Depression and recovery in Australia
Views about causes of depression
When asked about what they saw as the cause of their depression, people we talked to identified many reasons. Although we have summarised these into four major categories, most people identified multiple causes. Only person we talked to, Linda could not identify a cause for her depression. She told us: ‘But for me there was nothing, you know? I had a wonderful family, I had everything I wanted and then I just, I just didn't feel happy and nothing, nothing was really good enough’.
External causes - social or situational
Interpersonal difficulties including family relationship problems, difficult interactions at school or work, prejudice, and non-supportive social networks were a common theme in many peoples’ stories. Many stories described the interplay between domestic, professional and economic concerns.
People also talked about growing up in ‘alcoholic families’ or families who struggled with chronic illness, about long term substance use, life decisions they regretted, stressful life circumstances or difficult experiences.
Early experiences of racism and growing up in a migrant family which lacked a secure sense of...
Early experiences of racism and growing up in a migrant family which lacked a secure sense of...
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But yeah, I remember always not feeling very great about myself and feeling like I stuck out like a sore thumb.
And you know racism in the early 80s where I grew up was a constant feature and so you know I was very aware of what I looked like and very aware that I was a target and my family were targets. So I think I became quite self-conscious about all of that and I lost any sort of you know any sort of unselfconscious behaviour, because I was so conscious that people would see me as you know the you know one of the three Chinese people in (suburb) in the 80s, that yeah and would just hone in on that.
My family all, well certainly you know my family who are living all I think have got an element of what I have got. You know some members of my family perhaps are more anxious rather than depressed. I saw unhappiness as a child and I you know I wouldn’t describe my childhood as happy at all. So I don’t know if that comes from it.
I remember a lot of competition as a child, if you know within my family, at school, extracurricular things you know with family friends. I remember competition was a major feature and I don’t like that, I don’t, I’m not a thriver on competition at all. Fear of failure has always loomed as this major thing. So yeah competition freaks me out, unless it’s card games and or trivia.
Yeah, so I probably think it’s that sort of thing and I wonder if you know the stuff I have explained before about, particularly you know around when I was in my 20s, I wonder if I sought out a particular type of social circle or whatever because of what I saw at home as well. And you know but I am not blaming my parents or anything, it’s just what happens. And I don’t know if it’s also a first generation migrant rather intense experience, and you know my dad spoke with an accent and was you know his English wasn’t you, wasn’t like mine at all and it was very noticeable and I always felt responsible for that and wanted to protect him but also be really ashamed. So you know first generation migrant experience of their parents.
Stewart described a series of losses in his life as causing his depression. Particularly important was the loss of a caring stepfather, as Stewart's resulting grief was not acknowledged at the time. Susan talked about a number of losses building-up in a short time as contributing to her depression: ‘It was part of the loss that I experienced over this last little while. I lost my choir, I lost my job and my colleagues, and I lost my mother. So there are three really, really important things that have occurred in my life in short succession’.
Peter described depression as ‘such a broad thing’, adding, ‘I mean you've got reactive depression, you've got chemical depression. I mean essentially if you raised the living standards of all of these people that have got reactive depression you'd probably find that half of them will drop off the symptoms, you know, so that's a social problem’. Shaz described her strict upbringing, bad relationship decisions and substance use habits as causes of her depression. A few people said that their depression was due to working too hard for too long, as expressed by Ralph: ‘I blamed the fact that I was working too hard…I used to blame the fact that I was pushing myself too hard’. Other people we talked with who identified as gay, lesbian or queer cited homophobia and stigma associated with their identity and sexual orientation as contributing to depression for them.
A complicated set of circumstances caused Shaz long-term emotional distress and contributed to...
A complicated set of circumstances caused Shaz long-term emotional distress and contributed to...
