I have always believed that the name “depression” is unscientific.
“Depression” is a description of mood, a psychological term, and many people misinterpret it, thinking that depression is a mental illness. Including some patients, they would rather accept this judgment, not seek medical treatment, fantasize about changing their environment, making some adjustments, and thinking that the illness will go away.
Is there such luck? Yes. Depression is a self-limiting disease. When the condition progresses to a certain extent, sometimes the patient’s own life force can automatically stop the course of the disease.
Based on experience statistics, about one-third of patients do not seek treatment, spend a year or so, and gradually recover. However, this is very dangerous. Because this period of time is difficult to endure, the quality of life is low, the risk of suicide is high; and the so-called “recovery” is just a cessation of symptoms, like a sword of Damocles hanging over their heads, not knowing when it will fall.
Today, modern science has proven that depression is not just a psychological illness, but also a functional disease.
In early human history, the ancient Greeks believed that depression was caused by an imbalance of the four bodily humors – blood, phlegm, yellow bile, and black bile. This theory is of course unscientific, but it associates depression with physiological factors, which was a genius conjecture.
Today, researchers have collected and dissected brain specimens from some depression-related suicide victims and viewed under a microscope, they saw that the concentrations of three neurotransmitters (5-HT, norepinephrine, and dopamine) in the brain were lower than normal.
This established a research direction: to find the corresponding relationship between depression and these three neurotransmitter concentrations.
First, let me introduce what neurotransmitters are: as we know, the human brain has hundreds of millions of brain cells, called neurons; between two brain cells, there is a gap; when the brain transmits information, the nerve endings of the first brain cell release a chemical substance whose mission is to carry information across the gap, like a messenger delivering the information. This chemical substance is called a neurotransmitter.
The brain has many neurotransmitters, the most important of which are the three mentioned above: 5-HT, norepinephrine, and dopamine. These three neurotransmitters have slightly different functions:
5-HT: it governs emotions, desires, and willpower
Norepinephrine: provides vital energy
Dopamine: transmits pleasure
If these three neurotransmitters are imbalanced, the signals received by neurons will weaken or change, and the body will exhibit symptoms such as insomnia, anxiety, compulsion, depression, fear, which manifest as depression, bipolar disorder, schizophrenia, and other brain diseases.
Antidepressant drugs are developed based on the theory mentioned above, targeting these three neurotransmitters. For example, the most common SSRIs series now, full name “Selective Serotonin Reuptake Inhibitor,” its function is to specifically inhibit the brain’s reuptake of 5-HT, thereby maintaining a balance in blood 5-HT concentrations.
The first discovery of the antidepressant drug isoniazid was purely accidental. At that time, isoniazid was a drug for treating tuberculosis. In drug experiments, it was accidentally found that tuberculosis patients would have a cheerful mood after taking isoniazid.
Following this path, the first generation of antidepressant drugs was developed.
Now, antidepressant drugs have evolved to the third and fourth generations. The effectiveness of these antidepressant drugs fully proves the precise correspondence between depression and these three neurotransmitter concentrations.
In recent years, China has also made some progress in the pathological research of depression. Experts such as Dr. Gong Qiyong, Director of Radiology at Huaxi Hospital of Sichuan University, Dr. Jia Zhiyun, and Professor Kuang Weihong at the Mental Health Center use advanced imaging medical technology to study the characteristic abnormalities of brain regions such as the frontal lobe and edge systems, as well as damage to neural pathways, which may be related to suicidal behavior in depression patients.
They also recruited 16 suicide attempt patients and 36 depressive patients without suicidal behavior, and studied the volume of gray and white matter in their brains and the integrity of white matter fibers. By comparing brain images, they found that in these suicide attempt patients, the left anterior limb of the internal capsule in the brain showed significantly decreased anisotropic values, suggesting white matter damage leading to damage to the frontal lobe striatum pathway.
However, this is still just a description of the phenomenon. The correlation does exist, but why it exists is not yet clear.
The mechanism of depression is very complex, and at present, there are only some hypotheses. These hypotheses have some research results to support them, but sometimes these hypotheses contradict each other, and even deny each other.
It is now believed that depression is a group of heterogeneous diseases with different etiologies and mechanisms of onset, rather than a single disease. They each have their own causes and mechanisms, and cannot be explained by a single etiology and mechanism.
Therefore, the conclusion is clear: depression is not just a simple psychological disorder, but also a group of functional disorders.
Initially, the damage to the brain may not be observed, but if the disease progresses for too long and causes the hippocampus to shrink, then the functional disorder can become an irreversible organic lesion.
At this point, it’s too late for treatment.
Like many others, I used to think without much thought that depression was due to the patient’s lack of willpower. Now I understand that those who have not experienced the illness may never be able to understand the inner feelings of defeat, loneliness, and desolation experienced by the patients.
As the brain experiences functional or organic changes, individuals face uncontrollable mental disorders and suffering; bystanders from a moral high ground may exhibit a sense of sympathy, encouragement, or blame with a hint of superiority towards those with depression, but this approach is neither scientific nor fair.
