A Deeper Understanding of Depression: A Psychodynamic Perspective
What is it, and Why?
If you have suffered from a clinical depression, there is little doubt that you have unremitting and extremely painful symptoms, some of which include:
- Lack of Energy
- Anhedonia (an inability to enjoy ordinary pleasures)
- Problems eating
- Difficulty sleeping
For anyone who has been depressed or been around someone who has suffered from depression, they know all too well that there is an unbearable and unrelenting sadness that accompanies it. There is also a strong sense of dread, which can lead to overwhelming feelings of helplessness and hopelessness.
I Am Bad and I Deserve Bad Things to Happen to Me
In essence, depressed people fundamentally believe that they are bad. They can hate themselves for being greedy, selfish, envious, or prideful, and at times even consider themselves “dangerous” because of these thoughts. There is an irony to this, as depressed individuals are far less likely to act out on these feelings and are, on the whole, far more conscientious and ethical in their actions than your average non-depressed person. In fact, their feelings of guilt are so overwhelming, they are at times unfathomable.
The unmourned losses of the depressed person make them feel as though they have driven loved ones away, and as though their feelings of rejection have been converted into a strong conviction that they deserve these rejections for being “bad” or “sinful”. Since many depressed people tend to have an intellectual sophistication, they know at a conscious level that this is irrational, but they cannot help feeling otherwise.
Nature and Nurture
It is often said that we do not fully understand why people become depressed, but in reality it is a multi-layered, complex issue that cannot be attributed to a single cause. Studies of families, twins, and adoptees over the last few decades strongly suggest that one can inherit a vulnerability to depression. Depression clearly runs in families, although no one can confidently state to what extent the transmission of depressive tendencies is genetically based or how much is environmentally determined through family dynamics. It does appear to be a combination of both, and they can negatively influence each another in an unfortunate, negative dynamic.
Childhood Loss and Anger Turned Inward
In an early psychodynamic attempt to describe the depressive process, Freud theorized that depressive inclinations are often the result of experiencing premature loss. In this classical theory, people who are either overindulged or deprived in childhood become fixated or “stuck” emotionally, and then, as a result of these early frustrations, become overwhelmed and have difficulties adapting. There can be an oral quality to this type of depression; it is noted that depressed people are often overweight, and that oral activities such as smoking, drinking, and talking are found to be very pleasurable.
Freud also noted that people in a depressed state have difficulty feeling anger toward others. Instead, they will point their aggression toward themselves, hating themselves out of proportion to their actual shortcomings. This is known commonly as “anger turned inward” or “sadism against the self”. Rather than feeling unconflicted anger on their own behalf, the depressed feel guilt. Depressive people are agonizingly aware of every sin they have committed, every mean thought they have had and every kindness they refused to extend.
Early Loss in Childhood Relationships
It is the role of early and repeated loss that is often defining in the early relationships of depressed people. Often, there is an early separation from a love object, and such histories are common in depressed patients. The early loss of an attachment, however, is not always concrete and observable, but may be more internal, such as forcing a child to renounce dependent behaviors, such as giving up a security blanket or not being allowed to come into a parent’s room after a nightmare.
There is a theory in psychoanalytic thought where a child cannot be given too much attention in the first two years of life; then, at about two years of age, the child will choose to leave the mother. In other words, it is not the mother’s responsibility to wean the child from her—the child will leave the mother when he or she is ready, and ought not to be hurried. In fact, the desire for independence is as powerful as the wish to depend, and as such separation/individuation occurs when the child feels that the parent is available to take care of their needs, and will allow them to emotionally regress when they feel vulnerable. If the child’s needs are thwarted too often, a more hidden sort of loss may be experienced.
Often times, it is the mother, not the child, who feels a severe loss when her child begins to separate. When she feels the pangs of grief during this separation-individuation process, she will either cling to her child, and induce guilt or push the child away, both of which cause the child to become anxious. Children in the former situation are left feeling that their normal desires to separate and individuate are hurtful to their mother and feel guilty as a result, and consequently learn that their independent sense of self is a bad experience. Often times, parents create a toxic cocktail of vacillating between ignoring their child’s dependency needs and demanding that the child not separate/individuate at the appropriate developmental moment, which creates an emotional environment ripe for a depressive dynamic.
“Stop Feeling Sorry for Yourself”
From a family therapy/family systems perspective, another circumstance that encourages depressive tendencies is a family atmosphere in which mourning, whining, crying and other forms of self-care are considered selfish, contemptible or “just feeling sorry for yourself”. This sort of guilt inducement does not allow the child to feel vulnerable aspects of him or herself. An example of this would be a child who is told to “buck up” when they are crying on their first day at kindergarten. Children often start identifying with the critical parent, and learn to hate those parts of themselves, and even call themselves names, abusing themselves psychologically when they are upset.
The Depressed Parent
Finally, a powerful cause in the depressive dynamics for many people is the extremely depressed parent. A seriously depressed mother with little help or emotional support may only give her baby the most cursory of care, no matter how sincere her efforts. Children are profoundly affected by parental depression; they feel emotionally deprived and guilty for making normal emotional demands. Ultimately, they come to believe that they are emotionally exhausting, heavy, and overwhelming to others.
How to Treat Depression
The most important condition for therapy with a depressed person is the precondition of acceptance, compassion and respect, with an effort to understand their unique experience. I prefer a psychodynamic psychotherapeutic approach to help my patients work through their depressive condition.
Fortunately for many patients, there are antidepressants available (SSRIs) and other psychotropic medications that make life bearable for many depressed people. Although each person is unique, many depressed people find that a combination of drug treatment and counseling are the best remedy.
In therapy, it is also vital with depressed individuals to explore their reactions to separation. Depressive people are deeply sensitive to abandonment, and they experience loss (unconsciously) as evidence of their badness, as in “you are leaving me because I am not good enough!” Therefore it is not only important to be attuned to depressive loss but for the therapist to help interpret it. Unconscious guilt and pathological beliefs about the self should be unearthed and processed through.
Depressed people need to learn to feel their anger and accept that it is acceptable to feel all sorts of emotions, such as envy, pride, etc., and the therapist needs to help them realize that this is a natural part of the human experience.
If you are suffering from depression, please call me, Jennifer De Francisco, LCSW at (949) 251-8797.
MY PROMISE TO YOU
Every patient is a person, not a problem. Your situation is unique and cannot be solved with a cookie-cutter approach. I will take my expertise helping people work through their issues, and we will work together to understand your feelings and where you need to go. You don’t have to be alone – I will be available to you as the personal advocate for your mental health.