Leftovers from Christmas Season: Turkey and Depression
By Spencer Overgaard, Copyright 2015
Twice a year, in January and September I notice an increase in the number of people looking for therapy. In September, I think it's because people see the fall as a beginning of a new period with the arrival of new courses, fashions, and leisure and recreational activities. They take advantage of the fact that many people are signing up for new pursuits and decide it's time to make a change in their personal lives as well. The summer's over, schools are open and it's time to get back to work.
In January, despite the cold, there is also the spirit of new beginnings with New Year's and the accompanying resolutions ritual. The Christmas/Holiday parties are over and, it's back to work once again. People take this moment as a point of departure to address difficulties in their personal lives that persevere.
The other factor in January is that for many people the Christmas/Holiday season is very difficult emotionally. Despite all the festive trappings, many people are unhappy with their lives. It could even be that the happiness and intimacy portrayed in movies and songs and the joyfulness that supposedly attend family gatherings, make them reflect on the emptiness and perceived inadequacy of their own experience. Perhaps what rings true for them are not the bells of joy, but rather the state of their poor relationships with others, be it with their immediate or extended family or with work colleagues. Apart from that, there is always one's relationship with oneself. Santa doesn't always bring happiness in his gift bag. As a matter of fact, depression is often a left-over result of the so-called celebrations. And so you have part of the explanation for an increase for calls to therapists in January.
The post-holiday doldrums may be why Bell Canada started the 'Let's Talk' program which falls on January 28th. Its goal is to raise awareness of mental illness, depression being not the least of these types of illnesses. Depression is one of the most common complaints that family doctors receive. It interrupts life preventing people from feeling self-worth, fulfillment, and undermining love and family relationships. On-going depression in a parent can negatively affect children's development. Life can seem incredibly dreary, full of despair which, in the worst cases may end in suicide or worse.
Depression doesn't just affect people on the lower economic levels either. People with significant educational and career success and accompanying economic status are prone to depression as well. From the outside, we may see talented competent individuals performing complicated tasks that many would envy. But from the inside, a depressed person may feel they are not measuring up - that their efforts are simply fooling people. They often believe there is no real substance to their work and are likely to be exposed as frauds sooner or later. Not surprisingly, these people can end up feeling very lonely and hopeless. Their sleep can be undermined and they may also feel extremely anxious. Because of the stigma of depression, they keep their despair to themselves.
While I'm not normally prone to depression, I do recall once being depressed following a break-up with a girlfriend. I thought the world of this woman and she dumped me. My ego was hurt for sure, but it was more than me feeling sorry for myself. (I had certainly been dropped by others before that with far fewer negative results.) My world had been turned upside down. I couldn't sleep properly, and had little interest in eating. I continued to work, but was numb much of the time and found none of the usual satisfaction in it. I was pre-occupied with 'what-if?' scenarios. I felt worthless. I felt raw. My body felt like it wasn't really a part of me. And this lasted for many weeks.
This wasn't a clinical depression - that is far worse. However, it gave me a taste of what it's like to be in a dark cloud. So, when people speak about lethargy- feeling no energy for doing things, I get it. They lack motivation for work, or even getting out of bed: I know what they mean. They feel hopeless and even that life is meaningless: I get it.
If you go to your family doctor with these complaints, she will try to determine whether or not there is an organic cause. This means whether or not there is something in the body's chemistry that is contributing to the problem. If there is, then it's possible she will prescribe an anti-depressant. However, she finds that the symptoms are rooted in non-organic causes- determined by factors other than the body's chemistry or not only by the body chemistry, she will likely refer you to psychotherapy. Her conclusion is that the depression is either partly or mostly a function of the mind- the realm of psychology.
In today's science-oriented world, it's sometimes hard to imagine that ideas in our minds can actually have a powerful effect on our moods. Normally, if our mood is down for a significant period of time we might ask the doctor to give us something for it. It seems to work with headache medication, so why not with depression or anxiety? And, of course, sometimes the medications do work and we are able to resume our lives: get sleep, go to work and enjoy life again. But not always. And this is why your doctor might refer you for therapy. Her conclusion is that something is at work in our minds that is not going to be addressed or fully addressed by medication. The assumption is that there is activity occurring in the mind that is causing your depressed mood, Hence the referral for therapy.
