By Kevin Murphy, M.Sc.,
Psychoanalytic Psychotherapist,
Dublin, Ireland.
A client, who shall remain anonymous, said some things in the course of a session once that have stayed with me a long time. This particular client was suffering from a severe form of depression. What does that look like in reality? Well, it includes an inability to consider anything good about themselves, an inability to motivate themselves, a profound sadness and regret at who they are and what their lives have turned out to be, an absence of any hope for the future, and a harsh sense of judgement of themselves and their abilities.
It is depression and that is the diagnosis you would expect from a psychiatrist or a psychologist, which is valid in its own right. Psychoanalytic psychotherapists use the word too, in fact the theme for the 16th Annual Congress of the Association for Psychoanalysis and Psychotherapy in Ireland (APPI) next November is ‘Depression and Melancholia in Modern Times’. But where we differ is that this word depression is a starting point, rather than an end in itself. It is the place we begin a search, if you like, rather than the place where we settle down to consider the nature of the symptoms.
As I have said before, depression is a broad diagnostic label, one of many that give us the impression of understanding the issues involved when in fact they are only a very general guide. Description is not the same thing as understanding.
Taking the client I mentioned above, the things this client said in that session I referred to were that they (I use the plural to ensure confidentiality) were completely stuck on three ideas that had an almost persecutory quality.
One was the idea that the future would turn out bad. Something that had happened in their life was going to come back and haunt them in the form of unforgiveness from other people. There was some degree of reality in this, given the nature of this client’s background.
Secondly, this client was unable to stop thinking about a former lover, one that had since moved on to another relationship. The client felt extreme regret at having ‘lost’ this person through their own choice and now wanted this partner back even though the likelihood of that happening remained very slim.
And thirdly, as a result of this threat from others in the future, different options were constantly being considered to escape this threat. But the client experienced a deep depression around any of these options. In short, no matter where this client pictured themselves in the future, it was going to be awful.
The upshot of all this was a person who was deeply depressed about their situation and who was on the strongest depression medication available which, while keeping them from experiencing extreme pain, was far from blocking out all negative feeling.
The resonances I spoke of in this case were that this client was, while on the face of it anxious and depressed about the possibility of real things either happening or not happening in their life, the psychical reality was they were completely stuck. The ideation, or rather the process of idea formation, was almost exclusively centered around three identifiable issues, each with a modicum of real possibility about them. The tendency and indeed the temptation would be to work on the rationality behind these ideas and consider whether they might or might not happen while, along the way, work out options or strategies that might stave off the more unpleasant outcomes from taking place.
And yet that would be to ignore an essential point. It was not the content of the ideas themselves that was the source of distress for this client, even though at one level that was the case. It was more to do with the fixedness of the ideas; the fact that they could not escape thinking these ideas, despite the strong medication; that they could not escape the frightening and paralysing effect that these ideas had on them.
This form of thinking was, when we examined it more closely, quite similar to a style of thinking that this client had put into operation in many other areas of their life, both past and present. The gripping on to notions, and the worrying about them to an extreme degree, was part of a complicated internal defence strategy that they had learned over many, many years.
The issue was not what they needed to do about these ideas in themselves but what they needed to do about this kind of thinking. It sounds a bit like a behavioural approach to therapy doesn’t it? Simply teach the person to think in a different way. But it is not as simple as this either.
This kind of thinking is not simply un-learned and another more positive type inserted in its place. This style of thinking is, at a hidden level, designed to blot out many other aspects of the person’s life. It is, quite literally, a screen behind which the realities of their existence are kept concealed. So it is not a question of re-learning anything. It is, rather, a question of patiently and carefully dismantling a very sophisticated form of defence system in order to allow for a consideration of the fullest aspects of the life it seeks to conceal.
Now we are firmly back in the realm of psychoanalytic psychotherapy. A place where one takes one’s time and proceeds with the sense of caution and respect necessary to do a delicate job well. Unveiling things that have remained veiled for a great many years needs patience and care. It also needs a robust theoretical framework which allows for it to be recognised for what it is in the first place.
Thursday, May 28, 2009
Friday, May 22, 2009
Working with the Couch
By Kevin Murphy, M.Sc.,
Psychoanalytic Psychotherapist,
Dublin, Ireland.
As a piece of furniture the couch probably attracts more interest than anything else in my consulting room. Of course when I say couch I should more accurately describe it as a chaise longue, which is defined as an upholstered couch in the shape of a chair that is long enough to support a person’s legs. But calling it a couch works just as well.
I suppose it attracts interest because over the past 150 years, since Freud first gave us psychoanalysis as the original form of psychotherapy, the couch has become very much more than a piece of furniture. It has come to symbolize a great many things, possibly even psychotherapy itself.
In the process it has had its detractors from other schools of therapy who have seen in it an opportunity to criticize, sometimes with merit, sometimes not, custom and practice and, with much less success, the underlying theory.
You could say it has almost become a touchstone for inter-disciplinary strife, which is a great pity because we are all trying to achieve the same objective and at the end of the day it really is only a couch.
Freud began using it because his first forays into probing the unconscious mind of a Victorian-era clientele was through hypnosis. And when you hypnostise someone you want them to be in a comfortable position so they don’t fall over. When he left hypnosis behind and discovered the ‘talking cure’, in doing so founding the beginnings of all psychotherapies, he kept the couch.
Following his death, and even during his lifetime, splits and differences led eventually to what we have today in the form of three broad streams of psychotherapy. There is psychoanalysis and psychoanalytic psychotherapy which continues to use the couch and which, despite the claims from other branches of psychotherapy, is alive and well throughout the world.
Then there is the humanistic stream and the behaviourist stream, the former giving privilege to the notion of the conscious mind and the intrinsic wholeness of the person, the latter giving privilege to actively re-learning and retraining the person to more effective modes of both physical and mental behaviours. These two streams don’t have too much in common except they do not use the couch.
So what is it about the couch? The idea behind it, officially, is that Freud wanted to increase the ability of the client to allow ideas and thoughts, without censorship or editing, enter their mind. This happens because the client, by lying in a comfortable position facing away from the therapist, is not being impeded by the facial gaze of the therapist or the surreptitious body language that might inhibit this process. To this day, this objective has and continues to be fully met by the use of the couch.
Clients who work on the couch will tell you that it allows them the freedom to both relax and focus on their thoughts without have to attend to every little bodily cue that emanates from the therapist. It also, and more importantly, frees up the thinking process so that ideas come much more easily that can then be brought into the session.
That’s not to say that those of us who work with the couch are impervious to the cultural stereotyping that goes with it. Psychoanalysis has been around for a long time and it will continue to be. It also, by its very nature, deals with fundamental issues in people’s lives. The cultural stereotype of being ‘on the couch’, when it pokes fun at our doings, is a useful puncturing of the balloon and ensures we never get to complacent or smug or self-righteous. And that’s a good thing. It means we who practise have to be constantly reviewing its effectiveness and clarifying for ourselves the rationale for using the couch.
Psychoanalysis has become a classic target of cartoonists. Freud said that cartoons represent "a rebellion against [...] authority, a liberation from the oppression it imposes". So it was perhaps only fitting that the cartoon should be the medium for the longest-running and most iconic piece of send-up in the history of psychotherapy.
The ‘On the Couch’ cartoon that appears in The New Yorker magazine documents nearly 80 years of this send-up or rebellion against authority. The magazine published its first “psychoanalytic” cartoon in 1927 and since then its cartoonists have continually renewed the topic within the context of their own times.
