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Shame, Loss, and Degradation

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Bridget Murray

Adult Development and Aging

Sara Bressi Nath

15 December 2014

Shame, Loss, and Degradation: An examination of the lived association between childhood and depression in adulthood


In spite of its prevalence, depression is rarely discussed; when it is, it is glamorized and romanticized, adorned by pity or swelling parables of recovery. Writer Nell Casey compiles personal essays from a number of writers in her book Unholy Ghost to provide a fuller and more illuminating portrait of depression.  The result is a work that shows all sides: the ones we think we’ve heard, spun on their heads; the ones we think we know, with the details normally left out; the ones we aren’t sure we want to see, laid out for us with all of the hard-to-stomach details. Sometimes painful, sometimes darkly humorous, often uncomfortable, and always honest, Unholy Ghost both taught me about depression from a scientific, medical, and psychological standpoint and showed me the raw pain and numbness that is so frequently left unspoken. Given my own personal experiences with depression, I felt it necessary to read and learn more; given the significant bearing it has had in the life of my sister and the many ways it has shaken us and uprooted our lives, I felt it essential to read and attempt to understand.

In this paper, I will be closely examining the narratives related in Unholy Ghost using academic literature and theory; however, I will be focusing on critiquing that literature and theory using these personal essays, as, during the course of reading and considering stigma and treatment, I found this approach to be much more relevant. I will focus on depression in early adulthood to middle age, as this range is of specific interest to me and encompasses the majority of the pieces in Unholy Ghost. From a social standpoint, I will be examining the pieces in Unholy Ghost through the lens of Erik Erikson’s developmental stages, looking at the adult stages (caring, love, and fidelity) that may be dramatically impacted if depression sets on during them or shortly after they are traversed. I will then apply this understanding to analyze this link’s role in creating stigma around depression, drawing examples from the depiction of depression in media as well as my own experiences in watching and caring for my sister as she recovers from major depressive disorder. Finally, I will draw upon all of these analyses to, one, critique how we view both developmental standards and mental illness, and, two, to evaluate how, moving forward, social work practices can work towards removing the stigma of depression.

Note on Methodology

I have chosen to approach this paper through the examination not of a single memoir but of a collection of essays on depression compiled by Nell Casey in the book Unholy Ghost: Writers on Depression. To look at aging in the context of depression, I felt it necessary not to look at one person’s entire story—how could one make any statements about a larger revelation or suggestions for implementation in social work based on a single individual’s experience, when every one of the 1/3 of Americans who experiences depression does so in a different way?—but at snippets of many people’s perspectives. Moreover, Unholy Ghost offers the opportunity not only to hear the words firsthand but to experience the compelling prose of someone who is a writer by trade. These essays convey true weight not merely via relaying events but by expressing emotion, through poignant anecdotes, pensive narratives, and painfully vivid poems. Studying the parts of aging that I am—reflections on the role and transformation of depression while aging on various connotations of mental illness with childishness—require a personal perspective, exposure to diverse experiences, and narratives from a diverse body of writers, all of with which Unholy Ghost has provided me.  In studying them, I knew that it was essential to marry facts, research, and diagnoses with two hundred and ninety-three pages of subjective experiences, and the chorus of twenty-three distinct voices—and with my own perspective woven in, twenty-five—that need to be heard.


Depression through Erikson’s Stages

Anecdotally, the writers of Unholy Ghost express sentiments of no longer feeling like an adult; examining of Erikson’s theory of psychosocial development provides a more concrete analysis of why these behaviors are deemed unacceptable for adults and thus carry connotations of childhood. Erikson recognizes eight stages through which the “average” person passes in growing up, from infancy to adulthood. Several of these stages reflect important markers for adulthood; in looking at the effects of the depression, parallels can be drawn between the ways that depression “sets back” an individual and thus causes them to either embark on the “wrong” of two paths or regress from developmental points altogether.

