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Crippling depression meaning


SAMHSA’s National Helpline | SAMHSA

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  • SAMHSA’s National Helpline is a free, confidential, 24/7, 365-day-a-year treatment referral and information service (in English and Spanish) for individuals and families facing mental and/or substance use disorders.

    Also visit the online treatment locator.

SAMHSA’s National Helpline, 1-800-662-HELP (4357) (also known as the Treatment Referral Routing Service), or TTY: 1-800-487-4889 is a confidential, free, 24-hour-a-day, 365-day-a-year, information service, in English and Spanish, for individuals and family members facing mental and/or substance use disorders. This service provides referrals to local treatment facilities, support groups, and community-based organizations.

Also visit the online treatment locator, or send your zip code via text message: 435748 (HELP4U) to find help near you. Read more about the HELP4U text messaging service.

The service is open 24/7, 365 days a year.

English and Spanish are available if you select the option to speak with a national representative. Currently, the 435748 (HELP4U) text messaging service is only available in English.

In 2020, the Helpline received 833,598 calls. This is a 27 percent increase from 2019, when the Helpline received a total of 656,953 calls for the year.

The referral service is free of charge. If you have no insurance or are underinsured, we will refer you to your state office, which is responsible for state-funded treatment programs. In addition, we can often refer you to facilities that charge on a sliding fee scale or accept Medicare or Medicaid. If you have health insurance, you are encouraged to contact your insurer for a list of participating health care providers and facilities.

The service is confidential. We will not ask you for any personal information. We may ask for your zip code or other pertinent geographic information in order to track calls being routed to other offices or to accurately identify the local resources appropriate to your needs.

No, we do not provide counseling. Trained information specialists answer calls, transfer callers to state services or other appropriate intake centers in their states, and connect them with local assistance and support.

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Last Updated: 08/30/2022

Alcohol, Tobacco, and Other Drugs

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Misusing alcohol, tobacco, and other drugs can have both immediate and long-term health effects.

The misuse and abuse of alcohol, tobacco, illicit drugs, and prescription medications affect the health and well-being of millions of Americans. NSDUH estimates allow researchers, clinicians, policymakers, and the general public to better understand and improve the nation’s behavioral health. These reports and detailed tables present estimates from the 2021 National Survey on Drug Use and Health (NSDUH).

Alcohol

Data:

  • Among the 133.1 million current alcohol users aged 12 or older in 2021, 60.0 million people (or 45.1%) were past month binge drinkers. The percentage of people who were past month binge drinkers was highest among young adults aged 18 to 25 (29.2% or 9.8 million people), followed by adults aged 26 or older (22.4% or 49.3 million people), then by adolescents aged 12 to 17 (3.8% or 995,000 people). (2021 NSDUH)
  • Among people aged 12 to 20 in 2021, 15.1% (or 5.9 million people) were past month alcohol users. Estimates of binge alcohol use and heavy alcohol use in the past month among underage people were 8.3% (or 3.2 million people) and 1.6% (or 613,000 people), respectively. (2021 NSDUH)
  • In 2020, 50.0% of people aged 12 or older (or 138.5 million people) used alcohol in the past month (i.e., current alcohol users) (2020 NSDUH)
  • Among the 138.5 million people who were current alcohol users, 61.6 million people (or 44. 4%) were classified as binge drinkers and 17.7 million people (28.8% of current binge drinkers and 12.8% of current alcohol users) were classified as heavy drinkers (2020 NSDUH)
  • The percentage of people who were past month binge alcohol users was highest among young adults aged 18 to 25 (31.4%) compared with 22.9% of adults aged 26 or older and 4.1% of adolescents aged 12 to 17 (2020 NSDUH)
  • Excessive alcohol use can increase a person’s risk of stroke, liver cirrhosis, alcoholic hepatitis, cancer, and other serious health conditions
  • Excessive alcohol use can also lead to risk-taking behavior, including driving while impaired. The Centers for Disease Control and Prevention reports that 29 people in the United States die in motor vehicle crashes that involve an alcohol-impaired driver daily

Programs/Initiatives:

  • STOP Underage Drinking interagency portal - Interagency Coordinating Committee on the Prevention of Underage Drinking
  • Interagency Coordinating Committee on the Prevention of Underage Drinking
  • Talk. They Hear You.
  • Underage Drinking: Myths vs. Facts
  • Talking with your College-Bound Young Adult About Alcohol

Relevant links:

  • National Association of State Alcohol and Drug Abuse Directors
  • Department of Transportation Office of Drug & Alcohol Policy & Compliance
  • Alcohol Policy Information Systems Database (APIS)
  • National Institute on Alcohol Abuse and Alcoholism

Tobacco

Data:

  • In 2020, 20.7% of people aged 12 or older (or 57.3 million people) used nicotine products (i.e., used tobacco products or vaped nicotine) in the past month (2020 NSDUH)
  • Among past month users of nicotine products, nearly two thirds of adolescents aged 12 to 17 (63.1%) vaped nicotine but did not use tobacco products. In contrast, 88.9% of past month nicotine product users aged 26 or older used only tobacco products (2020 NSDUH)
  • Tobacco use is the leading cause of preventable death, often leading to lung cancer, respiratory disorders, heart disease, stroke, and other serious illnesses. The CDC reports that cigarette smoking causes more than 480,000 deaths each year in the United States
  • The CDC’s Office on Smoking and Health reports that more than 16 million Americans are living with a disease caused by smoking cigarettes

