Depression

Depression is always the result of some painful loss. The loss of a loved one, status, youth, health, beauty often triggers depression. The emotional experience we identify as depression is grief, abandonment, helplessness, hopelessness and the inability to find pleasure in anything. It is a state of despair and a paralysis to act on our own behalf.

One hundred years ago, in 1917, Freud published "Mourning and Melancholia". It is a masterpiece of insight, sensitivity and understanding. In it he outlines the distinction between mourning (the normal response to loss) versus melancholia (the old term for depression). Freud used his libido and structural theory to explain the phenomenon of depression. While these concepts are not widely used anymore their wisdom still rings true. When we love someone or something it is an instinct and drive within ourselves to join with them. This is the evolutionary basis of the need to love. It binds people together. It also helps to establish important connections within ourselves and to outside agencies (religion, government, team, school etc. ). For Freud love created an enduring attachment that promoted safety and psychological growth for the participants. When the loved object is lost the feelings connected to it remain. The pain we feel is the need to direct our love toward the object but it is no longer there to receive it. The need, desire and wish to express this love is thwarted. Having love for a lost object is the experience of depression. It is not a bio chemical disturbance of the brain. Depression may alter brain chemistry over time and medication can help. It should, however, not be the first method to alleviate symptoms unless absolutely necessary. Talking therapy is the modality of choice to treat depression. It is designed to create, foster and explore how an individual forms, maintains and inhibits their interpersonal relationships. Psychoanalytic treatment provides the medium through which change can occur (the therapeutic relationship) and the source of lasting change (internalizing the good qualities of the therapeutic relationship).

To overcome depression one must accept the loss and it's accompanying feelings of pain, fear, helplessness and hopelessness and learn to tolerate them. Once an individual can better tolerate the loss the goal becomes allowing the love instinct to express itself to an other. We must stay connected to the living not the dead. We must let our instinct to love express itself again in a new situation. Memorializing the departed and keeping our love bound up with them interferes with our capacity to find love again. It is the goal of psychotherapy, to help individuals liberate themselves from ties to the past that inhibit them so they may live freely with a sense of security and hope.