It doesn’t appear in the DSM, yet cynical depression is everywhere these days, concealed by chronic resentment, anger, entitlement, inflated ego, self-righteousness, dogmatic zealotry, chronic envy, abuse of substances, or, in its most soul-destroying form, abuse of loved ones.
What clinicians describe as refractory depression—persistent and treatment-resistant—is often cynical depression.
We can imagine the persistence and treatment-resistance of cynical depression from the dictionary definition of cynical:
Believing that people are motivated by self-interest, distrustful of human sincerity or integrity. Concerned only with one’s own interests and typically disregarding accepted or appropriate standards to achieve them.
Needless to say, treatment of cynical depression is difficult. Medication is ineffective for many and many others scoff at the suggestion that they try medication. If they come into therapy at all, it’s for symptoms and behaviors that derive from their masks, not for underlying depression. Most are spouse-ordered, job-ordered, or court-ordered. They don’t trust therapists, convinced that we’re “in it for the money.” Some dare us to help them.
In the formidable task of engaging difficult clients, more than a few therapists inadvertently validate their unrealistically negative appraisals of others. Some clinicians fear that confronting maladaptive attitudes will cause premature termination of therapy.
Of course, not all refractory depression is cynical. The distinguishing factors are the ways that sufferers mask their depression. These are typically adrenaline-based to energize or illusory to sedate.
The adrenaline mask takes the form of risky behavior, chronic resentment, anger, chronic envy, dogmatic zealotry, or abuse of loved ones. Sufferers don’t look or feel depressed; the adrenaline militates out of depressed mood. It gives a surge of temporary energy and confidence, manifested in facial expressions and body language.
But adrenaline works like an amphetamine; they get a surge of energy and confidence, then they crash, feeling worse than when they started. The crash intensifies the quest for more adrenaline to lift them out of the emotional hole. Each swing from energy/confidence to acute self-doubt and back (to adrenaline-powered energy/confidence) strengthens the defensive, self-defeating mask.
Sedating masks take the form of entitlement, inflated ego, self-righteousness, or abuse of substances, which temporarily numb the pain of depression. These are illusory and degenerative symptoms that feed on each other. Entitlement has built-in frustrations, as the world is unlikely to meet entitlement demands, once we’re over 5 and not cute anymore. Sufferers typically compensate for disappointment with inflated ego or self-righteousness, which allows them to look down on others. Presumed superiority justifies, in their minds, manipulation or exploitation. The bigger the ego, the less authentic it feels, which often drives sufferers to abuse alcohol or drugs.
After nearly 40 years of a practice specializing in chronic resentment, anger, and abuse of loved ones, I’m convinced that cynical depression is far more prevalent than most clinicians suppose.
The cynically depressed rarely admit to being depressed. But they readily admit to feeling resentful, because it sounds like their failures and bad feelings are someone else’s fault. Likewise, they’re more likely to recognize that looking down on people or abusing substances gets them into trouble. I’ve found it useful to embed depression-ameliorating techniques in treatment for chronic resentment, anger, and emotional abuse.
Depression has many causes, some of them physiological. I urge all my clients to get a physical. I urge them to walk 30 minutes a day, spend 10 minutes a day in sunlight, and an hour a week in nature. These have been shown to ameliorate depression for some people.
Cynically depressed clients buy into learning how to have a better life. Once they do, they accept the need to replace habits of blame and avoidance with habits of improving, appreciating, and protecting loved ones. They feel the empowerment of approaching emotional interactions and situations with an attitude of improving them, rather than blaming them on someone.
It may be impossible to break through masks of cynical depression, but you can go under them. I ask clients to focus on their deeper values, rather than temporary feelings. Feelings are based on past experiences. When we consistently act on feelings, we make the same emotional mistakes over and over. Acting on deeper values elevates feelings naturally. Cynically depressed clients learn that acting on their more humane values makes them feel more humane and replaces the artificial confidence of their masks with genuine morality. As they act more on their deeper values, self-value increases and cynicism declines.
Cynical depression cannot be overcome without compassion for self and others, especially for loved ones. When clients express resentful or cynical appraisal of others, I ask them to describe the same behaviors a bit more compassionately. They sometimes need help, but most can change the appraisal fairly easily. Then they’re asked which of the two outlooks makes them like themselves better. The side-by-side experience of resentment and compassion shows them that prosocial emotions increase self-value. As they practice what makes them like themselves more, cynical depression dissipates, rendering their various masks unnecessary.
To alleviate their fear of compassion (becoming a doormat), we practice compassionate assertiveness—standing up for their rights, privileges, and preferences, while being respectful of the rights, privileges, preferences, and vulnerabilities of their partners.
The masks of cynical depression create emotion regulation deficits. Without their masks, sufferers are unskilled in calming themselves when upset and cheering themselves when down and raising self-value when they feel devalued. Since most emotion regulation is habitual, new habits must be developed in ways that clients find empowering. After a few weeks of practicing emotion regulation skills, clients report that they’ve never felt so in control of their emotions. More tellingly, their partners appreciate the difference.
The brain is unlikely to give up habituated use of adrenaline and illusions, without the practice of behaviors that increase endorphins—the body’s natural painkillers. The most beneficial ways to increase endorphins are through exercise and brief prosocial behaviors, motivated by compassion, kindness, and affection. These should be incorporated into one’s everyday routine.
If implementing the suggestions above produces only slight improvement, which occasionally happens, they should at least make clients open to taking medication for depression. Medication alone will do little for cynical depression. But supplemented with values-motivated, skill-based interventions, results can be awesome.