This article was written by John Welwood, an American clinical psychologist, psychotherapist, teacher, and author, known for integrating psychological and spiritual concepts. He died in 2019. He wrote eight books, including Challenge of the Heart (1985), Journey of the Heart (1990), and Love and Awakening (1996). Trained in existential psychology, Welwood earned a Ph.D. in clinical psychology from the University of Chicago.

Depression is one of the most common problems in modern society. It appears in chronic low-grade forms that can drain a person’s energy and in more acute forms that can be completely debilitating. Our materialistic culture breeds depression by promoting distorted and unattainable goals for human life. And our commonly held psychological theories make it hard for people to make direct contact with depression as a living experience, by framing it as an objective “mental disorder” to be quickly eliminated. The current treatments of choice — drugs, cognitive restructuring, or behavioral retraining — are primarily technical, and often keep depression at arm’s length. However, in order to help people with depression, we must see how they create and maintain this state of mind in their moment-to-moment experience. This will help us understand depression not merely as an affliction, but as an opportunity to relate to one’s life situation more honestly and directly.

In simple human terms, depression can be seen as a “loss of heart.” This view is consonant with the approach of Buddhist psychology, which grows out of intensive study of human experience through the practice of mindfulness meditation. The essence of the Buddhist path is a process of awakening the heart or cultivating bodhicitta (In Sanskrit, the term bodhicitta literally means “awakened heart/mind”). We could define heart as that “part” of us that is most tender and open to the world.

A central discovery of mindfulness meditation is that sanity and vibrant well-being are intrinsic to human nature, because the basic nature of mind, or heart, is to be open, curious, sensitive, and connected to reality. In other words, our true nature is inherently attuned to things as they are, apart from our conceptual versions of them. For this reason, our basic nature is sane and wholesome. This connectedness to reality is unconditional, or, in Buddhist terms, “unborn and unceasing” — which means that nothing causes it. If we construct elaborate systems of defenses to buffer us from reality, this is only testimony to the raw, tender quality of the open mind and heart underlying them. The basic goodness of the human heart, which is born tender, responsive, and eager to reach out and touch life, is unconditional. It is not something we have to achieve or prove. It simply is.

Although there are many varieties of depression, we could describe this pathology in general terms as a feeling of being “weighted down.” The feeling of being cast down leads to a desire to close the eyes and turn away from having to face reality. Depression may also contain anger and resentment toward the way things are. Yet instead of taking a defiant or fluid expression, this anger is muted and frozen into bitterness. Reality takes on a bitter taste. Depressed people hold this bitterness inside, chew it over, and make themselves sick with it. They lose touch with the basic wholesomeness of being responsive to life and become convinced that they and the world are basically bad. In this sense, depression indicates a loss of heart — that is, a loss of contact with our innate openness.

GRIEF & DEFEAT

Loss of heart arises from a basic sense of grief and defeat. Specific losses may be involved: loss of a loved one, a career, cherished illusions, material possessions, or self-esteem. Or there may be a more global sense of defeat carried over from childhood. In either case, the depressed person feels a sense of powerlessness and loss of control, and is unable to trust reality.

The primary sorrow underlying depression is a reaction to the loss of stable reference points that have provided security and support in the past. Yet the intensive practice of mindfulness meditation reveals that this loss of stable reference points is actually happening all the time. Buddhist psychology describes this situation in terms of the “three marks of existence.” These three unavoidable facts of life constitute the basic context in which all human life unfolds.

The first mark of existence, impermanence, means that things are always changing, without exception. Meditators experience this by observing the ceaseless arising and passing away of their mental and emotional states.

The second mark of existence, called egolessness, follows from this pervasive impermanence. Because everything is constantly changing, no continuous, solid self can be found or experienced. In discovering how they are continually trying to maintain fixed ideas of themselves, meditators see that the self is an arbitrary construction rather than a substantial entity or essence. This discovery can give rise to either profound relaxation or intense fear.

The third mark of existence is that the nature of life always entails pain or suffering. There is the pain of birth, old age, sickness, and death; the pain of trying to hold on to things that change; the pain of not getting what you want; the pain of being conditioned by circumstances; and so on. Pain is inevitable insofar as being human involves being completely exposed to the larger forces of life and death that are beyond our control.

