Why Some Get Depressed And Some Do Not

It gets pretty evident pretty fast, to any psychiatrist who deals with the general public, that depression is daily bread. I mean, with current estimates at 19 million patients per year coming down with a depression even with less than one half of them seeking treatment it is a pretty sure bet that depressed people are common. This in no way diminishes the anguish I have seen in patients having that disease. The anguish is real and dramatic. I remember one of my earlier newspaper columns written for the Wichita Eagle-Beacon the largest daily newspaper in Kansas asking this simple question: Why when someone broke their leg a salt-of-the-earth next-door neighbor would never fail to bake a pie. But when someone had a depression, nobody would bake anything. The depressed person was basically treated like someone with a contagious disease. Part of it could be that many depressed people tend to isolate. I mean, I cant really imagine someone calling their neighbor and saying Hey there, Ive been in the psych hospital for a while, down with a depression dont you know, but Im doing pretty good now. Part of it could be the stigma of mental illness. People are still struggling with insurance payments and coverage saying it is a real illness. This still confuses me a bit, because whatever you do or do not believe about chemical causes within the brain, the suffering is very, very real. So I asked a question Can you depression-proof a human? One of the very earliest articles I read as a psychiatry resident in the heartland was that about 70% of depressed people had an identifiable stressful incident that happened not terribly long before the depression started. This of course meant that 30% of all depressed people did not have such an incident. So why did they get depressed? I asked my learned preceptor, who told me that this was the very proof that depression was biological and not, like some analysts or others tended to think, situational. In other words, when your time came, the neurotransmitters clicked magically. He could not answer my question, which was Maybe the other 30% did have stressful experiences, too (I think most folks do in their lives) but did not respond to them by getting depressed. A corollary to this, at least to my way of thinking, is to ask can you make someone depressionproof? I am no stranger to this particular kind of thinking. I remember during the year of training when I was supposed to learn psychotherapy by supervision at the residents clinic, I had known that about 70% of psychiatric outpatients (a stable percentage then in any non-VA setting) would be female. What I did not know was that almost every single one would be depressed. And almost

every one of those depressed women was fearing divorce, going through a divorce, or had just divorced. I treated them with medications and psychotherapy and generally helped them, I believe. I also seriously wondered if divorce was anything I could ever survive as well as they did, or at all. Even without children, for I had already decided for sure that I would be childless by choice, it was too devastating to take marriage vows honestly and then break them open; I mean, the whole thing was sacred after all. I decided to create a way to divorce proof a marriage, and to use it on myself. I did, and came up with the book and seminar How to Locate and Marry your Lifetime Love, as well as a marriage that has been sheer delight, even when life has been tough for a bit, and has lasted nearly 23 years as of this writing. Thinking of the times my husband has pulled me through my own low points, I wondered if normal people (I always have trouble thinking of myself as normal) could have adjustment disorders that did not progress to depression. An adjustment disorder is about as benign and common a psychiatric diagnosis as I can imagine. It means something has hit you that is beyond current coping mechanisms. You get over it either when the thing goes away, or when you build new coping mechanisms. For me, the situation is clear and has repeated itself multiple times. I have decided, with encouragement and strength supplied by my husband, to take a fairly adventurous life compared to the security my parents preached to me growing up. Their comments and reactions were generally pretty horrible, but even though I have taken a couple of blows, I really love my life. As far as I can tell, I probably have an adjustment disorder every six months or so, but I really have never had a major depression. The answer to can you depression proof somebody does not seem to come from the (largely medication-based) psychiatric literature that I usually read, but from that vastly larger and more diverse literature of the psychologists, who are very good with things like questions and statistics. But the first thing I think of that would document resilience is not research but an anecdote. It comes from the writings of Robert Schuller. This recently retired founder of the Crystal Cathedral we have driven by plenty in southern California wrote lots of positive-thinking texts. They were so powerful that at the end of my years in France, while struggling to complete my thesis for the doctorate (yes the M.D. is a thesis degree in France)I took some of his books back with me for my final stint in that country. I gave my parents some to read, too, because they were both born pessimists, motivated in life, alas, mostly by fear (like many). According to Schuller, there was one a man who was by all accounts a drunk and not useful to society in any discernible way. He had two adult sons. One was apparently somewhat of a wastrel, like dad, while the other was a pillar-ofthe-community churchgoing type. When asked why he was the way he was, both allegedly answered with a father like mine, how could I have turned out any other way?

The concept is resilience. The person who seems to have stated the research on this seems to have been Dr. Emmy Wermer, a much awarded child psychologist who is down the road a piece from me at U.C. Davis. Her fame came after a 40 year study of nearly 700 children born on the Hawaiian island of Kauai. Plenty were high risk criminal parent, etc. you name it. The take-home finding is that about one-third of them became caring, competent, exemplary citizen type adults. The major factors in making them this way included community agencies that took an interest in their plight, and adult authority figures who could take up some of the slack left by poor parental models. Makes sense. These findings alone are intuitive, but the worth of having them scientifically proven is great. Although there are many definitions of resilience, the simplest one fits what I wanted to believe. It is simply the capacity to deal with a stressor without manifesting psychopathology. The central process in teaching someone to deal with death or chronic illness or abuse or violence is the development of what are called coping skills. These skills may be:

Problem focused solve the damned problem! Emotionally focused, as a human learns to control emotional responses to the situation. Socially focused, using a social group to build support.

Some people actually welcome stressful challenges as growth opportunities may even seek them out. Others are more worn down, sometimes even say things like enough, already I cant handle this anymore. Both types can be the same person. People change, sometimes quickly, sometimes over a lifetime. This means that this is not so much a character trait, something that is part of a personality allegedly formed early in the developmental process, something you might think of as graven in stone. It changes. As with everything, I do some reality checking on my own life. When I went to France I was naive enough that I knew everything would be different in ways I could not predict, so I rolled with the punches easily. Sometimes, when I feel thing are stable, it feels like a single stressor has blindsided me, like learning that someone whom I thought would be a worthy business partner has turned out to be a real jerk. I change. Sometimes I do come back from the punches a little slower than I would like. But I do come back, I think.

Resilience is generally regarded as a good thing, but the people who demonstrate resilience do not necessarily get to be famous or virtuous. I have seen plenty of street people with animal cunning (and criminal records) who seem to have this capacity of resilience, too. The crucial question then becomes: Can we teach this thing called resilience to people? If it can be lived as a learning experience when somebody deals with a stressor or challenge and then gets some kind of support and then supersedes the challenge, maybe it is possible to set up gradations of challenges, with support present and, well learn. Learning is a model I relate to and understand. They have structured lessons. For children, adolescents. Their effects have been studied. They help with anxiety and depression. There is hope, much more than I thought. I just dont know how to get people to teach this in schools.