Depression | Inside The Work

Depression: Understanding What’s Happening (and Why It’s Not Your Fault)

Very few life challenges are as hard—and as privately distressing—as depression. It can alter the way you think, feel, sleep, relate to others, and even the way your body moves through the day. Many people describe it as living under a heavy fog, or wearing “psychological dark glasses” that tint everything in a darker shade than it truly is.One of the most painful parts of depression is that it often comes with shame:“Why can’t I just get a hold of myself?”“Other people manage—what’s wrong with me?”This shame is understandable, but it’s also part of what keeps depression in place.A more helpful starting point is this: depression isn’t one single thing. It’s a word we use for a cluster of symptoms that can emerge for different reasons—and understanding the “pathway” matters, because it guides the kind of help that will be most effective.

What depression feels like

You wake up one morning, and suddenly you realize you are going through the motions, but nothing is moving you internally. Someone is talking to you, someone you love, and you feel uninterested, numb, distant, far away. "He/She has no clue" you quietly think to yourself. Food? whatever... daily duties? You might or might not draw up the physical strenght to do them. What's for sure is that if you do, you're seriously exerting yourself, like lifting weight three times heavier than you.

Birds outside, a nice flower? Whatever.

People smiling in the street? What are they on about? They make you angry, because frankly, there is nothing to smile about.

And why does everything feels like nothing? This makes you feel tired, or maybe you were tired and this is what caused this whole thing to turn grey...? you're not sure anymore... you are not sure from where anything is coming from. It's kind of foggy in your mind anyways. And a part of you feels uninterested about that as well.

During the day you get glimpses of a feeling. Often it is sadness. You're pooring yourself a glass of water asking yourself for the 100 times why is it that everything feels strange and far away...and suddenly, tears come up.

I can't live this way.

Thoughts of dying start invading your mind... you get terrified from it . What's wrong with me?

It's not just thoughts of dying. Sometimes, very strange other thoughts come up. Thoughts unlike you, that surprise you. Thoughts of harming people you love, or other creative films your subsconsious is throwing at you... You start fearing you are becoming crazy. Do these thoughts reflect who I am? Who I have become?

This question increases the depression further...

You start worrying that your life will have amounted to nothing..

And so your days go on, mixed with numbness, anger, sadness and terror, like a cloud above your head, or inside your heart.

You are trapped inside.

And as the Pink Floyd song goes

There is no pain, you are receding
"A distant ship, smoke on the horizon
You are only coming through in waves
Your lips move, but I can't hear what you're saying "

This, is depression... in a nutshell.

Three ways depression can develop

Many clinicians find it helpful to think of depression through three main lenses:

Biochemical depression (body-driven)

Sometimes depression emerges primarily from changes in the body: sleep deprivation, hormones, thyroid imbalance, anemia, chronic pain, inflammation, medication side effects, substance use, or postpartum physiological shifts.

A striking example from medical history: In the mid 50s, a A blood thinner made from a derivative of the plant rauwolfia (from India) was introduced into the market - the drug was fairly effective in lowering blood pressure but it had a number of unpleasant potential side effects, one of which was that it could produce severe depression. This depression was not unlike depressive illnesses seen in psychiatric wards for ages. During that period, clinicians made it a point when an individual was admitted for treatment to ask first and foremost if they were taking any kind of blood thinners. If the answer was yes they simply discontinued the treatment and may individuals would recover naturally without any further treatment.

Chemical changes in the body can produce a depressive state.
In those cases, depression deserves to be treated with the same seriousness and compassion as any physical illness.

This is also why postpartum depression can appear even when a mother has good support and isn’t experiencing obvious postpartum stress. Sometimes it’s not “caused” by psychology or environment—it’s a physiological vulnerability window.

Depression as a response to loss (grief-related)

In other cases, depression is closely linked to a loss:

loss of a loved one
loss of health
loss of a relationship
loss of a dream, an identity, or a future you expected

When depression follows a loss, it doesn’t mean the person is “weak”—it means the psyche is processing something painful and destabilizing. Psychotherapy is often especially helpful here because the work is not only symptom relief, but meaning-making, integration, and emotional processing.

It’s important to say: yes, many depressions involve loss.

But it can become unhelpful when we assume that all depressions are simply hidden grief or an unconscious reaction to loss. That becomes a one-size-fits-all explanation—and real people don’t fit into one size.

Characterological depression (self-attitude / long-term pattern)

There is another pathway that looks more like a long-term posture toward self and life. This is not “fake depression,” and not “personality blame.” It’s a description of a chronic inner climate that may have been present for years, sometimes since childhood.