Stage Seven: Caring

Beginning with Erikson’s seventh stage of generativity versus stagnation, (the last stage the normative adult will reach, with the seventh being reserved for late adulthood) we begin to see deviation from of the expected psychosocial state. The caring stage, when “successful,” rides on productivity; though typically in the context of parenthood as the main form of social contribution, it, as Kroger writes, “resides also in the desire of an autonomous ‘I’ as part of an intimate ‘we’ to contribute to the present and future well-being of other life cycles” (31). Generativity might happen through “procreativity, productivity, and creativity,” contributing to “the generation of new beings as well as of new products and new ideas” (Erikson 67). These expectations are inherently ableist. In applying them to the stories depicted in Unholy Ghost,one might conclude that none of these adults—and, likely, no adult with depression—has reached or “succeeded” in any of these endeavors. And should that have happened, should they have failed to procreate, produce, or create, Erikson writes, they “often begin to indulge themselves as if they were their own—or one another’s—one and only child; and where conditions favor it, early invalidism, physical or psychological, becomes the vehicle of self-concern” (qtd. in Kroger 32). Erikson’s words are intrinsically problematic, as is the seemingly indelible paradigm of adulthood they represent that has permeated every facet of American society: that adulthood should fundamentally mean self-sacrifice; that productivity is not necessarily but often is verified via reproduction; and that “self-concern” and “indulg[ing]” oneself is an inherent flaw.

Depression inhibits productivity and the ability to be present—physically, mentally, emotionally. It often results in the inability to continue with daily activities, maintain expected social roles and responsibilities, and inappropriate guilt. Such a deviation from the normal self, and a deviation in such a negative direction, is read as self-indulgent both because the person in questions is no longer able to indulge others and divests more attention to themselves, especially accepting the need to break from “regular” life to seek treatment. In Unholy Ghost, a number of writers, especially young adults, with severe depression referenced both through content and language that depressive phases bring with them the need to retreat. As a common example, a well-known symptom of depression—both mentally and physically—is difficulty getting out of bed in the morning. A number of writers recounted urges towards withdrawing into the fetal position, a motion that, as its name suggests, holds obvious and direct ties to childhood and infancy. Donald Hall recounts in his essay “Hole in the House” how his wife, following the death of her father, “curled up in the fetal position and wept for three days” (Casey 164), while Darcey Steinke, during adolescence and well into adulthood, made “poodle beds” wherever she lived to curl up and hide in a cozy, confined, comfortable safety net (60). Adults are expected to, as Hoagland expressed in “Heaven and Nature,” have their affairs in order, to be consistent, reliable, and together. Being unable to face the world, or, on doing so, needing to jump ship and recoil, is the antithesis of consistent, reliable, and together.

Depression (or its symptoms) may also be read as selfish, further indication that an adult has failed in the generativity stage because they are too preoccupied with themselves instead of with Erikson’s “present and future well-being of other life cycles.” Most simply, depression is selfish because it makes both the person suffering and those around them more aware of the self than we are comfortable with being. Even something such as “excessive or inappropriate guilt (which may be delusional) nearly every day,” a medical symptom in the DSM, may be selfish because it entails thinking about oneself too much, indulging in negative emotions that can bring down others or make the situation “all about” the person with this symptom, or failing to grasp on to social conventions around erring and apologizing (adapted in Beck and Alford 65). Whether it’s neglecting to pick up their child after school because they were lying in bed crying or losing their job because they couldn’t concentrate at work, an adult’s failure to contribute to society in a “productive” manner is behavior deemed self-centered, self-indulgent, and immature, alienating them from society.

