“You have learnt something. That
always feels at first
as if you had lost something.”

– George Bernard Shaw

Depression

Depression is ubiquitous these days, to be found everywhere in our working lives, our personal lives, our sexual lives; in groups, couples, individuals. In 2010, according to the World Health Organisation, depression will be the single largest public health issue after Heart Disease, expected to be affecting between 25 and 45 per cent of the adult population. This is in stark contrast to the 0.5 per cent of the population estimated to be affected by depression back in 1950. Depression is endemic. And our current social and economic difficulties have certainly played their part in transforming personal grief into depression.

We live in a time where there are myths of depression. Firstly though we speak of depression as if it were one thing, there is no such single thing as depression; there are depressions and each is as individual as the person who is suffering it. But clearly there are market and social forces afoot that want us to see depression as an all-encompassing single, unique entity, an exclusively biological disease. Why? Because our medical and pharmaceutical and governmental industries want that when things go wrong, we are able to name and identify the problem quickly, and therefore be provided with a definite, fast, priced solution, in which profits are made, but it is not always the individual who profits.

If a person says they are depressed a psychoanalytically trained practitioner should never claim to know what this means, or what would be best for them. Instead they should assist the individual in unpacking what their symptoms, their life, their way of describing their lives, their individual words mean for the client and exploring how their present problems have been shaped by their unconscious mental life. The primary goal in psychoanalytic work is not the removal of symptoms, but that through the symptoms something gets articulated, the person speaks something of their unconscious truth. This is why Lacan very provocatively challenged people to “enjoy your symptom”.

Ironically, Depression is a way of saying No to what we are told to be. It is a refusal to be, do or fit in with something; hence it effects our energy, our sleep, our eating, our consumption, our relationships, our work. Rather than reprogramming us, or drugging us into fitting in and complying with social and economic demands, only Psychoanalysis asks the individual to ask themselves what it is they are saying no to, and why they might be saying no to this. Only psychoanalysis, ultimately returns choice back to the individual. And giving the individual choice in their lives, returning them to the steering wheel of their existence is the most successful and formidable anti-depressant.

In the CBT, pharma-medical world, we too often seem to have lost any sense that at the core of many people’s experience of depression, of an inertia and lack of interest in life, lies a loss of a cherished human relationship, or a crisis of personal meaning. Psychoanalysis would argue that behind much of what is labelled as depression is an underlying mourning or melancholia, with their equivalent questions and problems of loss. Someone suffering with depression is all too often trapped in an unending nightmare of self-accusation and guilt. And one of the most obvious triggers for depressive states concerns our self-image. Not merely how we look and our appearance, but at a deeper level, our ideal image of ourselves as loveable has been punctured. In Depression our doubt or conviction of our unloveability is reflected not only in our inability to love ourselves, but our inability to love outside ourselves, the world and others.

Another famous motto by the French Psychoanalyst Jacques Lacan was 'Don't give up on your desire' because desire is the engine that charges our lives; it is the eternal carrot that drives us forward in fantasy and in reality. In depression people feel no energy, no life force, because it seems that their desire is gone, or that they have nothing left to desire. This can be through loss, but ironically also through gain. It can be even more frightening when we actually get to attain our ideal, as then our desire is removed. Without Desire in our lives, we feel there is no longer anything to attain we can feel the presence of a void at the core of our lives.

In contrast to Grief which is our reaction to a loss, Mourning is how we process this grief, it involves the long and painful work of detaching ourselves from the loved one we have lost. Slowly, we realise little by little that the one we have loved is gone, and the energy of our attachment to them then can become gradually loosened that it might someday become linked to someone else. The other side of Depression is realising that life still might have something to offer. In Freud’s writings he refers to the work of mourning, it isn’t just our thoughts about the lost loved one that count, but what we do with these thoughts. And such loss does not necessarily involve death, the one we’ve lost may still be there in reality, but the nature of our relationship to them will have changed. And in other times it is the loss of an ideal, a fantasy that causes depression. What matters most is that a central focal point that has been important in our lives, and around which key attachments and identities were formed, has been removed.

Freud argues that while the mourner knows more or less what has been lost, this is not always obvious to the melancholic, he argues that we need to distinguish whom we have lost from what we have lost in them. It is the difficulty in making this separation between the person lost and the object(s) lost in them that can be the central block the mourning process, leaving someone stuck in a depression. Key features of this melancholia is a lowering of self-regard and a loss of the capacity to love. In contrast to the paranoiac who blames the outside world, the melancholic only blames himself.