What Are The 9 Causes of Depression?
Should I Say Mental Illness or Emotional Illness?
George Brown had a “rumbling” infection during WW2 at a time when there were no antibiotics.
He was a teenager living in a slum area of London.
A kind and caring female neighbor nursed him, and due to her ministrations, he survived.
In the days immediately after the war ended his neighbor walked to the Grand Canal and committed suicide.
George never forgot her.
He remembers the shame involved surrounding discussions of depression at the time.
In the early 1970s after spending years thinking about the causes of depression and finding science divided between the ideas of a “chemical imbalance” in the brain (endogenous depression) and “a traumatic life event” (reactive depression) without much empirical data to back either side up, he decided to conduct an experiment himself to see what argument the data supported.
I recently read the results of his experiments and as someone who has been diagnosed with major depression and treated (successfully and unsuccessfully at times) with different types of medication, I was interested in the results.
Reading about the results of his experiments changed the way I started to view my depression and its treatment.
The Experiment
He and his team interviewed a body of two groups of women in London.
These two groups were then compared to see what the differences between them were.
One hundred fourteen of the women were sourced from local psychiatric services and had been diagnosed with depression by a psychiatrist. In-depth interviews were conducted with each of the women.
One of the main focal points of interest was asking the women what significant things (severe loss or adverse event) had happened in the year before them becoming depressed.
Another group of 344 women who weren’t diagnosed with depression was chosen from the same income group and similar suburb. They were asked the same questions as the first group, including asking them if anything significant (negative) had occurred in the previous year.
If it was just random bad luck, that a chemical imbalance happened in your brain, there should be no critical differences between the two groups.
The team gathered up an enormous amount of data from interviewing the women.
Difficulties
They also collected data on what they labeled as “difficulties.” These were chronic situations such as living in a lousy marriage or living in inadequate housing.
Stabilizing Factors
Data also was compiled about positive factors in women’s lives (stabilizers) such as the number of close friends someone had, whether they had a good marriage or a supportive family.
Results of Data Analysis
20% of women who DIDN’T get depression had a significant adverse event in the previous year occur in their lives.
68% of women who DID get diagnosed with depression had a significant adverse event occur during the last year.
A difference of 48% between the two groups was significant.
So, experiencing something very stressful in your life could trigger depression.
BUT, there were other striking differences.
The women who experienced longterm chronic difficulties in their lives were three times more likely to be diagnosed with depression when a significant adverse event occurred in the previous year than women who did not experience chronic stressors.
So, it was not just one adverse event that could trigger depression. It was much more likely to develop in someone who also had to contend with chronic stress situations over a long period before this acute adverse event took place.
And the surprising result was that the more positive stabilizing factors women had in their lives (even if they had chronic longterm stress and acute adverse events) the less likely they were being diagnosed with depression. It reduced their risk.
So each extra “stabilizing factor” a woman had in her life, such as a supportive friend or neighbor, close family members, or a supportive husband or partner — these all reduced the likelihood of being diagnosed with depression.
What George Brown found unexpected was the cumulative effects if a woman had chronic longterm stressful situations to deal with, plus no friends or support networks, and then an acutely difficult and negative situation arose to deal with — these women were 75% more likely to be diagnosed with depression.
Each bad thing that happened, each lack of a supportive factor, all accumulated to increase the chance and risk of depression occurring.
Geroge Brown started to suspect that depression was less likely just a chance of something chemical going wrong in your brain but rather was the result of something having gone majorly wrong in your life, in the majority of cases.
The way the conclusion of their study was worded was interesting (published in 1978).
He said that rather than being an irrational response of the brain, depression was an understandable response to adversity.
Longterm stressors over a lifetime wore people down and produced a “generalization of hopelessness.”
Depression was caused by life going wrong.
Today it is well recognized that depression is often a combination of biological, psychological and social factors. All three of these factors are relevant and unique in their combination for why each person who is depressed is diagnosed.
In the years since 1978, there has been much research on the origins of depression.
Disconnection
In the research I have looked at compiled by Johann Hari, there appears to be a commonality amongst all of the causes postulated for depression.
They all relate to disconnection. A disconnection from significant things in a person’s life.
9 factors causing depression (7 are psychosocial, and 2 are biological)
Psychological reasons and upsets give rise to the physical symptoms of depression.
- Disconnection from work that gives meaning and purpose (little control or autonomy in your work).
- Disconnection from people (feeling profoundly lonely). Not sharing any meaningful experience with any other people.