Electronic cigarette (e-cigarette) use data:

  • In 2021, 13.2 million people aged 12 or older (or 4.7%) used an e-cigarette or other vaping device to vape nicotine in the past month. The percentage of people who vaped nicotine was highest among young adults aged 18 to 25 (14.1% or 4.7 million people), followed by adolescents aged 12 to 17 (5.2% or 1.4 million people), then by adults aged 26 or older (3.2% or 7.1 million people).
  • Among people aged 12 to 20 in 2021, 11.0% (or 4.3 million people) used tobacco products or used an e-cigarette or other vaping device to vape nicotine in the past month. Among people in this age group, 8.1% (or 3.1 million people) vaped nicotine, 5.4% (or 2.1 million people) used tobacco products, and 3. 4% (or 1.3 million people) smoked cigarettes in the past month. (2021 NSDUH)
  • Data from the Centers for Disease Control and Prevention’s 2020 National Youth Tobacco Survey. Among both middle and high school students, current use of e-cigarettes declined from 2019 to 2020, reversing previous trends and returning current e-cigarette use to levels similar to those observed in 2018
  • E-cigarettes are not safe for youth, young adults, or pregnant women, especially because they contain nicotine and other chemicals

Resources:

  • Tips for Teens: Tobacco
  • Tips for Teens: E-cigarettes
  • Implementing Tobacco Cessation Programs in Substance Use Disorder Treatment Settings
  • Synar Amendment Program

Links:

  • Truth Initiative
  • FDA Center for Tobacco Products
  • CDC Office on Smoking and Health
  • National Institute on Drug Abuse: Tobacco, Nicotine, and E-Cigarettes
  • National Institute on Drug Abuse: E-Cigarettes

Opioids

Data:

  • Among people aged 12 or older in 2021, 3. 3% (or 9.2 million people) misused opioids (heroin or prescription pain relievers) in the past year. Among the 9.2 million people who misused opioids in the past year, 8.7 million people misused prescription pain relievers compared with 1.1 million people who used heroin. These numbers include 574,000 people who both misused prescription pain relievers and used heroin in the past year. (2021 NSDUH)
  • Among people aged 12 or older in 2020, 3.4% (or 9.5 million people) misused opioids in the past year. Among the 9.5 million people who misused opioids in the past year, 9.3 million people misused prescription pain relievers and 902,000 people used heroin (2020 NSDUH)
  • According to the Centers for Disease Control and Prevention’s Understanding the Epidemic, an average of 128 Americans die every day from an opioid overdose

Resources:

  • Medications for Substance Use Disorders
  • Opioid Overdose Prevention Toolkit
  • TIP 63: Medications for Opioid Use Disorder
  • Use of Medication-Assisted Treatment for Opioid Use Disorder in Criminal Justice Settings
  • Opioid Use Disorder and Pregnancy
  • Clinical Guidance for Treating Pregnant and Parenting Women With Opioid Use Disorder and Their Infants
  • The Facts about Buprenorphine for Treatment of Opioid Addiction
  • Pregnancy Planning for Women Being Treated for Opioid Use Disorder
  • Tips for Teens: Opioids
  • Rural Opioid Technical Assistance Grants
  • Tribal Opioid Response Grants
  • Provider’s Clinical Support System - Medication Assisted Treatment Grant Program

Links:

  • National Institute on Drug Abuse: Opioids
  • National Institute on Drug Abuse: Heroin
  • HHS Prevent Opioid Abuse
  • Community Anti-Drug Coalitions of America
  • Addiction Technology Transfer Center (ATTC) Network
  • Prevention Technology Transfer Center (PTTC) Network

Marijuana

Data:

  • In 2021, marijuana was the most commonly used illicit drug, with 18. 7% of people aged 12 or older (or 52.5 million people) using it in the past year. The percentage was highest among young adults aged 18 to 25 (35.4% or 11.8 million people), followed by adults aged 26 or older (17.2% or 37.9 million people), then by adolescents aged 12 to 17 (10.5% or 2.7 million people).
  • The percentage of people who used marijuana in the past year was highest among young adults aged 18 to 25 (34.5%) compared with 16.3% of adults aged 26 or older and 10.1% of adolescents aged 12 to 17 (2020 NSDUH)
  • Marijuana can impair judgment and distort perception in the short term and can lead to memory impairment in the long term
  • Marijuana can have significant health effects on youth and pregnant women.

