My reflections in the aftermath of my experiences with Major Depressive Disorder have shifted my views of the condition. While biological processes, patterns of thinking and deep sadness may be common explanations for the experience, I now see that it is infinitely more complex than any of those explanations can accommodate.
I realized recently that central to depression is the loss of hope for a future worth living. In Greek mythology, Pandora (whose name means ‘all gifts’) opened the sealed jar she was forbidden to open. In the 16th century this vessel was mistakenly translated as a box and most popular references refer to Pandora’s box. Nonetheless, when she opened the jar, a sea of trouble was unleashed upon the world. Left behind in the jar was hope.
When hope is gone or inaccessible, life becomes precarious indeed. Without hope there may be little to strive for or find meaning in and, after repeated disappointments, little reason to continue trying. Having hope is more than positive thinking. It is the inner sense of possibility that one has the ability to have an effect on the nature of one’s experience of life.
It would be too simplistic to state that a lack of hope is necessarily synonymous with depression. They are deeply intertwined, however. Where, then, do hopelessness or depression begin? It is possible that there are two common, often overlapping, pathways: Discouragement and Discrete Shock.
The Discouragement Pathway into depression often occurs through repeated disappointments, unmet needs, and efforts that result in perceived failure. As these experiences accumulate over time, they can contribute to increased vulnerability and hopelessness, and may lead to negative expectations about the future. But the discouragement is real. Clarke and Kissane (2002) described ‘demoralization’ as a persistent inability to cope, coupled with helplessness, hopelessness, subjective incompetence and diminished self-esteem. The person begins to believe over time that they cannot make a difference in their life and a sense of hopelessness can grow.
By contrast, the Discrete Shock Pathway can occur suddenly. Something happens—a major rupture, loss, illness, or trauma—that overwhelms an individual’s resources for coping. The resultant disruption can damage one’s beliefs about safety, life, others and the future.
These pathways can overlap. For example, someone whose repeated efforts to make life better with limited success could be destabilized by a sudden shock or loss. Conversely, a sudden trauma or loss followed by a succession of further difficulties can erode hope.
In therapy, examining the challenges of living that contributed to the experience of Major Depressive Disorder can provide a way forward. It is not enough to simply cheerlead someone into positive thinking. Likewise, while medication can have a significant role to play in treating depression, symptom relief alone may not address the lived experiences that contributed to a diminished sense of agency and vulnerability to depression.
A crisis like depression can create an opportunity for growth. It can open a conversation with oneself and others about living authentically and intentionally.
Our relationship with hope can be deeply influenced by our awareness of time as finite. The pressure to live a good life can contribute to our distress, especially if the concept of a good life is not self-generated. Depression can be a catalyst for change. Before any commitment to the future, isn’t it wise to develop a map?
Therapy can be helpful in developing a map toward a meaningful life—an intentional direction forward that begins with a deep understanding of the personal landscape. We can honestly look at where we have been, the successes and failures, and use the truth of these experiences to choose a flexible course forward. This approach highlights experimentation, evaluation and revision, and just might result in a more satisfying life. Our values are the landmarks we can use to guide our life direction. Life will happen to and for us all. When Pandora’s legacy visits our lives—as it inevitably will—knowing the ground we stand upon is solid and can help to make the passage through difficulties easier. When the map makes sense, we have every reason to hope we can traverse the challenges and continue in a direction of our choosing.
Drawing that map is hard to do alone — and often, that’s where therapy begins. Dawna offers a complimentary 15-minute meet-and-greet, by video or phone, to see whether working together feels right. No pressure, just a conversation.
Dawna Silver, MA, RCC, is a Registered Clinical Counsellor at Acacia Health, offering counselling in Victoria, BC by video and phone. She specializes in EMDR therapy for trauma recovery and works with clients navigating depression, loss, and life transitions.
