Tag Archives: depression

What is the Difference between Sadness and Depression?

It may come as a surprise to some, but sadness and depression are not the same.

It would be easy to mistake the two if we simply listen to how people generally talk about their feelings when they are having a bad day or feeling down for some reason.

Most people tend to use the terms sad and depressed interchangeably, not knowing what the difference really is.

This confusion, however, does a disservice to us since it inadvertently gives sadness a negative reputation, while also minimizing and confusing the issues that are really at stake when someone is truly depressed.

I therefore want to clarify this confusion once and for all and make it clear why depression is not always about being sad.

What is sadness?

We all feel sad sometimes. Sadness is part of the normal human spectrum of emotions, just like anger, happiness, fear, and so on. In fact, the ability to feel sad is a sign of healthy human functioning. Sadness is how we cope with loss and reinvest our energy in something new that takes the place of what we have lost.

We feel sad when we lose a relationship, but also when we lose a job opportunity, or when we reminisce about good moments in childhood which are no longer part of our lives.

Sadness in this sense is the indication that we have lived fully, that we have dared to love, that we have dreamed of things, and that we have enjoyed life. And loss, of course as we all know, is an inevitable part of life since life is ultimately a change process.

What is Depression?

So now that we know what sadness is about, let’s discuss how it is different from being depressed.

Depression, is different from sadness in many important ways.

Unlike sadness, it is not an emotion. Rather, it is a response to not dealing well with one’s emotions.

Studies have shown that depression often relates to a person’s difficulty with accepting, tolerating, or expressing certain emotions.

It short-circuits emotions because something about these emotions seems overwhelming, threatening, or uncomfortable. The result then is a sense of being stuck in certain emotions or a general flattening of emotional experience that leads to lack of vitality and lack of excitement.

Hence a frequent cause of depression is the inability to tolerate loss and the experience of sadness.

Rather than allowing the natural process of grieving to occur, a person who finds it difficult to let themselves be sad, may instead numb themselves to feeling, collapse into helplessness, or let it affect their basic sense of worth.

In these cases sadness is no longer experienced and expressed as part of the natural process of life, but is instead short-circuited and turned into a depressed state.

Depression is in this sense not an emotion, but an anti-emotion. It is a result of life turning against life, or forces from within working against the natural process of living fully.

But isn’t Depression about Feeling Sad?

Research performed by emotion-focused psychologists Leslie Greenberg and Jeanne Watson, has actually found a greater connection between depression and anger, than depression and sadness.

Only in 39% of the cases studied did depression involve themes related to loss or sadness, whereas it involved anger in 66%.

By anger, I of course mean, unexpressed or repressed anger which keeps a person in a powerless or subordinate position, or expressed anger that masks underlying feelings of low self-esteem or unfulfilled needs.

Emotion-Focused Therapy for Depression
Les Greenberg and Jeanne Watson have written an excellent book on the emotions involved in depression.

Book cover for Les Greenberg's book: EFT for DepressionIt has been noted in particular that when men become depressed they are more likely to express outward anger than to feel inwardly sad. This is because men in general feel less comfortable and have been less encouraged by our society to fully embrace sadness as an acceptable emotion.

The relation between depression and emotion is therefore much more complex than we normally think of when we simply conflate feeling sad with being depressed.

What is the Cure for Depression?

Since depression often short-circuits the natural experience and expression of emotion, the cure for depression often consists of helping people experience, express, and cope with their banished or threatening emotions.

This process often involves the following components:

  • Freeing up blocked or inhibited anger or sadness so it can be dealt with and understood
  • Helping a person work through fear, shame, or guilt about acknowledging, embracing and expressing their natural emotional responses
  • Helping a person not feel overwhelmed by their emotions
  • Helping a person discover the cause of the emotional responses that have been blocked or deemed threatening, in particular the underlying unmet need for love, safety, approval, or mastery

Allowing oneself to be sad as a means of coming to terms with some loss or unfulfilled wish is oftentimes part of this process, but the process also often involves resolving other stuck points as they may relate to anger, fear, shame, or guilt.

The ability to feel sad fully without stopping the process prematurely due to discomfort or fear is therefore often part of the antidote to depression and not part of the problem of depression itself.

As you can now see sadness and depression are very different entities and should not be confused. Although depression may involve sadness, it often distorts or blocks sadness from its true purpose. Depression is therefore often just a way station on a journey toward fully recuperating one’s emotions, including the ability to experience and express sadness as a natural part of life.

image of psychodynamic therapist, Dr. Rune Moelbak
About Me:
I am Rune Moelbak, Ph.D., a psychologist in Houston Texas. I specialize in helping people get unstuck from their depression by using a variety of the most effective psychological methods. You can learn more about therapy for depression by visiting my website.