- Disconnection from meaningful values. Focusing on materialism, and doing things purely for extrinsic rewards instead of intrinsic reward.
- Disconnection caused by childhood trauma. For every traumatic experience, you go through as a child it significantly increases the likelihood of a later diagnosis of depression.
- Disconnection from respect. Modern life cultivates the view that status, celebrity and wealth are what denote success and anxiety over the loss of financial security and status often are underlying constant stress in people.
- Disconnection from the natural world. Faced with the vista of the natural world we feel ‘small’ not ‘big’, and we feel like we are part of something much bigger than ourselves. Animals in captivity rock, lose interest in sex (why they are so hard to breed in captivity) and show other compulsive and depressive behaviors they don’t exhibit in the wild. We are animals. We need to be outdoors. Rates of depression when exercising in the natural world, and spending time outdoors all reduce in comparison to time spent outside. We often feel ‘more alive’ when outdoors in nature. Grounded.
- Disconnection from loss of hope for a better future.
- The role of genes and biology in depression. Neuroplasticity means the brain is continually growing and changing and does not stay the same. This means the concept of a ‘broken’ brain that cannot be fixed is not supported by current scientific evidence. However, distress from the external world and brain changes occur together which lead to depression. Johann Hari in his book “Lost Connections” on page 146, says that these changes in the brain can then “acquire a momentum of their own that deepens the effects from the outside world.”
Scientists have discovered that for depression there is a 37% genetic inheritance, BUT for those who carry the gene and are born with it — the inherited gene HAS to be activated by your environment.
It is WHAT happens to you in life that determines if that gene for depression is switched on or not.
Biological factors can influence depression as it has been proven that suffering either glandular fever or underactive thyroid can significantly increase the rates of depression in people who are vulnerable.
Some forms of bipolar are seen by some (not all) scientists as having a greater biological component, but psychosocial factors are still seen as influencing and affecting all forms of depression.
When I studied psychology at university, I learned about the bio-psycho-social model about mental health. However, when I went to the doctors with acute symptoms, not one doctor has ever asked me:
“What happened to you?”
What has happened in your life?
What happened in your childhood?
What happened to you in the last year that has been a major trigger?
What support systems do you have in your life?
Do you have friends?
Do you have a family? Do you have a supportive family?
How is your marriage?
How are your children? What is happening to them?
How is your job? Are you fulfilled at work?
Not one.
A psychiatrist that I was referred to 20 years ago when I had attempted suicide asked me all these questions over the period I saw her. I do not think I would be alive today if it were not for her superb care and attention to help me create new meaning rebuilding my life.
But the doctor gave me a prescription for some pills, and I was out the door in 10 minutes. I was given a chemical solution.
None of them ever fully worked. I increased the dosages to the maximum each time.
I stayed on the medication for over five years the first time.
- I lost my sex drive.
- I put on weight.
- I felt flat and numb.
But I felt I could not exist without the medication. At least I was alive. That is how I felt.
It felt like my emotional pain increased too much when I tried to come off the tablets.
I went back on medication nearly a year ago. This new antidepressant does not affect libido and is meant to have no side effects when you come off it (no withdrawal symptoms). I tried to go off it a few months ago and started to get panic attacks and so started it again.
I then started to see a therapist who does body somatic therapy based on the work of Dr. Peter Levine on healing people from complex PTSD.
I can feel huge changes within my body and my ways of thinking since I have been exploring this healing modality on a regular basis.
I was told by my doctor to stay on the antidepressant for a minimum of one year before I tried to come off it. So I am going to do that.
What do I make of all this research as put together and researched by Johann Hari?
It all makes complete sense to me.
The combination of all these factors causing depression (the cumulative effects of chronic trauma and long-term stressors in life combined with acute stressors and loss of social supports) all make sense to me.
Maybe my accumulated life stress and the changes in my mind will require some biological chemical support for a while longer, or maybe for the rest of my life? I will not know.
I am not opposed to medication.
But, I can see the need to increase and improve my support factors — nurture my relationships and connections, continue in meaningful work, increase my connection with and time spent in the natural world and make sure I have things to look forward to in the future.
I can see that these are all significant factors and healthy ways that I can put in place to help me reduce the reoccurrence of any acute symptoms of depression (whether I am on medication or not).
“It is no measure of health to be well-adjusted to a sick society.” ~ Jiddu Krishnamurti
I feel greater hope that I can manage and stay on top of the symptoms of my depression.
