07 June 2007

Exogenous vs. Endogenous Depression

The idea that we freely choose our immediate responses in every circumstance isn't always valid. Some things that happen to people - not only in times of civil unrest, but in everyday homes and offices - are, simply, awful, and to respond to them instantly with joy or thanks, or even equanimity[!] would be, simply, insane.

One's situation CAN depress or kill.

Exogenous Depression [or PTSD] is a normal response to abnormal circumstances.

Exogenous Depression [or PTSD] may be the only sane response to an insane situation.

Exogenous Depression [or PTSD] is nothing to be ashamed of. It is something to understand, and to heal from.

It's important to know the difference between exogenous depression, arising from circumstances, and endogenous depression, arising, at least in part, independently of circumstances.

If you are depressed, and it is mostly exogenous, understanding your history will help you to recover - and to reprogram yourself properly, to avoid future entrapment, without denying the truth of what happened to you. Medication may help, but it is primarily a source of stability and energy for the mental work of recovery and escape.

If you are depressed, and it is mostly endogenous, understanding your vulnerability will help you to recover - and to protect yourself from future episodes, possibly with the aid of appropriate medication to readjust body or brain chemistry, possibly with only lifestyle modifications required to accomplish this goal.

The central problem of exogenous depression is this: in the circumstances that usually produce it, a person is not only trapped, they are usually experiencing such tremendous coercion that it is overwhelmingly difficult for them to resist or escape the trap.

If someone is literally trapped in Darfur or Haiti, there is no escape without great risk, and virtually nothing may be fully within that person's control. The depression one experiences in such situations - the sense of hopelessness - is a true message. If someone is in a domestic abuse situation, they may well be just as trapped, until they can begin to work out - at great risk - some plans for escape.

It is vitally important to realize that, in situations of this type, exogenous depression cannot be cured by simply reframing the situation with 'positive thinking'. The messages of entrapment and defeat are true in context; the antidote isn't to refuse to believe them, but to develop a means of escape, and determine if and when it is possible to avoid future traps.

In future entrapments, these messages would be true again. It is important to look at them and learn from them, to remember what the traps look like, how they feel, how they 'smell'. Because there are traps, and they are real.

As always, the answer is found in balance. On one side, there is inappropriate gloom and doom. On the other side, there is unrealistically rosy thinking. In the middle, there lies a narrow but navigable valley - this is the path through reality, with light and dark, warmth and cold, joy and tears, and a whole real world to explore.

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1 Comments:

Anonymous Anonymous said...

"It is vitally important to realize that, in situations of this type, exogenous depression cannot be cured by simply reframing the situation with 'positive thinking'. The messages of entrapment and defeat are true in context; the antidote isn't to refuse to believe them, but to develop a means of escape, and determine if and when it is possible to avoid future traps."

I've been unbearably depressed for almost 5 months now. I have an immediate family member who had depression. I know I'm higher risk. I got into my dream college, but couldn't afford it. I'm in a school that is the POLAR opposite of my dream school and I'm miserable. I hate the environment, I hate the classes, and when I talk to people about being depressed (in hopes of getting help) I'm told to "suck it up" and to "think positively."

I really did need to read that paragraph. Due to my financial/family situation, I'm stuck in this college for another 4 years. I know it's all in my head, so I'm hoping I'll get over it.

Thank you for the article. It made me feel like less of a freak.

18 January, 2009 00:22  

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