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Learn 15 of the most effective psychological techniques to beating the blues. Continue reading What is the Difference between Sadness and Depression?

Do You Feel Guilty about Your Own Needs?

One frequent problem people present with in therapy is: not knowing how to care for themselves emotionally. Many people make their lives all about caring for others, and not enough about caring for themselves.

They might make statements such as:

  • “My husband doesn’t like Chinese food, so we never go”
  • “I would never spend the money on a spa treatment for myself, I just don’t feel like I’m worth it”
  • “I did not feel proud when I got my promotion, I don’t want to be seen as egotistical”

Problems with Ignoring Own Needs:

This kind of attitude toward life whereby you shun your own needs, desires, and healthy pride due to feelings of guilt and shame can in the long run lead to problems.

First of all, when you shut down your natural desires and wants because you feel selfish for having them, you end up feeling more empty inside and more alien from yourself.

Second of all, when other people’s needs always take priority, you will end up feeling increasingly resentful of others and drained by other people’s company.

Is Your Focus on Others Self-Effacing?

Psychoanalyst Karen Horney refers to this lifestyle of minimizing your own needs and focusing always on what others want as a defensive strategy of self-effacement.

Karen Horney: Neurosis and Human Growth
Karen Horney has written about the strategy of self-effacement in her best-selling book “Neurosis and Human Growth”

Karen Horney: Neurosis and Human GrowthThe person who lives their life this way cannot spend money on themselves, cannot openly demand anything, and cannot celebrate their own successes. They always live in the shadows of others and shun any feelings related to being proud of themselves or entitled to having their needs met.

Although a certain amount of humility and perspective-taking is certainly both healthy and appropriate, it is not healthy when we cannot proudly own our accomplishments, assert our needs, and take interest in ourselves.

When We Lose Touch with Who We Are:

Sometimes the ability to feel inside ourselves for answers to what we want may become muted to such an extent that we feel rather empty inside and lose touch with who we really are. At this point we are likely to become depressed.

Therapy with such people will often uncover that the reason why they have become so alienated from their desires is that they experience intense guilt feelings, shame, or anxiety whenever the focus is on them.

Unless these feelings are resolved, they are going to continue to shun any feeling that hint of pride, confidence, self-interest, and making themselves a priority.

These positive feelings about the self which are vital for a fulfilling life, are then going to continue to be judged as “selfish”, “self-indulgent”, “egotistical” and will therefore continue to be rejected and disowned.

Indeed some people might even go the extra mile and idealize their lack of self-care as a sign of their good-hearted, self-sacrificing, and saintly nature, erecting an even more formidable barrier to regaining healthy self-esteem.

When Self-Sacrifice Becomes Sign of Low Self-Esteem:

The reason why the ban against caring for oneself is so problematic is that instead of being a genuine virtue it often covers up shame, lack of self-love, low self-esteem, and a sense of unworthiness. Were we to really get to the bottom of things, we would often discover that the primary motor for shunning one’s assertiveness is not really a commitment to a more ethical and virtuous life style, but doubts about being liked, needed, wanted, or loved.

Questions that often underlie a compulsive need to please or a fear-driven avoidance of assertiveness, include questions such as:

  • Would my partner still love me and be with me if I made more demands?
  • Would I really discover that I am a horribly selfish person if I indulge my impulses?
  • Am I really worth enough to myself or to anyone to deserve to have my needs met?

These are not the questions of a virtuous person, but the questions of someone who doesn’t love themselves deep down.

What is the Solution?

The solution to the problem of lack of self-love is not to become more virtuous, self-sacrificing, and caring of others, but to learn how to care better for oneself. One must get to the bottom of why it is that vital feelings of pride, self-respect, and self-interest became shameful and needed to be shunned.

As so often happens when people engage in the therapeutic work of truly identifying the causes of their defenses and distress, what they will likely find is a history of losses, absences, and neglects that will need to be properly mourned and confronted.

Once the person goes through this process and reworks the meanings and implications of these past events, they will no longer need to disown parts themselves because they deem them to be unworthy or shameful. Instead they will develop greater self-compassion. Instead of shunning parts of themselves in order to protect themselves from unbearable bruises or erroneous conclusions from the past, they will then once again feel entitled to own all of themselves.  They can then get in touch with the natural sense of pride and self-esteem that is the hallmark of a life worth living.

image of psychodynamic therapist, Dr. Rune MoelbakAbout me: I am Rune Moelbak, Ph.D., a psychologist in Houston, TX, who specializes in helping people get to the root of their depression, lack of self-compassion, and low self-esteem. Click here to read more about my treatment for depression.

