Revisiting Depression: Part One (the Science)
Hallo, you fantastic beauties. I haven’t written for myself—or for you—in a long while. But here we are! Together again! Now, ahead of National Condom Month, I want to talk about depression. I’ll wait while you investigate whether that’s an actual thing. The condom part, I mean, not depression.
All joking aside, I’ve been wanting to talk about depression again for a while. The problem lies in how to address something so large and weighted with so many layers. I want to talk about depression in terms of self-worth and social implications, but to get there I feel like we need to walk through the various psychosomatic effects of depression, and to get there we need to touch on the relationship between depression, anxiety, and anger …
Well, fuck, let’s give it a try! What say you, Dave? Dave? Dave, why are you cowering in the corner?! Sorry, guys, I think Dave is going to sit this one out. Let’s dive in, shall we? And, don’t worry, darlings, this will be a two-parter.
The Fanning of the Flame
(or if you’re southern: Adding a Little Lighter Fluid)
If you pop back over to my series on Mood and Anxiety Disorders, you’ll notice that depression and anxiety often go together … But anger? I’ve only recently thought about the relationship between anger and depression, but according to Fredric N. Busch’s article, Anger and Depression, “The oversimplified concept of depression as ‘anger directed inwards’ was a commonly held belief over many years in psychiatry.” Though today anger is more often considered a symptom of depression, there is little denying some type of correlation. Busch goes on to discuss defense mechanisms as applied to the anger-depression relationship. These mechanisms include denial, projection, passive aggression, reaction formation, and identification. Since denial, projection, and (everyone’s favorite) passive aggression are pretty familiar terms, I want to cover the other two in more detail:
- Reaction formation (as presented by Busch citing Freud): The individual denies their anger and instead increases their efforts to help others. Since the underlying issues causing anger aren’t addressed, feelings of rage intensify and can become directed inward, exacerbating depression.
- Identification: The individual links their self-image with someone who is aggressive and has made that person or others feel disempowered, frequently triggering guilty feelings which can exacerbate depression. This mechanism can help the individual with assertiveness, coping with anger, and creating boundaries but also has a lot to do with the idea of perceived power and can lead to abusive and controlling behavior.
While these psychoanalytic mechanisms are dated, more recent studies have also shown a correlation between depression and anger, whether that anger is outwardly expressed or not. According to Depression is More Than Just Sadness: A Case of Excessive Anger and Its Management in Depression: “Previous studies have revealed that patients with anger attacks are significantly more depressed, anxious, and have ideas of hopelessness compared to patients without anger attacks, and they were more likely to meet criteria for [histrionic, narcissistic, borderline, and antisocial] personality disorders in comparison to depressed patients without anger attacks.” The relationship between depression and anger causes a sort of feedback loop wherein anger can lead to depression and depression to anger. And, ultimately—obviously—the Dark Side.
Depression: It’s a Pain in the Ass
Fun fact: not only can depression itself be debilitating, it can also lead to major chronic health issues and be a hindrance to rehabilitation and healing. Okay, okay, so it was a not-so-fun fact. According to Depression and Other Common Mental Disorders: Global Health Estimates released by the World Health Organization (WHO) in 2017: “The consequences of [depression and anxiety] disorders in terms of lost health are huge. Depression is ranked by WHO as the single largest contributor to global disability (7.5% of all years lived with disability in 2015); anxiety disorders are ranked 6th (3.4%). Depression is also the major contributor to suicide deaths, which number close to 800,000 per year.” Spoiler alert, the situation hasn’t gotten any better.
Depression can play a role in immune, cardiovascular, and gastrointestinal health—among others. According to Depression as a Risk Factor of Organic Diseases: An International Integrative Review, “Depression often predisposes individuals to physical illness and disease.” The review assesses findings from 23 studies that consider depression in relation to various physical illnesses, including cardiovascular disease, metabolic syndrome, diabetes, Alzheimer’s, anxiety, and asthma. While the review “offers evidence that depression can be a risk factor for physical illness and disease,” even more intriguing is the study of depression-related pain.
Some studies on depression and somatic pain have shown a correlation between the two, although causation proves difficult to identify. In some cases, individuals suffering from depression may experience such issues as low back pain, jaw pain, and acid reflux. While causation is unclear (it’s kind of a “chicken or egg” situation), the Depression as a Risk Factor review states that there is “a strong association […] shown between severe depression and somatization, and the somatic effects of depression were unrelated to organic disease (Aguilar‐Navarro & Avila‐Funes, 2007; Drayer et al. 2005).” If I’m citing something citing something, is that reverse inception? Anyway, the review goes on to say that “depression and pain are independent processes that share a common mechanism that can lead to the onset of each other.” Furthermore, individuals suffering from depression tend to experience a decrease in pain tolerance and increase in origin-less pains.
Next Week’s Titillating Adventure
Now that we’ve covered the relationship between anger and depression and the psychosomatic effects caused by the unholy trinity (just assume anxiety is a habitual lurker), we can dive into the human side next week. While I opted to interview individuals suffering from depression and anxiety for the last series, this time, I want to get into the meat of how depression (and all its accoutrements) can affect an individual’s self-worth and how that might look to the individual’s family, friends, and society in general.