Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

Understanding depression beyond biology: the power of therapy and meaning

Maire Daugharty, MD
Conditions
July 1, 2025
Share
Tweet
Share

The Diagnostic and Statistical Manual of Mental Disorders (DSM) defines mental health, including depression, in terms of pathology or a deviation from normal that is reliably exhibited in observable behaviors. It describes genetics and risk factors, differences in gender, and considers cultural perspectives. Limitations of the DSM diagnostic criteria are acknowledged and recognize that human experience, or interaction between genetics and environment, cannot be captured completely. While the underlying neurobiology of depression has been the subject of focus in the medical field, interaction between the individual and their environment has been more the purview of infant research and the psychodynamic framework. In other words, the latter focuses on why the deviation from normal. This is important in understanding some of the benefits of medication and psychotherapy, where the strictly biological formulation robs the individual of any control over their symptoms. A purely pathological perspective diminishes the contribution of work approached in the context of a therapeutic relationship. Reframing pathology as possibly understandable self-preserving behaviors is an important de-stigmatizing perspective that also acknowledges the individual’s agency.

In exploring etiology and meaning in the devastating experience of recurring serious depression, there is a potential to reshape previously unexplored beliefs and assumptions. This includes learning what feelings more accurately represent, what they mean to the individual, a core feature missing in the experience of depression. Numbed, angry, irritable or sad, down, gloomy, blue, a lack of energy or joy, hopeless, helpless, lethargic, guilty, with a desire to disappear, melt away—all of these can be part of depression. Is this a mismatch in receptor neurotransmitter physiology? Or is it a reflection of the biology of an individual that learned in so many ways that their feelings are not important or even their own? It is an age-old question. If depression were predictably ameliorated with a medication and no other intervention, it would be simple.

A first indirect experience with depression was very early on reading a childhood story—the story of a quirky girl on a search for her father who disappeared under unclear circumstances at some unclear point in the past, leaving her mother behind, sad and disengaged. It was the story of a girl accustomed to entertaining herself with her imagination, making do with colorful threads and a view out her window. This was in fact the story of the disappearance of a parent to depression. The story was clever in centering the young girl’s central desire and sense of responsibility to fix everything for her sad mother and bring home the long-lost father. It of course was fantasy; rarely is there such a concrete success in fixing something so far out of the purview of a child.

Depression often grows out of childhood experiences. Raised by a parent who is depressed, angry, anxious, alcoholic, abusive, or neglectful, these children grow up learning a manipulation of their own emotions toward survival using the best logic of childhood, which is often long forgotten in the later world of adult responsibility. Additionally, instead of learning that this particular sensation in the brain or stomach is happiness, excitement, joy, or anticipation for something desirable, a child might not learn anything so reliable. Instead, messaging might depend on mother’s mood that day, anger toward the child, or state of inebriation. It might also depend on a need to appear admirable in every way as an extension of the parent instead of how the child authentically feels. That joy may suddenly be evaporated in the spark of a parent’s chronic sense of revulsion or rage and transmuted instead to shame. In addition to the chaos of unpredictability, the child’s perspective is developmentally egocentric. This creates a vulnerability to misappropriated responsibility for emotionally charged experiences. Mom is sad, mad, or confusing because I am bad. Like the little girl in the story, a child does their best to fix it, but unlike in the story, they often cannot.

Depression is a subjugation of feelings. It is a chronic, devastating evisceration of self—an emptiness, numbness, lethargy, moving through a sea of intolerable molasses, with depleting fake smiles and forced cheer. It is difficulty getting out of bed in the morning, with no sense of purpose or excitement, exhaustion before the day has started, defeated on repeat with no hope for change. It is an inability to enjoy the rest and regeneration of sleep and the pleasure of eating or company of friends. It is completing chores, getting by, and it is exhausting with no breaks. Depression can encompass a deep sense of self-hatred without really knowing why, an abandonment of self in an early enforced truce in a power-imbalanced authoritarian home. Sometimes it comes with feelings of guilt, failure, shame, and an inability to climb out of an unrelenting, intrusive sense that the world might be better off without such a creature as self around. Depression is a deeply held distorted belief about place in the world and an exhaustion that wants end. It is not hard to imagine how this might impact underlying neurobiology and how an antidepressant might help and support, even in the absence of understanding exactly how the medication works.

