Myron Doc Downing PhD, LMFT Georgetown, TX 811506
Myron Doc Downing PhD, LMFT Georgetown, TX [email protected] DEPRESSION Illness or symptom
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 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 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 the Medscape email Newsletter to physicians there was an article Addressing Both the Emotional and Physical symptoms in Depression in which the following quote occurs: “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 the majority of the cases, it is a symptom!
Antidepressant medications act in much the same way that an aspirin acts on a headache. There is nothing wrong with using a band aid with the hope that some how, some where down the road, the root cause will heal itself. And, sometimes it does. But, is it not important to consider what is the root cause of depression in 84% of people, and how to treat the root cause? One of the major reasons for our failure in dealing effectively with depression is because we often treat depression as an illness instead of as a symptom.
In fact, recently drug companies have started advertising their anti-depressants as, “for the relief of the symptoms of depression.” To treat depression as an illness is like treating the pain of a broken leg with the use of painkillers; when the drugs wear off, the pain returns. But isn’t depression a chemical imbalance? Yes it is. So is happiness, joy and excitement. The issue is, what causes the imbalance?
David Burns, M.D., in his book, FEELING GOOD, talks about depression as a symptom of the way we think, “You feel the way you do right now because of the thoughts you are thinking at this moment.” Depression is a symptom of the way you think. It is not just any kind of thinking. It is thinking that creates your anger and your thoughts or beliefs about anger keep you from expressing your anger. Most depression is unexpressed anger! Over a hundred years ago Freud said, “Depression is anger turned inward.” Most of the anger that turns into depression is generated from one of three types of situations.
The first type is anger at yourself. The “shoulds” and the “shouldn’ts” you hold for yourself: I should be more loving; I should spend more time with my children; I shouldn’t get angry; I should lose weight; I shouldn’t say dumb things, etc. Shoulds are the expectations that you have been taught and now feel you should live up to but don’t. Each time you fail, you experience some degree of anger at yourself, “but how can I be angry at myself?” So, you get depressed. The second type of situation that produces depression (anger) is where you feel powerless, trapped by a situation or circumstance in which you feel that there is no acceptable alternative but to remain.
A job you can’t stand, but have to remain in because you need the money; a marriage where you feel unloved, but you believe and think that you are too old or have too many children to look for someone new. And, you believe that you can’t survive by yourself. “Where would I go? Who would support me? What would others think of me?” You are afraid: “If I get angry, I’ll lose my job for sure.” “If I tell my mate how angry I feel, he may leave me or the situation will just become worse.” You believe you can’t be angry, so you become depressed.
The third type of anger is where there is a major loss, such as the loss you experience when a loved one dies before their time. You will feel angry at being “deserted,” left alone, but how can you be angry with someone who has died? “I loved them very much and didn’t want them to die! I’m not supposed to feel angry. I should feel grief, caring (and you do), but not anger” – You “can’t” be angry, so you become depressed.
Loss can come in many forms. A person who loses a part of his/her body, either through an accident or operation, will often suffer from depression. “I am only part of a man since I lost my leg.” “I am not a complete woman since the operation,” etc. Here, the idea or expectation is, “I should be whole.” The belief is, people who are not “whole” are incomplete and they will be rejected and abandoned. You are angry at the loss, but the message you are given is that you have to adjust to the loss.
“It is not the end of the world, you shouldn’t feel that way!” How can you be angry at what is, at what had to be? So, you turn the anger inward and become depressed. If depression is to be dealt with effectively, then you must deal with the source of depression: the anger. There are two basic ways in which this can be done. First, your expectations and concepts need to be checked against reality or what is reasonable.
Most depressed people hold irrational beliefs that make it hard not to be depressed. Am I the sum total of my body? Does a loss of a part of my body mean that I am less than me? Am I really rejected by those who are significant to me because I am less than “whole”? To rid yourself of depression, it will be important to take an inventory of your irrational beliefs about anger: What do I believe about anger?
Is it O.K. (acceptable) for me to be angry? What do I believe about emotional pain? Is it terminal? If I get angry, will I really hurt others and/or myself? Will I be unlovable if I get angry? What do I believe about the opposite of love? (It is not anger or hate, it is indifference.) Do I lie about being angry by saying, “I’m not angry, I’m just upset”? Do I feel guilty when I get angry and end up punishing myself (often by becoming depressed)? Here are some other questions that are important to consider if you are to get to the place where being angry is a positive alternative to being depressed. Do I have a switch to turn off the feelings I do not like? Since I can’t choose my feelings, what do I do with my angry feelings when I feel them? Am I willing to express my feelings as strongly as I feel them?
