|To link with glue depression and poor self-worth might create a misleading
over-simplification. The illness is complex.
A sufferer of depression can emerge from that illness with low esteem while no longer being
A person can have low self-esteem and not become depressed.
Depression sufferers are seldom realistic, having a poor view of everything.
Any cynic can say something derisive about most events, but depressed people will see negative
and believe bad about everything, including themselves.
A sufferer can become introspective even to the point of extreme somatic fixation and absolute
It is true that feelings of low self worth promote depression but no less true that depression
adduces notions of poor self-image. Is this a 'chicken before the egg...' conundrum?
Take a look at this example. When a life partnership breaks apart, is manic behaviour and
depression of the divorcing pair a consequence of loss and anger or is it a result of low
self-esteem? I suggest we deal with the loss first. If one can remove guilt for the break-up and
associated loss of 'what could have been', self-esteem is a lesser issue, right?
Degradation of self worth can be based on reality or a misconception.
A gentleman, a husband and father, becomes obese during his marriage and his self-esteem tanks as
his automobile sags on its coil springs and none of his cloths fit, his wife flees the marriage
and the kids won't be seen in public with him. I would write the referral to deal with the
physiological crisis causing the self-worth degradation which in turn catalyzed the family
break-up as the aggregate of events bred depression. Or did the depression come first? We might
never know for sure.
Did obesity manifest from depression? Perhaps chronic low-grade depression over years led to the
obesity. These are things we need to understand. But understand or not, the root cause of the
acute self-worth issue is obesity with attached health risk, life quality, and lowered expectancy.
A remedial plan for obesity with confidence needs to be set in motion while the therapeutic remedy
staggers forward awaiting milestones of progress in the physiological health remedy.
A self worth crisis is never without cause whether real or perceived. Treat that cause as well as
the depression. If the cause cannot be remedied as in the case with some illnesses (Multiple
Sclerosis etc.) or physical dismemberment or disfiguring (i.e.: automobile accidents), then a
blend of physical therapy, cognitive therapy and coping skill training with behavioural
modification therapy might accompany the depression's pharmacological (if indicated) and
I am trying to illustrate to you that no absolute equation exists between self worth and
Lacking social and life skills may also be at the root of a self-worth crisis and as in the
previous example, the causatory issues need to be addressed and managed in conjunction with
treating the depression.
It may be true that depressed people despair and wade through waves upon waves of low
self-esteem, even to the point of acting out a suicide attempt, but in my view, anger causing
depression is the root of intended suicide.
Anger is a powerful emotion. One needs to be very angry to truly intend self-inflicted death.
That is the measure of extreme anger leading to depression.
Every person is unique. Each handles depression differently.
Stress and depression are parts of life.
We often refer to the challenges of life as stress. Stress therefore must be normal.
Sometimes life heaps so many challenges upon us such that coping alone is too difficult. Caring
and sharing families (and their shared communities) make light work of multiple heavy challenges.
We help each other out by sharing the load. By caring. By loving. That's why it is important to
build caring and sharing relationships and avoid tension and hostility. Family communication
dynamics based on tension and hostility make dysfunctional the family and its members in more ways
than the obvious. Not only does this environment breed depression but also it has lost its latent
Tension and hostility as the prevailing glue in human relationships cause dangerous forms of
anger-driven depression. Tension and hostility breed depression. Tension, hostility, anger and
depression can narrow the behavioural path toward violent outbursts including murder, suicide and
other forms of criminality.
Functional families and communities have their problems too.
Think of life's big events as a figurative rocks in a knapsack on your back. Failures add a rock.
Successes can remove a rock or make a heavier one become lighter. Too many heavy rocks can create
a burdensome load inviting fatigue, anger and/or depression. When we are angry and depressed we
might do things that add more rocks. Depression can become a self-feeding, downward spiral. The
weight of depression can figuratively bring us to our knees.
On the other hand, a person having the compunction necessary to earn the goals they seek to
achieve usually does just that. They have their failures but the successes, which they pay most
attention to, pile up and their knapsack is light. Such people tend to either work their way out
of depression or they play their way out. They always focus on the good and briefly seek lessons
from their mistakes.
Sufferers are lethargic and loose their vim and vigour for life. They are slow to bounce back
from a failure. They find it hard to work or play. Their depression lingers.
When one's "knapsack" is laden with rocks, it is harder to feel good about self. Seek help. Find
someone to co-manage the process of 'removing some rocks'. That helper could be a wise aunt,
parent, sibling, teacher, minister, therapist or any other volunteer or professional caregiver.
Removing rocks is done by articulating the name and meaning of each "rock" and reassigning its
value or finding a solution when the rock represents an unsolved problem. Sometimes removing the
rock is a process of changing the way we think, or of giving ourselves some permission to say, 'I
am not responsible for that problem', or 'I am categorically unable to resolve it', therefore the
rock can be offered to someone able to fix it or tossed out altogether.
