"I'm really stupid, so incompetent, I can't do anything right, I'm completely useless..." In the counseling room, a man in his thirties sat on the sofa across from me, his face clouded with sorrow, expression pained and conflicted, head bowed in dejection.
I asked, "Why do you speak of yourself this way?"
He sighed and continued, "I'm worse than everyone else at everything. My coworkers never want to include me in anything. I'm worthless. I wasted so much time before—road trips, staying up all night gaming. It was such a waste. Looking back now, it feels unforgivable.I have no future prospects whatsoever. There's no hope left in this life. Living feels utterly meaningless..." He kept shaking his head while speaking, his chin hanging low.
With professional sensitivity, I pressed further: "It sounds like you find life deeply meaningless. Have you had any thoughts or actions of self-harm recently?"
"This morning I couldn't stand myself anymore, so I banged my head against the wall."
...
I asked, "From what you've shared, it seems you have a very negative view of yourself. Let's hear how your wife sees you, shall we?"
His wife, sitting beside him, said, "He's actually exceptionally talented. He was always top of his class, even the top scorer in the local college entrance exams. He got into a prestigious university and works as a software designer. He's very capable at his job, and his bosses and colleagues all recognize his value. But since he developed depression last year, he's been talking about himself like this all the time. He was hospitalized then and got better. But this past week, it seems his depression has flared up again. Just like last time, he's having a lot of negative thoughts.Today he even banged his head against the wall. I have to go to work and can't watch him all day. I'm so worried and don't know what to do." As she spoke, her eyes reddened, tears welling up.
At this point, the visitor said, "I'm sorry to my wife. When we first got married, I didn't pay much attention to her. Now I realize she's actually been very good to me. I'm sorry for that."
I replied, "Your wife's description of you seems quite different from what you've shared. She mentioned you're very capable. How do you see yourself?"
"I'm really stupid. My grades were only achieved through rote memorization and sheer drudgery. Honestly, I'm hopelessly inadequate—nothing worth mentioning."... This was a snippet from last week's session in my counseling room. The client is a patient with severe depression. Through this exchange, we see he is actually a socially functional and capable man. Yet he is consumed by self-deprecation—believing himself incompetent, hopeless about the future, devoid of worth, filled with regret and self-blame, even harboring suicidal thoughts and behaviors.This embodies what we often describe as the "three selfs and three lacks" in depression: "helplessness, hopelessness, worthlessness, self-blame, self-reproach, and suicidal thoughts."
We say the typical symptoms of depression are low mood, loss of pleasure, and diminished interest.The "three selfs and three lacks" represent common additional symptoms. That is, alongside the core experience of low mood, individuals grapple with relentless self-criticism, viewing themselves as utterly worthless—deeming their intelligence, appearance, social connections, and abilities completely inadequate. Despite potentially excelling in various areas, they perceive only negativity, as if desperately seeking evidence of their own failings.If their child struggles academically or a car tire goes flat, the depressed individual will attribute it to their own failure. This is often accompanied by profound guilt and self-reproach. Take the male patient mentioned earlier: activities that once brought him joy—like road trips or all-night gaming sessions—now feel like unforgivable sins.In severe cases, depression can manifest as delusions of guilt. I recall a patient who repeatedly bowed his head in penance while hospitalized, declaring he owed an apology to the nation and its people. He felt indebted because his medical treatment consumed public healthcare funds—hard-earned money from taxpayers—thus betraying the state and its citizens. Though astonishing, this reflects genuine emotions and thoughts experienced by those with depression.They tend to seek out negative aspects to align with their current depressive state. Additionally, individuals with depression frequently dwell on suicidal thoughts, and in more severe cases, develop suicidal ideation and behaviors. They perceive life as meaningless and painful, believing death offers liberation. These thoughts are strikingly similar across many patients. In fact, some individuals with depression do act on these thoughts, ultimately choosing suicide.
Typically, individuals with depression conflate these negative "three selfs and three lacks" feelings with their very identity. They cannot step back from the experience to view it as a symptom. Under the weight of depressive suffering, they cannot distinguish whether these feelings stem from the illness or reflect their true worth. They integrate this negative emotional experience into their self-perception, believing they are truly inadequate and worthless.
I recall a patient sharing her self-criticism and depressive mood with me. I told her: "Your current low spirits and sense of diminished capability stem from your illness. It's the disease causing these negative feelings, making you feel down and less capable."It's not that your actual abilities have diminished. Right now, the illness is controlling your emotions and capabilities. So you absolutely must not give up on yourself. Once you recover, everything will be fine." Later, this patient told me, "Whenever I feel down and start thinking negatively, I remember what you said: it's not that I'm truly bad, but that the illness makes me feel bad. Thinking this way makes me feel much better. This idea kept me going while waiting for the medication to take effect, easing my suffering. I'm much better now."
This kind of explanation also corrects the patient's cognition, which is quite effective for many individuals with depression. Therefore, during the treatment process for depression, depressive moods and negative self-evaluations may persist for a considerable period, bringing negative experiences. When we provide accurate cognitive correction and reasonable explanations, it can help patients better understand their symptoms and the unpleasant feelings they bring, thereby alleviating their suffering.
Thus, by explaining the "Three Selves and Three Absences" to depression patients, we aim to deepen understanding of depressive symptoms, provide practical relief for current distress, bolster confidence and motivation to overcome the illness, and reduce feelings of hopelessness.This approach assists patients in restoring the "Three Selves and Three Possessions": "self-respect, self-reliance, and self-improvement" alongside "capability, hope, and value." It also buys valuable time for medication to take effect, thereby reducing suicide risk. (By Wang Chunyan, Beijing Chaoyang District Mental Health Center)