Resources:

  • Know the Risks of Marijuana
  • Marijuana and Pregnancy
  • Tips for Teens: Marijuana

Relevant links:

  • National Institute on Drug Abuse: Marijuana
  • Addiction Technology Transfer Centers on Marijuana
  • CDC Marijuana and Public Health

Emerging Trends in Substance Misuse:

  • Methamphetamine—In 2019, NSDUH data show that approximately 2 million people used methamphetamine in the past year. Approximately 1 million people had a methamphetamine use disorder, which was higher than the percentage in 2016, but similar to the percentages in 2015 and 2018. The National Institute on Drug Abuse Data shows that overdose death rates involving methamphetamine have quadrupled from 2011 to 2017. Frequent meth use is associated with mood disturbances, hallucinations, and paranoia.
  • Cocaine—In 2019, NSDUH data show an estimated 5.5 million people aged 12 or older were past users of cocaine, including about 778,000 users of crack. The CDC reports that overdose deaths involving have increased by one-third from 2016 to 2017. In the short term, cocaine use can result in increased blood pressure, restlessness, and irritability. In the long term, severe medical complications of cocaine use include heart attacks, seizures, and abdominal pain.
  • Kratom—In 2019, NSDUH data show that about 825,000 people had used Kratom in the past month. Kratom is a tropical plant that grows naturally in Southeast Asia with leaves that can have psychotropic effects by affecting opioid brain receptors. It is currently unregulated and has risk of abuse and dependence. The National Institute on Drug Abuse reports that health effects of Kratom can include nausea, itching, seizures, and hallucinations.

Resources:

  • Tips for Teens: Methamphetamine
  • Tips for Teens: Cocaine
  • National Institute on Drug Abuse

More SAMHSA publications on substance use prevention and treatment.

Last Updated: 03/22/2023

“Without anxiety, she would have died” The story of a patient who could not live without constant fear, excitement and stress: Books: Culture: Lenta.ru

Fear not only makes the heart stop and palms sweat, fear allows a person to anticipate a conflict situation if possible, avoid it. However, in an effort to prevent danger, people - as individuals and as a society - can literally deprive themselves of the future. How to face your fears and understand the nature of their occurrence, tells the book by Frank Faranda "The Paradox of Fear: How the obsession with security prevents us from living. " With the permission of the Alpina non-fiction publishing house, Lenta.ru publishes a fragment of the text.

At the beginning of my work as a psychologist, I had a patient named Sherry who was experiencing severe anxiety. She was constantly overcome by vague forebodings of some kind of approaching disaster. The main symptom was constant anxiety, accompanied by irritability, insomnia and muscle weakness. She made plans and lists, as if possessed, and spoke so quickly that I could hardly keep up with her speech. Sherry didn't pause, and if I wanted to put in a word, I literally had to interrupt her.

It was hard to be around her. Sherry seemed to vibrate all over and seemed electrified. Most surprising and puzzling, however, was that she did not come to treat her anxiety. Twenty-three-year-old Sherry, a very successful young woman, was convinced that she had great untapped potential and was so in need of self-improvement that if she didn’t hurry, she would literally lose the future she was “destined to. ”

Of course, as a novice psychotherapist, I had no idea how to work with her. For many of us, anxiety is a crippling disease that restricts freedom and devours vitality. As we learned in the introduction, about a third of the adult population experiences anxiety at one time or another in their lives. It is an essential part of our society. Anxiety includes and is included in its statistics such disorders as phobias, obsessive-compulsive disorder, panic disorder and post-traumatic stress syndrome.

Advanced, severe forms of anxiety of this kind can lead to impotence and victimization, a person loses interest in life, self-respect and, ultimately, his "I". Interestingly, anxiety appears to exist in all cultures. Although the modern lifestyle in the West has exacerbated it, studies show that in the East and in developing countries there is almost the same level of anxiety as in the United States. Differences that appear to be cross-cultural relate more to the subject and forms of anxiety and, to a lesser extent, to the extent of underlying physiological and psychological distress.

For example, in 1967 Singapore was seized with a strange anxiety. Many men were afraid that their genitals would be drawn into the abdominal cavity. The anxiety was so strong and persistent that the clinics were filled with anxious men, terrified of the possibility of catching the "sickness" and dying. What caused the epidemic remains a mystery to this day. However, most of us by "anxiety" mean what happened to Sherry.

Photo: Ben Blennerhassett / Unsplash

Like Sherry, many of us have what's called generalized anxiety disorder (GAD). This type of disorder most often demonstrates the main difference between fear and anxiety. If fear is a neurobiological defensive reaction to an observed threat, then anxiety, on the contrary, is pointless fear, in which the threat is vague or hidden.

In my professional experience, GAD is a condition that ranges from the most severe forms, like Sherry's, to mild ones that fall short of diagnostic criteria. Many of us live with mild GAD, and it often seems to be a normal consequence of modern life. Such anxiety is often dealt with by "folk" methods, such as a glass of wine at five o'clock in the evening, a couple of joints when the children are put to bed, or even with the help of Xanax on a particularly difficult day.

Under the yoke of the demands of Western society, it already seems impossible for us to avoid this type of anxiety, which, perhaps, is becoming a more familiar and non-pathological condition for us compared to depression. It's hard to even roughly say how many times I've heard from patients: "Come on, nothing, I'm just a little worried." Often this is said to show that the state that creates the distress of excitement and anxiety that they suffer is just a small thing.

And although I am convinced that these disparaging statements are often a defense, a way to discount or avoid what is behind the anxiety, it is often said quite sincerely. However, such a pronounced concern and fear, like Sherry, is a completely different matter.

