Is Your Depression an External or Internal Job?

Rear view of person in black and red hooded sweatshirt walking alone down the middle of a road on a misty dayYou may know how common depression is—6.7% of all Americans age 18 or older experience at least one major depressive episode each year, according to statistics compiled by the National Institute of Mental Health. It might even be expected in certain contexts, such as the loss of a job or a loved one. Other times, it creeps in mysteriously. As a therapist, I see many people who struggled for a long time before they finally sought help.

One of the first things I do when meeting for the first time with a person experiencing depression is try to figure out if their blues are an internal or external job. This can take a little time to unravel, as there are many layers that can lead to someone feeling depressed. It’s important when treating depression to try to change what we can control and learn coping skills that can help us with the rest.

So how do you know if your depression is a product of your environment—family, friends, job, housing or financial situation—or if it instead stems from unproductive or self-defeating thoughts, self-esteem or self-control issues, or possible biological reasons that may warrant a medical assessment?

When It’s an External Job

Perhaps this winter has been a difficult time in your life. The holidays are past, the weather is cold, and the days are short. The nation is apprehensive and divided about a new presidential term. Maybe you are worried about tax season, waiting anxiously on news from college applications, or feeling bad after excess food or drink at the end of the year.

Many people seek therapy after enduring a difficult situation. They have been caring for a sick family member, are going through a breakup, or have failed a class for the second time in a row. They need help for a depression which is mostly a result of a life situation that has happened to them. They feel like a weight has been put on them and can identify what it is.

Right now, many people are feeling the weight of conflict on a global scale. Some are worried about climate change, health care, humanitarian crises, or unemployment. “State of the world” depression, as I call it, is a common woe in 2017.

These cases call for action:

  • Tools (to date again, for example, or to reconcile with a partner or roommate)
  • Skills (to interview for a different job or take better care of themselves)
  • Ideas (for how to ease overwhelm around finals at the end of a semester)
  • Information (how to sleep better, study better, or manage time more efficiently)

Taking action on external depression is an important step toward feeling better and more empowered. Fortunately, therapy can help—especially solution-focused therapy, which is practical and tool-oriented.

When It’s an Internal Job

Have you had a time in your life when you just couldn’t seem to get enough sleep? When the things you always looked forward to didn’t interest you or when you had trouble feeling much of anything at all? People with these depression symptoms might say their lives are “better than most” and may feel guilty for feeling down. They may struggle with feeling ungrateful because, at the same time, they feel like something is “missing.” Life may feel like an endless treadmill of nice-but-nothing-great.

The No. 1 indicator to me of an internally driven depression is when people can’t tell me anything they’re excited about in their future.

The No. 1 indicator to me of an internally driven depression is when people can’t tell me anything they’re excited about in their future. When we lose the ability to look forward to the things that historically keep us satisfied, we’re in trouble. People with internally driven depression may have grown used to being on the sidelines, watching the energy of the world bustle around them. They may find it tiring to make decisions or to engage.

These cases call for structured treatment:

  • Evaluation (by a medical doctor to determine there’s no medical cause, such as anemia, thyroid problems, or other issues that may cause fatigue or apathy)
  • Cognitive therapy (thought charts and other structured homework done daily to encourage the person to engage less with their “sideline”-causing thoughts)
  • A “good habits” checklist (making sure they are getting enough sleep, sunshine, healthy diet, exercise, contact with others, etc.—all the recommended depression treatments to give themselves the best chance of feeling better)
  • Journal therapy (structured 5-minute writing sessions that allow a solution-focused therapist to look at the person’s thoughts)

Some things are out of my scope of practice (medical evaluations, for example), but since symptoms of depression overlap with some treatable medical conditions, if there is no identifiable external cause it’s always a good idea to see a doctor, too. Recently someone I work with in therapy felt too tired to socialize or exercise, which was creating problems at work as well as causing him to spiral personally. When he learned he was anemic and started following his doctor’s medical recommendations, his fatigue went away, which started positive momentum toward participating in his usual, satisfying life.

People with internally or externally driven depression can usually expect their symptoms to improve if they use structured, research-based treatment methods such as cognitive therapy. Depression tends to call for a lifestyle tune-up—and you don’t have to go it alone.

Reference:

National Institute of Mental Health. (n.d.). Major Depression Among Adults. Retrieved from https://www.nimh.nih.gov/health/statistics/prevalence/major-depression-among-adults.shtml

© Copyright 2017 GoodTherapy.org. All rights reserved. Permission to publish granted by Lindsey Antin, MA, MFT, therapist in Berkeley, California

The preceding article was solely written by the author named above. Any views and opinions expressed are not necessarily shared by GoodTherapy.org. Questions or concerns about the preceding article can be directed to the author or posted as a comment below.

