Living with Depression: depression through the eyes of a psychotherapist

Image by Sebastien Thibault

Image by Sebastien Thibault

I came across an article in the Guardian last week, published as part of Depression Awareness Week (USA). In it, author Tim Lott writes about how it feels to live with depression.

It's a sobering account, and a reminder that whilst most of us feel depressed at different times over the course of a lifetime – only a small minority number of people suffer from depression to the extent that Lott writes about.

In my psychotherapy and counselling work, I remind clients that feeling depressed at certain times is a normal and important aspect of life, calling us to reassess what really matters and to action important change. Yet, this kind of depression clearly differs to the debilitating and frightening force that Lott experiences.

As a psychotherapist, I find the most useful way of helping the people I work with understand and manage depression is through the lens of the body – what is happening in terms of nervous system arousal, and also psychobiologically. Through this lens, depression is understood as being stuck in a pattern of parasympathetic (low) nervous system arousal. Also, called hypo-arousal.

Hypo-arousal manifests as a numbness, deadness or emptiness, both on an emotional and body level.  Cognitive functioning slows down and it becomes difficult to process information. 

People that tend to be parasympathetic dominant are more likely to self regulate arousal. That is they attempt to soothe intense physical, emotional, and cognitive states on their own; not by reaching out to people or interacting more with their environment. 

Chronic hypo-arousal can cause an overall weakening of the muscular system and movement function, confusional states, poor attention and a separate sense of self.

You can see how closely this matches Tim's experience

For a start, it can produce symptoms similar to Alzheimer’s – forgetfulness, confusion and disorientation. Making even the smallest decisions can be agonising. It can affect not just the mind but also the body – I start to stumble when I walk, or become unable to walk in a straight line. I am more clumsy and accident-prone. In depression you become, in your head, two-dimensional – like a drawing rather than a living, breathing creature. You cannot conjure your actual personality, which you can remember only vaguely, in a theoretical sense.
— Tim Lott

When working with depression through the lens of the body – early psychotherapy involves studying and increasing arousal levels. Arousal levels can be increased through gently activating the social engagement system (eye gaze, playing with proximity, self-touch), as well as through movement, increasing sensory awareness and developing somatic based resources which activate arousal.

Only when the nervous system is regulated, is it possible to restore physical energy and mental clarity, and for clients to return to a place of feeling more present and engaged in life. From this more resourced and regulated place, clients can begin to process and integrate more complex thoughts, difficult emotions and past experiences.

You can read Tim Lott's article here. 

If you would like to learn more about managing depression and levels of arousal through individual psychotherapy or counselling, please get in touch.


As an aside, the image that was linked to Tim's article. At first view, I saw this  image depicting the two hemispheres of a brain, a depressed brain – with information poorly flowing across a thorny corpus callosum. Now I  see that it's a mirror. Perhaps this image is intentionally ambiguous, or is this just my primed psychotherapist brain that is always thinking about neurological integration and hemisphere connection? What do you see?