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And then I met my son’s father. I was only with him a very short time and thought, ‘Oh this is the man for me’, you know. And at that time I was 20 and we were together about six months and then he said, ‘Look I’d like to start a family’. So I said, ‘Oh that’s fine, you know, we’ll do that’. And he said, I said, ‘You’ve got to marry me though’. And he said, ‘Oh yeah we’ll get engaged, blah, blah, blah’. So I got pregnant. And I was a month pregnant and I went into the bathroom and he was sitting on the toilet with a lady putting a needle of heroin in his arm. Now I’d smoked a lot of dope which, backtracking a bit I probably started smoking dope when I was about 19 because I met this guy, my first true love and he was a dope smoker.
But when I found out my son’s father was a heroin addict, I, when he went to work the next day, I just left. I rang my brother and I said, ‘You have to pick me up,’ and explained it to him.
I remember how, I remember when I was about in Form 2.
I wanted to shave my legs because all the girls were shaving their legs, you know. So I think oh yeah. So I said to Mum, I said, ‘Mum, can you, you know, buy me a packet of razors?’ She goes, ‘What do you want razors for?’ I said, ‘Shave my legs’. ‘Oh no, you’re not shaving your legs. If you shave your legs, they’ll grow back hairier’. Now I must admit, I only had fine downy hair but that’s not the point. And it was things like that that made me not fit in. So I really actually do blame my mother and I still do and she knows it and she actually blames herself, to a degree because - like we’ve got a pretty good relationship now, like we call each other girlfriend, you know, and when we meet, we go, you know and...
So I do feel the attitude of my parents didn’t help and they weren’t really in tune. But now I know they were only doing what they thought was best. So I’ve had to let that resentment go. I’m very lucky because my dad passed away just over a year ago and I’m very lucky that he - ‘cause I went through a phase where he wouldn’t even let me go and visit with them ‘cause I had - I’ve got tattoos and I had all these piercings up my ears and everything and he just thought I was like a freak show and couldn’t understand it, you know. But in the end they come around and let me go up and it was good, because if he had have passed away and I hadn’t been able to have some… understanding from him - not that he was - like they were never really affectionate.
We, we never really got - like I was a very good student, very good, even in primary school, you know, very good. And I learnt the piano. I learnt that for many, many years. But this is one other thing that I think happened, my Mum come from a very poor family and so did Dad and they got married and Dad started his own business. And he was very successful but he was very clever with his money. You know, he invested it in properties and he was a very smart man. And what Mum wanted to do was - this is what I think happened with my own psychoanalysis you know, she was trying to live her life through me. Because she’s often said, ‘Oh you’ve learnt the piano for so many years and you did all your exams and you went so well,’ and she says, ‘I wanted to learn an instrument but my parents couldn’t afford it’.
So I think she pushed me towards things that even though she was well meaning, it wasn’t what I needed. Does that make sense?
The stigma and abuse that Millaa experienced for being different was a factor in his anxiety and...
The stigma and abuse that Millaa experienced for being different was a factor in his anxiety and...
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But in the relevance to depression and anxiety and the mental disorder spectrum, I think queer people have a lot of abuse and a lot of depression and a lot of anxiety and a lot of pressures that perhaps people with just - straight people with just depression and anxiety don't. And they couldn't really understand because they're not of that persuasion or that orientation.
You know, I mean I was teased, like I said, for being queer or for being different. And queer in the sense that I was different, as well as queer as in gay or homo-, of a different sexuality than the norm, or what's considered “the norm”. And because we live I think in a very heteronormative world, which means one that based on heterosexual ideals such as, you know, weddings and masculinity and femininity as defined gender roles, and people that sway from that and perhaps mix you know, ball gowns and beards together are considered freakish or are considered queer or are considered completely different from the norm, and hence subject to, you know, ridicule and whatever else, and abuse.
Which, as people know, you know, if you're abused in any form, even people coming back from war or people just in the street, you know, if you’re abused, and even if by your friends if you're abused.
In his view, an extremely demanding job triggered John's depression. He had to revaluate his...
In his view, an extremely demanding job triggered John's depression. He had to revaluate his...
