Depression

Depression does not look the same in any two people, which is one of the reasons it goes unattended for so long. The version most people picture — visible sadness, unable to get out of bed — is only one of them.

Plenty of people who are depressed go to work, run a household, answer emails, and are described by everyone around them as fine.

What people actually say

Some of the sentences I hear most often:

If any of those is familiar, that is enough of a reason to talk to someone. It does not have to be worse first.

Two ways it tends to arrive

Not knowing why. The feeling is there and there is no obvious cause to point at. That version tends to carry hopelessness with it, partly because a problem without a name feels like one without a solution.

Knowing, and not having the energy. Others know exactly what is wrong. What they cannot find is the energy to pursue what looks like a healthy way forward — or the obstacles between here and there seem too many, too far, too draining, and too much to ask of anyone else.

Neither is a failure of will. Both are what depression does: it removes the very resources you would need to address it, which is what makes it so difficult to climb out of alone.

About the shame

Two of those sentences deserve a direct answer — I feel like a burden, and I am ashamed of who I have become.

Depression changes how you function, and then invites you to treat that change as evidence about your character. It is not. You are not a lesser version of yourself; you are a person carrying something heavy, and it is affecting what you can lift.

Nobody who has come to me about this has been a burden to me. It is the work, and it is work I chose.

Where we start

Whatever the cause turns out to be — a recent event, something older, a family history, a predisposition, or something not yet uncovered — we begin by getting the most important pillars back in place:

• Safety — being safe where you are, and safe from harm, including your own
• Health — sleep, food, movement, medical care
• Relationships — who is actually around you, and what reaches you
• Resources — financial and otherwise; what you have to work with
• The existential questions — meaning, purpose, and what your life is for

Those five hold a person up. When one or more has quietly gone, much else follows — and they are workable in a way that “feeling better” is not.

Seeing a psychiatrist

I will often suggest an appointment with a psychiatrist, and I want to explain why, because people sometimes hear it as being handed on, or as the beginning of being medicated.

It is neither. It is about getting a clear starting point: clarity on some things, and the exclusion of what turns out not to be relevant. It is just a visit. We get the feedback, and a diagnosis where one applies.

Nothing has to happen next. You have the most important say in what follows — that is not a courtesy, it is how this works. And if a specific structured process such as CBT is indicated, I will refer you to a clinical psychologist for it. Again, your decision is the one that matters.

There is no fast track

Healing from depression is mostly a process made of many small steps. I do not subscribe to a quick fix, and I would not offer you one.

This is the one area of my work where the process is likely to be ongoing, and where the details are not clear at the start. That is precisely why trust matters so much.

The opposite of depression

I have come to think that the opposite of depression is not happiness. It is connection.

That is why so much of this work is about what has been lost between you and other people, and between you and yourself. More on that on the loneliness page.

Practical details

Sessions are fifty minutes, in person at my practice in Stellenbosch or online by Zoom, in English or Afrikaans.

Most people come once a week. With depression that is not always enough, and sometimes twice a week, or a double session, works better — particularly when an hour a week feels like too little, too far apart. We decide that together, and it can change as things change.

Fees and other practical questions are answered on the FAQ page.

Getting in touch

Send me a message by email, WhatsApp or the contact form. You do not have to explain it well, or be sure that it is serious enough. “I think I might be depressed” is enough to start with.

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