Feelings are an intrinsic part of our identity, and our treatment of feelings reflects our sense of self-understanding and worth. Our feelings reflect how we experience the world around us, how we show up in relationship, our sense of values and ethics. They are our goalposts, our delight, our love, our grief. Without them we are robbed of critical experiences, our own intuition, part of the pattern-seeking brain that contributes to a felt truth, and which sometimes deepens our experience of meaning. Diminishing how we feel, or having this diminished for us, demeans a core part of who we experience ourselves to be. On guided reflection, it is sometimes revealed to favor the originally learned patterns in abusive circumstances with a parent who has frequently not done their own work. This is a direct reflection of the mechanism of action of intergenerational trauma. It is an unfair trade, though, because much of this was configured before language and sense of self were present enough to consider the messaging. Part of working with depression as a psychotherapist, then, is helping someone reacquaint themselves with their feelings, with accuracy, and with a new understanding for the critical nature of this part of who one is—that part of self which is reflective of an inherent truth: That I matter. Sometimes therapy is enough, or medication is enough, and sometimes both are essential, where medication provides support and the ability to get up and out of bed to do the work of grieving the lost parent, among other things.

Maire Daugharty is an anesthesiologist who expanded her expertise by earning a master’s degree in clinical mental health counseling, merging her long-standing interest in mental health with her medical background. As a licensed professional counselor, licensed addiction counselor, and licensed marriage and family therapist, she brings a well-rounded perspective to her private practice, where she works with adult individuals and couples on a wide range of concerns. In addition to her counseling practice, she continues to work part-time as an anesthesiologist and has a deep understanding of the unique challenges faced by clinicians in today’s medical landscape. To learn more about her practice, visit Physician Vitality Services.

Prev

Why compassion—not credentials—defines great doctors

July 1, 2025 Kevin 0
…
Next

How I learned to stop worrying and love AI

July 1, 2025 Kevin 0
…

Tagged as: Psychiatry

Post navigation

< Previous Post
Why compassion—not credentials—defines great doctors
Next Post >
How I learned to stop worrying and love AI

ADVERTISEMENT

More by Maire Daugharty, MD

  • Why peer support can save lives in high-pressure medical careers

    Maire Daugharty, MD
  • Why coaching is not a substitute for psychotherapy

    Maire Daugharty, MD
  • Why your emotions are your greatest compass in therapy and life

    Maire Daugharty, MD

Related Posts

  • Surviving medical school with depression

    Anonymous
  • Understanding critical care in the ICU: then and now [PODCAST]

    The Podcast by KevinMD
  • Understanding why people participate in clinical trials

    Pouria Rostamiasrabadi
  • The importance of physician education regarding psilocybin therapy

    Lynn Marie Morski, MD, JD
  • Ownership of outcomes: Reuniting power and responsibility

    Amelia L. Bueche, DO
  • Power at the top of health care in America

    Wendy Hind, PhD, JD

More in Conditions

  • Clinical ghosts and why they haunt our exam rooms

    Kara Wada, MD
  • High blood pressure’s hidden impact on kidney health in older adults

    Edmond Kubi Appiah, MPH
  • How declining MMR vaccination rates put future generations at risk

    Ambika Sharma, Onyi Oligbo, and Katrina Green, MD
  • How one unforgettable ER patient taught a nurse about resilience

    Kristen Cline, BSN, RN
  • Why regular exercise is the best prescription for lifelong health

    George F. Smith, MD
  • When the weight won’t budge: the hidden physiology of grief, stress, and set point

    Sarah White, APRN
  • Most Popular

  • Past Week

    • Who gets to be well in America: Immigrant health is on the line

      Joshua Vasquez, MD | Policy
    • Why specialist pain clinics and addiction treatment services require strong primary care