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I was working way too long, I was working way too many hours and I could never leave work. And I suppose being a pastor, a lot of your work revolves around people that you - you live with and are close to and friends and family, you're kind of all in that sort of same environment, so you never quite leave work and I think a lot of that started to take a toll on me.
I suppose the drawback of working so hard was that, whenever I was at home I was kind of still mentally at work and that created a lot of conflict between my wife and I. So I was having difficulties at work and then I was coming home and having difficulties at home. We were arguing a lot, we were fighting a lot, even though when I was physically present I was, you know, I was still checking my e-mails on my handheld, I was still making phone calls, I'm texting people and just trying to get the monkey off the back, just - I think I had this impression that if I could just get- catch up with work everything would be fine, I've just got to catch up, I've just got to clear the backlog.
I remember I had something like 1000 e-mails in my inbox and I just couldn’t clear them. I mean it was just - and then it became paralysing after a while. I was sort of the bunny in the spotlight and I was paralysed by all these things that I had to do. So I wasn't very effective and there was just constant arguing at home, there was chaos at home, I don't think my wife was coping very well either.
Suzi had a difficult childhood living in a family where her mother’s serious mental health condition was never acknowledged. Growing up, she felt unsupported and emotionally exploited by her father. She experienced anorexia and in her adult life had difficulty forming healthy relationships.
Suzi grew up in what she described as a 'toxic family', which had serious emotional and other...
Suzi grew up in what she described as a 'toxic family', which had serious emotional and other...
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And it was, we were a very secretive sort of family, we were never allowed to talk about what happened in the family. But – I didn’t know, and that’s probably why it was as bad as it was, but my mother had paranoid schizophrenia.
But I was never, ever told that she was sick. I had no indication that she was sick. Unfortunately as I was growing up all her delusions focused around me, and I don’t know - it also seems like she never actually bonded with me at all.
But I know that she thought I was wicked and evil and I remember her telling me that at age of four, and… She was really quite bizarre, my life was bizarre. She didn’t like me being away from her so I, you know, she was very protective, and so, you know, you can’t go out and play, you can’t do this, and you can’t do that. So I was with her a lot but she didn’t like my presence. And I got the full brunt of her craziness really. And if Dad had ever given me any indication that she was not well, things might have been a bit different.
I think that was the worst thing, is that I grew up not having an inkling that she was sick and thinking that everything she told me was the advice of a normal mum. And it wasn’t.
My dad he seemed to care about me. As I grew older I realised that it was a selfish thing. ‘Cause he didn’t care enough to take me away from my mother, which would have been… put my life in a whole different thing. He didn’t care enough that he would even explain to me or tell me that what she said was wrong. He heard what she said and he never, you know. And – even when I got older, when I started to realise and when I was anorexic and when I got out of hospital from the anorexia and they were, we don’t want you go back to that home situation, you will just get sick, the home situation is completely toxic.
And he just started pleading with me to come back, and when I first went into hospital, I only put on about half a kilogram and he was pleading with me to leave the hospital because he couldn’t cope with my mother without me.
And then when I’d put the weight on he was, ‘I wish, I wish you’d never gone there. I wish you’d never, I just wanted a fatter old you, and I don’t want this person who is going to move out.’ You know, and I think he would have preferred me to stay there and even perhaps die of the anorexia than actually leave. So...
Well, for my father I became like a partner in all but sexual things.
I used to think Dad was so wonderful because he never got angry. I used to get angry with my Mum. We used to fight something shocking. We used to get so angry and ah, you know, Dad would say to me, ‘There’s nothing worth getting angry about. You know, you’ve got to go and apologise.’
But when I went into hospital for the anorexic and I wasn’t in the situation, he and Mum fought, started to fight all the time. And I realised that he could get by without it, because I was doing it for him.
And he could sit back and say, you know, being angry is bad and feel self-righteous about not being angry. But in fact he was using me to do it for him. And then, yeah so, I didn’t realise. So the whole family was really just messed up.
What people, what you saw was very much not what you got.