Stage Six: Love

            Erikson’s sixth stage, intimacy versus isolation, occurs during young adulthood, and occurs when “issues of identity are reasonably well resolved” (Kroger 30), coming to “an ideal balance between intimacy and isolation… [in which] recognition of one’s ultimate aloneness…give intimacy its base… [and] one’s capacity for security in that aloneness…makes genuine intimacy impossible” (Kroger 31). Depression increases feelings of isolation that can harken back to adolescence in a number of ways—through loss of interest, a negative view of the world, weakened social skills and empathy for others, reduced optimism and motivation, and decreased competence in intimate relationships (Kaelber, Moul, and Farmer 26). These feelings contrast with an already existing relationship to create identity confusion and inhibit intimacy in a way that, in Erikson’s normative experience, exists primarily during puberty and adolescence. Donald Hall uses his essay “Ghosts in the House” to reflect on his wife’s struggle with love, through the eyes of a caregiver and husband, “One of the hardest things, if you are depressed, is to try to hold yourself up in the presence of others, especially others whom you love” (Casey 170). With one partner’s presence in the relationship constantly jeopardizes by the overhanging cloud of depression, brought in and then shadowing the both of them, there is a dichotomy created in which intimacy forced by the established relationship fights against loneliness and distance to inhibit what might otherwise be a healthy relationship.

Depression has the capacity to haunt not only the individual but also the relationship itself, tearing and withering away at attitudes, behaviors, and communication. Depression, Hall explains, is a constant third party in his marriage, a sentiment Russell Banks shares in “Bodies in the Basement”: “It’s not unlike the invisible third person who appears in one’s family when a parent or sibling or child is an addict or alcoholic and whose presence alters everyone’s behavior and perceptions in tiny, incremental ways, until before long… [no one] can know who he is anymore or who the others are without that third person present” (Casey 34).  It takes up space in the relationship, causing the depressed partner to perceive their partner as hostile while their own aversive behaviors function as an emotional contagion that “prompts others to act with interpersonal rejection (Segrin et al. 26).  Whereas up until this point a relationship might have been stable, fluid, and healthy, the strain of behavior, demeanor, and attitude depression brings wears away at the ties between partners and the functionality of the relationship.

            Depression can also eat away not just at relationship quality but at the process of identity sharing between lovers, cutting away at intimacy and connection. Banks comes to blame his wife “first, for not having allowed [him] to cure her of her depression, and then for infecting [him] with it” (Casey 36). As they grappled with the strains on their relationship, they “put [their] identities at risk” (34), a fundamental flaw in Erikson’s notions of intimacy: “‘Intimacy is the ability to fuse your identity with somebody else’s without fear that you’re going to lose something yourself’” (Erikson, cited in Evans 1967: 48, qtd. in Kroger 30). His love and compassion for his wife spurred an unhealthy reaction for Banks. Unable to process her decline in a healthy manner, he struggles to maintain an independent identity, even going so far as trying to feel her pain with her. Both of them fall apart in different ways, with her depression isolating her while also creating identity confusion and preventing their identities from fusing in that healthy way.

The increasing sense of isolation for the individual, the strain on the relationship, and the reduced ability to maintain healthy intimacy for the couple are causes for feeling like a child or an unformed adolescent. They these are more characteristic of relationships prior to or early in the sixth stage, when the self-assuredness and maturity to forge intimacy have yet to develop and relationships are characterized  by a tendency towards either codependence or isolation, adoration or mistrust, and a lack of communication and support. Thus, depression functions to diminish both perception of adulthood from the outside (for those who see this “immaturity”) and feelings of adulthood from the inside (for those who are involved with a relationship that gradually wilts as the depression grows).

Stage Five: Fidelity

            Erikson’s fifth stage is the development of identity in the context of the larger world, characterized by “finding a ‘feeling of reality’ in socially approved roles” (Kroger 29); in other words, directing one’s energies and values to an “ideological world” that enables one to find a role and feel a sense of purpose in  the prescribed social order. This stage, when growing up, resolves the identity crises of adolescence, creating directionality and reason so that one can function within the constructs of the world (“world” here primarily being Western society). However, as with the stage of generativity versus stagnation, identity versus role confusion exists by reinforcing the standards of the normative life cycle and assumptions about social roles. Depression often brings instead both the loss of and indifference towards social identity, replaced by unwillingness to engage in the tasks and chores of everyday life.  One study has found, for example that escapist and suicidal wishes were frequent among patients with depression; that is to say that they wished to escape the problems of everyday life—for example, some “had daydreams of being a hobo, or of going to a tropical paradise.” Actually “escaping” by evading tasks, however, only brought on guilt for shirking responsibilities instead of relief (Beck and Alford 203).

