Reflecting on my many years of working with depressed patients, I’m struck by how many of them felt a great sense of disappointment with themselves. Of course, feeling disappointed with yourself is a common symptom of depression so it is tempting to say that depression – this condition, disorder, or disease – caused the self-disappointment, as well as all the other symptoms of depression.

But the arrow of causation can also go in the other direction: a pre-existing poor self-assessment may increase the risk of developing a depressive disorder. And, once the depression arises, it exacerbates the patient’s self-disappointment and, perhaps, even turns it into something worse: self-rejection and self-loathing. So, in effect, the two phenomena, the earlier self-disappointment and the later depressive disorder, might form a self-reinforcing loop, one contributing and exacerbating the other.

Reflecting further on the patient stories I’ve heard related to poor self-concept is a common theme: that the patient, in their self-estimation, should be a certain way rather than another way. For example, to be outgoing rather than shy and awkward, to be smart rather than dumb, and to be hard working rather than lazy.

This way of viewing things has two inherent problems, both of which can set up the person for depression. The first problem is that the depressed patient’s self-concept usually falls on the all-bad side of an all-good / all-bad dichotomy. The second problem is setting up such dichotomies in the first place. This seems to be based on a view, often unarticulated, that people are one way rather than another way, that one is either smart or dumb, hard-working or lazy. But this way of viewing things is wrong: maybe the problem isn’t the fact that patients place themselves on the ‘bad’ side of a dichotomy, it is that setting up dichotomies is not reflective of the way humans are nor conducive to good mental health. After all, even if you believe you are smart and hard-working, it won’t be long before you discover you’re not all that smart nor all that hard-working.

Then what? Then, you’re likely to swing to the bad side of the dichotomy and judge yourself as dumb and lazy.

One solution is to turn the dichotomy into a spectrum, to not view yourself as either all good or all bad, but as somewhere in between. This is a good start and can counteract the perfectionistic and black-and-white thinking often seen in depressed (and anxious) people. But we needn’t stop here, instead we can complexify further. Rather than accepting that you lie somewhere on the smart/dumb and hard-working/lazy spectrum you can begin to consider that you cannot be captured by a single ‘point’ on a spectrum nor ‘number’ on a scale. Maybe you’re all over the place, maybe you’re many shades of smart and dumb, hard-working and lazy, all depending on the task and the circumstances. Maybe, going even further, you’re many such shades within single tasks and circumstances. Maybe you’re all these things at once. Maybe it’s better to stop judging yourself completely.

But how can we fix things and get better if we don’t judge ourselves? How can such judging even be stopped? It seems so ingrained.

There is a different way: to view yourself as navigating and engaging the world in complex ways. When in any kind of situation, you feel more competent in some aspects of your coping and in other aspects less competent. With this view, the focus can be taken away from an essentialized, “I am this or I am that” and instead moved toward assessing areas of more-skilled and less-skilled navigation. The unit of assessment is no longer >You< it is instead the >Situation<. You are part of the situation, of course, and judging takes place, but you can certainly identify areas of improved coping and skill attainment. Again, the unit of assessment is the situation and you, of course, are a part of that, but only a part.

This requires a shift in mindset. You are no longer shy or lazy. There are situations in which you feel awkward and uncomfortable and that you wish to avoid. There are other situations in which you feel competent and comfortable and that you seek out. What differentiates the two? What can you learn from the situations in which you feel more competent and comfortable? How can you carry over those competencies into situations you wish to avoid? Which specific aspects of those uncomfortable situations make you most uncomfortable and why? What would it take to turn those situations around? Do you need to change something within yourself or within the situation itself or, as is often the case, in both?

This new mindset focuses on situational awareness and situational assessment. It is more encompassing of all components of the situation — less totalizing of the self as a single, fixed, coherent thing — and more local to each situation. To maintain this mindset takes more work on the patient’s part since there is no single answer that resolves everything, and it takes more work on the clinician’s part since the patient and the world they inhabit are irreducibly complex and outcomes are multi-determined. Details matter.

But isn’t this what makes work fun? Haha!

Thanks, and take care.

Dr. Jack

Language Brief

“Stay out of the court of self-judgment, for there is no presumption of innocence.” ― Robert Brault

“When we struggle to change ourselves we, in fact, only continue the patterns of self-judgement and aggression. We keep the war against ourselves alive.” ― Jack Kornfield

“It is through serendipitous encounters with objects and strangers that the world speaks to us but we have to be listening. By learning to be alert for clues, one is suddenly caught up in an exciting inner adventure.” ― Stephanie Rosenbloom

“The world as we have created it is a process of our thinking. It cannot be changed without changing our thinking.” ― Albert Einstein