Individual response to external events or situations
People often focussed on their internal, emotional reactions to stressful external events or situations as causing depression. Stories of diverse losses experienced in adulthood also featured in these narratives. many people talked about loneliness, linking this to unsatisfactory, broken or dysfunctional intimate relationships, lack of close family members or wider social networks, not having children, and being single. Bereavement was also mentioned by several people. Very often life was described as conditioned by loss. Jules, who went through a traumatic caesarean and whose husband later died in an accident, was voluntarily hospitalised for depression several times.
In addition to various traumatic life experiences, Jules identified feelings of loneliness as...
In addition to various traumatic life experiences, Jules identified feelings of loneliness as...
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I put on a mask and people say I have been told that I have a presence. Now what, in adverted commas, what that means to them I don't know, but simply that to other people I appear to be very competent, very confident easy to talk to, so where's the depression, where's the tears, where's the anxiety.
And they talk about having a trial a night home, before you go back into the clinic and I think that's false. Why would that work for me because I have no doubt that a big part of my depression is my loneliness. My sense of isolation and loneliness, despite two wonderful daughters, being blessed with two fabulous sons-in-law and the most glorious five grandchildren. Loneliness is a fact, is a huge factor, and I've found that from talking to other patients.
Ruth identified being single and feeling pressure to marry and have a family as contributing to...
Ruth identified being single and feeling pressure to marry and have a family as contributing to...
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But things, you know, in my personal life were always difficult because I was now in my, my mid-30s. Everyone around me was getting married, having kids. I wasn't and I struggle with it; and I guess my family struggle with it.
And it was always the case when you go out to functions, you know, oh when are you getting married? When are you settling down? The whole bit. And that wasn't me; and it's still not me. So there was a lot of pressure. Even though I did - I was handling my, my depression, I was handling my condition, there was still the pressure from the - my surrounds. And I found it very hard to cope with that. 'Cause I'm one of these people who just does what they're told, to a certain extent.
You know, I'd been brought up in a Jewish environment, Jewish home, family are very, very big. It's a very big part of my life. So it's always, it's always part of, you know, the next step. You've got to find someone, you've got to settle down, you've got to have kids. And that wasn't the way my life panned out.
I actually think depression runs in the family and I think I've actually got it on both sides of the family. My dad actually had a couple of breakdowns. He was a very nervous, anxious man. He actually had a couple of nervous breakdowns. And my Mum - again, I could say to her, Mum, you're suffering from depression. But my Mum's 76; she won't do anything about it because it's that generation.
And it's a case of they think that if something in their environment changes, it'll be better. Well, it doesn’t - it's a case of almost, sometimes, where you can, you can never please them because they are so depressed. Even the nicest things will even - they'll see it in - it's glass half full, glass half empty; and hers has always been glass half empty. So, you know, it… I know my Mum suffers from depression, and I think - I believe also it's a bit - it is a generic condition.
Kim Hai experienced many losses related to living through a war and her experience migrating to Australia as a refugee, which left her with a 'deep sadness'.
Kim Hai experienced many losses related to living through a war and her experience migrating to Australia as a refugee, which left her with a 'deep sadness'.
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Yeah, so that's probably the first sign of - now that I, on reflection I thought that's probably I went through a period of depression because I was like plucked away from my environment, from my boyfriend, from, from the war, from the suffering of my whole country that I wanted to immerse myself in, to be a part of it, to, maybe to feel like I was doing something, rather than going to (country name), having - you know, I was thinking what was I doing there, having all these meals with a big piece of steak and while my country fellow man, or my father, didn't have that much meat to eat in like a week's time, and my boyfriend was in the war zone and sometime going hungry and fighting the enemy.
I didn't feel you know grieving or anything. I was just numb. And I just kept going on with my life, as usual. I never really properly grieved for that loss. But I was always very sad person because in the inside. Now that I think of it, it was probably my inclination to suffer from depression, probably, I don't know. With my knowledge now I'd probably say if I had some help at that time probably you know it would have been good.