So does everyone end up on the couch? No is the answer to that. Some clients sit in a chair facing me and do so for the duration of their therapy. The criterion for who uses and who does not use the couch is a detailed one. People in a high state of anxiety or in deep depression are not suited to it until their symptoms have reduced; nor are those who come with a rejection or a refusal to accept the notion of therapy and, believe it or not, some people do. And equally people with relationship issues who come to discuss the issues at hand as to why they are in or have endured in a relationship that is unfulfilling are not necessarily candidates for the couch. Often some people simply need to talk. As Freud is reputed to have said: sometimes a cigar is just a cigar.
But for the vast majority who come with a question, albeit one that may not yet be formed but which is forming within them, then the couch is the most effective form of therapy. For those who live lives of constant doubt, anguish or repetition and who question why their life is that way and how it can be changed, the effectiveness of the couch and the freedom – because freedom is really what it is – it offers is unparalleled anywhere, in any other form of therapy.
Not only is it a powerful method which allows people access parts of themselves they never thought possible. But to engage in the important business of examining one’s life in the presence of a trained other and without the gaze of that ‘other’ distracting them at every turn is the ultimate respect that can be paid to anyone.
Psychoanalytic Psychotherapist,
Dublin, Ireland.
As a piece of furniture the couch probably attracts more interest than anything else in my consulting room. Of course when I say couch I should more accurately describe it as a chaise longue, which is defined as an upholstered couch in the shape of a chair that is long enough to support a person’s legs. But calling it a couch works just as well.
I suppose it attracts interest because over the past 150 years, since Freud first gave us psychoanalysis as the original form of psychotherapy, the couch has become very much more than a piece of furniture. It has come to symbolize a great many things, possibly even psychotherapy itself.
In the process it has had its detractors from other schools of therapy who have seen in it an opportunity to criticize, sometimes with merit, sometimes not, custom and practice and, with much less success, the underlying theory.
You could say it has almost become a touchstone for inter-disciplinary strife, which is a great pity because we are all trying to achieve the same objective and at the end of the day it really is only a couch.
Freud began using it because his first forays into probing the unconscious mind of a Victorian-era clientele was through hypnosis. And when you hypnostise someone you want them to be in a comfortable position so they don’t fall over. When he left hypnosis behind and discovered the ‘talking cure’, in doing so founding the beginnings of all psychotherapies, he kept the couch.
Following his death, and even during his lifetime, splits and differences led eventually to what we have today in the form of three broad streams of psychotherapy. There is psychoanalysis and psychoanalytic psychotherapy which continues to use the couch and which, despite the claims from other branches of psychotherapy, is alive and well throughout the world.
Then there is the humanistic stream and the behaviourist stream, the former giving privilege to the notion of the conscious mind and the intrinsic wholeness of the person, the latter giving privilege to actively re-learning and retraining the person to more effective modes of both physical and mental behaviours. These two streams don’t have too much in common except they do not use the couch.
So what is it about the couch? The idea behind it, officially, is that Freud wanted to increase the ability of the client to allow ideas and thoughts, without censorship or editing, enter their mind. This happens because the client, by lying in a comfortable position facing away from the therapist, is not being impeded by the facial gaze of the therapist or the surreptitious body language that might inhibit this process. To this day, this objective has and continues to be fully met by the use of the couch.
Clients who work on the couch will tell you that it allows them the freedom to both relax and focus on their thoughts without have to attend to every little bodily cue that emanates from the therapist. It also, and more importantly, frees up the thinking process so that ideas come much more easily that can then be brought into the session.
That’s not to say that those of us who work with the couch are impervious to the cultural stereotyping that goes with it. Psychoanalysis has been around for a long time and it will continue to be. It also, by its very nature, deals with fundamental issues in people’s lives. The cultural stereotype of being ‘on the couch’, when it pokes fun at our doings, is a useful puncturing of the balloon and ensures we never get to complacent or smug or self-righteous. And that’s a good thing. It means we who practise have to be constantly reviewing its effectiveness and clarifying for ourselves the rationale for using the couch.
Psychoanalysis has become a classic target of cartoonists. Freud said that cartoons represent "a rebellion against [...] authority, a liberation from the oppression it imposes". So it was perhaps only fitting that the cartoon should be the medium for the longest-running and most iconic piece of send-up in the history of psychotherapy.
The ‘On the Couch’ cartoon that appears in The New Yorker magazine documents nearly 80 years of this send-up or rebellion against authority. The magazine published its first “psychoanalytic” cartoon in 1927 and since then its cartoonists have continually renewed the topic within the context of their own times.
So does everyone end up on the couch? No is the answer to that. Some clients sit in a chair facing me and do so for the duration of their therapy. The criterion for who uses and who does not use the couch is a detailed one. People in a high state of anxiety or in deep depression are not suited to it until their symptoms have reduced; nor are those who come with a rejection or a refusal to accept the notion of therapy and, believe it or not, some people do. And equally people with relationship issues who come to discuss the issues at hand as to why they are in or have endured in a relationship that is unfulfilling are not necessarily candidates for the couch. Often some people simply need to talk. As Freud is reputed to have said: sometimes a cigar is just a cigar.
But for the vast majority who come with a question, albeit one that may not yet be formed but which is forming within them, then the couch is the most effective form of therapy. For those who live lives of constant doubt, anguish or repetition and who question why their life is that way and how it can be changed, the effectiveness of the couch and the freedom – because freedom is really what it is – it offers is unparalleled anywhere, in any other form of therapy.
Not only is it a powerful method which allows people access parts of themselves they never thought possible. But to engage in the important business of examining one’s life in the presence of a trained other and without the gaze of that ‘other’ distracting them at every turn is the ultimate respect that can be paid to anyone.
Wednesday, May 13, 2009
What Should We Talk About?
By Kevin Murphy, M.Sc.,
Psychoanalytic Psychotherapist,
Dublin, Ireland
What is it that we are supposed to talk about in therapy? It seems an obvious question, doesn’t it? Presumably the answer is that we are supposed to talk about the very thing that is bothering us most. Or put it another way, the very thing that brings us to therapy in the first place. Yes that makes sense.
But what about someone who, for example, feels bad all the time? Are they supposed to talk about how bad they feel every time the come to a session? Certainly it is necessary to describe it at the outset, and there are times when it is necessary to describe its variations. But if it is the only thing that gets spoken about, is there a value in that?
And this feeling bad need not always be out-and-out depression. Often people can conduct a life for themselves, but there is always a heart-stopping worry going in the background, a fear that something dreadful will happen. Sometimes it stops them going out of the house, or relaxing around their family, and instead makes them irritable all the time and turns them into the kind of people they don’t want to be.
Or what if the thing that someone has come to talk about is the fact that they cannot talk? The very act of saying a simple thing about themselves is too difficult, too fraught with danger and so they cannot risk exposing any detail about themselves. They have, instead, learned over many, many years to say nothing. So what is someone like this supposed to say?
And what about someone who has been severely sexually abused as a child? The thing that brings them to therapy is so painful to talk about that they prefer to say as little about it as possible. Sessions are spent on other details of their lives, how they feel about current experiences, how they manage their relationships, and so great effort is spent not talking about the trauma.
So what then are we supposed to talk about in therapy? Well, as far as psychoanalytic psychotherapy is concerned the best way of looking at this question is to tell whatever stories we feel we can that have happened in our lives, either currently or in the past. The thing we are expected to search for are those scenes from our lives that we gravitate too most easily in our speaking out of our story. Now, the chances are that we don’t have any idea of what these are going to be when we begin the session. But experience shows that when we begin by speaking about the first idea that enters our head, and continue speaking in as uncensored a way as possible, that these scenes emerge, often to our great surprise. And, spoken out afresh, it is constantly surprising how people find a new added detail that they had not realized before that gives the situation or the event a whole new meaning.
You often find some people will want to know why it is so important to talk about these so called obvious details of their lives? Why is that they should talk about scenes from a life that we already know inside out? Surely recounting them won’t make any difference or change anything? Shouldn’t the therapy be focused on what is actually wrong or going wrong or causing the problem?