These three marks of existence do not present any insurmountable problem if we can maintain our basic openness toward reality in the face of them. Psychopathology arises, however, out of hardening into a position of rejecting what is. From a Buddhist point of view, different pathologies express different postures that people assume in reacting against the three marks. For example, rage against one’s pain might lead to a paranoid state of mind: “Who did this to me? Why is everybody trying to hurt me? I’m better than all this.” Trying to gain the upper hand over the three marks so as never to feel vulnerable might lead to a sociopathic condition. Catatonia involves a decision not to relate to these circumstances of life at all. And depression results from punishing oneself for the way things are.

Depression sets in when we conclude that there is something basically wrong with us because we experience pain, we feel vulnerable or sad, we cannot hold on to our achievements, or we discover the hollowness of our self-created identity. In feeling this hollowness of identity, we are very close to experiencing the larger openness of our being. However, those who fall into depression are unable to appreciate the fullness of the openness they stumble upon in this experience. Instead they react against this open, hollow feeling and interpret it as bad.

This negative interpretation is an ordinary pathology that all of us experience in one form or another. The openness of human consciousness springs from a ground of uncertainty — not knowing who we are and what we are doing here. Unfortunately, we come to judge this uncertainty as a problem or deficiency to be overcome. In so doing, we turn against our basic being, our intrinsic openness to reality, and invent negative stories about ourselves. We give in to our “inner critic” — that voice that continually reminds us that we are not quite good enough. We come to regard the three marks of existence as evidence for the prosecution in an ongoing inner trial, where our inner critic presides as both prosecutor and judge. And imagining that the critic’s punitive views are equivalent to reality, we come to believe that our self and world are basically bad.

LIVING IN THE MATERIAL WORLD

Our materialistic culture helps foster depression. Not only do we lack a living wisdom tradition to guide modern society, but we find it more and more difficult to achieve even the ordinary satisfactions of adult life: finding rewarding work, maintaining a long-term intimate relationship, or imparting a meaningful heritage to our children. Our sense of personal dignity and worth is quite fragile in a society where stable families, close-knit communities, commonly held values, and connection with the earth are increasingly rare. In a society such as ours, where the motivating ideal is to “make it” through social status and monetary success, depression is inevitable when people fail to find the imagined pot of gold at the rainbow’s end.

Furthermore, many in the psychiatric profession seem determined to view depression as an isolated symptom that can be excised from the psyche with the help of modern technology. The fact that drugs have become the treatment of choice indicates that we, as a society, do not want to face directly the existential meaning of this pathology. If we believe that depression is primarily psychological and treatable by drugs, we will not confront the ways in which we create it, both as individuals and as a culture. The view that depression is an alien force that descends on the psyche actually interferes with genuine possibilities for healing.

One young man who came to me for treatment of a clinical depression illustrates this alienated view common in our culture. At age twenty-seven, he suddenly discovered that he no longer enjoyed the things he used to: surfing, going out with the guys, chasing women. He was undergoing a major identity crisis, but because he believed in the ideology of materialism so thoroughly, he was ill-prepared for the life passage facing him. Rather than considering that his depression might hold an important message for him — for example, that he could no longer live the carefree life of a perpetual adolescent — he wanted only to get rid of the depression so that he could go back to his old lifestyle. He regarded his depression as an arbitrary quirk of fate that had singled him out for mysterious reasons. Although he was getting his first real glimpse of the three marks of existence, the only framework he had for interpreting them made them seem like the ultimate horror. No wonder he felt so depressed!

Depression is maintained through stories that we create about ourselves and the world being fundamentally bad or wrong. In working with depressed people, it is important to help them distinguish between actual feelings and the stories they tell themselves about the feelings. By “story” I mean a mental fabrication, a judgement, an interpretation of feeling. We usually do not recognize that these stories are inventions; we think that they represent reality. If we can sharpen our awareness, then we can catch ourselves in the act of constructing these stories and so begin to see through them. One of the most effective ways to learn to do this is through the practice of mindfulness meditation.