So I don't know if that's depression or not. You know, that could be. So sadness and depression I think in my case it was very severe sadness, though, compounded with the fact that my environment was changed and I had a lot of angst and anxiety and rebellion you know against the war, against my Mum. I think she was very dominating, domineering woman towards us and my dad as well.
Yeah, so I wasn't in control of my life at that point. So I wanted to be in control of my life by lashing out, doing these outrageous things against every value in our culture and everything.
Psychological factors
People we talked to saw low self-esteem, poor body image, insecurity and a focus on performance (perfectionism or failure) as ‘predisposing’ people to depression. Negative childhood experiences and difficult life-events in adulthood were present in these stories though again, people often presented several interwoven factors as the cause. Childhood experiences had profound consequences for many participants, and often resulted in a pervasive sense of worthlessness and low self-esteem. Clinton and Paul talked about the long-lasting effect of suppressed childhood memories of sexual abuse, resulting in a lack of confidence in later life, a sense of guilt and what they felt was a failure to realise their full potential. Emotional or psychological abuse in childhood left similar scars. Bullying at school and its impact on self-esteem in later life featured as another theme.
Clinton related his depression to childhood sexual abuse, but also reflected on hereditary factors.
Clinton related his depression to childhood sexual abuse, but also reflected on hereditary factors.
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Ah, and in that particular dream it was cemented in my mind that, ah, I had been sexually abused when I was around the ages of four and five, ah, by a next door neighbour who was, about 16 years old at the time that it happened, and quite, severely, mentally challenged. So that may have given me some answers as to what was going on before I became depressed, and when I was growing up as a child, and as a teenager, because my parents had a lot of problems with me. They took me to see a psychiatrist when I was about 13. Ah, they basically kicked me out of home when I was about 16, and then went on a holiday around the world. That's one way of saying goodbye.
Well something that's really fascinating is to look back, through the genes, and the family tree. And so that's one thing that I pursued, and found out that I had a grandfather who I never - never met, who was a chronic alcoholic, that apparently there was, you know, other stories with other distant relatives. But the - my Mum had been diagnosed with, major depression, and then she was actually one of, the first people in [place name] to be put on, lithium. And so there's some real - you know, some flags that come up there, and you think okay, well...
So then, you know, for me, the story which was me just having sexual abuse, all of a sudden there's another paradigm that comes in that my Mum was taking - was put on lithium that she was hospitalised many times, especially after giving birth to either myself or one of my two brothers. So then there could be a genetic component as well. So the picture starts to become more complex. But then you're also getting more answers.
Alice believed her depression stemmed from growing up in the shadow of her disabled brother and...
Alice believed her depression stemmed from growing up in the shadow of her disabled brother and...
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And then I thought, ‘But the reason people don’t understand, oh well they might, that I was so good is when you live in a family where there’s so many tragedies happening I was the only normal child…you know, one died, or two died, one’s disabled, I’m normal’. I felt guilty that I was normal. I felt the stress of being normal because I had to be better than normal, and I couldn’t misbehave because what would be the point in me misbehaving when my brother’s about to have grand mal seizure? I mean, how do you weigh that up, you know, who are they going to listen to? The person is having a tantrum and wants to be heard or the child that actually needs medical attention? And see, I lived 18 years with my brother, so that’s 18 years. Mum said to me once before she died, ‘Are you angry? Do you resent him? Do you resent him?’ And I said at that time, ‘No, I don’t, we had great life’. But then, you know, not long after that I sat down I thought, ‘Yes I bloody well do…I do.’ Because we couldn’t have dinner parties, we couldn’t have many friends over, we couldn’t go places, we couldn’t, we didn’t do anything because it was all about that and I think…I think that depression stuff is really, has come from a lot of factors - ah, low self-esteem, the you know, I always felt seen and not heard because as soon I was seen and heard, I was directly told by my father that it was ungracious to boast, or ungracious to say that how well, how well you do things, or, ‘People don’t want to hear people boast’. So, I learned straight away if I won something or I did something then no, and my father told me when I was in first class, when I didn’t topped the class, that academically I wasn’t very talented.
