Book Review: Depression: The Way Out of Your Prison

This book was first published in 1983 and is now in its third edition. The first 150 pages describe the experience of depression and how it develops. Rowe's key point is that depression is not an illness or a mental disorder but a defence against pain and fear. Whenever we experience a life event that shatters our ideas about our lives, the world and ourselves and leaves us fearful, we can use depression as a defence. If in looking for an explanation as to why a disaster happened we conclude it happened by chance or because of someone else's stupidity then we will feel more afraid and helpless to prevent further bad things happening. If, however, we blame ourselves, then we take responsibility and control. In accepting that the disaster is our fault then suddenly everything makes sense and we feel safe in our prison of depression where we hate ourselves, cut ourselves off from others (if they see how wicked we are they will punish us) and from our own past and future. Depression therefore gives life meaning. Being depressed is a safe place to be, every day is the same and we can be sure what will happen, we grow accustomed to its predictability.

According to Rowe, our sense of being a person comes from our structure of meanings (i.e. our guesses/theories about what is going on). When our guesses approximate what is actually going on we feel all right but when our guesses go badly wrong we feel shaky and frightened that we may be annihilated as a person. We constantly try to maintain our sense of existence and ward off threats of annihilation.

Rowe believes that people tend to see themselves as existing in one of two ways. Firstly, as existing in relation to others and therefore the threat of annihilation comes from feeling rejected. Secondly, as existing in terms of our own development and achievement and thus the threat of annihilation comes from a sense of losing control. Thus the core concept of depression is the discovery that there is a serious discrepancy between what we thought life was and what life is, which results in our losing a sense of meaning and purpose and feeling annihilated as a person, rather than being able to see that it is only our ideas that have fallen apart and no longer fit.

Having described how we can build our own prison of depression, what it looks like and why it is so hard to leave, Rowe devotes a chapter to the experience of living with someone who is depressed. She includes some suggestions about what to do if you are in this situation.

The final hundred pages of the book look at how we can leave the prison. She has eight suggestions summarised as follows: 1. Don't play the "yes, but..." game with yourself. When you catch yourself doing this ask "why"? 2. Treat yourself kindly. Accept yourself in all your humanness – you are not the most perfect wonderful person that ever lived but neither are you the worst, most imperfect wicked person. 3. Consider taking anti-depressants, some anti-depressants help some people some of the time. 4. Create a peaceful place within yourself. Relax from the struggle and pay attention to one thing at a time in the here and now. 5. Risk putting trust in yourself and others. 6. Find someone to talk things over with who has no interest in keeping you as you are. 7. Discover there is nothing wrong with seeing the funny side. Laughter is a way of seeing things differently and it casts out fear. 8. Dare to explore new ways of thinking and doing; discover that you have choices. This is my favourite part of the book. As a clinical psychologist working with people who are experiencing depression I found lots of practical suggestions for clients, written in an empathic and clear style.

The book is apparently written for depressed people, their family and friends and for all professionals and non-professionals, who work with depressed people. Writing successfully for such a wide audience is always a difficult aim to achieve. As a professional I would have liked the book structured in a different way, with the bulk of writing focussing on finding a way out of depression. There were times when I turned Rowe's written ideas into diagrams to make them clearer in my mind. I gave this book to one of my clients to read. He was thrilled that his experience had been documented in such detail but he also commented that all of the case examples given in the book were about people who had family or friends around them. Nowhere in the book did he find a case showing a person like him who was distanced from his family, socially isolated, approaching fifty and unable to contemplate ever having the life he had expected to have when younger. This could be interpreted as a "yes, but..." explanation for why he could not leave his prison of depression and encapsulates Rowe's point that my client's sense of meaning and purpose is gone and he feels annihilated as a person whereas in fact it is only his ideas falling apart and no longer fitting. However, I found myself wishing that there had been a case example that more aptly fitted his situation and that gave him some hope that his life could still have value.

This book has existential ideas at its core (although this is not explicitly stated), particularly in relation to meaning and existence. The book conveys these ideas in a very readable way. I like the fact that Rowe talks about her own experiences and occasionally uses examples from real life to demonstrate her points, such as the Enron scandal of 2002. The book talks a lot about religion which I sometimes found off-putting, although I agree wholeheartedly with Rowe about the importance of therapists asking about and respecting their clients' religious beliefs. If a client of mine wanted to read a book about depression then I would recommend this book as a way of generating some fruitful discussion about the client's own experience.

Dr Jenny Maslin