All my attempts to get Sherry to see her anxiety as a problem have been rebuffed. Whenever I asked her to slow down, dive into her bodily sensations, or get in touch with her inner emotional life, she resisted violently. I have never met a person more devoted to their anxiety than Sherry. She was genuinely worried about the future, especially that she would not be able to meet the challenges she might face.

As a beginner, I fell into the trap of trying to convince Sherry or reinforce the idea that she was outstanding, which means there was nothing to worry about. I tried cautiously to suggest that something deeper might be disturbing her, of which she was not yet aware, but all my efforts were in vain. She stubbornly continued to torment herself with cruel self-criticism, which only aggravated anxiety. When all was said and done, Sherry was convinced that her anxiety was justified.

I remember one time I asked her to imagine what would happen to her if she weren't so anxious. She looked at me with a smile and calmly said, “I think I would die.”

Photo: Jill Burrow / Pexels

Before delving deeper into Sherri's predictions for her own future, it must be acknowledged that her assessment of anxiety is not entirely without merit. Research dating back over a century suggests that anxiety can increase our performance. Howard Liddell, one of the first researchers on anxiety, at 1949 suggested that anxiety is the "shadow of the intellect" and, therefore, the inevitable accompaniment of the life of an educated and cultured person.

David Barlow, who is considered the author of the "bible" of anxiety, went even further: "Without anxiety, almost nothing could be achieved. The achievements of athletes, artists, leaders, artists and students would be lower; creativity would die out; it would be impossible to grow a crop. And we would all fall into the idyllic state that our hurried society has long dreamed of: we would spend our lives lying in the shade of a tree. For our biological species, this would be as disastrous as an atomic war.

In my opinion, Barlow went too far in assessing the role of anxiety in society and culture, especially in his belief that without anxiety, creativity would dry up. However, even with this exaggeration in his description, it is impossible not to notice something significant. Like Sherry, many of us are constantly in a state of apprehension and worry, yet we somehow continue to make progress.

Unlike fear, in which we are mainly driven to act by the desire to be away from the source of the threat, anxiety is a strange mixture of attraction and repulsion. Somewhere out there, ahead, there is a threat, and we are scared. However, as Sherry suggested, there is also an impulse in anxiety that, paradoxically, pushes us towards life, and ultimately towards the future.

Now that we have seen how vulnerable our long-time ancestors were in the dark, we can imagine the benefits of a developed imagination in terms of increased security. It was probably only 50,000 years ago that we moved from immediate reactions of fear to preventive reactions that reduced the possible risk. In addition to more skillful use of tools come long-term solutions such as stockpiling weapons, erecting permanent walls, strategic planning, and establishing agricultural settlements—all forms of long-term defense emerge.

Photo: Diana Smykova / Pexels

In addition to the value of these tools and approaches to us, an even more epoch-making achievement has come about with the advent of imagination. What was truly revolutionary, in my opinion, was the fundamental “invention” that basically defined our unique existence as Homo sapiens—we invented the future.

A space opened up in our minds that allowed us to anticipate future possibilities and enact probable outcomes. This new vision in the mind's eye is part of "time travel," in the terminology of Thomas Suddendorf of the University of Queensland.

In his study of the differences between humans and other animals, Saddendorf identified this ability to travel through time as the main thing that makes us human. Moreover, I would add that our sense of self and our ability to hope and dream are based on this.

Much of Suddendorf's and other time travel research is devoted to episodic memory and why it is central to this ability. Episodic memory enables us to create an experiential awareness of ourselves in time and space. For example, “I live in the 21st century; I grew up in the United States and I'm going on vacation in February." This is different from so-called semantic memory, memory for facts (like "the capital of the state of New York is Albany").

According to Suddendorf, episodic memory became a precondition for time travel. She created a cognitive schema that allowed us to move "forward" into the future. I see it as an experimental template by which we can extend our "feeling" of the present back into the remembered past and forward into the possible future. As a result, in our development we have moved beyond the standard set of reactions to a predictable environment - forms of behavior that have developed over millions of years - and entered a new era in which we took evolution into our own hands.

We, Homo sapiens, unlike other species, have fully acquired the ability to develop adaptively, and with this achievement, the ability to shape the future. It should be remembered, however, that when the imagination looks into the future, it does so in the service of fear. The very validity of a future existence depended on this ability of the imagination to act as the locum tenens of a suspicious mind. For all its potential value, a prosperous future with limitless possibilities is also a dark future of endless horror.

Imagination was able to help fear solve the problem of darkness due to its predisposition to suspicion. Therefore, the future, on which we are very dependent, always seems to us with an inherent imprint of an impending threat. Moreover, the future that we all face is time and place without material content. The vague hope expressed by Virginia Woolf in the epigraph to this chapter taunts us along with reality, saying, "The way you see yourself in the future is an illusion." In this sense, the security of existence that each of us aspires to is undermined with every breath we take.

Photo: Elsa Tonkinwise / Unsplash

Looking for a solution to the problem of darkness in the present, Fear and Imagination have created a new form of darkness. It is this new, future-stretching darkness that I believe plays a huge role in the psychological distress we now call anxiety.

