Depression has always had a PR problem—first in its conception, and then in its evolution. It was first understood as an excess of black bile disrupting the body’s equilibrium, then as a “nervous temperament,” then as a matter of subconscious loss, and later—almost full circle—as a chemical imbalance or biological disease. We are now edging toward a more contextual and neuroplastic understanding, one that tries to account for the complex interplay of biological, psychological, and social factors, alongside a big, adaptable brain that is constantly shaped by what it encounters.
Even now, depression remains deeply misunderstood. At times it is romanticised as the necessary – even noble—suffering of the creative, sensitive, artistic mind: a hazard of genius, as Aristotle supposedly suggested. At other times it is demonised as weakness, selfishness, or moral failure, or dismissed altogether as something that should be willed away. Both positions flatten the experience and miss the point entirely.
As a therapist in the 21st century (and a relatively new one at that), I know depression isn’t treated by removing black bile or simply correcting a neurotransmitter imbalance. We now know far more than that. But knowing more doesn’t make treatment uniform or straightforward, because depression looks different in different people. That variability doesn’t make it mysterious or untreatable—it makes it human.
People want to be seen and heard
Over time our villages became towns, towns became cities, and cities dissolved into an ever-expanding digital universe. Many people now experience life as if they are disappearing into an anonymous void. In this context, it can be harder than ever to feel as though you matter. That is why any effective therapeutic approach must first and foremost see, hear, and attempt to understand the individual in front of it.
No amount of worksheets, psychoeducation, or referrals can substitute for the experience of being met with care and genuine curiosity. There is something quietly powerful about having another human shine an empathic light on your inner world and say: you exist, and your experience makes sense.
People desire meaning and purpose
I am drawn to working through an existential lens, drawing on evidence-based third-wave therapies such as ACT and MBCT, particularly their emphasis on values, meaning, and our relationship to suffering. Much has been written about the damage to human life brought about by agricultural, industrial, and technological revolutions, yet I have little doubt that humans love to work—if we define work in the right way.
By work, I don’t mean a job, a career, or a 9-to-5. I mean engaging with life. Starting and finishing projects. Learning, building, practicing, improving, evolving. Humans are driven by purpose, and when purpose erodes, depression often follows. Therapy is not there to prescribe meaning, but to help uncover it and allow the person, the human, to find something to move towards.
People need support to move, not just understanding
At some point—usually sooner than feels comfortable—action enters the room. Anyone with lived experience of depression will tell you how impossible this can feel. Depression is very good at convincing people that life must wait until things get easier, until they get “better”. Motivation becomes the prerequisite for action, action the prerequisite for motivation, and around and around we go.
Therapy, then, is not about forcing movement or cheerleading productivity. It is a collaborative attempt to help people take small, imperfect steps while still feeling low, unsure, or afraid. Not grand transformations, but gentle re-entries into the life they want to live, and reintroductions to the person they want to behave like. Over time, this rebuilding of agency—acting in the presence of suffering rather than only after it has gone—is often where depression begins to loosen its grip.
As a therapist, I will always feel honoured to share space with a person who has momentarily lost their motivation, their meaning, and/or their sense of identity, because I believe wholeheartedly that all of it is discoverable again, and that getting it back might even be more rewarding than having had it in the first place.
