The goal of this brief commentary is to provide you with a better understanding of what drives depression. I wanted to put this out there now because the relationship between the coronavirus that causes COVID-19 and depression has been well documented and rates of depression have been on the rise. I would like to address just one etiological factor, loss, and the role it plays in driving up depressive symptomology.

While there are many factors that contribute to depression it seems that Covid restrictions that promote social distancing have quite a significant impact on one’s mental state. Particularly vulnerable are those who for one reason or another did not already have many existing close, intimate, enriching relations and due to the Covid restrictions, are not comfortable, or at least now have a good reason, to not develop new relationships. 

What Causes Depression and why the Heck is it Affecting ME! 

What makes someone who becomes depressed different from those who do not? This is a very complicated question with many answers. Again, for now, I will focus only on loss, and to be completely transparent, my perspective on this matter is biased by my psychodynamic training. From this perspective, one’s early upbringing plays a critical role in shaping one’s personality and who they are today. The very early relationship with significant caregivers influences how you cope with loss and isolation today. Loss can range from a death of a loved one; loss of close contact with friends or colleagues; financial insecurity; isolation from others, or loss of a sense of oneself. When things go well in early develop the loving caregiver is there to help a developing child tolerate natural and necessary losses of everyday life. At this early age loss can entail something as simple as darting away from the comfort of your caregiver (around age 2 to 3) or functioning more independently when dressing, feeding and later making one’s own decisions independent of the primary caregiver.

Emotional independence is a function of successfully mastering all the little separations and loss’ and internalizing (taking into oneself) the smiling comforting soothing capacities of the caregiver who supports each of these acts of independence. This leaves one with a stable sense of self and without this the self remains fragile and vulnerable to all subsequence losses.

If the developing child experiences a hostile or rejecting caregiver who was not sufficiently sensitive to these early separations this disrupts the capacity to take in and internalize the soothing, comforting functions that are so necessary to pull on in times of separation and loss. Alternatively, imagine a caregiver who for his or her own reasons cannot allow the child to develop a sense of independence and needs to always manage that child’s life (yes, this is what we call the ‘helicopter parent’) with excessive devotion. This too will interfere with the child’s capacity to internalize that comforting and soothing smile leaving one with a unstable sense of self.

The Unstable Sense of Self and its Relationship to Depression:

In my practice I have successfully treated many patients who came to me after having suffered with depression for many years, at times even decades. The depression, from my perspective, is not the problem, it is the outcome of the problem. As I mentioned earlier, there are many different reasons one can become depressed but at times, what I have discovered, is that repeated reactions to loss and separation often go unrecognized. These deeper feelings are hard to recognize because they are hidden away or made to disappear. In other words, compensatory actions are taken, and these actions require immediate attention but also distract from the underlying problem. There may be, for instance, a compensatory use of drugs, vaping, video gaming, over-eating, over-sleeping, withdrawal from life, etc. I have noticed that younger adults seem to be suffering more, as evidenced by increased substance use, increased engagement with mind numbing activities such as social media and video gaming, social isolation, dreams of idyllic relations, or many self-destructive behaviors that need constant attention, such as hypochondriacal symptoms – rashes, upset stomach, back aches, etc.  I will say more about this in a later commentary but all of these ‘symptoms’ are designed to not think and experience painful feeling around loss. 

Depression vs Ordinary Sadness, Disappointment, and Grief:

Why, you may be wondering, in the face of loss, doesn’t everyone become depressed. Many people have the inner resources, the inner comforting image of a caregiver, for instance, that allows them to experience disappointment, grief, and mourning, but this is not depression. This type of person has some capacity to regulate their emotions as they conjure up that image of the soothing, caring, loving figure. There is much more to be said about this, but for now I can provide a simple example. In order to protect the identity and anonymity of my patients I will not talk about any one experience or patient. The following example describes a composite of several patient issues.

Example:

Over the course of treatment Ms. A would experience frequent and severe depressive episodes. Despite her telling me that nothing had changed or caused her depressed state close exploration revealed that just recently her department at work had a going away party for an esteemed colleague of hers. She did not attend the party, claiming she was busy with work, and never did get the chance to say goodbye. As this was discussed we came to see that this fellow was indeed quite important to her and played a significant role in her professional development. I helped Ms. A give voice to that which she was not aware and was too hard to acknowledge; this colleague was important to her, and she would miss him. Over subsequence sessions further work was done around deeper emotions and she gained insight and increased awareness into an empty place in her life, a hole, she described, that she felt in her chest and stomach. Being able to work through the pain, by putting her thoughts and feelings into words, experiencing the loss was now possible.  I was able to help Ms. A maintain empathic contact with the separation and loss. I did not feel anxious or rushed to make her pain go away quickly and she therefore was able to withstand the discomfort as we worked together through painful feelings, emotions, and subsequently older memories dating back to earlier traumatic loss’ when she was a child. 

What was offered to Ms. A, and all my patients, is the talk therapy. When one can talk through and process thoughts and feelings, they can get better control over them. This puts the patient, instead of the un-thought emotions, in control.  For a deeper look at ‘un-thought’ emotions please refer to my blog post on “…How we Don’t Think.”  

Wrap Up:

In this brief commentary I have attempted to demonstrate one factor, loss, that plays a role in depression. Early relationships with important caregivers influence how one experiences loss and separation today. If you or someone you know is struggling to manage their depression it may be helpful to contact and talk with a qualified mental health professional.  If you have any questions about this commentary or if you would like to set up a consultation to talk about your emotional state feel free to reach out. 

https://www.webmd.com/lung/covid-19-depression#1
https://www.health.harvard.edu/blog/could-covid-19-infection-be-responsible-for-your-depressed-mood-or-anxiety-2021041922391

PROVIDENCE, R.I. [Brown University] — Depression among U.S. adults persisted, and worsened, during the first year of the COVID-19 pandemic, found a new study by public health researchers at Brown University and Boston University.

Published in the journal the Lancet Regional Health – Americas, the study found that 32.8% of U.S. adults experienced elevated depressive symptoms in 2021, compared to 27.8% of adults in the early months of the pandemic in 2020, and 8.5% before the pandemic.

Rates of depression did not decrease over time, nor did they stay the same — surprisingly, they went up,” said lead author Catherine Ettman, a doctoral candidate at Brown’s School of Public Health and chief of staff and director of strategic initiatives in the Office of the Dean at Boston University’s School of Public Health.

The most significant predictors of depressive symptoms during the pandemic were low

https://www.brown.edu/news/2021-10-05/pandemic-depression
https://psychcentral.com/depression/does-covid-cause-depression#impact-of-the-pandemic

ResearchTrusted Source shows that people experienced increases in depressive and anxiety symptoms during February and March of 2020, at the start of the pandemic.

https://www.health.harvard.edu/blog/intimacy-sex-and-covid-19-2020041519550
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7184005/

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