            Several of the writers in Unholy Ghost write of difficulty in their careers and lives. Virginia Heffernan, as a result of her manic depression, went seemingly overnight “from a twenty-eight-year-old optimist, the type advertisers and politicians take into account, who might find a career and start a family, to a person who is unreliable and preoccupied, a person other people find themselves trying to avoid” (Casey 10). Likewise, David Karp’s essay “An Unwelcome Career” reflects on the periodic impact depression had on each of his life roles: it “has made [him] that [his] life was not worth living, has created havoc in [his] family, and sometimes made the work of teaching and writing seem impossible” (148). Both writers, pre-depression, had everything Erikson describes: a vocational passion, someplace to channel their energies, desire to be an active member of society, and values and perspectives that supported all of the above. They are unable both to “affirm and be affirmed by a social order that identity aspires” (Kroger 29).

As a result of depression, Heffernan and lose their place in a pre-established social order, coming into positions that society disapproves of—and, in Heffernan’s case, even coming into a role that society actively resists. Moreover, depression brings indifference towards these the negative connotations of these positions. Heffernan’s descent into lying and damaging her relationships continued until her mother came in to support her, convincing her to begin medication; meanwhile, although Karp’s depression has not managed to take over or ruin his family, career, or life, he has only been able to avoid this fate by allowing it to become a part of his life, coming to terms with it in a way that is, in many aspects of American society, resists and criticizes. These twin sides of depression reflect two major foci of depression that create conflict throughout the identity stages and place the depressed in the realm of the child, the internal and external transitions. Internally, depression weathers away drive in career, social involvement, and sense of purpose, all of which are expected of adults. Externally, the people who interact with the depressed on a daily basis—for example, coworkers or neighbors—are likely to meet these changes with judgment, again seeing them as immature or even selfish.


Impact of Erikson’s Construct

Erikson’s fifth, sixth, and seventh stages encompass the process of forming and maintaining an “I” in relation to another “I” and a “we.” All are centered on developing and securing a unique identity in order to be accepted as a member in society. When an adult does not succeed in these stages (either because of the onset of depression during one of them or by returning to them as a result of depression), they are likely to be deemed childish and irresponsible—because of their difficulty caring for themselves, for caring for others, for maintaining an strong sense of self, and so on. Torn out of their “normal” lives; by wearing away at each of these senses of selves, adults with depression cease to be able to be perceived as adults. And the alienation they receive for failing to meet expectations of caring, love, and fidelity during adulthood is likely to  unravel the character, strengths, values, and faculties built up in the first four stages that typically occur during childhood and early adolescence:

These connotations, however, do nothing but damage, building up shame and stigma around mental illness while inhibiting productive response. Pre-established stages set standards for behavior which do not take into account the facts: that everyone experiences life differently; that any number of identities, illnesses, or experience can affect development, the aging process, and the person; and that these standards are a purely Western construct and feed into stereotypes about and discrimination against anyone outside of the Western world as well as non-normative members of Western society. In the quest to make sense of development, development markers like those set by Erikson ostracize those who are “non-normative.”

For one, the rigidity of numbered stages and their primary association with creates the impression of a domino effect that breaks down seven stages straight. As a result, the person in question is dehumanized because they failed in achieving “optimal resolutions” and thus seem to lack basic human traits. Furthermore, assumptions of development markers contribute to the stereotypes that depression is “all in your head,” curable by positive thinking and maybe talk therapy. Rather than encouraging research into how depression affects the body and brain, it is reduced purely to the conscious mind—as if it is something for which a person must take responsibility, as if it is their fault, their decision. The resulting stereotypes and stigma around mental illness function to condemn those with those illnesses, to silence their voices rather than listen to them, support them, provide them the care that they need, and encourage their recovery process.

