The Missing Piece in the Depression Conversation
Joana Esteves is the founder of Holistic Transformation Center and host of the Mind Untangling Podcast. As an international Rapid Transformational Therapy (RTT) practitioner and health coach, she helps high achievers reach the next level through the power of hypnosis.
Depression is usually described through its symptoms: low mood, loss of interest, fatigue, hopelessness, changes in sleep or appetite, difficulty concentrating, and sometimes thoughts of death or suicide. But symptoms tell us what someone is experiencing. They don’t necessarily tell us why.
Reducing symptoms can be enormously valuable, particularly when someone is suffering. But reducing a symptom is not necessarily the same as understanding what contributed to depression or what may be keeping it going. If we want to think about lasting recovery, I believe we also need to be willing to look beneath the symptoms.
For decades, many people were given a simple explanation: depression was caused by a chemical imbalance in the brain, often described as too little serotonin. It was an appealing story because it made an extraordinarily complex human experience seem understandable.
But science has never established depression as simply a serotonin deficiency. A major umbrella review published in Molecular Psychiatry found no consistent evidence supporting the idea that depression is caused by reduced serotonin.
That doesn’t mean biology is irrelevant. Far from it. Depression is complex, and biology is part of that complexity. But “biology matters” is not the same thing as “your biology is defective.” Perhaps that distinction gives us permission to ask a different question.
What about genetics? Having depression in your family does not mean that depression is your destiny. Research suggests that genetics can contribute to vulnerability, but inherited risk is not the same as inevitability. Genes operate within a constantly changing biological and environmental context. Predisposition is not predestination.
What if something is missing?
When somebody is depressed, we naturally ask: What’s wrong? We may ask about symptoms, diagnoses, medication, or family history. All of those questions can matter. But over years of working with people, I have become increasingly interested in another question: What are you disconnected from?
This way of thinking was profoundly influenced by Johann Hari’s book Lost Connections. Hari travelled around the world interviewing researchers and exploring evidence that depression and anxiety may be connected not only to biology but also to disconnection from other people, meaningful work and values, childhood trauma, status and respect, the natural world, and hope for the future. His work challenged me to think more deeply about what we may have lost and what we may need to reconnect with.
In my own work, I have come to organise this around three fundamental forms of connection: connection to others, connection to nature, and connection to self. I call them the Three Connections, and they have changed the way I think about depression.
Connection to others
Human beings are profoundly relational. We need to belong. We need to feel seen. We need affection, companionship, safety, contribution, and the experience of mattering to other people. Yet modern life can make genuine connection surprisingly difficult.
We move away from family. Relationships end. People die. Friendships disappear beneath work and responsibility. We work remotely. We become carers. We retire. We are bullied or rejected. We spend hours interacting through screens while becoming increasingly isolated in physical life.
Depression itself can make people withdraw, so the relationship can operate in both directions. But what I have observed is that disconnection often comes first. Loneliness isn’t simply about being alone. You can be surrounded by people and feel profoundly lonely. Connection is not simply proximity. It is belonging.
Connection to nature
There is another form of disconnection that is easy to overlook. For most of human history, our lives were inseparable from the natural world. Today, many of us spend enormous amounts of time indoors, sitting down, under artificial light, looking at screens. Yet our biology didn’t suddenly stop responding to the environment around us.
Research into nature-based interventions has reported improvements in depressive mood, anxiety, and positive affect. Exercise has substantial evidence behind it for depression. Daylight helps regulate the circadian systems involved in sleep, hormones, energy, and mood.
None of these things should be reduced to another simplistic cure. Depression isn’t simply a matter of not having enough serotonin, and it isn’t simply a matter of not getting enough sunlight, exercise, or time outdoors either. The point is bigger.
We don’t simply visit nature. We are nature. The brain is an organ. It needs nourishment, movement, sleep, light, stimulation, and rest. These things add up. Together, they support the body and brain, strengthen our connection with nature, and can become an important part of recovering from depression.
Connection to self
Of the Three Connections, this is the one I am most dedicated to because sometimes we become disconnected from other people and from life partly because we have first become disconnected from ourselves.
What does that mean? Not knowing what you feel or what you need. Saying yes when you want to say no. Having no boundaries. Silencing your voice. Continually chasing approval. Believing your worth has to be earned. These same patterns can also appear in recurring burnout, particularly when self-worth becomes connected to achievement, responsibility, or being needed. It can also mean losing touch with what you genuinely want from your life.
