Dave: In my view the depressed person is often the emotionally healthiest or better, the most emotionally adequate member of the family. When there is caring, (psycho)pathology is sharing or repairing. The depressed person’s effort at repair has failed, or is failing and they feel depleted. Their emotional batteries needs recharging. So why are they depleted? If the first move is to medicate, the condition that produced emotional depletion remains and continues to deplete.
This is an old analogy. It is simple but remains relevant. A person with abdominal pain is treated with morphine. The pain goes away and the appendix ruptures. The nature of the problem has become more complex and more serious.
So when someone shows up with “depression”, whether the label be applied by someone else or by the patient about themselves, here are some ways for a practitioner to respond.
The first question might be, “What do you mean? What’s up? Any idea where it came from?”
Depression may be considered a failing effort to figure something out.
“Do you have any idea what you are trying to fix? I think depression signifies a question or series of questions you are asking yourself. What do you think forced that questioning—a death, a brush with death, a serious illness?”
Depression is thought to be genetic. That is an interesting hypothesis on one hand, but on another it is assumption that can be used to stop important questioning, the kind of questioning that leads to wondering. Let’s say the genetic explanation is a good possibility. But it is not a sufficient explanation. It is a partial explanation. I think this genetic component is over-rated, but in this era it is a privileged explanation. It suppresses alternative considerations. It suggests more confidence of its correctness than it deserves. It is possible there are “social genes”. Social genes are embedded in family behavior patterns which naturally shape the behavior of family members. I will say more below.
Do you think there is someone who is glad you are depressed? Is there someone who is glad you are going through this?
I am not going to speak with tremendous authority here—I am not thinking about “evidence-based information”. I am playing with ideas, using ideas to stimulate imagination. Ezra Pound made this observation; “Knowledge is dead but not buried imagination.”
I think of depression as a trip inside, inside the Self, into the psychological interior. Usually we are forced there by Experience, we don’t decide to go there. The trip inside is one way we can learn about ourselves. Depression forces us to look at ourselves. Depression is like being in a tunnel with a very low ceiling where you cannot stand, where moving is limited. There is a feeling of being trapped. When we are trapped desperation develops and if you fight it too hard it gets worse. But if you give into it, the walls of the tunnel sort of soften, and develop some sort of peristalsis, and you get pushed through the tunnel slowly and come out the other end. It is possible to get through it. It is possible to learn something from going through it.
But there is also being depressed about being depressed. Because depression which is a result of experience, can be viewed by some families or some groups as a moral failure. “You should not be depressed.” Then a person becomes depressed about being depressed, and that is a tough one to wrangle out of. If you are depressed about being depressed you can’t get out of it. Part of the trap is to convert feelings into a moral action, as if feelings are something we decide about. I would put it this way; I don’t think we decide to have them or not to have them, but we do have something to say about what we do with them.
Giving a medication contains a variety of meta-messages. One is, “You shouldn’t feel that way.”
Here is a curious notion related to the “social” genes I mentioned earlier. Depression may also be a way to enact a role. For example, in some families, being a woman may mean being depressed. In some families being depressed is how a person goes about being a woman. Looking at life this way is an alternative to the genetic hypothesis of emotional disorders. There are complex behavioral patterns in families that get passed from generation to generation. The patterns are implicit in the way a family lives.
Depression may be a way to be intimate. This is based on the fact that early experiences with intimacy may come from feeling hurt, physically or emotionally and being comforted, cuddled by Mother. So when I need or desire love I signal it by giving signs of being depressed.
Depression can occur with a supportive, loving other, who provides the security to be depressed. So that inside a relationship, depression may be an expression of emotional hunger.
These are a series of ways that I think and talk about depression. They come from my imagination, but when I talk in this way with patients, these interpretations, these proposals are engaging. They invite thinking, consideration. But they are not conclusive suggestions. They are novel and ironic, and novel and ironic ideas and experiences open up possibilities.
Of course the term “Chemical imbalance” is another imagination based suggestion—but it is conclusive and convergent. It is a persuasive metaphor that leads to the logical therefore secure conclusion, that it is time for a chemical.
Once depression becomes neurochemically integrated, if it becomes persistent, it can be extremely difficult to over-ride it psychologically, philosophically or experientially. Then it can end up playing by physical rules, and medication becomes more necessary. But stubborn as I am, I remain convinced that what is designated “depression” can still be disrupted with experience. But I think the road out is about as long and as arduous as the road in—and thus the trip can take some time.
In many people there are two anti-depressants that can have a rather dramatic effect—Girlzac (for men and boys) and Boyzoft (for women and girls). And additionally, rage has very strong anti-depressant effects. The priniciple is that it is difficult to be rageful and depressed at the same time—I recommend Piztoff, for long standing depression.