brought together important insights into what depression is, the common causes for it and what we can do. Understanding these biopsychosocial dimensions of depression is the biggest challenge of the next decades because the solutions to our mental health problems and the promotion of wellbeing anfd flourishing are both individual but also collective and relational. The British Psychological Society offers important blueprints for this moving forward on many fronts – from diets and exercise to epigenetics, from personal therapies and mind training practices, to social and collective movements. There is much to inspire us here.