Positive Thinking: Not a Cure for Severe Depression

The piece "How Positive Thinking Drives You Into Depression" pushes back against a popular assumption: that someone can simply think their way out of a depressive disorder. It asks why people keep believing cheerful thoughts will dissolve depression, and it argues that managing depressive symptoms often has little to do with optimism at all. TJ Nelson locates the trouble in how depression gets framed. People treat it as a problem of thinking, something happening entirely "in your head." If you accept that, and you're depressed, you're signing up for a long and frustrating stretch. So if thoughts aren't the cause, what is?

Nelson writes from his own history with anxiety and depression. At his worst, one book meant to help him did nothing. He isn't dismissing cognitive therapy; he calls it highly effective, with a condition attached: your prefrontal cortex has to actually be working. When your body aches, food and sleep are impossible, and you're counting the minutes while fighting the urge to tear at your own skin, a workbook won't reach you. His line on it is blunt. Save Feeling Good for a day you feel good enough to read it.

He reaches for a weight-loss analogy. Picture a supplement that helps burn off the last stubborn pounds, but only when the diet and the workouts are already in place. Skip the exercise and the eating, and the supplement does nothing. A single hopeful thought works the same way against a deep depression: it isn't enough to move brain chemistry. Nelson grants that positive thinking can do real work in milder anxiety or low mood. In a severe state, he says, thoughts alone can't shift the underlying chemistry, and the order matters. Change the chemistry first, and only then are you positioned to change how you think.

His explanation runs through medication. Antidepressants do something because they alter chemistry, and with it the state of the mind. The common SSRI blocks serotonin from being reabsorbed, so more of it stays available in the brain. More serotonin moves the mood. A moved mood clears the way for thinking straight, and for thinking positively. Meditation can help with depression too, he notes, but most Westerners can't sit quietly for five minutes before they're up and off to do something else. Holding a chosen frame of mind across a whole day becomes an enormous ask, close to impossible for many. That's why the physical side has to be addressed first, to get basic physiology back into balance so those other strategies have a chance. The thread running through it: positive thinking isn't the cure on its own, and the origin of a depression may sit in blood chemistry.

The suggested approach starts with the body. Check for and correct deficiencies through vitamin supplementation. Restore neurotransmitter balance naturally with amino acids. Have thyroid hormones tested with bloodwork to confirm the gland is doing its job. Nelson's recommendation is to repair your body and brain state before you attempt to paper over the harder physical parts with forced cheer. He puts identifying the root cause first. Positive thinking has its place in a mild case; severe depression calls for something more intensive. (Attributed to Kim B.)

A second reader, Bergen, adds a different angle. Positive thinking is a fine way to meet life. It can carry hope, even some peace, into rough patches. Stay upbeat and you'll likely gather more friends and acquaintances, the person others want nearby. But it won't repair anyone, and it won't break you either. It won't make you the best at what you do, and playing Mr. or Ms. Positive might simply irritate the people around you. Which raises an odd question. Is positive thinking actually all that positive? At least it isn't negative. For someone who's depressed, a hopeful influence or role model can genuinely help and refresh, though how much depends entirely on how deep the depression runs. A severely depressed person can't just take up positive thinking and expect a cure, and that failed expectation can drive them further down. Someone decides the disorder is all in their head, that a good thought or two is the whole fix, and when it doesn't work, the fall is steeper.

Bergen tells a bowling story to make the point, with a disclaimer that no one with depression is being compared to a bowling game. He used to love it. He practiced and practiced, and his scores climbed. Some nights it felt like he could will the ball down the lane, the way the pros seem to. He never rolled a 300 and never averaged in the high 200s, but he could usually beat whoever he was up against, which maybe meant nothing more than weak competition. Then interest faded, the visits stopped, and when he came back he'd lost the edge. Out of practice. He sees positive thinking against depression the same way. Drop the routine and it loses its force. Positive thinking is a perishable skill.

Reference: How Positive Thinking Drives You Into Depression. (n.d.). Retrieved December 29, 2014, from dominatedepression.com.