“It’s very difficult for me to feel happiness at all. If I accomplish something, win an important case for instance, that feeling of happiness lasts for a very short time,” says Stefan (40), a lawyer from the suburbs of Belgrade. “It’s difficult for me to feel any satisfaction. I just don’t enjoy anything. I don’t sleep well at night because my thoughts keep me awake, constantly racing around questions to which I have no answer. All of this starts to overwhelm me and I fall into this black hole of anxiety and depression. I also have frequent episodes of paranoia. I don’t trust anyone. When I start to talk about something, I jump from topic to topic. It’s total chaos in my head.”
“Since I was a kid, I’ve been depressed quite often, though in the last five years my good moods got better and my bad moods subsided a bit. I still expect that once every three to six months I’ll feel like life isn’t worth it. It feels like a hole in my chest, a perpetual nonstop sinking feeling,” says Nick (41), a DJ and producer who lives in New York. “Often I’m triggered into depressive thinking by a sense that my life will never be the hero’s journey that I romanticise in others that i see.”
According to the World Health Organisation (WHO) 374 million people worldwide are afflicted with anxiety disorders and 280 million live with mild to severe forms of depression. In Serbia it is estimated that between 250.000 and 400.000 people suffer from a combination of anxiety and depression characterised by negative thoughts, unexplained sadness, feelings of guilt, heightened nervousness, irrational worry, insomnia, headaches and other symptoms that are consistently present for at least two weeks.
According to American cognitive behavioural therapist Sally R. Connolly, anxiety spectrum disorders and depression have a complicated relationship in which comorbidity is highly prevalent. “It’s a cycle. When you get anxious, you tend to have this pervasive thinking about some worry or some problem. You feel bad about it. Then you feel like you’ve failed. You move to depression. Depression is often spawned from an anxiety disorder left untreated.” According to Dr. Milutin Kostic, a psychiatrist at the Institute for Mental Health in Belgrade, “depression and anxiety are the most common mental disorders afflicting people today. “Generalised Anxiety Disorder is highly comorbid with depression. Patients who meet the criteria for Generalised Anxiety Disorder also meet the criteria for depressive disorder 95% of the time. Individuals who report feelings of tension, insecurity and irrational fears also present with symptoms of depression.”
Depression, anxiety disorders and other mental health conditions are a result of biological, psychological and social factors and often closely linked to childhood trauma. According to renowned psychiatrist and neuroscientist Bruce Perry who has researched the impact of childhood trauma on children and adults for thirty years, “if you have developmental trauma, the truth is you’re going to be at risk for for almost any kind of physical health, mental health, social health problem that you can think of.” In their book, What happened to you? Dr. Perry and American talk show host Oprah Winfrey offer a revolutionary shift in focus from the question what’s wrong with you to what happened to you. This book provides detailed and scientific explanations for how early childhood trauma can leave deep emotional scars, affect the development of our brain, our personalities and our behaviour, and can serve as a predictor for the risk of psychological problems problems in adulthood.
A traumatic event is defined by the American Psychological Association (APA) as “one that threatens injury, death, or the physical integrity of self or others and also causes horror, terror, or helplessness at the time it occurs.” Trauma, which can be acute, chronic or complex, can manifest as physical, emotional or sexual abuse and neglect, loss of one or both parents, parental domestic violence, community and school violence, bullying, substance abuse disorder in family members, death of a loved one. Chronic trauma is a result of exposure to repeated and prolonged adverse experiences which the child is unable to escape such as domestic violence.
As a response to traumatic events in childhood, individuals often subconsciously develop maladaptive behaviours to survive and to protect themselves from pain. Because they were formed as defense mechanisms during a child’s early emotional development and at a time when the brain was still developing, these maladaptive strategies persist into adulthood. An adult whose basic needs were not met in childhood may suffer from numerous physical and psychological symptoms later in life: deep-seated insecurity, difficulty trusting and empathising with others, emotional detachment and immaturity, perfectionism, self-sabotaging behaviour, an obsessive need for control, self destructive behaviour, guilt, dissociation, chronic pain, nightmares, anxiety, depression and other mood disorders. Trauma can have profound and long-standing consequences on an individual’s life and personality traits as they become ingrained patterns of behaviour.
“My father was a strict authority figure who was violent whenever he got drunk,” remembers Stefan. “We never knew what kind of mood he would be in when he came home from work, if he would be drunk and start hitting us and breaking things around the apartment all night long. We lived in perpetual fear of him. My entire childhood was torture. My parents realised early on that I was good at basketball, so they forced me into this training program four hours every day. The basketball coach was also violent when he drank just like my father. I didn’t have any one place where I felt peace. They turned my childhood into torture mixed with crazy ambition. Some time later, my brain started acting up. If I was sitting around and doing nothing, I felt useless. If I was doing something that should normally make one happy, I felt guilty. Because I don’t trust anyone, I built a wall around myself. I often have feelings of anxiety, a pain in my chest and tension accompanied by aggression.”
According to a 2019 study conducted by UNICEF, the Institute for Psychology and the Institute for Mental Health in Belgrade, 70 out of 100 individuals in Serbia have experienced some sort of adverse childhood experience (ACE) that has impacted their adult life. The focus group consisted of 2,792 participants who experienced physical abuse 13.6% (multiple times), psychological abuse 26.3% (multiple times), domestic violence directed at mother 12.1% (multiple times), domestic violence directed at father 5.6% (multiple times), sexual abuse 2.8%, physical neglect 5.6% (multiple times), psychological neglect 10.5% (multiple times), alcoholism in the family 16.7%, depression in the family 13.0%, separated parents 15.1%, abusive behaviour 11.0% (multiple times), domestic violence 37.7% (multiple times).
