Getting to Grips with Depression -1

By Kevin Murphy, M.Sc.,
Psychoanalytic Psychotherapist,
Dublin, Ireland.

When you hear people use the term ‘depression’ the tendency is to imagine that they are talking about one thing. The impression is that depression is a whole and unified experience much like, say,the common cold. But in the same way that the common cold is a collection of symptoms, so too is depression. It is a collection of conditions that differ in their intensity depending on the individual. The word depression, therefore, is a blanket term that, on the one hand, lets us know broadly what we are dealing with but, on the other, can potentially sow the seeds of confusion.
Why confusion? Because in the first instance when we say that someone has ‘depression’ it does not situate us, as therapists, to accurately approach the treatment of that person. As a blanket term, it lures us into the false belief that there is a stock approach, a manual that we can consult and a prescribed set of things we need to do. In other words, it gives the impression that someone with depression belongs to some collective grouping that responds equally to the same treatment.
If that becomes the starting point for therapy, then the person’s individual circumstances and the particular mix of elements that are present will take a back seat to a more generalized, this-works-for-everyone approach.
Secondly, the very label of depression stigmatizes the person who suffers from it and sets them apart from the very society that they are struggling to be part of. Insurance companies load people who admit to having depression and it is one of a select number of subjects that simply do not get discussed by society at large, notwithstanding the ongoing efforts to change that.
Thirdly, it creates the false impression, as does a lot of modern psychology and psychiatry, that by having a name for it we also have the answer or cure for it. Unfortunately this is not the case. Good medicines are available but they do not take away all depressive pain.
So what then does psychoanalytic psychotherapy have to offer? Well to try and answer this as best I can I will take this week and the following two week's to focus on the subject.
The defining psychoanalytic viewpoint is that since depression is a blanket term we must look beyond it for answers. This means taking into account that there is a diversity of depressive symptoms contained in the word "depression" and these include mourning, anxiety, inhibition, rejection of the unconscious, melancholia, dereliction, sadness, self disgust, pain of existence, and, indeed, many others. The attentive psychoanalytic psychotherapist must recognise this.

This is the modern view of depression but it has its roots in Freud who referred to it as melancholia in his paper Mourning and Melancholia (1915). He contends that the difference between mourning and melancholia is that in mourning all that has been lost has been lost from consciousness and there is a necessarily painful withdrawal or regression. But in melancholia (later to become known as depression) it is not clear what has been lost because the identification has involved unconscious components. As the man said himself, “In mourning it is the world which has become poor and empty; in melancholia it is the ego itself.” So, it is 'we' who become the impoverished thing when depression strikes.

Freud was also the first to notice that melancholics were inclined to accuse themselves of many failings in an entirely unjustified way, and noted that their self-accusations could just as easily be directed against someone whom the patient loves or has loved. This led him to theorise that the intense and unreasoning nature of depression indicated that what had been lost was not just the external person for whom one mourns but an internalized idea of that person, or even an internalised idea of ourselves, to which there had been an intense identification by our ego.

As he puts it in a well-quoted phrase from that same 1915 paper: “Thus the shadow of the object fell upon the ego, and the latter could henceforth be judged… as though it were an object, the forsaken object”.

More recent psychoanalysts have moved Freud’s thinking on. Professor Paul Verhaeghe of Ghent University agrees with Freud that the process of identification lies at the heart of both depression and mourning. He says this is evident in the need to dismantle the inner image and, hence, identification with it. In his view depression can be understood as one side of an opposition: the emptiness of it standing in contrast to the fullness of enthusiasm.
At the heart of depression, he says, is a lack of emotion and a confrontation with emptiness and loss of meaning. He says depression can thus be conceived as the reverse of identity acquisition. It is the loss of an identificatory anchoring point in the Other, meaning key figures in our lives or in society generally.
Interestingly, he says that depression begins when, for one reason or another, the person is convinced that she or he no longer satisfies the Other's desire. As a result, the person plunges from a necessary and sustaining fantasy of their place in the human world into the empty void. In short, anything that damages the person's certitude that they satisfy the Other's desire provokes depression.

It might sound like heady stuff but, in fact, it is pointing to a fundamentally simple truth: depression is a result of the human condition in a world where all the old certainties are gone. And it is inextricably linked to our personal development, our reliance on others, our formation through our interaction with others, our relationship to internal and external ideals that sustain us, and our un-ending search for meaning and happiness. If we accept this is the case, then the same logic insists that the solution to depression is also to be found in the equally human framework of a therapeutic endeavour that operates precisely within this field.


Next week I will continue on this theme.