In the first place, therapy is not trying to change things that happened because there is no way of doing that. What it is trying to change, is our view or perception or understanding or or relationship to those same things. Focusing exclusively on the problem, as it presents itself, is usually a sure way of picking up the wrong end of the stick. What most therapists will tell you is that the act of describing an emotional problem is only half the story when it comes to finding a solution. Someone suffering from anxiety, say, is in the grip of a fear that is there all the time. Describing the many and different ways that this fear manifests becomes a self-defeating exercise. The inventive ways that the psyche can find to be afraid, and the objects which can loom up, real or imagined, to become the cause of that fear, are as varied as the number of individuals in the world. Setting oneself up to describe all these variations and to look for answers in them is a recipe for disappointment.
Psychoanalytic psychotherapy operates on the basis that a person experiences these things, and many other and varied kinds of symptoms and disorders, as a result of their life experiences and the way they have either accepted or rejected those experiences. The answer is not to be found in the end result of these experiences but in the primary experiences themselves, no matter how small or insignificant.
The hard part is staying focused on talking about these often incidental details of our lives. The tendency is to retreat into generalizations, and vagueness and conceptual fuzziness. The test of this is to ask yourself to give an example, a situation or a scene that actually happened in your life that could describe what it is you are trying to say in a general way. That is not as easy as it sounds but persevere because the answer lies in the specifics.
Why? Because the actual things that happened to us or the actual things that were said to us, or the actual ideas that we had about others around us are, no matter how trivial they might seem, specific to us and only us. It doesn’t matter if others might remember things differently or put a different interpretation on things that happened. It is the memory we have, the perception we have, the interpretation we have of real events or situations that really happened to us. And don’t get me wrong, even therapists undergoing therapy fall into this same trap. It is easier to be general and vague and fuzzy with the details.
But the only way of truly examining a lot of our preconceptions about ourselves, our assumptions about who we are and how we came to be where we are today, is to deal with specifics, to focus on things that actually happened and to paint as accurately as we can our place in them. We are unique in that our set of experiences, even if we share many of them with others, are different and specific to us. Psychoanalytic psychotherapy and psychoanalysis give centre stage to this specificity. When we take this notion fully on board then at least we have something concrete to work on.
Psychoanalytic Psychotherapist,
Dublin, Ireland
What is it that we are supposed to talk about in therapy? It seems an obvious question, doesn’t it? Presumably the answer is that we are supposed to talk about the very thing that is bothering us most. Or put it another way, the very thing that brings us to therapy in the first place. Yes that makes sense.
But what about someone who, for example, feels bad all the time? Are they supposed to talk about how bad they feel every time the come to a session? Certainly it is necessary to describe it at the outset, and there are times when it is necessary to describe its variations. But if it is the only thing that gets spoken about, is there a value in that?
And this feeling bad need not always be out-and-out depression. Often people can conduct a life for themselves, but there is always a heart-stopping worry going in the background, a fear that something dreadful will happen. Sometimes it stops them going out of the house, or relaxing around their family, and instead makes them irritable all the time and turns them into the kind of people they don’t want to be.
Or what if the thing that someone has come to talk about is the fact that they cannot talk? The very act of saying a simple thing about themselves is too difficult, too fraught with danger and so they cannot risk exposing any detail about themselves. They have, instead, learned over many, many years to say nothing. So what is someone like this supposed to say?
And what about someone who has been severely sexually abused as a child? The thing that brings them to therapy is so painful to talk about that they prefer to say as little about it as possible. Sessions are spent on other details of their lives, how they feel about current experiences, how they manage their relationships, and so great effort is spent not talking about the trauma.
So what then are we supposed to talk about in therapy? Well, as far as psychoanalytic psychotherapy is concerned the best way of looking at this question is to tell whatever stories we feel we can that have happened in our lives, either currently or in the past. The thing we are expected to search for are those scenes from our lives that we gravitate too most easily in our speaking out of our story. Now, the chances are that we don’t have any idea of what these are going to be when we begin the session. But experience shows that when we begin by speaking about the first idea that enters our head, and continue speaking in as uncensored a way as possible, that these scenes emerge, often to our great surprise. And, spoken out afresh, it is constantly surprising how people find a new added detail that they had not realized before that gives the situation or the event a whole new meaning.
You often find some people will want to know why it is so important to talk about these so called obvious details of their lives? Why is that they should talk about scenes from a life that we already know inside out? Surely recounting them won’t make any difference or change anything? Shouldn’t the therapy be focused on what is actually wrong or going wrong or causing the problem?
In the first place, therapy is not trying to change things that happened because there is no way of doing that. What it is trying to change, is our view or perception or understanding or or relationship to those same things. Focusing exclusively on the problem, as it presents itself, is usually a sure way of picking up the wrong end of the stick. What most therapists will tell you is that the act of describing an emotional problem is only half the story when it comes to finding a solution. Someone suffering from anxiety, say, is in the grip of a fear that is there all the time. Describing the many and different ways that this fear manifests becomes a self-defeating exercise. The inventive ways that the psyche can find to be afraid, and the objects which can loom up, real or imagined, to become the cause of that fear, are as varied as the number of individuals in the world. Setting oneself up to describe all these variations and to look for answers in them is a recipe for disappointment.
Psychoanalytic psychotherapy operates on the basis that a person experiences these things, and many other and varied kinds of symptoms and disorders, as a result of their life experiences and the way they have either accepted or rejected those experiences. The answer is not to be found in the end result of these experiences but in the primary experiences themselves, no matter how small or insignificant.
The hard part is staying focused on talking about these often incidental details of our lives. The tendency is to retreat into generalizations, and vagueness and conceptual fuzziness. The test of this is to ask yourself to give an example, a situation or a scene that actually happened in your life that could describe what it is you are trying to say in a general way. That is not as easy as it sounds but persevere because the answer lies in the specifics.
Why? Because the actual things that happened to us or the actual things that were said to us, or the actual ideas that we had about others around us are, no matter how trivial they might seem, specific to us and only us. It doesn’t matter if others might remember things differently or put a different interpretation on things that happened. It is the memory we have, the perception we have, the interpretation we have of real events or situations that really happened to us. And don’t get me wrong, even therapists undergoing therapy fall into this same trap. It is easier to be general and vague and fuzzy with the details.
But the only way of truly examining a lot of our preconceptions about ourselves, our assumptions about who we are and how we came to be where we are today, is to deal with specifics, to focus on things that actually happened and to paint as accurately as we can our place in them. We are unique in that our set of experiences, even if we share many of them with others, are different and specific to us. Psychoanalytic psychotherapy and psychoanalysis give centre stage to this specificity. When we take this notion fully on board then at least we have something concrete to work on.
Friday, May 8, 2009
A Different View
By Kevin Murphy, M.Sc.,
Psychoanalytic Psychotherapist,
Dublin, Ireland.
It was coincidental that my last blog happened to be on the subject of madness while at around the same time Dr Paul Williams, a leading UK psychoanalyst and a former co-editor of the International Journal of Psychoanalysis was in Dublin giving a lecture on the topic ‘Madness in Society’. He was the guest speaker at the Irish Psycho-Analytical Association’s annual public lecture.
He covered many topics, including a historical perspective of how madness has been viewed by different stages of developing society. And as he steadily built up his argument about the current place of madness in modern society, he made the interesting point that psychoanalytic therapy does not set out to ‘cure’ in the bio-medical sense. That was why there are so many healers and so few effective psychotherapists. This was because psychotherapists, the good ones, that is, understand that successful therapy is only possible if there is ‘immersion in’ and not ‘control of’ uncertainty, contradiction and paradox.