Even Erikson’s very theory of identity disregards biology, genetics, and neurology, among numerous other factors: he claims that the life cycle is “a series of stages, critical periods of development which involve bipolar conflict that must be addressed and resolved before one can proceed unhindered” (Kroger 23). Each stage is a test, pass or fail, succeed and level up or get lost and be stuck until success is reached. Kroger likens this process to a child learning to crawl before walking, but this is an unforgiving and rather reductionist assessment. Rather than viewing life as a series of exams, it is essential to recognize the fluidity central to each individual’s unique experience. Some “phases” might be reached at different ages for different individuals, or in a different order, or not at all. These phases function only to create a norm from which to stray; that is to say, they affirm the life experiences of some while creating additional judgment for others—for not only are they coping with their own challenges, they are also failing to be proper humans by someone else’s standards. To shift our view of development away from these stages creates space for looking beyond their limited scope and understanding more about factors that alter individual experiences—not only mental illness but also a variety of intersectional identities such as race or class—by learning instead of condemning.


Hitting Close to Home

            The major challenges I have seen or faced with regards to depression are heavily influenced by judgment, stereotypes, and stigma, and go to demonstrate the detrimental nature of our understanding and categorization of development. They are rooted in several major problems caused by Erikson’s theorizing and similarly stigmatizing thinking: the notion of depression as a choice; the shame of receiving care, especially hospitalization; the neglect of biological and genetic components of depression; and the belief that life events have a sort of domino effect on Erikson’s stages and that one detrimental time in life is the cause for all of today’s problems.

            As a result of the common belief that depression is one’s choice or, in other words, that the symptoms of depression are one’s own fault and a person is in complete control of their thoughts, feelings, and behaviors, my sister’s realization that she had depression was delayed to a detrimental extent. It wasn’t until I told her that I’d just found out via my doctor that I’d been experiencing spells of depression, that she realized that she as well. It took her own sister seeking treatment to realize that her experiences—which were much more severe and inhibiting than what I’d been coping with—were not her fault, that it wasn’t her being a bad person but her body acting against her. We discuss depression in terms of symptoms and checking off boxes, but it’s something that doesn’t really seem to sink in until we’re living it, blaming ourselves for our recklessness and acting immature during a spell of depression. And then, once diagnosed, it can take a fair amount of coping and therapy (my sister certainly experienced this) to come to terms with the fact that depression does not make you a bad person. She was left believing that her struggles were her own fault, that she needed to get it together, even after being diagnosed. A 2011 study exploring resilience during depression found that her sentiments are shared: even though “many individuals consider the cause of depression to be beyond their control, they nevertheless consider the problem of depression as their inability to deal with themselves and their life situation” (Boardman et al. 2011). That is to say, even upon recognizing that depression is a disease, the stigma that problematizes the very state of having depression creates pressure to take personal responsibility for recovery. Had she not been exposed to this major inaccuracy, she may have realized her experiences were not normal much earlier; moreover, as she now seeks treatment, less outside pressure to push forward with the expected stages of her life and get back as soon as possible to being a “real” adult would only help her to become more comfortable and open with her recovery process.

            Feeding into the assumption that depression is a choice, or that it is the result of choices and events during the course of one’s life and is thus somehow within control, is the assumption that medicating is the easy way out and signifies weakness. I went on medication during my freshman year of college in an attempt to control frequent mood swings and depression spells. Pre-medication, I was unbearable to be around, and I couldn’t bear to be around other people. I couldn’t sleep and couldn’t eat, and alternated between shutting myself in the library basement for hours at a time and running my mouth unstoppably during lunchtime conversations. Post-medication, I was back to my normal self. As simple as that. I felt literally lighter, a weight removed. Yet I have had more than a few experiences that told me that I shouldn’t tell people about my depression, that I shouldn’t tell people I’m on medication, that I am somehow a feeble-minded person because I couldn’t think my way out of it.