When practicing meditation, we alternate between simply being present while following our breath, and getting caught up in our busy thought patterns. Mindfulness practice involves first acknowledging our thoughts, then letting them go and returning to a sense of simple presence. In the process, we begin to witness how we are continually making up stories about who we are, what we are doing, and what will happen to us next.

With continued practice, meditators can learn to develop a healthy skepticism toward this storytelling aspect of mind. In Buddhist terms, they develop prajna, a discriminating awareness that allows them to distinguish between reality and fabricated stories about reality, between simple attention to immediate experience and interpretations of that experience. A psychotherapist who has a well-developed meditation practice can help clients discern when they are caught up in stories about their experience and when they are actually in touch with their experience in a more immediate way.

THE INNER CRITIC

Beneath the stories that maintain the frozen state of depression are more simple, fluid, and alive feelings, such as sorrow, anger, or fear. These feelings are quite different from the stories the inner critic constructs from them — such as “I’m no good,” or “I’ll never get it together,” or “I’m just a weak person” — which are judgements or conceptual interpretations that freeze and harden feelings of vulnerability. Frozen fear leads to the constriction, dullness, and inactivity commonly associated with depression. Yet where there is fear of life, there is also sensitivity and openness to life. Fluid fear allows a person to connect with the tenderness of the heart. Frozen anger is turned inward against oneself and becomes a self-punishing weapon wielded by the critic. Yet anger also indicates a blocked desire to live more fully. Fluid anger is dynamic energy that can be drawn on to effect change. When we construct bitter stories about ourselves and the world out of these vivid feelings, they coagulate and turn into the monotones of depression.

Aside from fear and anger, the central feeling underlying depression is sorrow or sadness. Sadness is a particularly interesting feeling. The word sad is related etymologically to “satisfied” or “sated,” meaning “full.” So sadness indicates a fullness of heart, a fullness of feeling in response to being touched by the fleeting, hollow quality of human existence. This sense of empty fullness is one of our most essential, direct experiences of what it is to be human. As an awareness of the vast and hollow quality of the open heart, sadness connects us with the rawness of not knowing who we are and not being able to control or hold on to our quickly passing life. It invites us to let go of reference points we normally use to make ourselves feel secure. If we reject our sadness or judge it negatively, then its poignant quality, which is vibrantly alive, congeals into the heaviness of depression. In overlooking the opportunity that sadness provides for touching and awakening the heart, we quite literally lose heart.

It is important to help people suffering from depression to be more mindful of their actual feelings, so that they can see through the negative stories told by their critic and touch their genuine, open heart. The more carefully they examine their experience, the more likely they are to discover that it is actually impossible to experience their nature as basically bad. The idea of their basic badness is only a story told by their inner critic; it is always a fabrication, never an immediately felt experience. Therefore, by helping people reconnect with their moment-to-moment experience, a psychotherapist can help them glimpse their basic goodness and sanity — which is their unconditional openness and sensitivity to life itself. Unlike their fictional basic badness, their basic goodness can be concretely felt.

The basic goodness of the human heart, which is born tender, responsive, and eager to reach out and touch life, is unconditional. It is not something we have to achieve or prove. It simply is.

THE SUCCESSFUL LAWYER

One of the clients who has most challenged my own trust in basic goodness is a successful lawyer in his mid-fifties whom I have been seeing for more than two years. When he first came to see me, Ted had hardened into one of the most unyielding states of depression with which I have worked. Growing up during the Great Depression as the son of immigrant parents who taught him to hate and fear the white Anglo-Saxon world, he had learned to get ahead at all cost, and had driven himself for years to achieve a material and professional success. He had reached the top of his profession, yet was completely miserable and desperate. His body gave the impression of an armored tank, and his health was suffering from the amount of tension he carried around. He spoke at a raised pitch, as though he were preaching a series of sermons about himself and the world.

Ted had a sharp lawyer’s mind that attacked whatever he turned his attention to. His mind continually constructed arguments to buttress his views of reality. His themes were always the same: his weariness with life, his fear of death and letting go, the meaninglessness of everything, the demands people were always making on him, and the distrust he felt toward everyone because his rule of life was “attack or be attacked.”