People have problems, he said, not only because of the social conditions under which they operate, or what we know broadly as the civilized world. But added to this, each of us has to deal from infancy with an inheritance, as he called it, of powerful and contradictory capacities. A particular line I liked was his statement that our human instincts, strength and intelligence exceed our capacity for judgment and that is why we require a longer period of maturation of any primate. In other words, we come into the world as possessors of powerful engines that can take us a long time to figure out how to harness and drive in the direction we want to go. And usually we want to go in the direction of being successful in our human relations, in connecting with those around us, in finding our desire in and through others.
In addition to what he termed the impact of modernization of society and its ever growing need to control every aspect of people’s lives, we each have our own personal endowment of sexuality. Each of us has to come to terms with our sense of sexuality and often society, because that is what it does, tends to understate the impact of this. The passage from boys and girls to men and women can often be a difficult one and that has to be continually recognized.
On top of that we have the impact of the twin psychical forces of aggression and narcissism as we make our way along the path to becoming the individuals we would like to be. All in all it adds up to a busy and complex process that is rarely given much credence by social commentators. And so this brings us to the concept of madness.
According to Dr Williams, the individual suffering from psychosis (or madness in plain English) suffers both a fracture and dissolution of their thinking so that their dependence on human relations, the one most of us learn to accommodate, is ‘abolished’. In its place comes a seriously skewed relationship to fellow humans, often to the point of non-relationship. Or indeed, instead of human relationships, fantasy relationships are substituted which keep the person ‘preoccupied, isolated and ill’, as he put it.
So, he asked, is it any wonder that our caring agencies behave defensively when faced with such a task. Nor are they the only ones. Patients who are deemed mad are put in hospital as part of a collusion between family and doctors because the family cannot deal with the behaviour any more. So now the caring agencies take on a responsibility that is beyond their capacity to resolve. And to defend themselves against the anxiety that this produces, they introduce ‘devices’ such as work routines and division of tasks that preclude them relating ‘as a whole person, to the patient as a whole person’, Dr Williams said.
On this point it is interesting to note in my last blog on the madness experienced by London-Irish poet John O’Donoghue, that it was not the electric shock treatment or the drugs or the psychiatrists that he said cured him. It was the unexpected experience of going to university where he discovered poetry and, also, where he met the lady who was to become his wife.
And I am also reminded of a particularly evocative lecture given by Dublin psychoanalyst Dr Helen Sheehan at a conference on Schizophrenia last December at St. Vincent’s Hospital, Elm Park, Dublin organized by the Irish School for Lacanian Psychoanalysis. She spoke eloquently about the place of the psychotic person in our Celtic heritage and consciousness and reminded us that even in mythical times there was a place for them, not behind high walls but somewhere radically special. And it is still there today.
Gleann-na-nGealt is a valley in the Dingle peninsula, Co. Kerry and in English it means the Valley of the Mad, because of a belief that a cure for insanity exists in a well which is situated in the valley. Legend has it that the name is associated with Gall, who was king of Ulster and was cured of madness when he drank from the well and ate the watercress growing in its waters. Ancient history also tells of "Bolcan" King of France who was also restored to full health when he drank from the well fleeing from the battle of Ventry harbour. In the 12th. century tale of "An Bhuile Shuibhne", Gleann-na-nGealt is said to be the place where Mad Sweeney found peace when he was banished to wander Ireland for a year and a day. Mad Sweeney was one of the early kings of Munster and recent historians link him with King Arthur’s Merlin the Magician.
So our own history tells us that there once was a place for those who were deemed mad, but it was a natural setting, in relative harmony with the world at large where they could recover and come back again.
Dr Williams in his lecture said the madness that exists in society is created within us and within society itself. It is partly a result of living in a complex, confusing, contradictory and very often de-stabilising world. He acknowledged that the work of caring agencies is a difficult one because the nature of the work is undoubtedly difficult and the demands placed on care workers at the coal face is quite often unrealistic, as is the caseload of most public sector psychiatrists. But he ended by saying that, difficult and painful as it can be, the only chance for improvement is to pay close attention to the individual who suffers, to the personal and social contradictions that created them and to do so in the context of authentic therapeutic relationships.
Psychoanalytic Psychotherapist,
Dublin, Ireland.
It was coincidental that my last blog happened to be on the subject of madness while at around the same time Dr Paul Williams, a leading UK psychoanalyst and a former co-editor of the International Journal of Psychoanalysis was in Dublin giving a lecture on the topic ‘Madness in Society’. He was the guest speaker at the Irish Psycho-Analytical Association’s annual public lecture.
He covered many topics, including a historical perspective of how madness has been viewed by different stages of developing society. And as he steadily built up his argument about the current place of madness in modern society, he made the interesting point that psychoanalytic therapy does not set out to ‘cure’ in the bio-medical sense. That was why there are so many healers and so few effective psychotherapists. This was because psychotherapists, the good ones, that is, understand that successful therapy is only possible if there is ‘immersion in’ and not ‘control of’ uncertainty, contradiction and paradox.
People have problems, he said, not only because of the social conditions under which they operate, or what we know broadly as the civilized world. But added to this, each of us has to deal from infancy with an inheritance, as he called it, of powerful and contradictory capacities. A particular line I liked was his statement that our human instincts, strength and intelligence exceed our capacity for judgment and that is why we require a longer period of maturation of any primate. In other words, we come into the world as possessors of powerful engines that can take us a long time to figure out how to harness and drive in the direction we want to go. And usually we want to go in the direction of being successful in our human relations, in connecting with those around us, in finding our desire in and through others.
In addition to what he termed the impact of modernization of society and its ever growing need to control every aspect of people’s lives, we each have our own personal endowment of sexuality. Each of us has to come to terms with our sense of sexuality and often society, because that is what it does, tends to understate the impact of this. The passage from boys and girls to men and women can often be a difficult one and that has to be continually recognized.
On top of that we have the impact of the twin psychical forces of aggression and narcissism as we make our way along the path to becoming the individuals we would like to be. All in all it adds up to a busy and complex process that is rarely given much credence by social commentators. And so this brings us to the concept of madness.
According to Dr Williams, the individual suffering from psychosis (or madness in plain English) suffers both a fracture and dissolution of their thinking so that their dependence on human relations, the one most of us learn to accommodate, is ‘abolished’. In its place comes a seriously skewed relationship to fellow humans, often to the point of non-relationship. Or indeed, instead of human relationships, fantasy relationships are substituted which keep the person ‘preoccupied, isolated and ill’, as he put it.
So, he asked, is it any wonder that our caring agencies behave defensively when faced with such a task. Nor are they the only ones. Patients who are deemed mad are put in hospital as part of a collusion between family and doctors because the family cannot deal with the behaviour any more. So now the caring agencies take on a responsibility that is beyond their capacity to resolve. And to defend themselves against the anxiety that this produces, they introduce ‘devices’ such as work routines and division of tasks that preclude them relating ‘as a whole person, to the patient as a whole person’, Dr Williams said.
On this point it is interesting to note in my last blog on the madness experienced by London-Irish poet John O’Donoghue, that it was not the electric shock treatment or the drugs or the psychiatrists that he said cured him. It was the unexpected experience of going to university where he discovered poetry and, also, where he met the lady who was to become his wife.
And I am also reminded of a particularly evocative lecture given by Dublin psychoanalyst Dr Helen Sheehan at a conference on Schizophrenia last December at St. Vincent’s Hospital, Elm Park, Dublin organized by the Irish School for Lacanian Psychoanalysis. She spoke eloquently about the place of the psychotic person in our Celtic heritage and consciousness and reminded us that even in mythical times there was a place for them, not behind high walls but somewhere radically special. And it is still there today.
