How did it happen that my patient chose to remain stuck in an unfulfilled, psychically dulling and isolated life? 

He is depressed.  No surprise.  The medical collective and even many in the mental health field might immediately blame a “chemical imbalance” in his brain.

Let me offer another way of looking at this that takes into account learning, relationships, and habit.

If a patient’s life is not going well, certainly not going they way he wishes – and he would not be talking to me if it were going otherwise – I must ask, “what is getting in the way?”  Together, we must look at his choices because this will put us on the right trail.  What are you choosing on a regular basis?

Don’t you make choices that feel right and natural to you at the time, even if it ends up feeling bad?  These are your natural patterns that evolved over years of learning in your growing-up environment.  They evolved within relationships that mattered to you.  You just wanted to do the right thing, or get by, or not get in trouble, right?

Here is an example:


The child who cannot rely on her parents learns this lesson:  she must be over-self-reliant at a too-young age.  This child grows into an adult who feels she has to do it all herself, or is angry when others don’t take responsibility for themselves.

She may not be able to ask for help when she needs it.

Then she builds up resentment.

Then important people in her life avoid her.

Then she feels more alone and unable to ask for help.

She may surround himself with people who cannot help her: busy people, self-involved people, needy people.

She feels more and more alone then.

Can you see how this happens?  Can you see how this might lead to depression?  Yet it started out as an adaptive coping strategy.