Therefore, in my opinion, Kierkegaard, Rollo May and other philosophers saw the source of anxiety in the separation of existence and meaning. How can we have the certainty of existence when the future we so desperately long for slips through our fingers every time we anxiously try to grasp it.

For most of us, anxiety is an inevitable experience in preparing for the future. This is how we deal with the “What if?” questions that life asks us. However, anxiety is also an irrational obsession that requires you to prepare for the worst again and again.

On closer examination of anxiety, it becomes clear that if it is driven by an exaggerated sense of threat, even an unlikely or fantastic one, then this forces the mind to look for ways to prevent it. But, as experience shows, anxiety rarely leads to a practical solution to the problem.

Theorists of anxiety and pathological anxiety do not agree on what causes and maintains anxiety. According to one of the ideas about the sources of anxiety, it is supported by the desire to avoid the "contrast" of alternative emotional states. From this point of view, people who are prone to pathological anxiety prefer to maintain a negative state of anxiety so as not to experience risky transitions between positive and negative states. They believe that it is not the negative state that should be avoided, but the change of states.

This view is consistent with real evidence of how we keep ourselves from disappointment. To be sure, we have all tempered our exuberant anticipation of the future in preparation for disappointment. This is the essence of cynicism: “If you always prepare for the worst, you will not be disappointed!”

The second theory states that anxiety is a way to avoid unwanted emotions that are inseparable from the object of our fears. Since anxiety manifests itself primarily in verbal/linguistic activity, it is very different from the emotional distress of fear and anxiety. One of the proponents of this model, researcher Thomas Borkovec, describes anxiety as a form of "self-talk".

When the mind is engaged in linguistic "anxiety" work, awareness of emotional distress is reduced. This model suggests that the value of anxiety lies in its ability to distract us from distress.

I would suggest that anxiety as the primary instrument of anxiety is an attempt to build a shaky bridge between "us" in the present and "us" in the future. Worry may have arisen in us as a way of cognitively compensating for the lack of emotional security in a future that is beyond our control. Can we then argue that anxiety is both a symptom of the problem and its imagined solution?

Translator Natalya Kolpakova

Psychological meaning of depression //Psychological newspaper

According to the generally accepted definition, depression is a mental disorder, the main features of which are low mood and a decrease or loss of the ability to experience pleasure (anhedonia). Additional symptoms of depression may include low self-esteem, inadequate guilt, pessimism, impaired concentration, sleep and appetite disorders, and suicidal tendencies. Severe forms of depression are characterized by the so-called "depressive triad": decreased mood, mental retardation, and motor retardation.

Depressive mood in some cases can be a normal temporary reaction to life events, such as the loss of a loved one. Depression can be a symptom of certain physical illnesses and a side effect of certain medications and treatments; if the cause of depression is not obvious and depressive disorder occurs without external influences, such depression is called endogenous. With depression, self-esteem is reduced, there is a loss of interest in life and habitual activities.

Depression is experienced as a loss of activity, a certain vital motive, value. Such a loss can be obvious when the life situation is connected with parting, death, serious illness. But you can also lose something that is difficult to define, to express in words, but what made life full, gave meaning. In case of loss, we are faced with emptiness. Devastation. This meeting itself shows us the limitations of our Being.

Existential analysis, based on the four dimensions of human existence: physical, social, personal and spiritual, establishes four limits - death, loneliness, absurdity and lack of freedom. Rarely do our experiences relate to one thing, in isolation from others, along with loneliness, we experience absurdity, nonsense, and death, and the restriction of our freedom, our capabilities. Emptiness in the sense of emptiness is a projection onto the boundaries, edges, limits, certainties of our being, our life.

As never before, in a state of depression, we feel our “abandonment” (“abandonment”), and along with it, other fundamental existential experiences are actualized. existential loneliness. Existential guilt. existential vacuum. The last category, introduced into psychology by Viktor Frankl [5], to the greatest extent reflects the encounter of the individual with emptiness, but he specifically implied the loss of the meaning of life. The meaning of life implies a rather extensive range of phenomena, this is the sphere of relations with other people, this is both activity and creativity, the search for answers to spiritual questions. So we can agree that the "existential vacuum" is analogous to the emptiness that a person experiences in depression.

What is this emptiness?

Our consciousness is heterogeneous and is a system consisting of several levels. The most considered of them are two: the level of involuntary regulation and the level of voluntary regulation. These two levels are S.L. Rubinstein considered as two modes of existence. The first way is a life that does not go beyond it; “such a life acts almost like a natural process, in any case, the immediacy and integrity of a person living such a life is obvious ... Here morality exists as innocence, as ignorance of evil, as a natural state of man” [3, p. 336]. The second mode of existence is connected with reflection and leads to the construction of life on a new basis. “Consciousness acts here as a break, as a way out of complete preoccupation with the immediate process of life in order to develop an appropriate attitude towards it, taking a position above it, outside it for judging about it” [3, p. 336].