Gleann-na-nGealt is a valley in the Dingle peninsula, Co. Kerry and in English it means the Valley of the Mad, because of a belief that a cure for insanity exists in a well which is situated in the valley. Legend has it that the name is associated with Gall, who was king of Ulster and was cured of madness when he drank from the well and ate the watercress growing in its waters. Ancient history also tells of "Bolcan" King of France who was also restored to full health when he drank from the well fleeing from the battle of Ventry harbour. In the 12th. century tale of "An Bhuile Shuibhne", Gleann-na-nGealt is said to be the place where Mad Sweeney found peace when he was banished to wander Ireland for a year and a day. Mad Sweeney was one of the early kings of Munster and recent historians link him with King Arthur’s Merlin the Magician.
So our own history tells us that there once was a place for those who were deemed mad, but it was a natural setting, in relative harmony with the world at large where they could recover and come back again.
Dr Williams in his lecture said the madness that exists in society is created within us and within society itself. It is partly a result of living in a complex, confusing, contradictory and very often de-stabilising world. He acknowledged that the work of caring agencies is a difficult one because the nature of the work is undoubtedly difficult and the demands placed on care workers at the coal face is quite often unrealistic, as is the caseload of most public sector psychiatrists. But he ended by saying that, difficult and painful as it can be, the only chance for improvement is to pay close attention to the individual who suffers, to the personal and social contradictions that created them and to do so in the context of authentic therapeutic relationships.
Friday, April 24, 2009
The Other Side of Madness
By Kevin Murphy, M.Sc.,
Psychoanalytic Psychotherapist,
Dublin, Ireland.
You don’t often hear people talk about madness. Not the real, out there, delusional kind. It’s a word you’ll more often than not hear in its sanitized form. It was a mad night out on the town, or such and such a character is ‘mad’ because of his daring behaviour or a gig or event was mad, meaning it was fun to the point of wild or unruly. We toy with the word in order to make ourselves feel a little less bound by society’s rules and regulations.
And that in itself is no bad thing. We need to let our hair down once in a while. We need to get out from under the yoke of convention every now and then.
But when we do use the word for real we think of a place that is, if you like, beyond the normal boundaries of thought or behaviour. Madness is a realm that we shut off, that we treat almost as if it were not there. And very certainly we tend to consider it as a place that once you wander in, there is no getting out of it again.
That’s why it was so refreshing to hear from one man who wandered in and made his way out again. London Irish poet John O’Donoghue was in town this week giving a reading at University College Dublin as part of the John Hume Institute’s lunchtime ‘Writing Home’ series. He was born in the late 1950s to native Irish speaking parents who had emigrated to London. So he described growing up speaking with an Irish accent at home and an Eastender’s accent when he was out with his mates.
The reality of his life, however, was that he was ‘sectioned’ at the age of 16. Sectioned is a word, for those who don’t know it, that means being detained under the Mental Health Act because you have been diagnosed with, usually, a moderate to serious mental disorder. In John O’Donoghue’s case he said he was mad, psychotic, delusional. And in short, when you present in society with those symptoms you get ‘sectioned’ and your freedom is taken away.
He read a piece of prose about being prepared for electric shock treatment, which he received on numerous occasions, and spoke freely of his stays in psychiatric institutions, of his dealings with zany psychiatrists, and of his battle with the see-saw life of madness and sanity.
It began to end for him, even though it has not quite ended, through, of all things, education. He puts his acceptance to East Anglia university down as the turning point in his life. He studied English and American literature, began writing poetry and saw writing as a cathartic way of understanding and dealing with the world as he saw it. The university was also the place where he met his wife of 20 years.
As he said himself, he is not fully out of the grip of madness. Sometimes he feels it coming on but he quoted something that actor Stephen Fry said about depression. Describing it as an unwelcome visitor, Fry’s words, John O’Donoghue said that when he feels this unwelcome visitor approaching he feels much more ‘friendly’ to the visitor now.
It’s a simple thing but it points up one man’s remarkable ability to come to terms with, even have a relationship with, the symptom that threatened to destroy his life and that, in many other instances, has actually destroyed the lives of others.
It is a fascinating insight into something that psychoanalysis has been championing, if that’s the right word, for over a century and a half. You’ll notice that John O’Donoghue didn’t talk about the word ‘cure’. There was no ‘cure’ for him in the strict sense of the word. But there was an accommodation and acceptance and learning to live with what it was he was suffering from. His madness, according to him, hasn’t gone away but his understanding of it and his relationship to it has changed in such a way as to allow him live and love and work. And that, given the particular mountain he had to climb, must seem close enough to a cure.
The 'fix me' attitude that is so prevalent in society today stems from a belief that all ailments have a cause and a cure and that the cure must involve the taking away of all suffering. All ailments have a cause. But taking away all suffering? Lessening the suffering is the aim, making it understandable and manageable is the goal, and releasing the capacity for happiness that is tightly sealed up within it is the aspiration.
If you are interested in reading John O'Donoghue's work then his current memoir is called ‘Sectioned, A Life Interrupted’ (John Murray 2009) and his full length collection of poetry is called ‘Brunch Poems’ (Waterloo Press 2009).
• The next blog will appear on Friday May 8th, 2009.
Psychoanalytic Psychotherapist,
Dublin, Ireland.
You don’t often hear people talk about madness. Not the real, out there, delusional kind. It’s a word you’ll more often than not hear in its sanitized form. It was a mad night out on the town, or such and such a character is ‘mad’ because of his daring behaviour or a gig or event was mad, meaning it was fun to the point of wild or unruly. We toy with the word in order to make ourselves feel a little less bound by society’s rules and regulations.
And that in itself is no bad thing. We need to let our hair down once in a while. We need to get out from under the yoke of convention every now and then.
But when we do use the word for real we think of a place that is, if you like, beyond the normal boundaries of thought or behaviour. Madness is a realm that we shut off, that we treat almost as if it were not there. And very certainly we tend to consider it as a place that once you wander in, there is no getting out of it again.
That’s why it was so refreshing to hear from one man who wandered in and made his way out again. London Irish poet John O’Donoghue was in town this week giving a reading at University College Dublin as part of the John Hume Institute’s lunchtime ‘Writing Home’ series. He was born in the late 1950s to native Irish speaking parents who had emigrated to London. So he described growing up speaking with an Irish accent at home and an Eastender’s accent when he was out with his mates.
The reality of his life, however, was that he was ‘sectioned’ at the age of 16. Sectioned is a word, for those who don’t know it, that means being detained under the Mental Health Act because you have been diagnosed with, usually, a moderate to serious mental disorder. In John O’Donoghue’s case he said he was mad, psychotic, delusional. And in short, when you present in society with those symptoms you get ‘sectioned’ and your freedom is taken away.
He read a piece of prose about being prepared for electric shock treatment, which he received on numerous occasions, and spoke freely of his stays in psychiatric institutions, of his dealings with zany psychiatrists, and of his battle with the see-saw life of madness and sanity.
It began to end for him, even though it has not quite ended, through, of all things, education. He puts his acceptance to East Anglia university down as the turning point in his life. He studied English and American literature, began writing poetry and saw writing as a cathartic way of understanding and dealing with the world as he saw it. The university was also the place where he met his wife of 20 years.
As he said himself, he is not fully out of the grip of madness. Sometimes he feels it coming on but he quoted something that actor Stephen Fry said about depression. Describing it as an unwelcome visitor, Fry’s words, John O’Donoghue said that when he feels this unwelcome visitor approaching he feels much more ‘friendly’ to the visitor now.
It’s a simple thing but it points up one man’s remarkable ability to come to terms with, even have a relationship with, the symptom that threatened to destroy his life and that, in many other instances, has actually destroyed the lives of others.