      Olumuyiwa Bamgbade, MD | Conditions
    • Harassment and overreach are driving physicians to quit

      Olumuyiwa Bamgbade, MD | Physician
    • Why peer support can save lives in high-pressure medical careers

      Maire Daugharty, MD | Conditions
    • When a medical office sublease turns into a legal nightmare

      Ralph Messo, DO | Physician
    • Addressing menstrual health inequities in adolescents

      Callia Georgoulis | Conditions
  • Past 6 Months

    • Forced voicemail and diagnosis codes are endangering patient access to medications

      Arthur Lazarus, MD, MBA | Meds
    • How President Biden’s cognitive health shapes political and legal trust

      Muhamad Aly Rifai, MD | Conditions
    • Why are medical students turning away from primary care? [PODCAST]

      The Podcast by KevinMD | Podcast
    • The One Big Beautiful Bill and the fragile heart of rural health care

      Holland Haynie, MD | Policy
    • Who gets to be well in America: Immigrant health is on the line

      Joshua Vasquez, MD | Policy
    • Why “do no harm” might be harming modern medicine

      Sabooh S. Mubbashar, MD | Physician
  • Recent Posts

    • How shared language saved a patient from isolation

      Syed Ahmad Moosa, MD | Physician
    • The shocking risk every smart student faces when applying to medical school

      Curtis G. Graham, MD | Physician
    • Clinical ghosts and why they haunt our exam rooms

      Kara Wada, MD | Conditions
    • High blood pressure’s hidden impact on kidney health in older adults

      Edmond Kubi Appiah, MPH | Conditions
    • Deep transcranial magnetic stimulation for depression [PODCAST]

      The Podcast by KevinMD | Podcast
    • How declining MMR vaccination rates put future generations at risk

      Ambika Sharma, Onyi Oligbo, and Katrina Green, MD | Conditions

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

Leave a Comment

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

ADVERTISEMENT

  • Most Popular

  • Past Week

    • Who gets to be well in America: Immigrant health is on the line

      Joshua Vasquez, MD | Policy
    • Why specialist pain clinics and addiction treatment services require strong primary care

      Olumuyiwa Bamgbade, MD | Conditions
    • Harassment and overreach are driving physicians to quit

      Olumuyiwa Bamgbade, MD | Physician
    • Why peer support can save lives in high-pressure medical careers

      Maire Daugharty, MD | Conditions
    • When a medical office sublease turns into a legal nightmare

      Ralph Messo, DO | Physician
    • Addressing menstrual health inequities in adolescents

      Callia Georgoulis | Conditions
  • Past 6 Months

    • Forced voicemail and diagnosis codes are endangering patient access to medications

      Arthur Lazarus, MD, MBA | Meds
    • How President Biden’s cognitive health shapes political and legal trust

      Muhamad Aly Rifai, MD | Conditions
    • Why are medical students turning away from primary care? [PODCAST]

      The Podcast by KevinMD | Podcast
    • The One Big Beautiful Bill and the fragile heart of rural health care

      Holland Haynie, MD | Policy
    • Who gets to be well in America: Immigrant health is on the line

      Joshua Vasquez, MD | Policy
    • Why “do no harm” might be harming modern medicine

      Sabooh S. Mubbashar, MD | Physician
  • Recent Posts

    • How shared language saved a patient from isolation

      Syed Ahmad Moosa, MD | Physician
    • The shocking risk every smart student faces when applying to medical school

      Curtis G. Graham, MD | Physician
    • Clinical ghosts and why they haunt our exam rooms

      Kara Wada, MD | Conditions
    • High blood pressure’s hidden impact on kidney health in older adults

      Edmond Kubi Appiah, MPH | Conditions
    • Deep transcranial magnetic stimulation for depression [PODCAST]

      The Podcast by KevinMD | Podcast
    • How declining MMR vaccination rates put future generations at risk

      Ambika Sharma, Onyi Oligbo, and Katrina Green, MD | Conditions

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

Leave a Comment

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...