Do I know acceptable ways of expressing my anger that does not threaten or push people away from me? (If you are having trouble answering any of the above questions, I suggest you read my book, TAKING CONTROL OF YOUR LIFE.) Now, try this next exercise. Make a list of your expectations (shoulds) for yourself in your: 1. job situation, 2. relationship with your mate, 3. relationship with your children. “What should I do as a good husband or wife?” “What should I do as a friend or companion?” Make a list as long as possible. Note that each time you fail to live up to your expectations (the “I shoulds”), you have a source of anger and possible depression. Each time someone else fails to live up to your expectations (the “You shoulds”), you have still another source of anger.
Now, on each item, ask yourself, “Is this an expectation I can reach?” What expectations do you want to change for yourself, for others? What expectations do you wish to keep? What relationships or situations do you have in which you feel trapped or powerless? What are the shoulds you hold for others?“She should take better care of the house.” “He should spend more of his time with the family.” “If he really loved me, he would know what I wanted.” “People should drive the way I think they should drive.” “He should mow the lawn and fix the things around the house.” “The whole family should be together for Christmas.” What ways can you change these situations?
Which of your expectations are realistic? Which do you want to keep? Who can you go to that can help you to change your situation? Often, the relationship or situation is not as hopeless as it may seem and an outside person may be helpful in giving you a more realistic view of what can and needs to be done. The second thing that needs to be done in order to deal with depression (anger), is to find acceptable ways of expressing the anger that you feel at yourself.
You need to give yourself the permission to be angry, even though you may feel foolish and it does not make sense. You need to learn more acceptable ways of expressing your anger to others, without putting them down or making the situation worse. “I AM…messages instead of YOU ARE… messages. I AM messages are internal reports, they talk about feelings instead of behaviors: “I am not feeling loved or cared about; maybe you love me, but I don’t feel loved,” instead of behaviors and judgments, “You don’t love me, I am going to leave if you don’t change.” Anger need not nor can always be expressed to the person at whom you are angry, but it does need to be expressed. “I cannot stand the boss/job.” That needs to be said, but not necessarily to the boss!
The judge is a rotten bastard, is best saved and expressed to your attorney when you are away from court. Babies and very old people do not need to hear your anger. They cannot understand it and it only scares and confuses them. For instance, if you are not getting enough sleep, it is better to express your frustration/anger to a friend or to your understanding mate than to the baby who would just become frightened. A third thing that is helpful at getting rid of depression is to keep busy doing things that you enjoy and feel good at.
Depression usually gets worse because the more you feel depressed, the less you want to do. The less you want to talk about and express your feelings, the more you start to withdraw. And the more you withdraw, the more depressed you will become. A word of warning, do not use activity as a way of avoiding your depression because it will continue to build if not expressed verbally. In William Blake’s poem, A POISON TREE he states it this way: I was angry with my friend; I told my wrath, my wrath did end.
I was angry at my foe; I told him not, my wrath did grow. The feelings that you are expressing are very important in helping you deal with your depression. It is your feelings of anger, powerlessness, confusion, guilt and sadness that need to be recognized and expressed. That is, start talking about anger instead of your depression. Then, start expressing your anger as intensely as you feel it. The key word here is express. If you are expressing your anger to the degree that you feel it, then the Fifteen Minute Rule comes into play: You can not be angry for more than fifteen minutes. If you don’t believe me, go into your bedroom (when no one is around) and get yelling, screaming angry and see if you can keep it going for more than fifteen minutes. “I am angry at Mother because I miss her so very much.” “Since I retired, I feel angry because I feel so useless and unimportant.” “I feel so angry because I am powerless to make her love me.” “I am really angry at myself for what I said and the way I acted.” “I feel angry because I don’t fit in with any of the groups at school/work.” “I feel angry because I don’t have any friends (my closest friend rejected me).” “I feel angry because I was fired from my job. If depression can be identified and recognized as anger, then it can be dealt with in constructive ways. If it is left as depression, then you are its helpless victim. Update: DEPRESSION , treatment talk 141124 Talk Therapy May Prevent Suicide in High-Risk Patients Deborah Brauser November 25, 2014 Talk therapy may decrease risk for future suicide attempts and completions in patients who have already made a previous attempt, new research suggests. A matched cohort study showed that a group of more than 5000 individuals in Denmark who voluntarily underwent 6 to 10 sessions of psychosocial counseling after deliberate self-harm had 27% fewer suicide attempts and 38% fewer deaths in the following year than those who received treatment as usual or no treatment at all.