It is a fascinating insight into something that psychoanalysis has been championing, if that’s the right word, for over a century and a half. You’ll notice that John O’Donoghue didn’t talk about the word ‘cure’. There was no ‘cure’ for him in the strict sense of the word. But there was an accommodation and acceptance and learning to live with what it was he was suffering from. His madness, according to him, hasn’t gone away but his understanding of it and his relationship to it has changed in such a way as to allow him live and love and work. And that, given the particular mountain he had to climb, must seem close enough to a cure.
The 'fix me' attitude that is so prevalent in society today stems from a belief that all ailments have a cause and a cure and that the cure must involve the taking away of all suffering. All ailments have a cause. But taking away all suffering? Lessening the suffering is the aim, making it understandable and manageable is the goal, and releasing the capacity for happiness that is tightly sealed up within it is the aspiration.
If you are interested in reading John O'Donoghue's work then his current memoir is called ‘Sectioned, A Life Interrupted’ (John Murray 2009) and his full length collection of poetry is called ‘Brunch Poems’ (Waterloo Press 2009).
• The next blog will appear on Friday May 8th, 2009.
Wednesday, April 15, 2009
Depression, A Symptom of the Age - 3
By Kevin Murphy, M.Sc.,
Psychoanalytic Psychotherapist,
Dublin, Ireland.
I wrote last week and the week before about depression being linked to a sense of loss. You could say that the classical psychoanalytical position posits an ego (the conscious part of our mind mediating between our internal and external world) that is so weak and so depressed, it has almost disappeared. It is the ego, the part of us that gives us the sense of ourselves, of who we are, that has become lost. The basic condition for depression, therefore, is this loss of ego with all the symptoms that are so similar to the state of mourning.
More modern psychoanalytic thinking moves this on somewhat. While the notion of loss, and the mourning for some intangible thing that is lost, remains part of the theory of depression it has more recently come to be understood as a tumbling out of a fundamental fantasy in which we situate ourselves in relation to significant others in our lives. This fundamental fantasy is an elaborate and necessary fiction by which we construct our identity in accordance with the desire or desires of others.
In depression we fall out of this desire of the other. We become un-desired, unable to cause desire, unable to re-ignite desire and our view of ourselves suffers detrimentally as a result. In short, we lose that vital sense of meaning, of who we are, the inner thing that supports us and allows us face the ups and downs of life with, not immunity to pain, but a sense of being securely anchored within ourselves in terms of facing it.
As I said last week, if depression is a sign of the times then we have to look closely at the times we are in. Yes, depression results in sadness, inability to function, unwillingness to engage with others, poor self esteem, a sense of isolation, lack of sleep, negative thoughts, irritability/aggression, and so on, but with changing times new depressive symptoms have been steadily emerging. Most if not all therapists working in clinical practice will be familiar with this phenomenon.
By new depressive symptoms I mean things like borderline personality disorder – this includes intense bouts of anger and anxiety that may last only hours, or at most a day and can be associated with episodes of impulsive aggression, self-injury, drug, or alcohol abuse. We also see symptoms like self harm, eating disorders, aggressive and sexual acting out.
This new evolution of depressive symptoms is driven by the need to sustain the weakening self in the face of an aching, unnameable loss. And, unlike the more classical symptoms that centre around the psychical concept of ‘feeling’ bad, the new symptoms are centered as actual and real events on the body. Self inflicted pain, bodily discomfort, as well as physically and often impulsive actings out are physical, bodily solutions to the underlying emptiness of depression. They are a forced way of feeling alive, a shock that brings us back from the void, a physical and destructive response to the emptiness of depression and the fear that this sense of emptiness engenders.
A further characteristic of these symptoms is that they avoid language, or symbolization through speech, or communicative sharing with others, or any attempt to put into words what is going on for the sufferer. They are pure action; immediate and direct administrations of negatively charged pleasures.
Professor Paul Verhaeghe of Ghent University sees depression as a possibility for every person because it is rooted in the process of identification, which is essentially dependant on our ability to inter-relate with others. This process of identification is central to everyone’s formation as a person. If this process of identifying with significant others – allowing us form our own identity – is hampered or weakened in any way, we risk tumbling out of the fantasy I spoke of earlier.
Dublin psychoanalyst Rik Loose, on the other hand, believes depression is due to anxiety and the latter’s prevalence in modern times. As an expert on addiction, he refers to drugs as externally situated products of negative pleasure with which users administer their own compensatory internal pleasures in order to avoid depression.
But he makes an interesting point. Anxiety comes first since it is part of the human condition and is laid down very early in all our lives, to a greater or lesser extent. But anxiety is not something that is acceptable in ‘modernist’, progressive society. This unacceptability leads us to deny it and repress it and this is where the problem of depression comes in, he says.
While it is a new take on depression, it also harks back to an idea of Freud (1926) that anxiety is the thing that drives us to bury and repress and deny certain wishes and desires and thoughts. So, in this light, depression arises from a denial of anxiety. This then leads us to seek out artificial means to deal with depression itself, in effect a second denial.
Other writers have agreed with this idea and have further suggested that depression is a giving up of one’s place in the world of ideas, words and satisfying relationships and retreating instead to a more silent, secretive, personally isolated world where artificial ‘comforts’ are sought by way of compensation. However, these ‘comforts’ – alcohol, drugs, sex, masturbation, aggression, food, self-harm, etc., – only add to the depressive experience in the long term.
I mentioned the notion of falling out of the desire of the other and it can have one other consequence. It can lead a person to feeling as if they are a mere puppet at the mercy of an omnipresent significant other or others. In this case depression acts as a defence – albeit not a very effective one - against being crushed under the weight of this oppressive other or others by effectively putting oneself out of the service. The job of therapy in this instance becomes that of carefully rebuilding the person’s ability to trust, love and enter into relationships without fear of being overwhelmed.
In summary, psychoanalysis stands against the vague generality of the term ‘depression’, a stance that today has greater urgency when you consider the attempts to transform sufferers into consumers of ‘happy pills’. The term is, as one writer put it, a ‘non-differentiating cloak’ that seeks to describe the ‘symptoms of the discontent’ in our modern age.
It has become an overused concept as a result of two main forces. One is pharmacology, which is at times indispensable but which leads us to believe that there is a pill that can ‘cure’ it. It can certainly alleviate but it cannot cure.
And, secondly, the human condition means we are complicit too because, in our own way, we like to believe that there are artificial means of administering pleasure that will offer a form of cure.
Psychoanalysis, in contrast, is always looking for a cause, and this is to be found in the particularity of each individual’s real and human situation. It is to be found in the totality of their lived experience. That’s where we look to find the answers.
Psychoanalytic Psychotherapist,
Dublin, Ireland.
I wrote last week and the week before about depression being linked to a sense of loss. You could say that the classical psychoanalytical position posits an ego (the conscious part of our mind mediating between our internal and external world) that is so weak and so depressed, it has almost disappeared. It is the ego, the part of us that gives us the sense of ourselves, of who we are, that has become lost. The basic condition for depression, therefore, is this loss of ego with all the symptoms that are so similar to the state of mourning.
More modern psychoanalytic thinking moves this on somewhat. While the notion of loss, and the mourning for some intangible thing that is lost, remains part of the theory of depression it has more recently come to be understood as a tumbling out of a fundamental fantasy in which we situate ourselves in relation to significant others in our lives. This fundamental fantasy is an elaborate and necessary fiction by which we construct our identity in accordance with the desire or desires of others.
In depression we fall out of this desire of the other. We become un-desired, unable to cause desire, unable to re-ignite desire and our view of ourselves suffers detrimentally as a result. In short, we lose that vital sense of meaning, of who we are, the inner thing that supports us and allows us face the ups and downs of life with, not immunity to pain, but a sense of being securely anchored within ourselves in terms of facing it.