A similar point of view was expressed by Heidegger . M. Heidegger believed that there are two fundamental modes of existence in the world: 1) the state of oblivion of being, 2) the state of awareness of being... Usually people stay in the first mode. Forgetfulness of being is an everyday way of being. M. Heidegger calls it "inauthentic" - in it we do not recognize ourselves as the creators of our own life and world, we "flight", "fall into a trap" and become calm; we avoid choice by being "carried into" nobodyness ". Having passed into the second mode, the mode of consciousness of being, we exist authentically... We become fully self-conscious - aware of ourselves simultaneously as a transcendent (determining) Ego and as an empirical (determined) Ego; accepting their capabilities and limitations; confronting with absolute freedom and non-existence" [9, With. 37].

Practically in every psychological theory these two forms - natural and cultural consciousness - are described in different terminology depending on their value context. The multidirectionality and, if I may say so, the "diversity" of these components determines the majority of internal conflicts, breaks in internal integrity. The feeling of fullness of life and self-fulfillment arises due to the synthesis of these components.

Accordingly, the conflict and rupture of these two "consciousnesses" leads to a feeling of emptiness. What is behind the disconnection of these modes of consciousness? We see three possibilities.

1. Existential (natural) consciousness is included in the system of life relations and is inseparable from them. When something in life relations changes, is lost, the existential consciousness loses the habitual space of life, and the reflective consciousness "survives" the lack of support - the content of reflection. These are cases of depression associated with life circumstances, ranging from autumn depression to depression due to the loss of a loved one.

2. In another case, the reflexive consciousness breaks away from life relations, making an arbitrary effort to achieve the set goal, and this goal is alien to the natural psyche of a person, his existential consciousness. This is the “depression of asceticism”, the ascetic way of life. It is especially experienced when the goal is achieved and the expected satisfaction from the result is not expected. These are cases of depression of people who are actively engaged in a career or business, or who have gone to distant lands for a “new life”. What matters here is the organic nature of the goal set by the inner nature of man. If a person acquires something that harmonizes, although it changes, it, the restructuring of the system of relations occurs quite quickly.

3. The third variant of the gap is a crisis. In the event of a crisis, the existential consciousness of a person requires new forms of reflection, which a person does not possess. This is a period of searching for the spiritual foundations of life for further transformation, and this search is often accompanied by depression, since the gap itself is an experience of emptiness. Despite the natural nature of this variant of depression, it is experienced with great suffering, already because it has no obvious causes.

These three options arise depending on where the person's I is, the center of his identity, value priorities.

The first option, when depression arises from changes in the life world, the existential consciousness is dominant. In addition to difficult life circumstances, depression can be exacerbated by the accumulation of emotional experiences that have a destructive effect on a person. This is resentment, guilt, envy, helplessness, etc. Personality in this variant often "merges" with depression. The state of depression is accepted as one's own, as heredity, as a result of one's wrong actions. A person begins to limit himself in initiatives, the circle of interests narrows, more often hypochondriacal experiences occur.

Healing from depression here will depend on how developed a person's reflective consciousness is. Yes, and the depressive state itself directs to the development of reflection and self-awareness. In the event that self-consciousness is active and self-esteem is sufficiently realistic (the level of claims corresponds to the possibilities), a person can work with destructive experiences with a psychologist or independently. In one of the works ML von Franz [6] recommends in case of depression to occupy one's thinking with various tasks, puzzles. This allows a person to "get out" from the power of negative feelings, at the same time activates the arbitrary function of consciousness, strengthens attention.

In the case when self-consciousness does not represent such a support, when there is a gap between the expected and achieved, when the main direction of the locus of control is external, depression can give rise to various forms of deviations. In this variant, a stable role of the victim in interpersonal and social relations can be formed.

By shifting responsibility for one's condition to those around one, a person is not only freed from feelings of guilt, but also manages and controls others. Such co-dependent relationships relieve depressive experiences, but do not overcome depression. The latter is “embedded” in the system of personality regulation with other people. Resentment, accusations, tormenting guilt, increased anxiety are constantly present in interactions. Dependence on feelings, emotional background, mood gives rise to other problems. Being unable to cope with his lack of activity, a person is looking for ways to have fun. Often such depression is the beginning of alcohol and drug addiction. This is how the illusion of controlling one's emotional state arises, leading to the destruction of the personality.

The second option concerns people with a developed reflective consciousness. In this case, the suffering emotional part of the psyche is poorly realized, it is, as it were, in the shadow of consciousness. A person often cannot understand what is happening, there are no ways to recognize changes in emotions. This is a frequent variant of masked depression, or somatized. A depressed person begins to look for the causes of poor sleep, dreary mood, reduced activity, attention disorders in health problems. It can be fixed for a long time on various diseases. Or he finds his own way to force himself to be healthy, changes his lifestyle, overcoming mental anguish.

The main life guide for people with a dominant reflexive consciousness is a sense of duty. And the destruction of the way of life (divorce, change of government or state foundations, the destruction of a career, etc.) is most often the cause of depression for them. It is difficult for them to rebuild and build a different order of their own lives. The rigid form of the system of relations does not correspond to changes in content. This can lead to agitated depression—depression with high levels of anxiety. Anxiety is a predictive emotion ( E.P. Ilyin ). For people who are characterized by a sense of duty, it is characteristic to be goal-oriented, the goal is in the future. And this future is not just doubtful, it is completely destroyed. Agitated depression is depression with a pronounced sense of guilt, guilt that is not real, but has a basis within the person himself. This painful condition can lead a person to suicide.