Many people become extraordinarily skilled at being who everybody else needs them to be while becoming strangers to themselves. Beneath that disconnection, I often find beliefs: I'm not enough, I don't matter, I'm unlovable, there's something wrong with me, I don't belong.
These beliefs are not necessarily conscious. A person can intellectually know, Of course I'm worthy, while something deeper continues to organise their emotional responses as though they are not.
Our self-talk can reveal some of these underlying beliefs, which is why simply telling someone to “think positively” can be so inadequate. This is also why I believe meaningful personal growth often needs to happen from the inside out. Knowing something isn't true is not always the same as no longer believing it.
What did what happened to you teach you about yourself?
Trauma-informed therapy helped move the conversation from “What's wrong with you?” to “What happened to you?” I think there is another question worth asking: What did what happened to you teach you about yourself?
A child who is continually criticised may not conclude, My parent is emotionally dysregulated. They may conclude, I'm not good enough.
When a parent leaves, a child may not understand the complexities of an adult relationship. They may learn, People leave me. I'm not worth staying for.
Trauma can also involve what didn't happen: the affection that wasn't given, the safety that wasn't created, the reassurance that never came, the voice that was never encouraged. Eventually, a person may learn: Don't speak. Don't feel. Don't need. Don't upset anyone. Don't take up space. Be who they need you to be.
This is why I find Marisa Peer's therapeutic description of depression as the opposite of expression so thought-provoking. What happens when a person learns that it isn't safe to fully express who they are? What happens when they suppress their needs, their voice, their anger, their grief, their creativity, their boundaries, their authentic self?
Trauma may steal someone's voice. Reconnection to self involves helping them discover that they are allowed to have one again.
Perhaps depression is asking us to look deeper
None of this means that every person becomes depressed for the same reason. Depression is complex. Biology matters. Genetics can matter. Medical conditions can matter. Medication can be valuable and, for some people, lifesaving, providing a bridge until deeper work becomes possible.
But perhaps the mistake is believing we have to choose between biology and experience. Experience is biological. Relationships affect us. Trauma affects us. Isolation affects us. Sleep affects us. Movement affects us. Meaning affects us. The stories we repeatedly tell ourselves affect how we experience the world.
Our biology is not separate from the life we are living. That gives us somewhere to look. Not for blame. For agency. If disconnection can contribute to suffering, then reconnection can become part of recovery.
Reconnect with people who allow you to belong. Reconnect with the natural world your body evolved within. Reconnect with your needs, your voice, your boundaries, your desires, your worth, and the parts of yourself you may have learned to suppress.
I explore the research behind the Three Connections, depression, subconscious beliefs, genetics, nature, and hypnotherapy in greater depth in my article, Depression: What If We've Been Looking in the Wrong Place?
Perhaps we've spent too long asking only, What's wrong with me? Maybe we should also be asking: What happened to me? What did it teach me about myself? What am I disconnected from? Because where there is depression, I believe it is worth looking for the disconnection. Then we can begin finding our way back.
If your depression includes thoughts of suicide or you feel unable to keep yourself safe, please seek immediate support. Tell someone you trust, contact a qualified healthcare professional or crisis service, or seek emergency help if you are in immediate danger. You do not have to carry suicidal thoughts alone.
Ready to explore what may be happening beneath the surface?
If you recognise yourself in some of these patterns and would like to explore the beliefs and experiences that may be keeping you disconnected from yourself, others, and nature, you can learn more about my work with subconscious transformation at Holistic Transformation Center.
If you're curious about how hypnosis works as a tool for accessing subconscious patterns, I explore some of the most common misconceptions about it here.
This article is intended for educational purposes and is not a substitute for personalised medical or mental health advice. If you’re concerned about your mental or physical health, please seek direct support from a qualified professional.
Read more from Joana Esteves
Joana Esteves, RTT Practitioner, Clinical Medical Assistant & Hypnotist
Joana Esteves helps people from all walks of life with issues like stress, anxiety, weight loss, insomnia, addiction, wealth, relationships, confidence, self-esteem, phobias, sports performance, procrastination, and any undesirable patterns that may be keeping them from living at their highest potential. Using the phenomenal RTT method, Joana taps into individuals' subconscious minds to get to the root cause of the issue, removing old beliefs and reprogramming the mind to achieve the desired goals.
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