The study concluded that individuals who experienced a greater number of ACEs reported numerous physical and psychological problems in adulthood, among which were alcohol and drug dependence and abuse, self-destructive behaviour, insomnia, uncontrollable aggression, panic, dissociative episodes, an inability to form emotional attachments, gastrointestinal, cardiovascular and respiratory problems.
Family members, friends, partners and loved ones are often unable to comprehend mental problems and mood disorders and lose both their empathy and desire to spend time with a depressed individual after some time. I remember how many times I said the words “but how can you be all alone when you have me?!” or “what on earth is emptiness? How can someone feel emptiness?” We think that they are lazy, spoiled and unmotivated. We think that they are ungrateful and that they don’t care about what they have, don’t care about us who love them. We think that they are intelligent, talented, good-looking, and that they have everything. We look for concrete answers and explanations that we can understand. We talk, we pressure them, we resent them. We go around in a circle from which we can’t escape. And after we have loved them, supported them and gone through everything with them, we decide that they are toxic and we start to avoid them.
We provide them with diagnoses and personality disorders: bipolar, narcissist, borderline personality, obsessive control freak, sociopath, paranoid, emotionless, Peter Pan. We don’t know and we don’t ask what has happened to them in the past, and they rarely, if ever, talk about their childhoods. We don’t connect the past to the present because we only see the picture that is in front of our eyes. Everyone is chasing their own happiness and no one wants to waste their time with depressives and narcissists. They are already gone.
Individuals with mood disorders are often negative, difficult, withdrawn, frustrated, obsessed with themselves and their problems and unable to form attachments to other people. While the person with the psychiatric disorder sits locked away in his thoughts, we withdraw because we realise that we can’t help them and patience is limited; we are getting zero emotional fulfilment in return, the situation is hopeless and whatever we give, it is never enough.
“I know that I am not alone in the literal sense of the word. I have the best sister in the world. But it means nothing to me,” says Jovan honestly.
Individuals suffering from comorbid depression and anxiety often feel guilty and don’t want to burden the people around them. “I know that I have no right to complain,” admits Nick. “I was born financially lucky and I’ve never had to do anything with my life, thanks to being born high in the merchant class, or something like that. I’m aware that others see me as a rich, white male. No one wants to hear me complain about anything.”
“I had this fantasy that things would change when I moved out of my mother’s apartment in New York to Los Angeles. I’m not really sure what I was expecting to happen to me there. After two horrible years there, I thought that I would get another chance by moving to Belgrade. But somewhere along the way I realised that none of that mattered because wherever I went I had to take myself with me, and that was the problem,” explains Jovan. “So I started drinking a lot. Belgrade is a great city and people are very friendly. I met a lot of people when I moved here, but your friends eventually stop calling you to go out and do things with them when you never answer the phone. And I stopped answering the phone and going out because I don’t want to inflict my negative vibe on everyone around me. Anyway, I totally understand why some people don’t call me anymore while others have completely cut me out of their lives.”
“I haven’t given up and not gotten out of bed,” says Stefan. “Maybe I would have if I didn’t have to work, but as it is, I show up at my job, I go out with my friends. I want to get married and have children. But I don’t feel any satisfaction at all from the things that I do. From the outside it looks like I have a pretty good life, but no one knows what it’s like in my head.”
Individuals look for various ways to cope with, and reduce, mood disorders. Many are dependent on antidepressant and anti-anxiety medication for years, sometimes even decades. According to Dr. Kostic, Serbia is the fourth largest benzodiazepine consumer in Europe. Others turn to alcohol and drugs. “No medication has ever had the same effect on me that alcohol has,” explains Jovan. “Whether I drink or I don’t drink, I’m not happy. The difference is that when I drink, it doesn’t bother me that I’m not happy.” It is estimated that around 30% to 50% of individuals in Serbia who abuse alcohol suffer from depression while one third of those with depression abuse alcohol.
“Sometimes I wake up and it’s just one of those days when the hole in my chest is particularly expressive and I just need to feel a deep feeling, and no amount of venting can help it,” describes Nick. “It’s hard to say what it is exactly, but it feels like several days of hating myself and envying everyone else’s experience. For me walking is the best thing. Sometimes I’ll walk all day if it’s bad. Sometimes I feel like if I stop walking I’ll find some way to kill myself. When I am on the verge of tears or rage, which happens every few weeks or months, I really need to walk.”
“I have several depressive episodes yearly, usually tied to worrying about money, my financial situation and my job,” says Stefan. “When I feel the depression coming on, I try to occupy my mind and distract myself however I can. My thoughts race all the time and my mind constantly needs to be busy with a project, but I haven’t had much success with any of my projects and that causes me additional anxiety. Maybe I have unrealistic expectations. I don’t know. I’ve always tried to focus on something concrete and put my depression to the side, but sometimes I fall into self-sabotaging behaviour and I start to think that everything is pointless.”
Nick believes that depression is part of the existential nature of modern life. “In this digital age where we are all tuned into each other’s idealised self-projections, the strength of one’s joy can feel like an assault on someone who is not feeling joyful. We may wish that we were as brave and joyous as people we see on the internet who share themselves often and enthusiastically. I know that I need to stop treating my personal story as if it is some epic movie that needs some huge victory and just enjoy my life, which is actually pretty great when I’m not trapped by my own personal demons.”