Erikson might tell both me and my sister that our inability to conform to what was expected of us—that our feelings of isolation and indifference towards nearly every part of our respective lives—were a result of taking the wrong path somewhere, maybe that we have trust issues stemming from a dysfunctional relationship with our parents early in infancy. And, in return, I might tell him that I have a great relationship with my mother, and that he should pay a bit more attention to the role of genetics in brain chemistry, because my depression comes primarily from a long family history. I might tell him that my sister had the same biological components; that she studied a pressure-cooking major at a pressure-cooker school; and that, the summer the need became evident that she needed intensive care, she was alone on the opposite side of the country as her family and friends at a miserable internship in the middle of the desert. In more, an entire life can’t be reduced to eight stages, pass or fail. There are complex layers, folds, seams, and fractures. Experiencing a “failure” later in life—for example, lack of so-called “productivity”—cannot and should not be reduced to simply a failure to properly form an identity. There are so many more components to an individual’s life and personhood than just events and choices—genetics, upbringing, relationships, growth, brain wiring, environment, physicality—that neither can be simplified to numbered stages during a predetermined life cycle.

To elaborate, there is also a central flaw in the notion that problems in the present can be traced back to one failure or mistake years, even decades, prior, and that failing somewhere during the formation of “identity synthesis” somehow prevents one from ever reaching any other stage.  Placing each of these stages in a numerical order functions to associate one’s orientation relative to a stage with one’s age. For example, although she is in young adulthood and should therefore have emerged from the fifth stage of fidelity after adolescence, her depression has resulted in loss after the fact. Fidelity, Erikson claims, is “not only a renewal on a higher level of the capacity to trust (and to trust oneself), but also the claim to be trustworthy, and to be able to commit one’s loyalty…to a cause of whatever ideological denomination” (Erikson 60).  However, as a result of her illness, she has lost her ability to trust herself—in anything from her physical body to her ability function in stimulating environments. She has lost faith additionally in those around her; the uprooting she is experiencing causes her often to draw back and, as she explores different parts of her life, past and present, to lose faith in those closest to her. The process of restoring faith is one that relies primarily on time and recovery, not on growing up—for she already has. Moreover, fidelity also is meant to encompass the period when trust transitions from “infantile trust” to “mature faith,” from “the need for guidance from parental figures to mentors and leaders” (73), a statement that puts into words the criticism of adults who still require the care of parental figures. Thus, my sister, who lives at home and requires relatively high levels of care, guidance, and support from our parents, is infantilized instead of supported in an endeavor that is essential for her recovery. Erikson’s theory fails to take into account life events that could disrupt an earlier stage while criticizing those who “regress” due to said life event by rooting them back in the age range with which that stage is associated—in my sister’s case, rooting her with adolescence. The assumption that stages take place sequentially, one after another, then helps contribute to stigma around those with depression being deemed childish or immature as a result of their development (or “lack” thereof).


What can Social Work do?

            It is evident that Erikson’s model is highly problematic when examining depression in the context of standards for development; however, social work can actively reduce the stigma of depression by rethinking it for the reasons I have described. Although there is certainly validity to understanding aging through his eight stages in certain situations, in the context of depression it serves only to add shame to illness by infantilizing those who have depression, have been diagnosed, or are being treated. Approaching aging with fluidity and flexibility enables a stronger understanding of depression as an illness; by allowing for Erikson’s stages to be moved around, expanded upon, and eliminated, categorization by development and age can be replaced with association between processes of growth and interaction.

None of the individual in Unholy Ghost had the same experiences—some may have been comparable, but all had unique journeys and outcomes. Some began medicating and recovered almost immediately, returning to “normal” life. Others went through numerous treatments; still others didn’t even begin treatment until it was necessitated by the loss of a job or a death in the family or even a suicide attempt. Moreover, experiences were complicated by other intersecting identities; for example, Lauren Slater’s “Noontime” addresses conflict between the need to medicate, the severity of her depression, pregnancy, and her forthcoming identity as a mother with a severe mental illness, while Meri Nana-Ama Danquah writes in “Writing the Wrongs of Identity,” “As a black woman struggling with depression, I don’t know which I fear more: the identity of illness or the identity of wellness” (Casey 175). With so many layers, it is essential to be mindful that, to begin with, not everyone will conform to Erikson’s standards; with depression added to the dilemma, there is no single approach to treatment that can be prescribed in every case. And, as Boardman et al.’s study demonstrated, “nurturing resilience,” though a widespread attitude for depression patients who either are receiving subpar care or still think of recovery as a personal undertaking, simply is not enough.

