All too often I have patients saying to me, “but Dr. Nelson, nothing bad has happened to me so I shouldn’t be depressed.” I have to explain to them that depression does not require a precipitating event. When people think about depression, they often confuse it with Post Traumatic Stress Disorder (PTSD) which can have overlapping symptoms with depression, but PTSD does require an exposure to a traumatic event. PTSD involves various symptoms and depression-like symptoms can be included. Another thing to remember is not everyone who experiences a traumatic event will end up having PTSD.
So, although depression does not require a precipitating traumatic event, it can be present. There does not need to be one defining event or series of events that leads to depression and a trauma is not required. With that being said, the next thing I often find myself saying to patients is, “of course you have had bad things happen to you because (1) you are human and (2) given the information you have provided me, I see that you have been through a handful of difficult experiences” (I may even give specific examples here).
An important fact I stress to my patients is that all humans experience pain, suffering, loss and various other difficulties in life. This is the human condition. Most people also experience many moments of joy, love, companionship and triumphs. These various experiences all impact people in different ways. Some may experience more sorrow than others, some may have a stronger support system than others and most people have never been taught ways to understand and cope with difficult emotions and painful events. So, it becomes quite difficult and often uninformative or helpful to determine single factors that “caused” the depression. Instead, it is useful to acknowledge that life is not easy for anyone, it is okay to be struggling and it is okay to be experiencing depression without any horrible life event taking place. It is also necessary to note that depression can have a biological factor as well and it may be helpful to explore that in therapy or with a medical doctor/psychiatrist.
“Okay fine, my life hasn’t been perfect but like you said, everyone has problems and not everyone is depressed like me.” This is a typical next response in my sessions.
We could get into a lot of things here about how individual people have different support from others, different temperaments, different biological factors and contextual factors, and so much more. Sometimes, I will go down this road with patients and it doesn’t take long to see that it would be impossible to explore each of these differences. The more important thing to discuss is how to give yourself some empathy! Having depression is not a weakness and struggling with your mental health is something I would argue all people experience at different points in life. Some may never step into a therapy office, but I commend those that do. You don’t need a “reason” to want or need to talk with someone. You don’t need a “reason” to be depressed. You don’t need a “reason” to seek support and tools to use in your day-to-day life. All you need is the ability to embrace your humanity and remind yourself that what you are feeling is real, it is okay and you deserve support. Let go of the search for reasons.
Next time you are asked, “What brings you to therapy today?” It can be as simple as, “I am human. I am hurting. I need and deserve support.”
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