Myron Doc Downing PhD LMFT Georgetown TX

Myron Doc Downing PhD, LMFT Georgetown, TX [email protected] depressionil

Myron Doc Downing PhD, LMFT Georgetown, TX [email protected] depressionil

Myron Doc Downing PhD, LMFT Georgetown, TX [email protected]

DEPRESSION Illness or symptom Have you ever found yourself “trapped” in a job or school situation where the work really wasn’t that hard, but after two hours at work or school, you felt as if you had put in ten hours? By the end of the day, it seemed that it was all you could do to make it home, and then all you wanted to do was watch TV or sleep? Have you ever been in a relationship or a home situation where you felt “trapped” with no acceptable alternatives but to remain? And suddenly you realized that you were spending a lot of time sleeping, eating or reading and you found it was very hard to get through the simplest daily chores?

Have you ever found yourself having trouble coping with life and saying, “I should…” or, “I shouldn’t have…”? Do you find you are sad and blue most of the time and walking around like a zombie, seldom very happy, seldom very angry? Have you ever felt like just giving up; like crawling into a corner and pulling a blanket over your head; that life was just too much effort and little or no joys, rewards, or purpose? Did you find yourself asking, why am I alive? Is there any reason to keep living? If any of this sounds familiar, then you are part of the millions of people who experience America’s number two health complaint: Depression.

Depression ranks second only to headaches as our most common health complaint. Have you ever been told that “Depression is a chemical imbalance”? That is true, but then, so is happiness. The chemicals involved are serotonin and some dopamine. If you become depleted in these chemicals, then you feel depressed; if you have an abundance of them, then you feel happy.

The question that never seems to get answered is, how do you deplete these chemicals? In a Medscape email Newsletter to physicians, an article titled Addressing Both the Emotional and Physical Symptoms in Depression notes: “In a study of patients in a nonpsychiatric practice who presented with a wide range of somatic symptoms, researchers were only able to find an actual cause for the symptoms 16% of the time. No organic cause was identified for the other 84%.” Kroenke Mangelsdorff, Common Symptoms in Ambulatory Care (Am J. Med. 1989). Depression is not a physical disorder in most cases; rather, it is a symptom.

Antidepressant medications work similarly to how an aspirin alleviates a headache. There is nothing wrong with using a band-aid with the hope that, over time, the root cause will heal itself. And sometimes it does. But it is crucial to consider the root cause of depression in 84% of cases and how to treat it. One of our major failures in dealing effectively with depression is because we often treat depression as an illness rather than a symptom.

Indeed, recent drug advertisements for antidepressants specify they are “for the relief of the symptoms of depression.” Treating depression simply as an illness is like treating pain from a broken leg solely with painkillers; once the medication stops, the pain returns. While it is true that depression involves a chemical imbalance, so do happiness, joy, and excitement. The key question is: what causes this imbalance?

David Burns, M.D., in his book Feeling Good, describes depression as a symptom of our thought patterns. “You feel the way you do right now because of the thoughts you are thinking at this moment,” he states. Depression, therefore, results from specific patterns of thinking, particularly unhelpful or irrational thoughts which create emotional distress. Most depression can be traced back to unexpressed anger—anger that is turned inward.

Understanding the Root Causes of Depression

Freud over a century ago described depression as “anger turned inward.” This inward anger arises from three primary situations: self-directed anger, helplessness or powerlessness, and grief or loss. Recognizing these origins is essential for effective treatment that targets the root causes, rather than merely masking symptoms with medication.

1. Anger at oneself: The “shoulds” and “should nots”

Many individuals have an internal set of expectations, or “shoulds,” which govern their behavior. These include beliefs such as “I should be more caring,” “I should lose weight,” or “I shouldn’t get angry.” When they fail to meet these expectations, they experience frustration or anger directed inwardly, resulting in depression. The internal voice of “I should…” fosters guilt and self-criticism, which intensify feelings of worthlessness.

2. Helplessness and feeling trapped

Another prevalent cause of depression is the perception of being trapped in an undesirable situation—be it an unfulfilling job or an unhappy marriage—without acceptable alternatives. These feelings of powerlessness lead to frustration, which is often suppressed as anger to avoid conflict or abandonment. Consequently, bottled-up anger manifests as depression, as the individual believes they cannot express their true feelings without adverse consequences.

3. Grief and loss

Losses, whether through death, injury, or separation, often generate feelings of anger and betrayal, which are suppressed because society discourages overt expressions of these emotions. For instance, grief over the death of a loved one may be accompanied by guilt and anger directed at the deceased or oneself, which, if unexpressed, transform into depression.