In informing treatment for adults with depression, it is essential to consider issues that specifically pertain to adults: functioning and role in day-to-day life; expectations around family, career, and social standing; and stigma around seeking treatment, especially when unable to live independently. Some of the gaps in care provision became evident in the way that various authors described their experiences with treatment. Slater was faced with a major ethical dilemma; on the one hand, her already-severe depression worsened during her pregnancy, but she would run high risks of harming her child if she chose to medicate. However, she received little guidance; a perinatal psychopharmacologist prescribed her lithium, Prozac, and Klonopin, all of which could pose a risk to a fetus. She received no guidance from a counselor on the emotional difficulty of potentially having to choose between the life of her unborn child and her own life. Russell Banks compromised his wife’s health and their relationship by fusing their identities to an unhealthy level, harming himself until he learns “to feel for [his] wife and to avoid feeling with her...[because] it is arrogant for [him] to claim to feel another person’s pain—unless he’s willing to become that person” (Casey 37). Had he and his wife received or had access to better guidance or therapy, he may have been able to avoid the semi-depressive spells he fell into as a result of no knowing how to help her. Counseling for depression in adults entails specificities beyond what is needed for other age groups, as each age group has particular and unique needs. For adults, as demonstrated, these needs might include parenting (either during pregnancy or with children in addressing the concerns of being a “fit” parent, as Slater coped with) or relationships.

Similarly, there is a stigma for adults around receiving round-the-clock care, either living with, depending on age, their grown children or their own parents. The field of disability studies often supports the solution of interdependence when one is no longer able to live independently. Rather than institutionalize (dependence) a disabled individual who cannot live on their own any more (independence), the notion that individuals living together and supporting each other is often the best solution. Erikson’s standards along with those most commonplace today emphasize independent living; however, here again there is a substantial amount of ableism present in modern expectations, since many disabilities can make living completely independently nearly impossible, while having to maintain “normal” arrangements is done only to the detriment of the family and the individual with depression. Studies cited in the article “Life Context, Coping Processes, and Depression” break down the many ways the “normal” adult’s daily life “normal” life can inflict harm. Cronkite and Moos explore the impact of two forms of chronic life stressors. Role stressors “encompass ongoing difficulties or problems that are associated with occupying certain roles” (573), including occupational, familial, or caregiver roles, while also layering in the additional stress that occurs between roles that are inescapable (e.g., parent) and roles that conflict with one another. Ambient stressors, meanwhile, are “problems that characterize the quality of life of the individual, such as disadvantageous life circumstances (financial difficulties, unsafe neighborhood) or the physical or emotional dysfunction of a family member” (573).

Role and ambient stressors comprise the parts of an adult’s environment that contribute to depression that are inescapable without major adjustments, due to obligations to family, financial restraints, expectations for providing care, and, perhaps most importantly, expectations to maintain stability and “normalcy.” But rather than promote a lifestyle to the detriment of both the patient with depression and those around them (e.g., their child or spouse, as above), it is essential to support and give access to interpersonal care, whether by financially supporting or providing for caretakers, backing any sort of interpersonal living community for individuals with mental illnesses (as Camphill Village lifesharing communities provide for adults with developmental disabilities), and spreading information about alternative living arrangements to provide better support for adults with severe mental illnesses. Common understandings of depression cite four interacting sources: psychological, biological, genetic, and environmental. Genetics are inalterable, but psychological and biological causes are treated relatively effectively with combinations of therapy and medication, leaving only environmental as the one major cause that is left out of common courses of treatment due to the difficulty in changing environments in spite of major stressors. However, environmental stressors are also those which social work can readily alleviate. By taking the approach of improving living conditions—through anything from providing financial support to assisting in relocation—social work has the capacity to improve the quality of lives of those with depression, enabling a more productive recovery.



