Depression in the modern world

By Kevin Murphy, MSc.,
Psychoanalytic Psychotherapist,
Dublin, Ireland.

It is good to see the popular advice around depression making it seem a less threatening ailment than it first appears. Pretty much wherever you look these days, the language you hear is usually the same - calming, practical, commonsensical. Seek help, talk to someone, don’t get isolated, consider medication, go to therapy, tell someone you trust how you are feeling. If your job is making you blue, change it. If you are feeling lonely, get out and make friends. The emphasis is on de-stigmatising and de-mystifying which, in themselves, are good things.
And when it comes to the causes of depression, which is a crucial question when in Western society it is reaching pandemic proportions, you usually find that the commonly provided view is that it is a mix of things: some social, personal and biological factors. It is hard to argue with any of this, especially as all the bases seem to be covered. Even genetics is usually thrown in for good measure.
Where psychoanalytic theory and practice differs from the usual run of advice and information, is that its focus on cause is more detailed, more directed at the individual sufferer and more relevant to our contemporary society. You could say it is a hand-stitched approach rather than a production line one.
Why? Because it includes two other sources of depression that other theories either ignore or don’t recognise. These are the unconscious, the individual unconscious of the person suffering depression, and the wider cultural context as it has evolved today.
This notion struck me at the recent 16th Annual Congress of the Association for Psychoanalysis and Psychotherapy in Ireland (APPI) which was held in St. Vincent’s University Hospital, Dublin. The theme of the Congress was ‘Depression and Melancholia in Modern Times, A Psychoanalytic Understanding’. When the papers for the event are published I may do a blog summarising each of them, because they give a flavour of the unique way that psychoanalysis has in approaching this subject.
I won’t go into the history of it but if you want to read the seminal paper then Mourning and Melancholia (1917) by Freud is the place to go. Since then the theory has been steadily evolving and it was fascinating to hear what contemporary theorists and practitioners had to say about it at the recent Congress.
While most commonly accessible advice on depression focuses on the social, personal and biological aspects that cause depression, psychoanalysis hones in on the fundamental place that the individual takes up for significant others in his or her life. It posulates that we are driven to be the thing that drives important others. Put another way, our true desire is to be the desire of the other person. Depression, therefore, is essentially caused by a setback that sees us ‘tumbling out’ of this desire of the other. As perspectives go it is a fascinating one. But, equally, it is not something we are consciously aware of. It is all happening at the unconscious level.
Talking to people suffering from depression in the consulting room, it is striking how they speak the language of loss – this brings us back to Freud’s paper above, in which he was the first to see that depression had a great deal in common with mourning. They understand that something, or someone, has been lost to them but they do not know what it is in those people that has been lost to them. On the conscious level, they understand that they experience the unpleasant symptoms of depression – something within themselves has been lost – but they do not know what that something is - the loss is at an unconscious level. For psychoanalysis the thing that has been lost is this essential position within the human dialectics of desire, the place of being the desire of a significant or important other or others.
The theory also depicts how, as a result of this tumbling out of the desire of the other – a mother, a father, a main carer, a lover, a friend, a sibling - the individual is then thrown onto a trajectory of essentially attacking him or herself as a result of this failure. Failing to be the desire of an ‘other’ means that an ideal they had of themselves – something we all need to get us through life - has been damaged. And, because they were unable in some way to sustain this essential ideal, they then become the target for self-hate and self-loathing.
That’s the unconscious part. Then we have the wider cultural context. Changes in the role of fathers, in the methods of child rearing, in the responsibilities of mothers, in the value systems of society, in the importance of ideals of bodily perfection, in the decline of religion and authority, in the rise of scientific and capitalist discourses and in a devaluation of human individuality, has meant that it is harder for people to find sustainable ideals. By this I mean, ideals that are within reach, that come without too much expectation, that are credible and workable.
In the Victorian era people lived according to a widely understood and often unspoken command to ‘obey’. It was an era characterised by obedience, self denial, the repression of bodily desire and obedience to church, state, community and family. We can never go back to that because the world has evolved, for better or worse, depending on your point of view.
Today, we live according to a widely understood and often unspoken command to ‘enjoy’. For some, it is an easy one to follow because it matches perfectly our contemporary desire to escape, de-stress, find meaning, be happy, be free, experiment, give free rein to our curiosity. For those who suffer depression, however, it is just as ferocious and unrelenting a command as the earlier one to obey. And this, among many other reasons, is how psychoanalysis is different to other approaches.