I am going to talk about a slightly controversial topic - depression as a symptom of PTSD. I want to start off by saying that Major Depressive Disorder and Persistent Depressive Disorder are both very real. My argument here is that they are often over-diagnosed and those who find themselves going back and forth with antidepressants, are struggling on and off for years, and don't quite know why "nothing is helping" may also be dealing with something else, such as Complex Post-Traumatic Stress Disorder (C-PTSD).
Ongoing depression can be created from the trauma response collapse/submit. This is often when the person cannot do anything else to fight back and feels like the only thing they can do is submit or collapse. This is one of the body's most primal responses to intense fear. Many people who have experienced significant trauma might ask themselves, "why didn't I fight back? why didn't I fight or scream or do something?" -- often understanding this as your body's response to intense fear can help some of those critical thoughts coming through. I did research and studied intimate partner violence and sexual assault for several years in college and in my early 20s, and one story that really stuck with me actually had nothing to do with partnerships. I was listening to a presentation at a conference on Tonic Immobility, which is the body's collapse/submit/ultimate shut down response, and the presenter shared a story about seeing a coyote in his driveway carrying a dead squirrel. When he turned his headlights on, it scared the coyote, who then dropped the dead squirrel. The squirrel then got up and ran away, completely uninjured. The presenter went on to say that he would have never thought the squirrel was alive - it was completely limp and lifeless in the coyote's mouth. This is a physiological response of bodily shut down to prevent further injury and pain to the body. Needless to say, I have always been fascinated by this.
Fast forward more than a decade, I am deep in the trauma treatment world of EMDR therapy and DBR therapy, and I have seen more and more the responses of shut down happening. Many posts I have written have been about shutting down emotions as a major survival skill. I see it all.the.time. with people who have had to grow up in families where their emotional experiences weren't validated, or their requests to meet their needs were confused. For example, neurodivergent children might need to be soothed in a different way than neurotypical children, and this may result in a "misattunement" on the part of the parent. And then that child grows up thinking, "I guess there's something wrong with me" if they are not being soothed by the comfort offered like other children are. When the child goes years and years with this belief, it can often lead to a regular experience of shut down as a way to get the emotional experiences to not be as painful. This can also lead to the fear of their emotions. Fear of emotions, or intense negative emotions, can come from many different upbringings, and for many different reasons. Without the consistent experience of co-regulation with a caregiver in childhood, the child is not able to understand that emotions, like waves, come and go, and have more intense periods. There may be high peaks and low valleys, but they will ALWAYS even themselves out. When the child does not understand that and therefore does not trust that, they may begin to preemptively shut down. They may start to believe that their feelings will make them lose control, lose attachments, and/or kill them. [Back to the neurodivergent child... they may additionally have a belief that their emotional experience is "incorrect" or "too much" because their responses may be different than those of their peers, and this may be reinforced in many areas of their lives.]
So what does this have to do with collapse or submit in the body and the experience of depression? Well, when we see that the chronic shut down of emotion, we can often see that that leads to numbness, apathy, anhedonia, low self-esteem, etc -- all symptoms of depression. Oftentimes people will report that growing up or in adolescence, it was safer to be numb because then they would not get hurt, which was scary for them. It was safer to not experience joy, because then it couldn't swing the other way to disappointment. If someone stays numb and apathetic, they are also staying away from deep pain.
We might see that people who have tried a whole bunch of different treatments for depression may experience this distress. And I would never tell someone to stop trying different medications or finding relief for their symptoms, it is only to consider that perhaps some of the attachment-based work is also needed -- to learn that it is safe to experience all emotions, and all of them are temporary. I find myself saying almost all day, every day "the conditions are different now because YOU are different now" -- our brains are incredible - they protect us when we don't have other tools. We needed to go numb, go limp (physically and/or emotionally) in childhood or during particular events because it was saving our lives, making it easier to connect with other people and feel less like a burden for just being there.
So what do we do now? Definitely seek some attachment-based trauma therapy, such as EMDR based in structural dissociation theory and/or Deep Brain Reorienting (DBR).
I would start with trying to see that depressive, submit part of your brain as a child. That is often the most effective first step -- even if we can't connect to a particular image, try to call one up. Try to imagine your younger self having to try to be well when having a difficult time with big emotions in childhood. Let that part know that you, as the adult, are there now to help them. Try to understand that that part might be saying, "nothing will help" or "there's no use" or "I don't care" for the reasons I mentioned before - it makes sense that that would happen in the brain, and that the body might start changing the chemicals in response because the brain holds onto things that are most helpful for survival. Try to sit with that part of yourself and see what it needs from you, the adult. Work with your therapist to try to understand how to give that part what it needs, or to further find out what it needs, and try to even use the support of the therapist to remind yourself that these big emotions are not problematic - that you can feel them and let them pass. That your therapist, that you as an adult, that other safe people in your life can be a witness to that experience, and that the conditions are different now because YOU are different now.
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