journal/2020-12-27--19-49-15Z--we_ve_got_depression_all_wrong_it_s_trying_to_save_us.org
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#+Author: Yann Esposito
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#+Author: Yann Esposito
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#+Date: [2020-12-27]
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#+Date: [2020-12-27]
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tags ::
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tags :: [[file:2020-07-01--07-25-51Z--psychology.org][psychology]]
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source ::
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source :: https://www.psychologytoday.com/us/blog/shouldstorm/202012/we-ve-got-depression-all-wrong-it-s-trying-save-us
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We’ve Got Depression All Wrong. It’s Trying to Save Us.
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New theories recognize depression as part of a biological survival strategy.
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Posted Dec 22, 2020
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For generations, we have seen depression as an illness, an unnecessary
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deviation from normal functioning.
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It’s an idea that makes sense because depression causes suffering and even
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death.
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But what if we’ve got it all wrong?
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What if depression is not an aberration at all, but an important part of
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our biological defense system?
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Depression is a courageous biological strategy to help us survive.
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Source: ActionVance/Unsplash More and more researchers across specialties
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are questioning our current definitions of depression.
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Biological anthropologists have argued that depression is an adaptive
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response to adversity and not a mental disorder.
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In October, the British Psychological Society published a new report on
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depression, stating that “depression is best thought of as an experience,
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or set of experiences, rather than as a disease.”
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And neuroscientists are focusing on the role of the autonomic nervous
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system (ANS) in depression.
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According to the Polyvagal Theory of the ANS, depression is part of a
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biological defense strategy meant to help us survive.
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The common wisdom is that depression starts in the mind with distorted
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thinking.
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That leads to "psychosomatic" symptoms like headaches, stomachaches, or
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fatigue.
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Now, models like the Polyvagal Theory suggest that we’ve got it backward.
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It’s the body that detects danger and initiates a defense strategy meant to
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help us survive.
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That biological strategy is called immobilization, and it manifests in the
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mind and the body with a set of symptoms we call depression.
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When we think of depression as irrational and unnecessary suffering, we
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stigmatize people and rob them of hope.
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But when we begin to understand that depression, at least initially,
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happens for a good reason we lift the shame.
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People with depression are courageous survivors, not damaged invalids.
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Laura believes that depression saved her life.
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Most of the time her father only hurt her with words, but it was when she
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stood up to him that Laura’s dad got dangerous.
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That’s when he’d get that vicious look in his eyes.
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More than once his violence had put Laura’s life at risk.
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Laura’s father was so perceptive, that he could tell when she felt
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rebellious on the inside even when she was hiding it.
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And he punished her for those feelings.
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It was the depression that helped Laura survive.
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Depression kept her head down, kept her from resisting, helped her accept
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the unacceptable.
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Depression numbed her rebellious feelings.
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Laura grew up at a time where there was no one to tell, nowhere for her to
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get help outside her home.
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Her only strategy was to survive in place.
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And she did.
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article continues after advertisement Looking back, Laura does not regret
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her childhood depression.
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She values it.
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Going through her own healing process and working with her therapist helped
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her see how depression served her.
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Laura’s story is stark.
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It’s ugly.
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And it helps us understand that even though depression may happen for a
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good reason, that does not make it a good thing.
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Laura suffered deeply and describes the pain of her hopelessness vividly.
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Her depression was a bad experience that started as the last resort of a
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good biological system.
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* Depression starts with immobilization
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According to the Polyvagal Theory, discovered and articulated by
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neuroscientist Stephen Porges, our daily experience is based on a hierarchy
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of states in the autonomic nervous system.
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When the ANS feels safe, we experience a sense of well-being and social
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connection.
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That’s when we feel like ourselves.
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But the autonomic nervous system is also constantly scanning our internal
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and external environment for signs of danger.
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If our ANS detects a threat or even a simple lack of safety, its next
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strategy is the fight or flight response which we often feel as anxiety.
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Sometimes the threat is so bad or goes on for so long, that the nervous
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system decides there is no way to fight or to flee.
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At that point, there is only one option left: immobilization.
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The immobilization response is the original biological defense in higher
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animals.
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This is the shutdown response we see in reptiles.