Unlike many other physical ailments, depression is not easily self-noticeable. Some diseases, such as the common cold, exhibit visible symptoms like fever and runny nose due to external pathogens, whereas physical wounds can swell and become inflamed as warning signals. In contrast, brain disorders develop silently, and patients may only realize something is wrong when emotions drastically drop and cognition veers off course. Often, individuals perceive these symptoms as mere psychological issues.
It’s clear by now why I find the name “depression” unscientific. Perhaps it should be termed as “brain functional disorder.” However, since conventions have been established, changing the name may not be necessary. Nevertheless, we must not be misled by this name and equate depression solely with psychological problems, thereby missing the optimal time for medical intervention.
Depression is one of the most devastating illnesses that can undermine human willpower, bringing about two consequences:
Firstly, it significantly reduces the quality of life, to the extent that patients might prefer death;
Secondly, it can lead to actual suicide.
How can we fulfill our duty to take care of those with depression?
In my experience: accompany them, rather than preach to them.
Many believe that depression is a psychological issue and that patients need to be “opened up.” However, fundamentally, depression is more organic in nature. In moderate to severe stages of depression, advising someone to “cheer up” and “not to die” is ineffective.
What’s crucial is to provide companionship, not deliver grand moral lectures, as the world is not short of such advice;
Lets patients know that someone is there for them when needed;
Allow them to be quietly at peace when they want to be. Do not disturb them with incessant chatter and unwanted suggestions.
I recall during my illness, my colleagues tried numerous methods to help me. Jieqi forcefully brought me salmon; Zhang Xiang coaxed me to go on a trip to Qingdao; Xu Xiao forced me to see a psychologist; Jiwei attempted to take me to a literary gathering (unsuccessful);
Shuli arranged for me to write some articles to regain confidence, and even planned for me to live on a farm in Shunyi, like the later years of Tolstoy participating in agricultural labor. The thought was touching, but none of these efforts were actually effective.
Once, I visited a psychologist who talked incessantly for a whole hour. As I saw her become more enthusiastic, fluent, and bright-eyed, I thought to myself: who is treating whom here?
There was a former subordinate who came to see me, and as soon as we met, she forcefully took me out for a walk. At that time, I could hardly walk steadily; she affectionately told me many things along the way.
Midway through our walk, she suddenly stopped, looked at me blankly for a few seconds, and as if she had just awoken from a dream, said: “Hey, why am I telling you all this? Weren’t these things what you taught us before?”
Here I conclude with a purely technical issue:
Try to arrange a room filled with abundant sunlight and bright colors for the patient.
Experiences have shown that in severe cases of depression, a patient’s vision may change, perceiving everything as gray. Bright, vibrant rooms are conducive to improving mood.
I once believed that my perception of colors was subjective to myself, but just a few days ago, a father of a young depression patient who came seeking help revealed my feelings were not unique.
This father recounted that his son had been suffering from depression for four years with no improvement through medication. In a last resort to save his life, he had to coerce his son into hospitalization for electroconvulsive therapy. On the day scheduled for the therapy, he arrived at the ward early in the morning to find his son already out of bed, sitting by the bedside, with a calm expression and clear gaze.
Surprised, he asked, “How come you are better?”
The son pointed to a pot of flowers in the ward and said:
“Yesterday I saw this flower as gray, today it looks red.”
Depression is a necessary threshold for human growth; the ability to ensnare oneself leads to the potential of breaking free as a butterfly.
An unexamined life is not worth living. – Socrates
Symptoms are merely a way for an individual to shield themselves from internal and external pain. – Freud
Before a seed breaks ground, please wait patiently. – Carl Jung
Every person who truly wants to understand themselves must pay a corresponding price.
Summary:
**1. Symptoms are not important.** Symptoms are just a way for individuals to shield themselves from internal and external pain. Psychological counseling should focus on the reasons behind the symptoms rather than labeling individuals with depression or anxiety.
**2. Depression is not scary.** Depression should not be feared or stigmatized; it is a form of psychological distress that can offer opportunities for growth and self-discovery.
**3. The process of depression: Phase One – Self-Reflection and Self-Imprisonment.** Depression is a form of introspective thought, a state of consciousness accompanied by pain. It is a way for individuals to contemplate life’s meaning and question their existence.
**4. The process of depression: Phase Two – Contemplation in Darkness (Nurturing the Chrysalis).** Depression often leads individuals to deepen their thinking, reflect on their internal struggles, and search for meaning amidst despair.
**5. The process of depression: Phase Three – Breaking the Chrysalis and Emerging as a Butterfly.** Individuals trapped in depression undergo a process of suffering, introspection, and growth, ultimately leading to a rebirth and renewal of spirit.
**6. Enduring hardships to achieve greatness.** Like gold refined through fire, individuals can transform their suffering into growth and resilience. The journey through depression offers the opportunity for profound self-discovery and inner transformation.