In one of the previous articles, we considered the types of despair defined by S. Kierkegaard in the work "Sickness to Death" on the example of the heroes of the novel by L.N. Tolstoy Anna Karenina. Kierkegaard considered the types of despair differently than we analyze the types of depression. He singled out three forms: 1 - desperate, not conscious of his Self, 2 - desperate, conscious of his Self, but not wanting to be himself, and 3 - desperate, conscious of his Self and wanting to be himself. However, the analysis of the behavior and experiences of the characters perfectly illustrates the descriptions of the first two variants of depressive experiences. Anna Karenina and Steve Oblonsky - the first option, Alexei Karenin - the second. Below is a quote from this article.

Despair will be resentment if the despairing one does not ask himself what his fault is. So, Anna Karenina runs this issue. Feeling no guilt (and split) within herself from the duality of her position, the external world appears dual and guilty for her. S. Kierkegaard writes: “...what we are dealing with now, despair, when they want to be themselves, is the most saturated and condensed of all, this is demonic despair. Moreover, a person wants to be himself not because of a stoic addiction to himself or idolatry before himself, ... no, he wants it in hatred for existence and in accordance with his misfortune” [3, p. 303]. Further: “In order to represent this in images, let us suppose a certain typo that eludes its author - a typo endowed with consciousness - which in essence may not be such at all, but if you look at the whole text as a whole, some inevitable feature of this whole—and now, having rebelled against its author, it would hatefully forbid him to correct itself, but would exclaim in an absurd challenge: no, you will not cross me out, I will remain a witness against you—a witness that you are just an insignificant author! » [3, c. 304]. In her simple naivety of the desire for love, in her truth-for-herself, Anna rightly expects that the outside world (the people around her: loved ones and the upper world) will understand her and accept her as she is. In fact, Anna cannot accept herself without the approval of the light. By her actions or her inaction, indecision, inability to go to the end, to sacrifice her truth for the sake of others (her one of her loves - for Vronsky or Seryozha), she calls on the outside world to change, but she does not change. Her desperation is desperation-challenge. This is the strength of a person who seeks to throw his whole being into the destruction of the “old wrong structure of society” and die with it. Anna's despair leads to death.

The despair of her brother, Steve Oblonsky — we will call his experience desperate, relying on those moments when he cannot, does not understand what to do, when the shadow of retribution for his “petty joys” hangs over him — leads to the consent of the lack of ethical principles . “Yes, the person is weak, awkward, clumsy, but the soul is kind. Yes, he cannot resist temptations, but you can also forgive. He himself is ready to forgive others for their sins. As a rule, such an understanding is characterized by the realization that the whole world is so arranged, that a person is so arranged, and nothing can be done about it. The value of "eternal" is closed to such a despairing one. “... Such a desperate person forgets about himself, forgets his divine name, does not dare to believe in himself and considers it too daring to be himself, and therefore believes that it is easier and more reliable to be like others, to be the embodiment of monkeying, one of the numbers absorbed by the herd ... At the price the loss of his Self, such a despairing one immediately acquires infinite dexterity, thanks to which he is readily accepted everywhere and he achieves success in the world” [3, p. 271].

Karenin's despair is quite the opposite of Oblonsky's. Although this is also an unconscious despair, but preference in the choice is given to the "eternal" in man. His original desire for universal "correctness", his holy faith in the perfection of moral principles, rather leads him to enjoy the consciousness of ethical positions, to "emasculated religiosity", to dogmatics. The immediate, concrete, "temporary" Self ceases to be active. S. Kierkegaard, in describing this despair, introduces the concept of imagination. Imagination, he believes, takes a person to the infinite, but in doing this, only removing him from himself and preventing him from returning to himself. “And when one of the faculties of this Self, that is, will, knowledge or feeling, is mired in the infinite, my whole Self is ultimately in danger of being drawn into the infinite.” Describing one of Karenin's conversations with his son, L.N. Tolstoy notes: “Seryozha’s eyes, shining with tenderness and fun, went out and lowered under the gaze of his father. It was that familiar tone with which his father had always treated him, and which Seryozha had already learned to imitate. His father always spoke to him - this is how Seryozha felt - as if he was addressing some imaginary boy, one of those that are in books, but not at all like Seryozha" [2, p. 522]. The imaginary world in which Karenin lives changes the world of real relationships for him. Real relationships are replaced by ideal ones. So, in the same “instructive dialogue” with Seryozha, recalling the overcoming of disgust for his work, Karenin speaks of love for work. Karenin's religious orientation feeds the imaginary world. “The orientation towards God endows the I with infinity, but in the cases mentioned, the infinite, which arises when the imaginary has completely absorbed the I, only leads a person to an empty intoxication” [2, p. 270; 10].

