Examination of Depression and Treatment Assessment

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Depression is an often-devastating symptom and illness in people. It affects millions of people worldwide and can last anywhere from week to months to years. People often have issues with depression and seek treatment. When they do, they do not adhere to treatment protocols and may regress back into depressive episodes. There are also situations and history that may attribute to the feelings of depression such family history, tragic events, job loss, or other high-stress events that bring an abrupt and uncomfortable change in a person's life. All these things will be discussed through a theoretical lens as well as introducing populations that may become more affected by depression than others are.

Many consider depression the "common cold" of mental illness. Depression is so common that the majority of the human population will know or be related to someone that suffered from depression. However, even though depression is commonplace, most people are confused over what depression is and how it affects people. People may confuse depression for acute episodes of sadness and do understand the kinds of depression out there. There are several different types of depression from biological depression, to seasonal affective disorder (that only happens when there is absence of natural light). However, certain things are always experienced when a person has depression.

Some of the common symptoms are a persistent anxious, sad, or "empty" mood, feelings of pessimism or hopelessness. A depressed person may also feel worthless, helpless and guilty. The things a depressed person found pleasure in or took interest in no longer satisfies him or her. They may also experience oversleeping, insomnia, or early-morning awakening.

People that are depressed, especially long-term may overeat and thus experience weight gain, may eat less and experience weight loss. Numerous others will experience a decrease in energy and fatigue with a constant feeling of being in slow motion. Those with severe depression will also contemplate suicide. A person gender may also affect how a person experiences depression. Males for example, more often than females, feel restless and irritable and may be diagnosed with ADHD.

There are a myriad of problems (both mental and physical) stemming from depression. Some of the mental symptoms were covered but some of the physical can be digestive disorders, headaches, and chronic pain. They may be signs of depressive illness, a physical manifestation of depression. What regularly differentiates occasional bouts of sadness from depression is the level of severity of the symptoms aforementioned and the length of time a person experiences them. When depression begins affecting daily life and a person's work ethic, that is when depression becomes unmanageable and professional help is needed.

There are several theories that may help one understand what depression is and how it manages to seep into a person's daily life and affect them so intensely. It can range from negative coping mechanisms to tragic life events, to a mixture of the two, and even genetics. Some people for example, have brains that naturally produce an imbalance of essential chemicals in the brain like serotonin or dopamine that produce symptoms like depression. The important thing is to be treated and work hard to fix what causes the depression, which comes from becoming aware of being depressed and things that may have led to the depression.

Depression is a serious and severe disorder. However, most people cannot tell when someone is depressed or if they are depressed themselves. It can creep without anyone knowing. Depression can be gradual and often strikes in adulthood versus teenage years where frequent mood swings are normal during that age. Men, who frequently display their depression in external ways, may not be diagnosed as much as women leading to many cases of depression going unnoticed. This paper is meant to show the effects of depression, what may cause depression and differences in gender, race, sexuality, and income that may bring about depression earlier and more severe than in others.

Objects and relations theory as well as behavioral and cognitive theories will provide the backdrop to study depression, how it may form within the life of a person. Theorists like Fairbairn, Winnicott, and Bowlby will be highlighted to show how the theory of depression as changed and expanded throughout the years. Depression will also be examined from a neurobiological perspective and a treatment section will show what current research suggests to be effective treatment against depression.

Theoretical Perspectives

Winnicott

The first theoretical perspective that will be examined comes from Winnicott and his view on creative and depression.

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To begin, Winnicott was a student of Klein. Klein supervised him as he expanded his knowledge on mental illness. Throughout his studies, he retained belief within two positions: the depression position, which slightly differed from Klein's, and the paranoid-schizoid position. How Winnicott's position differed from Klein's was in his preferences towards a less pathological term. As a manner in which to normalize depression in relation to regular concern and sadness. He began expressing his viewpoint within his famous saying "there is no thing as a baby" (Winnicott, 1952, p. 99). This saying refers to the mother-baby dyad as an entity. The relationship served Winnicott as a basis for a diagnostic template from which a patient's early disruption could be discovered.

Winnicott sought to understand the origins of a feeling in terms of how a person connects to him or herself and to others as well as the person's relations to objects and what a person does to retreat for relaxation. He contends that an infant locates a path separate from absolute dependency on the mother figure to relative dependency through the passion of three stages. These three stages are:

1. absolute dependency

2. personalization

3. primitive object relating

Absolute dependency means the infant has no control over the environment and itself. The baby experiences unusual moments of self-awareness linked to emotions of great intensity like excitement of feeding or rage. During these moments, the mother must hold the infant empathically, giving the infant support of her own self, allowing the baby to feel its own ego is connected. During this process, infants develop trust within the maternal environment. Sleep then becomes a pleasurable return to a version of un-integrated self.

To have the ability to exist peacefully within the environment leads into the capability to be truly alone. The baby establishes an internal mirroring or a kind of internal environment from the mother's ability to care for it within the stage of absolute dependence. If there is any failure during this stage, it may lead to paranoid stages. In an ideal environment, the infant gradually develops a true self. Although some may see Winnicott's "true self" as a conceptual ideal, it does provide some incentive for exploration into the idea that the negative attitudes and coping mechanisms a depressed individual has later on in life can stem from failure of support during his or her infant years and that stage of absolute dependency.

The second stage, a scenario where the mother is "adapted," managing her own as wwell as her baby's body allows formation of a unit. In addition, the psyche becomes in-dwelling within the soma. Manifestations of this arise in satisfactory muscle development and good body co-ordination. Essentially, during this state, the infant develops a sense of its own physical truth. The infant knows what is outside, what is inside.

The third and final stage, primitive object relating is where Winnicott believed the ego capable of affecting its environment. It begins when an infant feels pleased in creating a satisfying object. The infant feels in a way, its creator of a world and projects a healthy and necessary omnipotence. From there, fantasy and reality correspond for the baby.

When the infant experiences failure in this stage, it is generally because the mother puts her own needs first. Such inadequacies lead to formation of a "false self" that becomes a caretaker for the infant's true self. Therapy aimed at fixing this kind of error attempts to unlock the repression experienced during this stage.

Some individuals who have experienced many failures in childhood develop a false self to conceal the failure true self. This repression is unlocked in therapy when an opportunity is given to the patient to become angry at the therapist's errors. As a result, stored anger is released; and the patient becomes able to reality test (Winnicott, 1956, p. 386).

Winnicott explains the false-self comes from the result of the infant's need to conform to outside expectations and demands rather than responding to spontaneous, natural needs of its real self.

When an infant complies in meeting mother's needs while not having his/her own gestures affirmed and mirrored, the breakdown of the suitable environment occurs and results in development for the infant of a false set of relationships. Meaning if a person continues to attempt to cope with the world without help, it will lead to amplified feelings of emptiness, boredom, despair and isolation, culminating in suicide.

A certain level of assertion and independence is needed.....

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