Before my illness, most of my knowledge of depression came from media reports. Sanmao, Leslie Cheung, Chunru Zhang, Cui Yongyuan...... This long list makes me take it for granted that depression is a relatively "advanced" disease. Elites, or at least cultural talents, are susceptible to this disease.

This misconception was dispelled when I first went to Anding Hospital.

In the crowded waiting hall of Anding Hospital, I saw the sad faces that are characteristic of all parts of China. They had obviously traveled a long way to get here; Looking around, cramped and uneasy, with a look of confusion and fear. They often sit for long periods of time, like clay carvings and wood sculptures. Looking at them, a sentence from Wang Xiaobo flashed through my mind - the silent majority.

Yes, in China, even among the depressed population, there is a silent majority – the largest population of depression in China, the poor, in the countryside.

The poor are the largest group of people with depression

Depression can occur in any class of people, especially in the poor. Just because this class lives out of the spotlight, their suffering is not known.

Research has proven that poverty is a major trigger for depression. Poverty makes people depressed, and depression makes people poorer, and the two interact to lead to mental disorders and isolation. Poverty and depression are a chicken-and-egg or egg-and-egg problem.

Depression can be traced back to human childhood. When our ancestors evolved from a hunting civilization to an agricultural civilization, some hunters who did not adapt to this change and could not master farming techniques became the earliest victims of depression.

Therefore, I make a bold guess that in the face of great social changes, people who cannot keep pace with the times and are abandoned by the times may become captives of depression because of their anxiety, panic and despair - this may explain why in the past decade or so, laid-off workers from Chinese state-owned enterprises and left-behind people in rural areas have become groups with a high incidence of depression.

Another circumstantial evidence is that the proportion of people receiving social assistance who are depressed is three times higher than the prevalence of the general population.

Poor students in Chinese universities have always been a sensitive topic. If poor students enter the city, if they do not receive material and spiritual help, the incidence of mental illness is extremely high. At present, poor students account for about 15%-20% of the total number of students in Chinese universities, and 65% of them have psychological problems.

In the United States, many poor people also suffer from depression. According to a survey, 85%-95% of people with severe mental illness in the United States are unemployed.

Poor groups have low rates of recognition of depression, which makes treatment even worse for them. Generally speaking, the middle class has a relatively happy daily life, they suffer from depression, and the unusual pain is relatively easy to detect. The poor living at the bottom of society are already in a difficult situation, and their symptoms of depression will be masked. He couldn't figure out whether his pain was depression or life itself. Many poor people suffer from depression and are never aware of it or known about it.

So, anti-poverty and anti-depression go hand in hand. An important means of fighting depression is to help the poor get out of poverty and improve their ability to change their lives.

Genetics cause depression

Among the intellectual class, people with depression also have different occupations.

Actors, civil servants, media people, police officers, and teachers are more likely to get depression - this is the observation summary of Jiang Tao, the chief physician of Anding Hospital, in his 24-year medical career.

He elaborated on me: "There is a big income gap in these industries. There are law-abiding and law-abiding civil servants; Journalists are blackmailed and non-blackmailed; There are good cops and bad cops...... The income gap is very large, and they are prone to imbalance, anxiety, and stress. ”

What Jiang Tao said was completely a description of personal experience and could not be verified. However, he revealed a phenomenon: intense inner conflict is associated with depression.

The next step can be discussed: What factors predispose to depression in terms of individuals?

The first is the biological factor. Depression is generally divided into two categories: endogenous and exogenous, and endogenous depression is often caused by internal factors and has obvious biological characteristics. This "internal factor" is actually a genetic, often genetic, which is the source of the imbalance of the three neurotransmitters (serotonin, norepinephrine, and dopamine) in the brain.

In real life, it is often observed that among the immediate or collateral relatives of a depressed patient, there are other patients with mental illness. This indicates that this family has a clear genetic predisposition. Yan Wenwei, a psychiatrist in Shanghai, believes that about 5%-10% of the world's population has this gene, which makes them prone to depression.

Jiang Tao also believes that genetic factors play an important role in the pathogenesis of depression. He gave me a statistic: the heritability of depression is 80%. The so-called "heritability" means that if you carry the disease-causing gene, the probability of developing the disease is 80%.

However, so far, there has been no scientific explanation for the intrinsic link between genetic factors and depression. Even the most advanced instruments cannot observe the process of chemical changes inside the brain.

There is a lot of opposition in the psychology community to the idea of biological factors. They believe that depression is primarily a mental illness. When I was interviewed, a psychiatrist said indignantly that Western medicine emphasizes biological factors and "wants to pull patients to the hospital", which is harmful to depressed patients, and will make them think that their "species" are not good and lose confidence in the cure.

The "inner punisher" of humanity

The theory of genetic factors has not been scientifically verified, and personality factors can be considered to play a more important role.