An example of Anna's experience of depression is absorption by destructive emotions: jealousy, resentment. Her reflective consciousness, let's say, was "deactivated" when she encountered emptiness. The example of her brother, Steve Oblonsky, does not illustrate depression so clearly, but shows us what happens when there is no depression as such - the loss of one's own Self. This desire for pleasure is a kind of response to depression, a defensive reaction that does not allow "destructive" ethical moral basis. And the completely opposite variant of Karenin's experience is with the dominance of reflexive consciousness, when orientation towards the future turns into "imaginary". In general, Kierkegaard writes that the I is a relation to the synthesis of the "eternal" and "temporal" in man (in other words, reflexive and existential consciousnesses). Depression as a meeting with emptiness is a violation of the "temporary", "eternal" and the connection between them. In the case when existential (“temporary”) consciousness dominates, a person is oriented to a greater extent to the past. On the existing life relationships, emotional ties. And it is precisely the destructive force that is given to unforgiven grievances, unexpressed anger, jealousy - all that stems from the past.

In the case of the dominance of reflective consciousness, a person is primarily focused on the future. These are achievements, development of abilities, new qualities. Destruction of the set goals or the loss of their meaning is a violation of the future, and it causes depression. The question is legitimate: where is the present?

The third variant of depressive disorders, related to the crisis, is typical for a person whose self is localized in the very synthesis of existential and reflective consciousnesses, the synthesis of "temporal" and "eternal". Crisis, as you know, is an experience of personal change. This change occurs in the search for new forms of combination of existential and reflexive consciousnesses without taking into account their own changes, which, as a rule, are also present. The self of a person in this version refers to the experience of correlation, connection, synthesis of two forms of consciousness. What a person lived and lives in suits him, what was and is his perspective, in principle, also suits, but at the same time, a feeling of emptiness and meaninglessness appears.

The negative form of experiencing this depression is detachment. Emptiness is experienced as the loss of dialogue. As an example, we can recall the film by I. Bergman "Persona", in which the famous actress became dumb. Her state is the state of meeting with emptiness.

The interaction of two levels of consciousness is a necessary dialogue for creative work. The creative basis is indispensable for the implementation of a person's life path, for his actions, for making life choices. An internal dialogue is always present if a person lives an authentic life. Kierkegaard views this dialogue in a religious way as a dialogue with God. It defines three stages of human life: aesthetic, ethical and religious. The transition to the latter, as can be assumed, corresponds to a mid-life crisis. In any case, depression of this type suggests psychological maturity, although it can manifest itself much earlier than 40 years.

Phenomenologically, “detachment”, “muteness” are experienced as internal fragmentation, disunity, artificiality, lack of an internal core. Depending on the strength of this manifestation, a person may retain or lose his ability to work, as the stability of attention and memory are sharply reduced.

"Emptiness" in our culture has, first of all, the meaning of "nothingness" and has a negative connotation. But emptiness has a downside. In the introductory article to Martin Heidegger's Time and Being V.V. Bibikhin writes: “… in Heidegger, emptiness, as they would say in philosophical jargon, is productive as an inclusive openness…” [7, p. 15].

In other words, emptiness can be a starting point, a beginning or a condition for the manifestation of human creativity in various forms, including in relation to oneself. Reflecting on the essence of the concept of "emptiness", M. Heidegger writes:

“Quite often, emptiness appears simply as a lack. Void is then regarded as the absence of filling of cavities and intermediate spaces. But, perhaps, just the emptiness is akin to the proper essence of the place and therefore it is not an absence at all, but a product. Again, language can give us hints. In the verb "to let in" there is an inlet, in the original sense of a concentrated gathering reigning in a place. An empty glass means: collected in its release and able to let in the contents. The void is nothing. It is also not an absence” [7, p. 315].

The special meaning of emptiness is noted in the Tao Te Ching: “Thirty spokes are connected in one hub, [forming a wheel], but the use of the wheel depends on the emptiness between [the spokes]. Vessels are made of clay, but the use of the vessels depends on the emptiness in them. They break through doors and windows to make a house, but the use of the house depends on the emptiness in it. That is why the usefulness of [something] that exists depends on emptiness” [1, p. 118].

Depression, which affects the synthesis of two forms of consciousness, can be the best medicine if through it a person sees emptiness as freedom. In this case, the opportunities for development and creativity increase.

But how is this possible? If old grievances do not cling (the past does not take hold of the personality), and anxiety about the future is insignificant, at least enough to not cause anxiety, this creates the possibility of living in the present. In the experience of the present there is an openness to the outer world. Depression as a feeling of isolation strikes the sense of belonging to the world, but it makes it possible to understand that in the world there is not only love and joy, but also suffering, disappointments, ruins, all those existential limits that we talked about at the beginning of the article. Creating a new, “dark” window to the world, depression, strange as it sounds, enriches the experience of a person, balancing in his mind the experiences of joy and grief, love and loneliness, meaning and absurdity. A person's attitude to life becomes deeper when he accepts depression for what it is, without fighting or condoning.

  1. "Tao Te Ching" trans. Yang Hing-shun // "Ancient Chinese Philosophy", vol. 1. - M .: Thought, 1972. - 362 p.
  2. Kierkegaard S. Fear and Trembling. — M.: Respublika, 1993. — 489 p.
  3. Rubinshtein S.L. Man and the World // Problems of General Psychology. — M.
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