So, I took that on board and so when I did do something good and tried to say, ‘Well look what I...’, well no, you, it’s, you don’t do that, that’s not right, so I really learnt that. So when people said to me later on in life, ‘Gee that was well done’, no, like, ‘No, we don’t talk about that’. So you feed that along, you know and yeah I sort of felt that I was nothing, I was invisible and nothing and all I had to rely on was my personality which I did rely on. I relied on being nice so that everybody would get on with me. I was nice. I was good…
Biomedical explanations
A few people attributed depression to a ‘chemical imbalance’ or ‘lack of serotonin’. As a result they believed depression was beyond their control. They described having a genetic predisposition to depression that was ‘triggered’ by unfavourable environmental circumstances. This idea of hereditary-based health problems usually underlined a sense of inevitability and therefore absence of personal responsibility for peoples’ feelings and actions. Some of those we spoke with presented their condition as an interaction between medical problems and their social context. A few people discussed causes of depression in conjunction with other health conditions, including other mental health conditions, cancer and diabetes. Others attributed depression to serious physical illness and corresponding medical treatment.
Despite a complex set of life circumstances and difficult life events, Akello believed that her...
Despite a complex set of life circumstances and difficult life events, Akello believed that her...
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Yeah, so to me it’s, it’s helped, and I’ve also learnt that it’s, it’s a chemical imbalance in my brain. It has nothing to do with me. It’s, that’s what happens, so…
First of all I learnt it in - when I was doing my nursing training, and also reading a few books, it has helped me to know that, yeah, it’s got nothing to do with me, it’s a chemical imbalance in my brain. It’s - and the, the medication that I take helps balance out that bit in my brain that’s not balanced.
Gabrielle thought a chemical imbalance was one of several factors contributing to her depression.
Gabrielle thought a chemical imbalance was one of several factors contributing to her depression.
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You would constantly - I would constantly look up the latest ideas on medication or the chemical imbalance; why they thought that or, and I always knew there was more to it than just a chemical imbalance.
There was, I think - hereditary. You can have a chemical imbalance. But you can, depression is also not just a chemical imbalance. It's a social imbalance. It's an emotional imbalance. It's a lot of things. And you know, yourself, but you only deal with it when you're ready.
Colin had not anticipated the effects of prostate cancer on his sexuality and he found this hard to deal with. In addition, the lack of information about the consequences of his illness and treatment was upsetting.
Colin identified prostate cancer and the impact of treatment on his sexuality and sense of...
Colin identified prostate cancer and the impact of treatment on his sexuality and sense of...
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I suppose the thought of what I was missing, what I’d lost, that’s probably the biggest thing. It would be the greatest thing; that you’re no longer able to perform as a complete man and the other thing that was with it as well is this terrible thing called incontinence all the time.
So you’re incontinent and you’re unable to, to perform - erectional dysfunction is - it’s there, but after medication all those things changed.
But if you were given a - with a lot of these things that they - if you’ve had a surgical procedure I think that there is enough information to tell you that yes depression is a possibility with most of these things because lifestyle change and the lifestyle change can affect a person dramatically because you have to stop doing (a) what you love; you have to stop doing what you have a passion about and with those changes it makes life very hard to get back in again, and that’s where I think the, the worthlessness comes because you knew you could do it in the past and now suddenly you can’t do it and the whole thing just really falls apart and that’s where - and the depression you don’t notice it but other people do because you’re virtually - you’re retracting into self; that black hole.
It’s anxiety that really starts it off; the anxiety of not being able to do things; anxiety, stress and then if you’re not I suppose strong enough but I don’t think we’re all that strong. I believe in everybody there is a, a little weak spot that can be called depression where you withdraw. Anyone who withdraws into themself to me now I see it as depression.
Last reviewed January 2016.
Last updated January 2016.
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