I’m describing these two types of suffering together here because of the symptoms of excessive or muted sadness, denial, anger, guilt/shame, helplessness, hopelessness, apathy, low energy, low confidence, a sense of failure, and self-loathing that they often have in common.
Loss happens a million times every day, much of it insignificant and not rising to the threshold of our noticing or concern let alone grief. But big losses — of a loved one to death or breakup, of a job due to a layoff or a mistake, of physical or mental ability due to aging or illness or accident, or of self-confidence due to any of the above — are impossible to miss. Big losses make it hard to move about let alone function well in our typical everyday roles.
So we go to a friend or family member for a listening ear and a strong shoulder... That level of connection can assuage mild depression and grief. But if the depression is moderate to severe, the support system could at some point be overtaken by the relentless “intelligence” of self-loathing and despair. Deeply depressed or bereaved people are compelling in their reasoning as to how pervasively hopeless their situation is and will always be. They seem devoid of self-compassion and walled off from possibility, and after a while it’s understandable that devoted family and friends would lose heart, too.
A good therapist carefully and compassionately but confidently approaches that wall in treatment, knowing it’s not as solid as it feels to the client and looks to family and friends. The wall represents fear of and resistance to not just external opportunities for enrichment, but to the depressed person’s own rich and vivid inner experience. The healthy ups and downs (joy and sadness, hope and fear, clarity and confusion) of a non-depressed person's emotional experience are, to a very despondent person, unmanageable and pointless and therefore relegated to the generalized darkness of depression.
Therapy chips away at that wall over time with the client’s permission and at times effortful participation. Therapy persistently, respectfully, and directly yet gently invites whatever the client’s relegated experience to come forward and be experienced, expressed, and respected. Treatment for recurring depression takes some time because the ruts of the blahs and the blues are well established and some therapeutic bushwhacking must occur for the client’s experience of self and life to take on a new direction.