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  • Coker

    Coker

    February 7th, 2017 at 4:44 PM

    My husband is experiencing an external depression. He hates his job so much right now and is even having problems with his blood pressure that I am also sure is a result of how much stress he is feeling. I am scared of what will happen to him if he isn’t able to find something soon because we need both incomes to stay afloat. But I don’t want him to risk his life over a job either, and I want to tell him just to leave but that is a little scary for me without having another job in hand. He has taken antidepressants before and didn’t like how it made him feel but I told him that there are so many kinds out there now that there could be something new he could try.

  • Lori

    Lori

    February 8th, 2017 at 11:30 AM

    The one time in life when I have felt that real depression was when I was going through menopause and my hormones were all out of whack. It is like you are self aware enough to know that there is something going on there that isn’t right but you lack any sort of ability to even care about doing anything about it.

  • Karin C

    Karin C

    February 9th, 2017 at 9:09 AM

    This is a good article-however one word of caution, Lindsey. You referred to depression in the very beginning of your article as ,”the blues.” Depression is a severe and ongoing medical condition that if left untreated, can lead to suicide and other lethal behaviors. The blues , as society calls it, is a very temporary feeling that is resolved rather easily and generally has no lasting long term effects. People need to understand that a depressive disorder vs “the blues ” is as different as a head cold and a heart attack. People need intervention, sustained professional help and sometimes medical management when they are suffering from depression. Usually “the blues” can be remedied by taking the girls out to lunch.

  • A. Johnson

    A. Johnson

    May 6th, 2017 at 4:07 PM

    Perhaps I’m misunderstanding the point of this article….. but as a sufferer of Major Depressive Disorder for over 20 years, I’m making the following comments based on personal experience, not career-based assessment.

    First, I agree with another commenter, Karin C. except she was very diplomatic in her “word of caution” to this author’s bogus statements that “internal” vs. “external” depression are based on what can be perceived as, “the blues”. If I were goodtherapy.org, I’d never allow this article to be published, despite the disclaimer. This author’s article has basis for discussion, but totally lacks substance. First, in lieu of referencing the NIH statistics of 6.7 adults in the US being diagnosed with depression disorder, it might be more eye-capturing and better absorbed by the reader to state, “In 2015, an estimated 16.1 million adults aged 18 or older in the United States had at least one major depressive episode in the past year” ~
    nimh.nih.gov/health/statistics/prevalence/major-depression-among-adults.shtml

    What truly serves as a counterproductive effort on part of this author to help and support those who suffer this mental disorder is that she seems to essentially VALIDATE non-sufferers who have no inclination of what Depression is about and who suggest that it is a sadness which can be cured by taking action. The reality is: there is no “reason for” or “types of” depression. Another area of concern, aside from the stigma which is totally discouraging for those who suffer depression is reading these “cure-all” articles by a clinician or physician who claim to be “an expert” albeit never having the disorder themselves. Mind you, I’m not trying to discount this author’s credentials. In fact, I didn’t even research her background prior to this comment only because it’s really a moot point. Unlike what we know about other ailments and disease such as cancer and cardiac illnesses, mental health disorders cannot be defined to the point where there is rational explanation of what prompts it, let alone being referred to as either “internal” or “external” suffering.

    DEPRESSION HAS VERY LITTLE TO DO WITH A CURRENT SITUATION – that noted, there are in fact “triggers” which cause relapse and ignite harsher symptoms than the day before, etc….. but to claim it is something which actually stems from a cause or purpose (breakup, family issues, etc) is truly inaccurate and misleading. If there is just ONE person out there who is misguided by this article to believe that those who suffer from clinical depression disorders can be “cured” by narrowing down whether it’s an internal or external “job”, it totally negates the reality of it all. This disorder only allows for the treatment of symptoms; however, is a lifelong battle in which relapse is prevalent. To suggest that those who suffer clinical depression “..can usually expect their symptoms to improve” once identified as an “internal” or “external” job can very well be communicating false hope. Rather, while DBT or CBT and daily journaling are great resources for coping on a day-to-day or even minute-by-minute basis, the emphasis of this mechanism is not stressed upon on as much as it should be. From my standpoint, if someone wants to help someone with Depression, then don’t try to understand it because you never will (we don’t even understand it). Keep it real by offering resources to cope and inspiration to work through each setback…..

  • Lindsey Antin

    Lindsey Antin

    September 8th, 2017 at 5:09 PM

    Hi readers,
    Thanks for the comments. You’re absolutely right that depression is much more than the “blues” and this edit of my piece should have not used those words as they are not a proper synonym.
    However, I stand by the reality that some individual’s depression — for them — can be circumstantial and it is helpful for these individuals to see it as such. For example, those with a longterm injury, financial stress, or those who are managing the care of another sick or elderly person are all situations which can contribute to a depressive episode, and which are likely to improve when the situation is changed. Also some individuals experience depression due to physical problems which can be treated (those with hormonal, thyroid, sleeping problems etc).
    This is of course different than major depressive disorder and should be treated as such. I have found over my years of practice that it is helpful for the person I am working with to understand what elements of their depression will respond to different treatments. It is this outlook that empowers the clients I work with to help address their depression, even if it is likely to be something they struggle with throughout the years.

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