His life had been a series of unsuccessful attempts to escape the three marks of existence. The more he struggled to gain the upper hand over them, the more aggressive he became, and the more he fell victim to the very circumstances he was trying to avoid. He had tried to escape his fear of egolessness and death by climbing the professional ladder, but in doing so, he was literally killing himself. He desperately wanted to be somebody. Yet in continually trying to win recognition, he had become so overbearing that people rejected him — which left him feeling even more like a nobody. In trying to overcome his pain, Ted had numbed himself into a profound state of depression. The three marks of existence persistently haunted him in the form of a continual sense of emptiness, loneliness, and death-in-life.

Initially I felt assaulted by Ted’s manner and presence. In order to be able to stay present in the room and listen to him at all, I found that I had to engage in swordplay with his sharp mind during our first few months together. Through these encounters, which involved much more intense confrontation than I usually engage in with clients, I was eventually able to penetrate his stories and contact him in a more human way. As Ted began recognizing the difference between his actual feelings and the stories he fabricated about them, he could see how these stories only dug him deeper into his rut. He began to slow down and stop broadcasting the same stories again and again. Eventually he was able to be more still and pay attention to what he was feeling in the moment.

The next step in my work with Ted involved helping him to recognize and step back from the inner voice that kept telling him what he “should, must, ought to” do. We came to call this voice by various names: “the critic,” “the driver,” “the tyrant,” “the judge.” As we proceeded, Ted discovered that his main aim in life was to win approval and recognition from others, as well as from his own inner critic. He had chosen to pursue the more tangible comforts of recognition and approval as a substitute for having to feel his own need for love. Feeling that need only put him back in touch with the despair, fear, and helplessness he had felt as a neglected child. Ted had come to hate his vulnerability so much that he had abandoned his own tender heart. As he realized this, he began to touch his anger, sadness, and fear directly, instead of blaming the world for his condition.

Eventually Ted reached an important turning point that has enabled him to start choosing life over death-in-life. Underneath all his compulsive striving and attempts to win recognition, he felt the tremendous sorrow of having lost touch with his own heart. It took a long time for him to let this pain touch him. In the process, Ted has started to acknowledge his desire just to be, without having to be an important somebody. He has started to soften and to feel his humanness.

All our reference points are continually slipping away. We can never create an unassailable identity that will guarantee happiness and security. Shall we be depressed by this fact of existence or shall we dance with it? The grand cosmic dance of Siva in the Hindu tradition or Vajrayogini in the Tibetan Buddhist tradition takes place on the groundless ground of everything arising and slipping away. These ancient images of the cosmic dance symbolize the way in which egolessness and impermanence can be a source of energy, rather than depression. Depression is the loss of heart that results from turning against the flux of things as they are. And yet at the root of depression — in the rawness, vulnerability, and poignancy underlying it — our basic sanity is always operating. That is why depression, like all psychopathology, is not merely a disease to be quickly eliminated. Instead, it can be an opportunity to awaken one’s heart and deepen one’s connection to life.

-John Welwood, Ph.D.

Dan Lukasik has given over 200 presentations throughout the U.S. on the topics of depression, anxiety, and stress. He tells his own powerful story of his struggles with growing up in a traumatic home with an alcoholic father, overcoming obstacles to become a successful lawyer, diagnose of major depression at age 40, learning to overcome and manage. One on the most difficult aspects of living with depression was dealing with the stigma surrounding his own mental illness. At first hurt and then angered by such stigma he and others encountered, he launched Lawyerswithdepression 15 years ago to educate others about depression, provide resources, and combat the stigma to those who often struggle in a lonely battle against this disease.

Dan’s work on mental health has been featured in The New York Times, The Wall Street Journal, The National Law Journal, The Washington Post, on CNN, and NPR, and many other national and international publications. He was recently selected by WebMD to for a video on the importance of working with a therapist throughout one’s life to manage clinical depression. In addition, Dan was chosen by the Substance Abuse and Mental Health Services Administration (“SAMSA”) in Washington, D.C. as their spokesman in a PSA video of someone living successfully with depression. Watch the video. For inquiries, please go to the contact tab at the top of the website homepage.