Different people have a variety of personality traits. Relatively speaking, people who are simple, sensitive, self-respecting, stubborn, strong, competitive, and perfect, and are accustomed to self-denial, guilt, self-blame, self-reflection, and self-guilt are prone to depression.

Why? There is no scientific explanation. My personal observation is that the above personalities tend to put emotions in a state of tension; Emotions are the bridge from the psychological to the physiological, and in the long run, the nervous emotions will destroy the brain's function of secreting neurotransmitters, and the seeds of depression will be planted.

Psychology believes that self-blame and self-guilt are the most likely to destroy people's psychological structure, and it constitutes an internal punishment mechanism to condemn and sanction themselves. Depression, low self-esteem, low self-esteem, and decreased vitality in patients with depression mostly come from this.

I have carefully traced the cause of my illness. In the end, it may have something to do with the environment I was in during my childhood and adolescence. Before I was born, my father was assigned to work in a rural area in northern Jiangsu because he was a rightist. He was persecuted and bullied outside, and when he returned home, he had no good reputation. Because of my sensitive nature, I have a sense of the harsh living environment beyond my age since I was a child, and I have learned to be rational, patient and restrained, as well as to resist external aggression by restraining myself. However, the inner rebelliousness and anger quietly grew in my heart. When I was a teenager, I was actually facing a different world with an attitude of "marginal non-cooperation".

After I was admitted to university, I have been working hard for many years to overcome the tension with reality that I have formed since I was a child, and to find a way to reconcile myself with the outside world. I thought I had succeeded, but I didn't know that the shadows of childhood and adolescence would become subconscious conditioned emotional reactions, rooted in the depths of human nature.

Then there are the environmental stressors. For example, work pressure, life pressure, interpersonal relationship pressure, etc., they should be based on emotions as a bridge, and act on neurotransmitters.

However, I've never believed that stress alone is not enough to cause depression. As mentioned earlier, most people with depression are able to introspect and restrain themselves, even to the point of self-sacrifice. If the pressure comes from only one side, they can also resolve it by compromise; However, if stress from multiple different directions swarms, and these pressures are intertwined and mutually exclusive, even if they are not compromised, depression can come into the house.

A netizen once came to me to talk about her mother's illness. She said that her mother had a simple, cheerful personality, lived a happy life, worked well, and could not find any reason for her illness. There was only one accident: last year, my grandfather and grandmother were transferred from her uncle's house to live in her house; And the two old men belong to a type of people who are selfish and eccentric, have many and high requirements, and don't think about others at all. As a result, the quiet and orderly life at home was disrupted. In her opinion, her mother suffered from depression because she couldn't cope with the pressure of her parents.

From the girl's gushing narrative, I could hear her and her father's antipathy for her grandfather and grandmother. I hesitated for a moment when she unilaterally attributed the cause to the two elderly people, and decided to be honest with me.

I said that even if the two old men were really selfish, picky, unreasonable, and greedy for enjoyment, they might not be able to crush her mother, after all, they are father and daughter, mother and daughter. The question is will your mom be under more pressure from different directions? For example, is your uncle stressed? Your mother has not fulfilled her support responsibilities for many years, and now her grandparents are not satisfied, how does she face her younger brother? Could your complaints with your dad be a stressor for your mom as well? All three are her relatives, what should she do? These three pressures are intertwined and opposed, and she can only endure and self-sacrifice; And if she can't get the right thing done, her inner anxiety, self-blame, self-guilt, helplessness and other emotions may gather together and become a torrent that breaks down her spiritual embankment.

"If you love your mother, you should stop complaining about your grandparents and remove the pressure on your side." I say.

The last factor is traumatic emergencies. For example, dropping out of school, unemployment, falling out of love, the death of a loved one, the failure of stock trading, and so on. However, the sudden event is only a stimulus, not a real cause. Depression is deeply rooted in your human nature, and even without this traumatic event, there will be other events, the difference is only in the timing of the outbreak. Of course, if you are lucky, it will drag on for ten or eight years and disappear on its own, it is not known.

In summary, depression is the result of a combination of factors. It is not just a simple mental illness, it has its roots in a certain alienated way of life that leads to inner division and betrayal. The only way to overcome it is to correct it in another way.

Finding the cause of depression has reference value for the treatment of depression. However, there is no need to be too entangled in the cause and trace the cause, otherwise it will create new pressure and contradictions, which will be detrimental to the condition. In a short period of time, it is impossible to trigger depression by just a few triggers. Once the disease has broken out, the cause is no longer important, just like if you light a firecracker with a match, and the firecracker has exploded, and you pursue the match, it will not help. For example, the cause of a girl's illness is a broken love, and even if her boyfriend changes his mind, her illness will not be cured for a while.

As for how to deal with the cause of the disease after recovery? This is another question, and we will leave it to the topic of "how to reintegrate depressed people into society".

The most important thing for people with depression is confidence – confidence in the doctor, confidence in themselves.