We can learn to worry about the things we have ability to change or fix and not worry about those
things we can do nothing about. We can learn to make new policies for ourselves, to say that we
are no longer offended or bothered by those menial events that previously represented a
We can also learn about what matters most and what matters not at all. We can identify which of
our expectations are dreams and which are goals. Dreams are fun and exciting. The rare time for
dreaming is when we need a diversion. On the other hand, we always need our realistic goals in
clear sight. Failure at achieving unrealistic goals is not worthy of any concern. We can't become
an 'American Idol' if we can't hold a tune, so lets not confuse that dream with real goals. Young
people worry about being 'accepted'. They fear rejection. Life is full of rejections so let's
learn about criteria. Getting rejected by the local street gang is not such a bad thing. Getting
rejected by a snobbish cliche of never-do-wells is not a bad thing. Rejection for membership in
the Harvard Mensa club might just mean we set our sights too high. Let's try the local
stamp-collectors and become a bigger fish in a smaller pond. Young people worry about their
clothes being in fashion. Later in life they learn they were actually setting the fashion.
Learning that earlier might ease some feelings. This is all about cognition. Cognitive therapy is
available from a wide range of mentors and therapists.
Defeating depression often is a matter of learning to think in somewhat different ways. Cognitive
approaches to the things that bother us can be most helpful in coping with self-esteem problems.
Better cognition and goal management are sometimes hard to learn for some people. Those people are
vulnerable to lasting depression until they learn how to learn.
- We all have our failures.
- We all have our losses.
- We all have depression.
- Some folks cope well. Others do not.
Sometimes we go with those 'rainy days'. We chill a little. We feel a little sorry for
ourselves. We might pamper ourselves a little. We find a pleasant distraction. We might seek and
find sympathy or permit ourselves to make our own ruling to say 'that doesn't matter' or 'I'll do
better next time'. We brush off the blues and move on to our next challenge.
Some people are good at doing that. Others are not.
Self-esteem is arguably a manifestation of many possible issues that are more likely to live at
the root of the depression. A clinician would better serve the patient by addressing and
co-managing solutions where existent:
- Rational and/or irrational fear,
- Persistent boredom,
- Physiological conditions (creating digestive issues, communication problems, appearance issues
- Sleep disorders,
- Attention deficit disorders,
- Transitory hormonal conditions (i.e.: teens),
- Mania (bi-polar or manic depressiveness),
- Dependency issues,
- Life passages,
- Grief, and so on
Likely the most dangerous occurrence of depression in society is a chronic condition that is
asymptomatic, leading to severe depression. A moderately depressed person may exhibit no
identifiable symptoms to lay people or may exhibit masking symptoms that draw social reactions to
exacerbate the problem. They don't know they are depressed nor does their close family. (Masking
of depression can sometimes lead to obnoxious behaviours that fetch much disapproval.)
I know that public health officials wish to identify features and share speculation on family
impact analysis to help the public identify which of its members may be suffering, but as a
clinician, attempting to map out such global impact predictions is hazardous. I am a little stuck.
I need the help of a caring and sharing family. I won't scare them off with dark predictions of
depression's infectiousness. That doesn't really exist.
"People who live with depression are at a greater risk of getting depression themselves," is by
itself not a true statement. Given that depression in any measure must be treated and that some
instances must be institutionalized, family impact depends on the severity and oddity of the
Much also depends on the family players themselves. Susceptible people are exactly that. Genetic
predisposition is also another issue to consider. In a family where caring and sharing are the
bywords of life, love will prevail. It is no less true that living with a depressed person can be
a huge trial and test of ones love, care, and patience. One should only take on what they are
capable of achieving without harming their own health. In addition to treating the ill person,
counseling for the entire family is also indicated. A good counselor should be on the watch for
emerging health risks or vulnerabilities within the family unit and take remedial action as
Think of this figurative illustration of a depressed person. Imagine this unkempt individual
being curled up in a fetal position deep in the midst of a long, narrow, dark culvert. In the case
of mild depression, stretching out a caring hand to the person while doing some soft coaxing in a
loving manner will inevitably draw them out. In the case of more severe depression, that won't
work. One might need to get around behind them and do some pushing and prodding to get them out of
that awful place. One might need protective gear because the sufferer will snarl and scratch and
howl and bitch. How much of that are you willing to tolerate? Not much. That's why professional
help is needed to identify the measure of the illness and plan the solution. In severe cases, the
ill person may need to be removed to a hospital, group home or other 'away' place for some
learning and healing to take place.
A person prone to depression with only nominal coping and cognitive skills could well be at
greater than normal risk under any circumstances but could also benefit from the treatment
experience. Consider this. If within your family a person was diagnosed with moderate or severe
depression and that diagnosis was shared with the family while participating in the remedial
treatment -- some family counseling etc. -- each family member has their own private opportunity
to identify and make some judgments on the causes and effects of depression. This is a good
learning experience. Learning about depression is helpful to its cure and a positive contributor
to its prevention.
Helping another person in any crisis is a sound method for helping one's self.
caring and sharing family will go a long way toward defeating this horrible
illness. Such an enriched family has far more power for prevention than do all the clinicians and
researchers of the world.
Micheal J. O'Brien