This kind of depression often includes:

a deep sense of inadequacy or inferiority
expecting rejection, assuming “people don’t really like me”
chronic dissatisfaction (“nothing ever feels good enough”)
harsh self-criticism (and often criticism of others as well)
a feeling of “I don’t remember a time I was truly happy”

Sometimes what people call a “midlife crisis” is partly this: not only life changes, but the surfacing of a long-standing inner narrative of discontent, comparison, or failure. Often it arrives after the person has tried "everything" to relief himself from this sense of existential discomfort: changing jobs, cities, countries, houses.. having children, sending children to college, marriage, divorce... identity ... the list can be long. Mid life crisis then often occurs when that existential dissatisfaction has caught up with the person and he/she is forced to face it directly. It can be very distressing, destabilizing and confusing.

In these cases, psychotherapy is often central, because the work involves shifting an internal relationship: moving from shame and self-attack into self-understanding, self-respect, and a more stable sense of worth.

These three pathways can feed into each other

Here’s a practical way to think about depression that avoids blaming and also avoids helplessness:

Body / Biology
Sleep disruption, hormones, thyroid/anemia, pain, medication/substances, postpartum changes.
Mind / Inner process
Rumination, self-criticism, catastrophic narratives, shame, hopelessness—what we repeatedly tell ourselves.
Life-in-context
Daily structure, workload, isolation, practical support, relationship dynamics, community expectations, finances, and losses.

Any one of these can trigger depression. And once depression begins, these layers often start feeding each other in a loop.

Intrusive thoughts, despair, and the fear of “going crazy”

This is a very important point and I would want to say even more so in a postpartum depression because very often these symptoms are deeply miss understood and can create terrible distress in a person:

When depression becomes intense—especially when mixed with despair—it can make life feel intolerable and unchangeable. Some people find themselves thinking:

“I just wish I could die.”
“What good am I to anyone?”
“Everyone would be better off without me.”
"What if I threw my baby off the balcony"
"What if i suffocated my child"
"What if i poisoned my husband by accident"

These thoughts can be frightening and shameful. Many people keep them secret because they fear being judged, misunderstood, or seen as “crazy.” Many people think these thoughts could be a reflection of their "character" something that is fueled by the negative glasses put on by depression.

But here’s something important about the unconscious you should know:

The unconscious has no rules like in our day to day world. It does not abide by what is social acceptable and what is not, and certainly does not take into consideration our deep, layered complex existence of contradictory feelings. It simple creates images that form a certain type of relief even if they can be also intensely distressing. Think of it as "dreaming outloud". Do you ever judge yourself for dreaming strange dreams? No, because you know they are dreams. They are raw images expressing a more subtle feeling. They are the subconscious loudspeaker.

In the case of the mother undergoing a postpartum which finds herself having terrifying thoughts of throwing her baby off the stair cases and starts being frightened of herself to the point of closing up into deep shame and terror... it would be useful for her to realize that perhaps her subconscious is talking out loud, but really only saying that she is tired, or maybe that a part of her feels at loss of her identity, that the change is overwhelming. It is normal sometimes to feel like we would have wanted things to go back to the way they were when the baby was not here. And if we repress this thought, more often than not our subconscious is going to let it bubble up any ways.

If you see them as dream symbols of more subtle emotional energies, it might help to feel less shamefull and terrified from them.

I just want to add that some thoughts of self-harm and desperation can sometimes increase the risk of suicide. We do not think stress during a depressive episode, and helplessness can be one of the most distressing experience out there on earth.

If you are experiencing thoughts of self-harm or suicide which are becoming more and more frequent, you deserve immediate support. Please reach out to someone —your local emergency services, a crisis hotline, or a trusted person who can stay with you and help you get care.

“If it’s emotional, why can’t I just reason my way out of it?”

Many people assume that physical illness is outside our control, but emotional illness should be fixable through willpower or logic. As if we had more control over our emotions than our body.

That belief is one of the reasons depression carries so much shame.

In reality, depression can involve:

real physiological constraint (energy, sleep, appetite, neurochemistry)
and also
patterns of thought, behavior, and relationship dynamics that maintain it.

This is where two truths can coexist:

1) Depression is not your fault.
2) There are still steps that help—often small ones at first.

Treatment: matching the help to the type

Because depression has different pathways, it often responds best to a tailored approach.

When biology is prominent, medical evaluation and sometimes medication can be essential (alongside psychological support).
When loss/grief is central, psychotherapy is often the main path: processing, meaning, integration.
When self-attitude and shame are central, psychotherapy helps transform the inner relationship: reducing self-attack, strengthening self-worth, and building a more stable internal foundation.

Many people benefit from a combination: the goal is not to “pick a side,” but to help your system regain stability, clarity, and hope

Depression is closely linked to doubt: doubt about yourself, about the future, about whether relief is possible. One of the most important messages I can offer is:

Depression lies about permanence.

It can feel like “this is how life will always be,” when it is actually a state—often treatable, often reversible, and always deserving of compassion.