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Also known as the freeze or faint response, immobilization is mediated by
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the dorsal vagus nerve.
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It turns down the metabolism to a resting state, which often makes people
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feel faint or sluggish.
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Owlie Harring/Unsplash
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The immobilization response dulls pain.
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Source: Owlie Harring/Unsplash Immobilization has an important role.
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It dulls pain and makes us feel disconnected.
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Think of a rabbit hanging limply in the fox’s mouth: that rabbit is
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shutting down so it won’t suffer too badly when the fox eats it.
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And the immobilization response also has a metabolic effect, slowing the
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metabolism and switching the body to ketosis.
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Some doctors speculate that this metabolic state could help healing in
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severe illness.
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In humans, people often describe feeling "out of their bodies" during
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traumatic events, which has a defensive effect of cushioning the emotional
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shock.
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This is important because some things are so terrible, we don’t want people
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to be fully present when they happen.
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So the immobilization response is a key part of the biological defense, but
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it is ideally designed to be short term.
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Either the metabolic shut down preserves the organism, i.e.
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the rabbit gets away, or the organism dies and the fox eats the rabbit.
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But if the threat continues indefinitely and there is no way to fight or
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flee, the immobilization response continues.
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And since the response also changes brain activity, it impacts how people’s
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emotions and their ability to solve problems.
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People feel like they can’t get moving physically or mentally, they feel
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hopeless and helpless.
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That’s depression.
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* Does depression have value?
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It’s easy to see why Laura's childhood circumstances would set off the
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immobilization response, and even how it might have helped her survive.
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But why does it happen in people with less obvious adversity?
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Our culture tends to think of depression in the person who finds work too
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stressful as a sign of weakness.
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Self-help articles imply that they just need more mental toughness and they
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could lean in and solve it.
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Even some therapists tell them that their depression is a distorted
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perception of circumstances that aren’t so bad.
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But that is not how the body sees it.
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The defense responses in the autonomic nervous system, whether fight/flight
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or immobilization are not about the actual nature of the trigger.
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They are about whether this body decides there is a threat.
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And that happens at a pre-conscious point.
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The biological threat response starts before we think about it, and then
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our higher-level brain makes up a story to explain it.
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We don’t get to choose this response; it happens before we even know it.
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Studying anxiety has revealed that many modern circumstances can set off
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the fight or flight response.
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For instance, low rumbling noises from construction equipment sound to the
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nervous system like the growl of a large predator.
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Better run.
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Or feeling like they are being evaluated at school removes kids' sense of
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safety and triggers fight or flight.
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Better give the teacher attitude or avoid homework.
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And to most of us, fight or flight feels like anxiety.
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Eventually, if these modern triggers last long enough, the body decides it
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can’t get away.
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Next comes immobilization which the body triggers to defend us.
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According to Porges, what we call depression is the cluster of emotional
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and cognitive symptoms that sits on top of a physiological platform in the
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immobilization response.
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It’s a strategy meant to help us survive; the body is trying to save us.
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Depression happens for a fundamentally good reason.
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And that changes everything.
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When people who are depressed learn that they are not damaged, but have a
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good biological system that is trying to help them survive, they begin to
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see themselves differently.
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After all, depression is notorious for the feelings of hopelessness and
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helplessness.
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But if depression is an active defense strategy, people may recognize they
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are not quite so helpless as they thought.
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* Shifting out of immobilization
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If depression is the emotional expression of the immobilization response,
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then the solution is to move out of that state of defense.
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Porges believes it is not enough to simply remove the threat.
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Rather, the nervous system has to detect robust signals of safety to bring
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the social state back online.
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The best way to do that?
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Social connection.
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One of the symptoms of depression is shame, a sense of having let other
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people down or being unworthy to be with them.
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When people are told that depression is an aberration, we are telling them
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that they are not part of the tribe.
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They are not right, they don’t belong.
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That’s when their shame deepens and they avoid social connection.
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We have cut them off from the path that leads them out of depression.
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It is time that we start honoring the courage and strength of depressed
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people.
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It is time we start valuing the incredible capacity of our biology to find
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a way in hard times.
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And it is time that we stop pretending depressed people are any different
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than anyone else.
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