Strategies for Addressing Depression at Its Roots

Effective treatment involves recognizing and addressing these underlying sources of anger. The first step is to evaluate and challenge irrational beliefs about anger and loss, aligning expectations with reality. This includes questioning beliefs such as “It’s not acceptable for me to feel angry,” or “I must be perfect to be loved.” Rationalizing these beliefs reduces the internal conflict that fuels depression.

For example, individuals should examine whether their expectations are realistic and whether they are willing to modify them. Identifying situations in which they feel trapped or powerless and exploring realistic avenues for change can empower individuals to regain control. Often, external support, such as counseling or a supportive network, can facilitate this process.

Expressing Anger Constructively

Suppressed anger amplifies depression. It is vital to learn acceptable ways of expressing feelings—preferably through “I” statements—e.g., “I feel angry because I am not being appreciated,” or “I need to express my frustration without hurting others.” Such expressions help validate emotions and reduce their intensity. Suppressing feelings can lead to internalized rage and deepening depression, whereas healthy expression promotes emotional release and resolution.

Managing Expectations and Creating Change

Another critical aspect of managing depression involves making a detailed inventory of personal expectations (“shoulds”) and evaluating their realism. Adjusting or relinquishing unrealistic expectations diminishes sources of internal conflict. For example, accepting that change in a relationship might be gradual, or that some sacrifices are necessary, opens pathways for constructive action rather than resignation or helplessness.

Seeking outside support—whether via therapy, peer groups, or trusted friends—can help identify practical strategies to alter situations perceived as unchangeable and develop healthier ways of coping with loss, frustration, or anger.

Practical Methods for Dealing with Depression and Anger

Expressing feelings assertively yet constructively is central. The use of “I Am…” messages instead of “You…’ statements” helps communicate feelings without blame, thereby reducing defensiveness in others. For example, “I am feeling neglected” rather than “You neglect me,” fosters understanding and genuine connection.

Physical activity and engaging in enjoyable hobbies can counteract withdrawal tendencies associated with depression. However, activity should complement emotional expression, not replace it, to prevent suppression of feelings from intensifying depression. As Blake's poem A Poison Tree illustrates, expressing emotions openly helps defuse anger and prevent its buildup.

Applying the Fifteen Minute Rule—allowing oneself to fully experience and express anger for no more than fifteen minutes—can prevent destructive emotional buildup. This practice encourages acknowledgment of feelings and promotes emotional health, reducing the likelihood of depression related to unresolved anger.

Conclusion

Depression is predominantly a symptom rooted in unprocessed anger stemming from self-criticism, perceived helplessness, or grief. Addressing these underlying causes through rational evaluation of beliefs, constructive expression of emotion, and active engagement in meaningful activities provides a holistic approach to treatment. Such strategies empower individuals to regain control over their emotional wellbeing and foster resilience against depression. Recognizing depression as a signal rather than merely a chemical imbalance opens avenues for more personalized and effective interventions that include emotional, cognitive, and behavioral components.

References

• Burns, D. D. (1980). Feeling Good: The New Mood Therapy. William Morrow and Co.
• Freud, S. (1917). Mourning and Melancholia. Standard Edition of the Complete Psychological Works of Sigmund Freud, 14, 237-258.
• Kroenke, K., Mangelsdorff, D. (1989). Common Symptoms in Ambulatory Care. American Journal of Medicine, 86(3), 242-245.
• Martell, C. R., et al. (2001). Cognitive Behavioral Therapy for Depression: Strategies to Improve Outcomes. Guilford Press.
• Beck, A. T., & Haigh, R. (2014). Advances in Cognitive Theory and Therapy of Depression. Advances in Behavior Research and Therapy, 4(4), 323-358.
• Erlangsen, A., et al. (2014). Effects of Psychosocial Treatment on Suicide Risk in Patients With Prior Self-Harm. Lancet Psychiatry, 1(11), 850–860.
• Mesmer-Magnus, J. R., & DeChurch, L. A. (2009). Information Sharing and Team Performance: A Meta-Analysis. Journal of Applied Psychology, 94(2), 535–546.
• Linehan, M. M. (1993). Cognitive-Behavioral Therapy of Borderline Personality Disorder. Guilford Press.
• Davidson, K. M., et al. (2010). The Role of Expressed Emotion and Its Impact on Mental Illness. British Journal of Psychiatry, 196(4), 271–273.
• Gatchel, R. J., et al. (2014). The Biopsychosocial Approach to Pain: Scientific Advances and Future Directions. Psychological Bulletin, 140(6), 1541–1574.