Archives for : Depression

We know what good depression treatment looks like. You probably won’t get it.

We know what good depression treatment looks like.  You probably won’t get it.

Approximately half of people with post-traumatic stress disorder (PTSD) also suffer from Major Depressive Disorder (MDD) (Flory). That is my justification for treating depression in a blog primarily devoted to PTSD.  Depression usually follows some of the earliest symptoms, such as anxiety and flashback but there are no fixed rules (

As I’ve posted recently, it has become almost commonplace today, at least among those impressed by the latest results of neuroscience, to say that Descartes got it backward.  Not “I think therefore I am,” but “I am therefore I think.” The mind is composed of body.  Brain makes mind possible.

Yet, this is not how we experience ourselves.  “I feel therefore I am” is probably the first and fundamental experience of self, or at least the experience that makes life worth living.  It is the feeling of being alive. Depression is the opposite.  It robs existence of vitality and pleasure.  That’s the cardinal symptom of major depression; it can make life not worth living. Depressed people are about twenty times more likely to commit suicide (Gotlib and Hammen).   

“Depression is the flaw in love”

A couple of recent books that take the neurological basis of depression seriously, also see love and its loss as central to the experience of depression.  Because the mechanism of depression takes place in the brain, and because medication and other treatments that work on the brain help, doesn’t mean that our experience of the world is unimportant.  Most important is loss, above all the loss of love: of being loved, of a loved one, as well as the loss of values crucial to one’s identity, such as the loss of religious belief.*

Depression is the flaw in love. To be creatures who love, we must be creatures who can despair at what we lose, and depression is the mechanism of that despair. When it comes, it degrades one’s self and ultimately eclipses the capacity to give or receive affection. It is the aloneness within us made manifest.

Love, though it is no prophylactic against depression, is what cushions the mind and protects it from itself. Medications and psychotherapy can renew that protection, making it easier to love and be loved, and that is why they work. (Solomon, p 15)

Medication and therapy make love possible.  For what is the good of a more balanced mind if one has nothing of value to do with it?  Generally, this love is of another person, but it can be love of one’s work, or faith. 

Stress causes depression among the vulnerable.  Surprisingly, humiliation is the greatest stressor, loss is the second. (Solomon, p 61).  But perhaps they are not so different.  Though we seldom think about it this way, loss is shaming.  After loss we are exposed to the world, naked and alone.  Once you experience a shaming loss, you will never be the same, for you will have learned something about your vulnerability that you may have sensed but never known.

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Mourning and Melancholia: narcissism or object relations?

Mourning and Melancholia: narcissism or object relations?

Freud’s “Mourning and Melancholia” is mistaken, it seems to me, in drawing such a sharp distinction between the two experiences.  What Freud called melancholia is today called depression.  It generally refers to major psychotic depression and is no longer a useful label (Quinodoz, p 181).  Still, it seems best to stick with Freud’s term, remembering that we are always talking about depression, and not some more exotic state. 

Vamık Volkan introduces the category of the perpetual mourner, one who cannot, as Freud puts it, be “persuaded by the sum of narcissistic satisfactions it derives from being alive to sever its attachment to the object that has been abolished.” (M&M, p. 255) These mourners retain an intense tie to the lost object without slipping into melancholia (Volkan, p 199).  It’s a simple point, but a powerful one.  It fits more people than severe depression.  Many of us know someone like this.

For Freud, melancholia is narcissism

For Freud, melancholia is marked not only by a refusal to give up the lost object (as people and occasionally ideas are called) but identification with it.  As Freud puts it, “the shadow of the object” falls upon the ego.  “In mourning it is the world which has become poor and empty; in melancholia it is the ego itself.” (M&M, p 246)  The lost object becomes a part of the ego, the nucleus of an unforgiving superego that judges the one who mourns so harshly that he becomes depressed, melancholic. 

This is the key distinction between the mourner and the melancholic for Freud.  Both suffer from the loss of the beloved object but only the melancholic blames himself for being such a miserable person.  Both withdraw their interest from the world, but only the melancholic experiences a drastic

lowering of the self-regarding feelings to a degree that finds utterance in self-reproaches and self-revilings, and culminates in a delusional expectation of punishment. (M&M, p 246). 

This is accompanied, Freud continued, by a lack of concern with the one who is actually lost, as though there was never any real connection.  In a sense, there wasn’t.  The narcissist, for it seems that it is only narcissists who develop melancholia, always saw the other as an extension of himself, never existing in his own right.  In melancholia, the narcissist, whom Freud compares with an amoeba, withdraws his pseudopod engulfing the object into himself, possessing the devalued object all to himself.  He has lost nothing.

Striking is the harshness with which Freud condemns the melancholic narcissist.

When in his heightened self-criticism he describes himself as petty, egoistic, dishonest, lacking in independence, one whose sole aim has been to hide the weaknesses of his own nature, it may be, so far as we know, that he has come pretty near to understanding himself; we only wonder why a man has to be ill before he can be accessible to a truth of this kind. (M&M, p 246)

The melancholic really is a poor excuse for a human being, for he cares about no one but himself.  He has not lost another.  The other always existed primarily within himself, a possession of his ego that in loss has turned against him.

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