One characteristic that is sometimes noted in depression is negative self-regard - a sense that you don't measure up, as noted earlier. Sometimes very highly functioning people with depression will tell you they feel they are incapable of good work. Others may tell them their work is solid, even admirable, but they won't believe it. 'They are just being nice' is what they think to themselves. In their own minds they are saying, "I'm not good enough for my position. My last project was nothing special- it just barely met the acceptable standards." But when you mention that objectively they are really doing outstanding work, they don't take you seriously. They think you are out of touch. Freud was aware of this feature and recommended that one not challenge the person: If that's their experience, then they must have it for a reason. His solution was to listen even more closely and he did end up with an important insight.
The more Freud listened to people with melancholia (what we now call depression) speaking self-critically, the more he came to realize that they were talking about someone else. Instead of the negative self-opinion applying to the speaker, he found it usually fit a loved member of that person's circle. This observation gave him reason to believe that in fact the depression might be related to the client having displaced his dissatisfaction with another onto himself. But why would one be self-critical when one's disapproval had to do with a different target?
This is where our mind plays tricks on us. We do things without recognizing our actions. In this case, our displeasure with another person's behaviour or attributes ends up being turned upon ourselves. Jonathon Lear (Freud, p.171) illustrates this in the following example:
I feel myself to be unkind. I could be more kind. Consequently, I'm displeased with myself. I criticize myself for being unkind. I get angry at myself. But the anger is displaced because in reality (but unknown to me) that anger really should be directed at my father because he was unkind to me. The more I'm self-critical, the more I'm actually perpetuating a pathology of self-regard. I'm actually in the dark about who I really am. I need a psychological way out of this.
Breakdown of the dynamic in 4 stages (though it could happen in many different ways):
1. I experience my father as unkind and consequently feel angry at him.
2. I experience anxiety. This could be for many reasons. It could be simply from feeling anger or because I fear a reprisal from my father for being angry at him. He may withdraw from me if I'm angry at him and so I'm anxious because I don't want him to withdraw, because I also love him. However, and very importantly, I may not be aware of these anxious feelings consciously.
3. My anger (at my father) and anxiety disappear and get replaced by an angry voice directed at me. The angry voice is manifested in comments like, "I'm worthless. I'm a failure at life." The anger is useful to me because it is safe and justified. Safe because I don't feel retaliation from father is likely. Justified because I feel I deserve the self-criticism. (I deserve being punished for being angry at my dear father.) Lear says this 'strategic outcome is neither chosen nor intended.' But, very importantly, I have removed a threat of retaliation from my father from the external world. This is why 'it has been selected.'(Notice the passive voice, not an active choice or intention.)
4. The angry voice disappears. All that's left is depression, low self-esteem and a sense of not being a nice person. Anger is still being expressed, but it is not being recognized as such.
What is remarkable in this illustration is that something negative I feel about another person- something that's unpleasant- ends up being directed at myself. The dynamic is not in my awareness: I don't know that I'm transposing an emotion (in Lear's case, anger) away from the legitimate target onto myself. My deluded thinking - if I'm aware of it all - is that my inadequacies are the result of insufficient effort. I have a right to be self-critical. The way out of my current circumstances is through hard work. (The fact that hard work hasn't led me out of my wilderness to this point is ignored.) What really needs to happen is for the subject to get in touch with the emotion (in Lear's example, anger) he's directing at himself and realize that he should be leaving it at someone else's feet. This doesn't mean we encourage our clients to actively direct their anger at others. It means we help the client recognize that the emotional-psychological dynamic is at work. We explore the troubled relationship between the subject, his emotion and the object. We examine why that emotion ends up being self-directed. In the long run, once we become aware of these dynamics it is easier to do something about their effects.
Depression can be devastating, but is all too common. Hopefully I've helped you become more aware of how it may work. Feel free to call me to follow up on my writing about this subject. I invite your responses.