In his essay “Heaven and Nature,” Edward Hoagland reflects, “Nobody expects to trust his body much over the age of fifty…But not to trust one’s mind? ... Adults might be vain, unimaginative, pompous, and callous, but they did have their affairs tightly in hand” (Casey 52). His words sum up one root of American culture’s general difficulty de-stigmatizing depression. Depression is a betrayal of the mind and body. It is a betrayal that forces the mind to fight against the soul, every step of the way, it weathers and burdens until the weight becomes a reality that permeates and controls everything: interactions, fears, anxieties; awareness of self and behavior; ability to continue on with the motions of daily life necessitated by society. It is this stagnation, this loss of role in society, which calls to mind childhood. Adults with depression are removed and distant as a child; lose control in a way that is unacceptable for adults; and require care that is only seen as appropriate for a child). As Meri Nana-Ama Danquah sums up in “Writing the Wrongs of Identity,” with depression, “you are lazy, incapable, selfish, and self-absorbed” (176), everything most unacceptable in adulthood.  

Although the pain and trials that come with severe depression are often inevitable before meeting and while traversing the path to recovery, the shame, distress, and infantilization that may be experienced are not. Though beliefs surrounding adulthood may be social constructed by Erikson’s theories of development and the standards they produced, the impact they have on the mental illness community is very real. Adults with depression experience not only the disease but the stigma: internally, the many voices of Unholy Ghost expressed that they have no control; that they do not know what’s coming next or what to do when it arrives; that they are out-of-place in today’s world; and that they are not only shamed for their illness but degraded as human beings. It is this stigma, then, that social work can reduce, and it is this additional pain that it can eradicate.



Works Cited

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Beck, Aaron T., and Brad A. Alford. "Psychological Studies." Depression: Causes and Treatment. 2nd ed. Philadelphia: U of Pennsylvania, 2009. 169-210. Print.

Boardman, Felicity, Frances Griffiths, Renata Kokanovic, Maria Potiriadis, Christopher Dowrick, and Jane Gunn. "Resilience as a Response to the Stigma of Depression: A Mixed Methods Analysis." Journal of Affective Disorders 135.1-3 (2011): 267-76. ScienceDirect. Web. 14 Dec. 2014.

Casey, Nell, ed. Unholy Ghost: Writers on Depression. New York: Morrow, 2001. Print.

Cronkite, Ruth C., and Rudolf H. Moos. "Life Context, Coping Processes, and Depression." Handbook of Depression. Ed. E. Edward. Beckham and William R. Leber. 2nd ed. New York: Guilford, 1995. 569-87. Print.

Erikson, Erik H. The Life Cycle Completed: Extended Version. Ed. Joan Erikson. London: W.W. Norton &., 1997. Print.

Kaelber, Charles T., Douglas E. Moul, and Mary E. Farmer. "Epidemiology of Depression." Handbook of Depression. Ed. E. Edward. Beckham and William R. Leber. 2nd ed. New York: Guilford, 1995. 3-35. Print.

Kroger, Jane. Identity in Adolescence: The Balance between Self and Other. 3rd ed. New York: Routledge, 4004. Print.

Segrin, Chris, Heather L. Powell, Michelle Givertz, and Anne Brackin. "Symptoms of Depression, Relational Quality, and Loneliness in Dating Relationships." Personal Relationships 10.1 (2003): 25-36. Wiley Online Library. Web. 14 Dec. 2014.


MyTherapist New York's picture

As a mental health counselor in New York, I see a lot of my colleagues with social work backgrounds and often wonder - but how do they work with clients? I get that the author sees the problem as the depression, and the feeling degraded about HAVING the depression, but what exactly does a social worker do to TREAT the depression? Social work as working towards social change so that mental illness is not stigmatized- yes, totally. But what does social work offer as depression treatment?