As I said last week, if depression is a sign of the times then we have to look closely at the times we are in. Yes, depression results in sadness, inability to function, unwillingness to engage with others, poor self esteem, a sense of isolation, lack of sleep, negative thoughts, irritability/aggression, and so on, but with changing times new depressive symptoms have been steadily emerging. Most if not all therapists working in clinical practice will be familiar with this phenomenon.
By new depressive symptoms I mean things like borderline personality disorder – this includes intense bouts of anger and anxiety that may last only hours, or at most a day and can be associated with episodes of impulsive aggression, self-injury, drug, or alcohol abuse. We also see symptoms like self harm, eating disorders, aggressive and sexual acting out.
This new evolution of depressive symptoms is driven by the need to sustain the weakening self in the face of an aching, unnameable loss. And, unlike the more classical symptoms that centre around the psychical concept of ‘feeling’ bad, the new symptoms are centered as actual and real events on the body. Self inflicted pain, bodily discomfort, as well as physically and often impulsive actings out are physical, bodily solutions to the underlying emptiness of depression. They are a forced way of feeling alive, a shock that brings us back from the void, a physical and destructive response to the emptiness of depression and the fear that this sense of emptiness engenders.
A further characteristic of these symptoms is that they avoid language, or symbolization through speech, or communicative sharing with others, or any attempt to put into words what is going on for the sufferer. They are pure action; immediate and direct administrations of negatively charged pleasures.
Professor Paul Verhaeghe of Ghent University sees depression as a possibility for every person because it is rooted in the process of identification, which is essentially dependant on our ability to inter-relate with others. This process of identification is central to everyone’s formation as a person. If this process of identifying with significant others – allowing us form our own identity – is hampered or weakened in any way, we risk tumbling out of the fantasy I spoke of earlier.
Dublin psychoanalyst Rik Loose, on the other hand, believes depression is due to anxiety and the latter’s prevalence in modern times. As an expert on addiction, he refers to drugs as externally situated products of negative pleasure with which users administer their own compensatory internal pleasures in order to avoid depression.
But he makes an interesting point. Anxiety comes first since it is part of the human condition and is laid down very early in all our lives, to a greater or lesser extent. But anxiety is not something that is acceptable in ‘modernist’, progressive society. This unacceptability leads us to deny it and repress it and this is where the problem of depression comes in, he says.
While it is a new take on depression, it also harks back to an idea of Freud (1926) that anxiety is the thing that drives us to bury and repress and deny certain wishes and desires and thoughts. So, in this light, depression arises from a denial of anxiety. This then leads us to seek out artificial means to deal with depression itself, in effect a second denial.
Other writers have agreed with this idea and have further suggested that depression is a giving up of one’s place in the world of ideas, words and satisfying relationships and retreating instead to a more silent, secretive, personally isolated world where artificial ‘comforts’ are sought by way of compensation. However, these ‘comforts’ – alcohol, drugs, sex, masturbation, aggression, food, self-harm, etc., – only add to the depressive experience in the long term.
I mentioned the notion of falling out of the desire of the other and it can have one other consequence. It can lead a person to feeling as if they are a mere puppet at the mercy of an omnipresent significant other or others. In this case depression acts as a defence – albeit not a very effective one - against being crushed under the weight of this oppressive other or others by effectively putting oneself out of the service. The job of therapy in this instance becomes that of carefully rebuilding the person’s ability to trust, love and enter into relationships without fear of being overwhelmed.
In summary, psychoanalysis stands against the vague generality of the term ‘depression’, a stance that today has greater urgency when you consider the attempts to transform sufferers into consumers of ‘happy pills’. The term is, as one writer put it, a ‘non-differentiating cloak’ that seeks to describe the ‘symptoms of the discontent’ in our modern age.
It has become an overused concept as a result of two main forces. One is pharmacology, which is at times indispensable but which leads us to believe that there is a pill that can ‘cure’ it. It can certainly alleviate but it cannot cure.
And, secondly, the human condition means we are complicit too because, in our own way, we like to believe that there are artificial means of administering pleasure that will offer a form of cure.
Psychoanalysis, in contrast, is always looking for a cause, and this is to be found in the particularity of each individual’s real and human situation. It is to be found in the totality of their lived experience. That’s where we look to find the answers.
Wednesday, April 8, 2009
How Does Depression Work? - 2
By Kevin Murphy, M.Sc.,
Psychoanalytic Psychotherapist,
Dublin, Ireland.
Picking up where I left off last week, depression is a particularly prevalent psychological disorder that affects between 8% and 12% of the populations of most countries worldwide. Not only is prevalent it also has a long history. The Ancient Greek physician Hippocrates (who gave us the Hippocratic Oath in medicine) described a syndrome of melancholia as a distinct disease with particular mental and physical symptoms including sadness, dejection, and despondency, along with fear, anger, delusions and obsessions. The term ‘depression’ is derived from the Latin verb deprimere, "to press down" and from the 14th century it meant to subjugate or to bring down in spirits.
There are a number of factors which have to be borne in mind when discussing the issue of depression. One is that, if you accept that depression is centered around a sense of loss within the person – an emptiness, a void, an inexplicable and debilitating lack – you also usually find that the person is not aware of what has been lost.
The nature of the loss is not conscious, and may just as well involve a disappointment or slight as a large traumatic event. Freud said in 1915 that if the depressed person has an idea about 'whom' he has lost, he does not know 'what' he has lost in them. This remark is interesting because it implies that there is a difference between a 'who' and a 'what' when it comes to what has been lost.
French psychoanalyst Jacques Lacan, who re-invented Freud and took his thinking to new heights, believed there was a link to human aggressivity. In his earliest seminar, he said that if we cannot imagine that we are something special for others, then the only other way to relate would be through intolerance for each other.* It is, like so much of the man's thinking, a fascinating idea.
In essence, if we lose that often times imaginary but nonetheless essential belief in what we represent for others, then it can allow a primordial aggressivity to overtake us. That is to say, a potential for aggression that is directed outwards and, in turn, can also be directed inwards.
When you consider depression, aggression is a favoured reaction of the wounded ego to protect itself from further harm, whether real or imagined. It is much the same if we become aggressive to protect a broken arm or a cut finger. But aggression can equally direct itself against oneself as punishment for becoming a wounded person in the first place.
The same Jacques Lacan, however, also believed the term ‘depression’ was too frequently used and too vague a term, a tendency that has continued to grow rather than reduce. Whenever the term is chosen to describe ordinary sadness, he said, is akin to a 'moral failing'.
Many theories have looked at why people become depressed. Some point to the earliest experiences of the infant who might have endured an absence of adequate care. At a very early formative stage, the progressive flow of the infant’s development becomes obstructed and so its identification of its own self as a safe, secure, worthy being is put at risk. This is what is called a narcissistic wound.
Narcissism, as a degree of self love, is necessary for the infant to convince itself of its wholeness and so cope with both its internal demands and the demands of the external environment that threaten to pull it in all directions. If the right level of narcissism is not there, problems in dealing with these forces can emerge.
Linked to this narcissistic notion is, and we come back to it again, the notion of aggression. The infant’s ego is continually trying to integrate itself in such a way as to overcome the unpleasure caused by the separation operative from birth, combined with those same internal and external psycho-physical demands on its system. When this integration of the ego is threatened because of inadequate resources a primitive aggressivity is released.
That is why the fragmentation of self-image that so many depression sufferers describe is accompanied by so much aggression, a lot of it self-directed. The aggressive threat of fragmentation, of being broken up, pulled in all directions, made to feel ‘in bits’, is the polar opposite of the unified, harmonious ego that is relatively comfortable with itself and its place in the world.
The perceived attainment of this unified ego is essential for anyone to remain beyond the reach of depression. But where do we get this image of a unified ego? We get it reflected back to us from the significant others around us at the formative stages of our lives. And so by tuning ourselves into the thing that most successfully fits with these others, we enhance this process. In short, from an early age we set out to realise the desire of others, to become the thing which others desire, to cause their desire for us, ignite their passion for us.
