How Does Depression Work? - 2

By Kevin Murphy, M.Sc.,
Psychoanalytic Psychotherapist,
Dublin, Ireland.

Picking up where I left off last week, depression is a particularly prevalent psychological disorder that affects between 8% and 12% of the populations of most countries worldwide. Not only is prevalent it also has a long history. The Ancient Greek physician Hippocrates (who gave us the Hippocratic Oath in medicine) described a syndrome of melancholia as a distinct disease with particular mental and physical symptoms including sadness, dejection, and despondency, along with fear, anger, delusions and obsessions. The term ‘depression’ is derived from the Latin verb deprimere, "to press down" and from the 14th century it meant to subjugate or to bring down in spirits.
There are a number of factors which have to be borne in mind when discussing the issue of depression. One is that, if you accept that depression is centered around a sense of loss within the person – an emptiness, a void, an inexplicable and debilitating lack – you also usually find that the person is not aware of what has been lost.
The nature of the loss is not conscious, and may just as well involve a disappointment or slight as a large traumatic event. Freud said in 1915 that if the depressed person has an idea about 'whom' he has lost, he does not know 'what' he has lost in them. This remark is interesting because it implies that there is a difference between a 'who' and a 'what' when it comes to what has been lost.
French psychoanalyst Jacques Lacan, who re-invented Freud and took his thinking to new heights, believed there was a link to human aggressivity. In his earliest seminar, he said that if we cannot imagine that we are something special for others, then the only other way to relate would be through intolerance for each other.* It is, like so much of the man's thinking, a fascinating idea.
In essence, if we lose that often times imaginary but nonetheless essential belief in what we represent for others, then it can allow a primordial aggressivity to overtake us. That is to say, a potential for aggression that is directed outwards and, in turn, can also be directed inwards.
When you consider depression, aggression is a favoured reaction of the wounded ego to protect itself from further harm, whether real or imagined. It is much the same if we become aggressive to protect a broken arm or a cut finger. But aggression can equally direct itself against oneself as punishment for becoming a wounded person in the first place.
The same Jacques Lacan, however, also believed the term ‘depression’ was too frequently used and too vague a term, a tendency that has continued to grow rather than reduce. Whenever the term is chosen to describe ordinary sadness, he said, is akin to a 'moral failing'.
Many theories have looked at why people become depressed. Some point to the earliest experiences of the infant who might have endured an absence of adequate care. At a very early formative stage, the progressive flow of the infant’s development becomes obstructed and so its identification of its own self as a safe, secure, worthy being is put at risk. This is what is called a narcissistic wound.
Narcissism, as a degree of self love, is necessary for the infant to convince itself of its wholeness and so cope with both its internal demands and the demands of the external environment that threaten to pull it in all directions. If the right level of narcissism is not there, problems in dealing with these forces can emerge.
Linked to this narcissistic notion is, and we come back to it again, the notion of aggression. The infant’s ego is continually trying to integrate itself in such a way as to overcome the unpleasure caused by the separation operative from birth, combined with those same internal and external psycho-physical demands on its system. When this integration of the ego is threatened because of inadequate resources a primitive aggressivity is released.
That is why the fragmentation of self-image that so many depression sufferers describe is accompanied by so much aggression, a lot of it self-directed. The aggressive threat of fragmentation, of being broken up, pulled in all directions, made to feel ‘in bits’, is the polar opposite of the unified, harmonious ego that is relatively comfortable with itself and its place in the world.
The perceived attainment of this unified ego is essential for anyone to remain beyond the reach of depression. But where do we get this image of a unified ego? We get it reflected back to us from the significant others around us at the formative stages of our lives. And so by tuning ourselves into the thing that most successfully fits with these others, we enhance this process. In short, from an early age we set out to realise the desire of others, to become the thing which others desire, to cause their desire for us, ignite their passion for us.
Out of this process of learning to deal with the external world of others and their complicated matrix of desires, our ego is formed. And I mean ego in the sense of that part of us that tells us who we are, that gives us our conscious identity.
But there is one further step involved. In order to achieve the objective of becoming the thing that causes an other to desire us, we have to perfect ourselves and this leads to the concept of ideals. We are powerfully attuned to notions of ideals, possibly as young as two or three years of age, ideals to which significant others in our environment respond favourably. From an early age we strive to use what we can of these ideals in order to perfect ourselves in the eyes of others. While it is not our subject now, this in turn takes us down the road of body image, ideals of perfection and so on.
But what we can draw from the link between ideals, our ego formation and depression is that it is within this process that the onset of the collection of symptoms we broadly term 'depression' is laid down. It is not uncommon nowadays for these symptoms to emerge in early childhood. But mostly they lie dormant until triggered in adolescence or adulthood.
Operating at the core of depression is not just the sense of loss but also a sense of impossibility at making good the loss. The lack of hope experienced by the depressed person is a response not only to loss but also the perceived impossibility at finding the tools to get out from under its burden.
This impossibility originates along the axis of ideals and ego formation. Either the person feels it is impossible to 'become' the ideal thing that others will desire, or that it is impossible to 'find' the ideal thing that others will desire, or that it is impossible to 'sustain' being the ideal thing that causes others to desire.
Hand in hand with this, the wider cultural context has ensured that sustainable examples of ideals on which to model ourselves are increasingly harder to find. What are quaintly referred to as 'the old certainties' are gone and the role of authority (in the form of State, church, community, family, parenthood and so on) has been eroded. So now we have fewer places to look for ideal figures. If, as we are often told, depression is a sign of the times, then we must consider the times we are in.

I will conclude this topic next week with a look at the various ways in which depression manifests in contemporary culture.

* Lacan, J., 'Freud's Papers on Technique 1953-1954', Book I, Norton, 1991, p.177