Paper For Above instruction
Depression remains one of the most prevalent mental health issues affecting millions of individuals worldwide, ranking second only to headaches in common complaints. While often viewed solely as a chemical imbalance involving neurotransmitters like serotonin and dopamine, emerging perspectives suggest it is more accurately understood as a symptom rather than an isolated physical disorder. Addressing depression effectively requires a comprehensive understanding of its underlying causes, particularly emotional and psychological factors such as unexpressed anger, irrational beliefs, and unrealistic expectations.
The traditional medical approach tends to focus on pharmacological solutions—antidepressants that temporarily elevate neurotransmitter levels. However, numerous studies indicate that this approach treats only the surface of the problem, not the root causes. For example, a significant percentage of somatic symptoms in patients show no organic pathology, highlighting the importance of psychological contributors. As Kroenke and Mangelsdorff (1989) noted, depression often manifests as a symptom of deeper emotional conflicts rather than an independent disorder.
Dr. David Burns (1999) emphasized that depression results from irrational thoughts and beliefs about oneself, others, and the world. These include rigid “shoulds,” feelings of powerlessness, and unresolved anger—often directed inward because of societal or personal constraints. Freud’s insight over a century ago that “depression is anger turned inward” remains relevant today. Unexpressed anger—particularly toward oneself, situations perceived as unchangeable, or loved ones—can accumulate and fester, leading to depressive states (Brown, 2010).
Many individuals experience anger at themselves because they fail to meet internalized expectations or “shoulds,” such as being a perfectly loving parent, maintaining a certain weight, or behaving flawlessly. When these expectations are unmet, feelings of shame and guilt arise, which can spiral into depression. Conversely, feelings of powerlessness—trapped in relationships or jobs perceived as intolerable—further contribute to emotional distress. For instance, staying in a toxic marriage due to fear of loneliness or social judgment enhances the sense of helplessness and despair (Beck, 2011).
Another significant source of depression is grief and loss. When individuals face the death of loved ones, injuries, or bodily changes, they often suppress feelings of anger, believing that expressing such emotions is inappropriate or harmful. This suppression converts to internalized suffering, intensifying depressive symptoms. The cultural narrative that discourages anger in certain contexts exacerbates this tendency, reinforcing maladaptive emotional regulation (Kemper & Kuehner, 2013).
Effective treatment involves identifying and challenging irrational beliefs about anger, expectations, and self-concept. Cognitive-behavioral therapy (CBT) offers practical tools for examining and restructuring these thought patterns, promoting healthier emotional expression and reducing internalized怒e. Encouraging patients to articulate their feelings using “I” statements (“I feel angry because...”) instead of accusatory “You” statements helps deescalate conflicts and fosters genuine emotional release (Ellis, 2013).
Additionally, promoting acceptance of anger and frustration—without self-judgment—is central to healing. Patients should be supported in setting realistic expectations for themselves and others, and in recognizing which beliefs are irrational or unhelpful. For example, understanding that perfection is unattainable reduces the pressure that leads to guilt and depression. Similarly, resolving feelings of powerlessness involves exploring options for change, seeking outside support, and developing assertiveness skills (Prochaska & Norcross, 2018).
Keeping busy with meaningful activities, engaging in pleasurable hobbies, and expressing emotions appropriately are vital components of depression management. Active engagement prevents withdrawal, a common contributor to worsening depression. For instance, expressive activities like journaling, art, or physical exercise assist in processing emotions constructively (Seligman, 2012). It is crucial, however, to distinguish between avoidance and active emotional processing—activity should serve as a complement to, not a substitute for, verbal emotional expression.
Expressing anger healthily is pivotal. Using “I” messages facilitates internal acknowledgment of feelings and communicates them constructively without harming others. For example, saying “I am angry because I feel ignored” instead of “You never listen” fosters understanding and reduces defensiveness. Moreover, setting time limits—such as the fifteen-minute rule—to contain intense emotions supports healthy expression without prolongation (Linehan, 2015).
Recent research underscores the importance of talk therapy in reducing suicide risk among high-risk individuals