The Causes of Depression: Attachment Trauma

As a psychologist, a question I often get asked is: What are the causes of depression?

The answer to this question is not one you will find in an encyclopedia or the latest research; it is one you will have to find within yourself.

Even though the causes of depression are multiple and highly specific to each individual, there are some common psychological causes of depression that often reveal themselves through the course of therapy.

In the coming months, I want to address these causes in a series of articles called “The causes of depression”.

In today’s article, I want to focus on attachment trauma as a frequent cause of depression. In future articles, I will address other causes, including: emotional inhibition, and unconscious conflict.

Why Am I Depressed?

Depression is a sign that you have become psychologically stuck and that some internal conflict or issue is halting your ability to deal with current life circumstances. Instead of meeting these challenges and feeling effective in your life, you are shrinking from them and feeling blocked.

The challenges you are shrinking from do not have to be conscious. Even if we may not be aware of the cause of our depression, and may not be able to point to a particular dilemma in our life, our body and psyche still keeps score. The answer to the question: why am I depressed? is thus always within me, hidden underneath layers of my more conscious understanding.

Causes of Depression: Attachment Trauma

A frequent cause of depression that I see a lot in my psychology practice is what could be referred to as an early attachment trauma.

Research is increasingly validating the idea that human beings are driven to maintain a secure connection to other people. We are not isolated individuals from birth, but highly relational beings.

When ruptures occur to our relational bonds, we react as if we are endangered.

Sometimes, in response to this threat, we may cling more to people in our surroundings. We  may abandon ourselves in order to become what we think others need us to be to make sure they want to be around us.

In other instances, we may go numb, lose contact with our feelings, and begin to live deprived and hollow lives to protect ourselves from the risk of rejection.

In both cases, we pay a heavy toll to protect ourselves from loss and rejection. The toll we pay is that we become depressed.

Avoidant attachment:

In the avoidant response to unsafe attachment, we deaden ourselves. We come to therapy complaining that we are just going through the motions or don’t feel much excitement in life. We may not even consciously feel that we need others in our life, because to feel the need is already too dangerous and threatening.

The unconscious life strategy in this avoidant attachment pattern seems to be:

“Life is not giving me what I want and I can’t do anything about it. My only option is therefore to cut out my needs for comfort and love and pretend that I don’t care about these things.”

Unfortunately, the body keeps score, and my depression is a reminder that my solution to life’s deprivations is not a satisfying one.

Anxious-Pursuing Attachment:

In the more actively pursuing response, we may come to therapy complaining that no one really knows us or appreciates us for who we are. Or, we may complain that we feel lonely even when we are with people.

In this unconscious strategy to secure love and affection, we may largely ignore our own needs. Because our main focus is to make sure that others don’t leave us, we focus mostly on them and not on us.

Of course this spells trouble because we never really feel that the other person loves us or likes us simply for us. Instead, we suspect that they only stick around as long as we cater to their needs.

In the lighter end of this spectrum, we may thus feel annoyed or deprived, or simply scared of being alone. In the more severe end of the spectrum, however, we may feel completely lost to ourselves, and be so alienated from our own needs and wishes that we don’t know what we want or who we really are anymore.

Because deep down, we don’t feel seen and don’t believe others care about us, we begin to feel depressed whenever others seem to confirm this fear. A missing phone call, a friend who is too busy, another’s desire for alone time can all activate our fears, and we may find ourselves confused about why these little slights can plummet us into the depths of a depression.

Getting to the Root of Our Depression:

In therapy, the root cause of these ways of living can often be found in early deprivations and insecurities related to our primary caregivers or early childhood experiences.

Maybe we had an inconsistent alcoholic father, who frequently let us down, or who could not consistently show his love.

Maybe our mother was not psychologically available due to prolonged periods of depression during which she would become despondent.

Or maybe we moved around a lot and found it distressing to lose our friends or to not know when emotional ties would have to suddenly be cut off.

Whatever the reason, therapy might help you discover ongoing or very specific attachment traumas that made you feel uncertain about the dependability of others and unsafe in your attachment to other people.