Out of this process of learning to deal with the external world of others and their complicated matrix of desires, our ego is formed. And I mean ego in the sense of that part of us that tells us who we are, that gives us our conscious identity.
But there is one further step involved. In order to achieve the objective of becoming the thing that causes an other to desire us, we have to perfect ourselves and this leads to the concept of ideals. We are powerfully attuned to notions of ideals, possibly as young as two or three years of age, ideals to which significant others in our environment respond favourably. From an early age we strive to use what we can of these ideals in order to perfect ourselves in the eyes of others. While it is not our subject now, this in turn takes us down the road of body image, ideals of perfection and so on.
But what we can draw from the link between ideals, our ego formation and depression is that it is within this process that the onset of the collection of symptoms we broadly term 'depression' is laid down. It is not uncommon nowadays for these symptoms to emerge in early childhood. But mostly they lie dormant until triggered in adolescence or adulthood.
Operating at the core of depression is not just the sense of loss but also a sense of impossibility at making good the loss. The lack of hope experienced by the depressed person is a response not only to loss but also the perceived impossibility at finding the tools to get out from under its burden.
This impossibility originates along the axis of ideals and ego formation. Either the person feels it is impossible to 'become' the ideal thing that others will desire, or that it is impossible to 'find' the ideal thing that others will desire, or that it is impossible to 'sustain' being the ideal thing that causes others to desire.
Hand in hand with this, the wider cultural context has ensured that sustainable examples of ideals on which to model ourselves are increasingly harder to find. What are quaintly referred to as 'the old certainties' are gone and the role of authority (in the form of State, church, community, family, parenthood and so on) has been eroded. So now we have fewer places to look for ideal figures. If, as we are often told, depression is a sign of the times, then we must consider the times we are in.
I will conclude this topic next week with a look at the various ways in which depression manifests in contemporary culture.
* Lacan, J., 'Freud's Papers on Technique 1953-1954', Book I, Norton, 1991, p.177
Psychoanalytic Psychotherapist,
Dublin, Ireland.
Picking up where I left off last week, depression is a particularly prevalent psychological disorder that affects between 8% and 12% of the populations of most countries worldwide. Not only is prevalent it also has a long history. The Ancient Greek physician Hippocrates (who gave us the Hippocratic Oath in medicine) described a syndrome of melancholia as a distinct disease with particular mental and physical symptoms including sadness, dejection, and despondency, along with fear, anger, delusions and obsessions. The term ‘depression’ is derived from the Latin verb deprimere, "to press down" and from the 14th century it meant to subjugate or to bring down in spirits.
There are a number of factors which have to be borne in mind when discussing the issue of depression. One is that, if you accept that depression is centered around a sense of loss within the person – an emptiness, a void, an inexplicable and debilitating lack – you also usually find that the person is not aware of what has been lost.
The nature of the loss is not conscious, and may just as well involve a disappointment or slight as a large traumatic event. Freud said in 1915 that if the depressed person has an idea about 'whom' he has lost, he does not know 'what' he has lost in them. This remark is interesting because it implies that there is a difference between a 'who' and a 'what' when it comes to what has been lost.
French psychoanalyst Jacques Lacan, who re-invented Freud and took his thinking to new heights, believed there was a link to human aggressivity. In his earliest seminar, he said that if we cannot imagine that we are something special for others, then the only other way to relate would be through intolerance for each other.* It is, like so much of the man's thinking, a fascinating idea.
In essence, if we lose that often times imaginary but nonetheless essential belief in what we represent for others, then it can allow a primordial aggressivity to overtake us. That is to say, a potential for aggression that is directed outwards and, in turn, can also be directed inwards.
When you consider depression, aggression is a favoured reaction of the wounded ego to protect itself from further harm, whether real or imagined. It is much the same if we become aggressive to protect a broken arm or a cut finger. But aggression can equally direct itself against oneself as punishment for becoming a wounded person in the first place.
The same Jacques Lacan, however, also believed the term ‘depression’ was too frequently used and too vague a term, a tendency that has continued to grow rather than reduce. Whenever the term is chosen to describe ordinary sadness, he said, is akin to a 'moral failing'.
Many theories have looked at why people become depressed. Some point to the earliest experiences of the infant who might have endured an absence of adequate care. At a very early formative stage, the progressive flow of the infant’s development becomes obstructed and so its identification of its own self as a safe, secure, worthy being is put at risk. This is what is called a narcissistic wound.
Narcissism, as a degree of self love, is necessary for the infant to convince itself of its wholeness and so cope with both its internal demands and the demands of the external environment that threaten to pull it in all directions. If the right level of narcissism is not there, problems in dealing with these forces can emerge.
Linked to this narcissistic notion is, and we come back to it again, the notion of aggression. The infant’s ego is continually trying to integrate itself in such a way as to overcome the unpleasure caused by the separation operative from birth, combined with those same internal and external psycho-physical demands on its system. When this integration of the ego is threatened because of inadequate resources a primitive aggressivity is released.
That is why the fragmentation of self-image that so many depression sufferers describe is accompanied by so much aggression, a lot of it self-directed. The aggressive threat of fragmentation, of being broken up, pulled in all directions, made to feel ‘in bits’, is the polar opposite of the unified, harmonious ego that is relatively comfortable with itself and its place in the world.
The perceived attainment of this unified ego is essential for anyone to remain beyond the reach of depression. But where do we get this image of a unified ego? We get it reflected back to us from the significant others around us at the formative stages of our lives. And so by tuning ourselves into the thing that most successfully fits with these others, we enhance this process. In short, from an early age we set out to realise the desire of others, to become the thing which others desire, to cause their desire for us, ignite their passion for us.
Out of this process of learning to deal with the external world of others and their complicated matrix of desires, our ego is formed. And I mean ego in the sense of that part of us that tells us who we are, that gives us our conscious identity.
But there is one further step involved. In order to achieve the objective of becoming the thing that causes an other to desire us, we have to perfect ourselves and this leads to the concept of ideals. We are powerfully attuned to notions of ideals, possibly as young as two or three years of age, ideals to which significant others in our environment respond favourably. From an early age we strive to use what we can of these ideals in order to perfect ourselves in the eyes of others. While it is not our subject now, this in turn takes us down the road of body image, ideals of perfection and so on.
But what we can draw from the link between ideals, our ego formation and depression is that it is within this process that the onset of the collection of symptoms we broadly term 'depression' is laid down. It is not uncommon nowadays for these symptoms to emerge in early childhood. But mostly they lie dormant until triggered in adolescence or adulthood.
Operating at the core of depression is not just the sense of loss but also a sense of impossibility at making good the loss. The lack of hope experienced by the depressed person is a response not only to loss but also the perceived impossibility at finding the tools to get out from under its burden.
This impossibility originates along the axis of ideals and ego formation. Either the person feels it is impossible to 'become' the ideal thing that others will desire, or that it is impossible to 'find' the ideal thing that others will desire, or that it is impossible to 'sustain' being the ideal thing that causes others to desire.
Hand in hand with this, the wider cultural context has ensured that sustainable examples of ideals on which to model ourselves are increasingly harder to find. What are quaintly referred to as 'the old certainties' are gone and the role of authority (in the form of State, church, community, family, parenthood and so on) has been eroded. So now we have fewer places to look for ideal figures. If, as we are often told, depression is a sign of the times, then we must consider the times we are in.
I will conclude this topic next week with a look at the various ways in which depression manifests in contemporary culture.
* Lacan, J., 'Freud's Papers on Technique 1953-1954', Book I, Norton, 1991, p.177
Subscribe to:
Posts (Atom)