If we think about the many causes behind depression, we always return to the experience of powerlessness.

It follows then that if we are to recover from depression we need to feel more empowered. Understanding the links between powerlessness and depression can help us in beginning to feel more in control of our lives. The causes of long-term depression can be understood through looking at the work of the French child psychologist Jean Piaget.

Looking at child development to understand adult experiences

Piaget had a framework for understanding how children develop. His "preoperational stage" of childhood development states that between the ages of 3 and 7, the child feels unconnected with the outside world. This makes sense. If we look at our own children or remember our own experiences from childhood, we can remember living in our heads. We would speak to ourselves as we played. We may even have had imaginary friends. In this stage of development we will not be aware that our actions have consequences on our environment. The next stage of development - the “operational stage” - is when the child begins to realise that their actions do have an impact. The reason why this theory is important is because people with long term depression often report some kind of damage in their relationships with the significant people in their lives between the years of 3 and 7. The damage, whether it is abuse or neglect, results in the child retreating from intimate relationships.

If unchecked, they will continue to think in preoperational ways. They live in their heads into adulthood. The relationships that they may have in adulthood are fearful. Closeness and intimacy are threatening. They may cope by wearing a mask in their relationships. Unfortunately this strategy can result in feeling powerless. If you wear a mask you can never be truly aware of the impact you have on others because you are fearful of being yourself. Any reaction you experience is to the mask rather than you. If you feel powerless, it will mean that you cannot be held to account for your actions. You have no agency. 

The importance of agency 

The term “agency” comes from the work of the psychologist Albert Bandura. Agency is the belief that we have a capacity to influence what we encounter in life. It is helped if we are clear about what we want. If we are clear about this, then we are more likely to hold ourselves accountable for our actions. However, having agency and holding ourselves to account is not a risk free strategy; we will get things wrong.

If we apply this idea to our personal history, it follows that we must have been responsible for our depression. The conclusion we may then reach is that our depression is our fault. In considering this, it helps to think about what we can and cannot control in life. Our depression is ultimately the end result of the life situations that we were born into. These are life situations we did not choose. The philosopher Kierkegaard said that life is understood backwards but it must be lived forwards.

Agency means recognising what we are possible of doing and working towards that outcome. Once we achieve this, then we can feel empowered. Bandura reminds us that agency was never about “doing everything on our own”. We can have agency by proxy where we influence others who have the resources to help us as well as collective agency: acting with others to achieve a goal. 


Michael O'Sullivan is a Cognitive Behavioural Therapist in the Derbyshire Healthcare Foundation Trust.

Buy Michael's book "A Practical Guide to Working with Depression: A cognitive behavioural approach for mental health workers"