If this is the case for you, the recipe for overcoming your depression, will not be an anti-depressant. Instead it will be coming to terms with interpersonal disappointments, mourning your losses, and integrating a more positive view of yourself instead of viewing yourself as flawed, faulty, or undeserving of love.

book cover for becoming attached

A good starting point for your exploration, will be to read the book by Robert Karen : Becoming Attached. This book will help you understand the link between frustrated attachment needs and the development of depression.


Dr. Rune Moelbak

About Me: I am Rune Moelbak, Ph.D., a psychologist who help people discover the psychological causes of their depression. Click on link to read more about the psychological treatment of depression.

The Myth of Major Depression – Why Depression is not an Illness…

depressed person

The Rise of Major Depressive Disorder

It has become common nowadays to think of depression as a medical condition. If you visit your general health practitioner, she might ask a few questions about your energy level, appetite, sleep, and mood and, if you answer these questions in a particular way,  tell you that you have “Major Depressive Disorder”. Major Depressive Disorder, you will be told, is a real illness. And like any real illness, it even comes with its own pill prescription (SSRIs)…

This way of thinking about depression, however, is really the product of a medical discourse that has been spoken so many times that it is has begun to ring true. And yet, as a psychologist with many years of experience helping people who are depressed, I am here to tell you that the emperor has no clothes on…

The Reduction of Subjective Distress to Objective Symptoms

The talk about depression as an illness is really the result of a more overarching trend in the mental health field to reduce life to objective behaviors or symptoms. We take two individuals and observe how they act, talk, or say they feel. We extract the behavior they have in common, and bam! we have arrived at a symptom. One person’s sleepless nights, for example, are equated with another person’s sleepless nights, and what we now have is the symptom of “reduced sleep”. When we observe a collection of such abstract symptoms that appear to frequently occur together, we end up with a “syndrome”, or a certain cluster of symptoms. And when we give a name to such a cluster, by inventing nouns like “Major Depressive Disorder” or “Generalized Anxiety Disorder”, these nouns then take on the status of illnesses that appear to preexist and explain the appearance of the symptoms.

The Loss of the Subjective Meaning of Depression

So what is the problem with this way of thinking? Well, for one, we have abstracted the symptom from the life of the person, and without this person, the symptom has lost its meaning. It is for example quite different to have a sleepless night because one feels empty inside and can’t stand the stillness of the night, and to have a sleepless night because one lies awake beating oneself up about things one should have done differently during the course of the day. In the one case, the sleeplessness announces to the person that they have become too alienated from their own experience (emptiness being the result). In the other case, the sleeplessness may bear witness to a traumatic event that the person has resolved to deal with by feeling eternally guilty…

The idea of the symptom as some abstract behavior erases these differences and treats each individual’s behaviors as if they were the same. Reduced sleep thus becomes a rather hollow concept. In its abstractness, it hides more than it reveals. To say of both instances of sleepless nights that they refer to the same phenomenon is a stretch, for what looks the same on the surface, betrays significant differences when an understanding of the life of the person is taken into account.

When depression becomes a universal construct or set of behaviors, its true meaning is lost. For in reality, there can be no depression outside the concrete life of an individual. And even though we may label two people’s behaviors as depressed, the meaning of their depression can vary widely. One person may be depressed because they are faced with a life situation that demands they assert themselves, but have fears about doing so, and therefore can do nothing but admit defeat. Another may be depressed because they have cut out social contacts to deal with their social anxiety and now find themselves devoid of meaningful relationships. In short, there are as many types of depressions as there are people who are depressed. There is always a unique story to be told…

The problem with a construct like Major Depressive Disorder is that it gives us the illusion that it exists as some “thing” in itself. It conveys that the “wizard behind the curtain” is a disease process and not a person.

A Faceless Healthcare…

In line with this view, “treatment” of depression becomes a rather impersonal endeavor. One treats “symptoms” not “people”. Instead of taking time to listen and understand, to help people figure out what depression means in the context of their other life problems, one now gets prescribed an SSRI or gets education about sleep hygiene…

Constructs like Major Depressive Disorder, and the philosophical assumptions that underlie them, lead to a faceless kind of healthcare that is devoid of the subjectivity of the person. They trade an abstract category, for the real deal…

Depression is, and always will be, shorthand for a multitude of particular ways that people struggle. Only when we understand the life of each struggling person, will we succeed in understanding what depression really is, for it is many different things to different people. Depression is not a “thing”, and is not an “illness”. Instead it is a marker of a particular stuckness in a person’s life. It  acts as an invitation or perhaps a dictate to discover something deeper about ourselves…

About me: I am a clinical psychologist in Houston Texas. Visit my therapy website to read more about my treatment approach to depression.