Depression: The way out

For those suffering with depression, life can feel pointless. Life holds little or no joy (or even pleasure) and, even if there are small pockets of pleasure, happiness or joy, it is remarkably short-lived. This in a sense can make it feel worse. It is like you are shown what you are missing but cannot have!

Depression is a thief of living and, with living swallowed by depression, what one is left with, is existing.

For many, it is so powerful that it can be quite disabling leaving what once were simple tasks such as getting out of bed, washing, and even sometimes eating, difficult. It is as if anything that would benefit the sufferer becomes impossible. This brings me to what I consider an interesting aspect of low mood or depression. Anything that would normally benefit the person with depression, becomes experienced as pointless. It is as if the person, due to depression, loses absolute interest in themselves! For the sufferer, depression feels like a huge sense of loss, as if someone close has indeed died.

Sigmund Freud (1856-1939), in his works titled Mourning and Melancholia, explores how both mourning and actual loss have similarities with melancholia (depression). Freud (1914, p243) writes “Mourning is regularly the reaction to the loss of a loved person, or to the loss of some abstraction, which has taken the place of one, such as one’s country, liberty, an ideal, and so on”.

He goes on to talk about melancholia as a ‘profoundly painful dejection’ that can lead to:

• loss of interest in the outside world
• loss of the capacity to love
• inhibition of all activity
• a lowering of self regarding feelings, leading to self-reproaches

The above "...culminates in delusional expectation of punishment" (Freud, 1914, p.244).

Freud states that the above experiences are most like those experiences in mourning with one exception, the lowering of self-regarding feelings. In other words, with depression, all the difficult feelings of mourning exist, with the additional trait of often highly critical feelings (self-punishing) against one’s self.

Why does this happen?

This is a valid question if we are, at all, to understand the possible cause of depression. Freud suggested that in experiencing some form of loss (this is more so the loss of an ideal i.e. an ideal mother or father), one turns inward and a process of self-evaluation begins.

With the event of the experienced loss, all of the feelings and energies in the feelings that were once directed at the lost ‘thing’ must come to an end. The lost ‘thing’ is no longer there to love, hate, be angry at or to ‘receive’ any other feelings that were once toward it.

Freud suggested that this ‘libido’ (emotional energy) was not then displaced onto another ‘object’ (this could be a person, interest, or subject) but, in the process of introspection (looking inward), is withdrawn into the ego.

As this happens, a process of self-evaluation occurs. So this libido establishes itself into our ego and identifies now with it. 

That sounds complex. However, if we think about something we have a strong emotional connection to, if we were to lose that connection, the thoughts and feelings would not just stop. They cannot go to something that is no longer there and, with nowhere else to flow, they turn inward for relief. 

However, this means that the sense of loss initially experienced is ‘connected’ to our ego (our sense of self). So our ego is experienced as being an abandoned object. Freud suggested that the original ‘object’ loss is transformed into an ego loss.

As this is the loss of an ideal, it is not clear to others, or often oneself, what loss has been experienced. As this loss is turned inward, it is the self which feels ‘responsible’ for the loss.

Freud (1914, p.248) writes "If one listens patiently to a melancholic’s many and various self-accusations, one can not in the end avoid the impression that often the most violent of them are hardly at all applicable to the patient himself, but with insignificant modifications they do fit someone else, someone who the patient loves or has loved or should love."

What does that mean?

What Freud (1914) is suggesting, is that one suffering from depression is often filled with a lack of confidence, self-loathing and self-hatred. It is not uncommon to hear such things said as ‘I am useless’, ‘I hate myself’, ‘what is the point’, ‘I am sh*t at coping with…’ etc. This is something I often see both in and outside of the therapy room.

Although directed at oneself, they are nearly always misdirected at the self and are, in fact, originally directed toward another that failed to be the ideal that was expected. This ideal parent or caregiver failed to be ideal when you expected them to be. In failing, there was a loss and without the ideal, that loss was turned inward and such negative phrases ‘attached’ to the self.

In our childhood, when we are disappointed or let down by someone whom we idealise, there are strong feelings of love and hate. These ambivalent feelings cause conflict, which is turned inward towards one's inner psychological world.

The way out

Psychodynamic counselling is the most effective way of recognising our unconscious mechanisms and bringing them into consciousness. In doing so we can start to understand the loss(es) of the ideals that may have followed the psychological ‘routes’ described above.

In doing so, we can hope to make sense of the loss(es) and how, what one feels about oneself, is simply misdirected at oneself. In finding its original focus, we can start to understand what was lost and how (mostly in childhood) painful it was. 

From this, we start to make sense of the conflicting feelings we are left with using our now adult eyes and understanding.

The failing, useless person we once felt we were can reroute the hatred, anger and self-criticism. Freeing oneself to grow to become something far more capable and self-affirming.