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Depression is one of the major causes of human suffering. Studies on the general population suggest significant environmental circumstances and the nature of one’s close relationships affects the risk of depression. For Persian-Americans the risk factors are social and economic factors, stress of political unrest and severe economic situation in our home country Iran, being away from close family members, and cultural and financial issues relating to immigration. However, no other factor is as important as the nature of close relationships. A close relationship can help someone when it is working well and also hinder their abilities, when it is not working, to cope effectively with the ups and down of life. Here I focus on the importance of relationships, particularly couple and family relationships. I will briefly point to the role of medication in treatment of depression, and at the end I will introduce a recent book about overcoming, and even preventing, depression.
The Nature of Relationships and its Effects on Depression
Studies on depression present that many factors, including biological, psychological, and social contribute to depression. The biological aspect of depression and, as a result, the use of medication, has been presented and discussed most in the related literature and in the media. The social aspects of depression have received less attention than it deserves, as it is required for a comprehensive understanding of all factors involved in cause and treatment of depression.
Imagine an unhappy relationship where people have little trust in each other, and there is no accountability. The communication is predominately negative. Both sides feel disconnected, and tend to become more distressed by fear and insecurity. All of you can make a long list of problems and things that do not work in such a relationship. The studies repeatedly have shown that the unhappy relationship is one of the major contributors to major depression. One depressed member of the family affects everyone in the family and spreads the depressed mood over to the other family members.
Awhile ago I had a call from a middle-age woman. She liked what my ad in PAYAM said and at the same time, made a comment on the statement in my ad that said, “Take the chance in life and make the most of it.” She asked how one can live a happy life when there are people who just make one’s life miserable and take all hope away. During a short conversation I tried to communicate that there is always hope and help to make your life better and the fact she was an active participant in her own life and potentially she could make her life better. But she was so deep in her own negative and destructive thoughts, as if her life was all misery, that she did not believe that anything could be helpful. Now imagine how her depressed attitude can affect her family members, children, partner and even friends. Family members, who live in the same household, trying to help with no result, feel sad, depressed, and guilty and in turn they themselves are at risk developing a major depression.
Now let’s look at what the tenets of a good relationship are; the ones that foster health and growth. In a satisfying couple relationship both feel safe and secure with each other. They trust each other in which each in the relationship accepts and respects the other’s uniqueness with all her or his strength and weaknesses. Both are accessible and responsive to each other’s needs and have a healthy interdependence relationship. When depression occurs, a supportive relationship is a positive factor in its treatment of depression, and a strained, dissatisfied relationship potentially can be a cause and/or an addition to the pain of depression.
Medication
I support the use of medication. I believe it can be beneficial. I myself refer my clients to be evaluated for medication to help with their depression, but I would like my clients to be informed consumers of medication. I want them to be aware of effects and limitations of medication. It is clear that taking medication does not change your partner, does not make your relationship better, does not make your boss nicer, and does not change your habits of many years. Until you learn skills how to cope with the social and environmental contributors to your unhappiness effectively and grow personally and socially through the experience to become stronger, the causes of unhappiness still remain. I would like to make it clear that there are times that medication is certainly called for, but it should not be the only approach to treatment of depression.
The book I would like to introduce to you, which I also recommend to all my clients, is "Depression Is Contagious" by Michael D. Yapko, 2009, Free Press, New York, NY. The main message in this book is that people can spread depression. What people do to each other can become the source of hurt and can result in an enduring way of thinking, feeling and relating to others. Here are two quotes from the book:
“New research makes it clear that depression is not just about suffering of one individual, as if he or she lives in total isolation. Rather, depression occurs in a social context; it occurs within people, and also arises from the hurts that take place in relationship between people.”
“Relationships can spread depression as surely as germs can spread illness.”
The testament to this reality is the fact that a number of my clients and so many of people who call me for help are those who are living with a loved one who is suffering from depression. They are asking for help because they are suffering too.
I wish you more use of your skills and abilities to live well. Until the next issue, all the best!
Dr. Khazrai is a licensed Marriage & Family Therapist with more than 25 years of experience in individual, couple and family psychotherapy, practicing in Newport Beach.
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