The Mystery Known as Depression, Part 4/12

4. WHAT IS DEPRESSION?
Throughout the ages, writers and thinkers have come up with poetic sobriquets to describe depression. Hippocrates called it the "black bile." Susan Sontag famously dubbed it "melancholy minus its charms." For Flaubert, it was simply “the eternal ‘what’s the use?’ ” And in his book The Noonday Demon, Andrew Solomon says “depression is grief out of proportion to circumstance.” (Solomon, 2002) Today, this ancient malady is poised to become the second leading cause of disability through the remainder of this decade, according to a report from the World Health Organization titled “The Global Burden of Disease.” (World Health Organization, 2004) By any name, depression has clearly become a plague among us. From a public health standpoint alone, it behooves us to understand precisely what it is and how to treat it humanely.

People often say they “feel” depressed, but depression is not a feeling. It is a defense against feeling,– against an accumulation of imprinted pain. As such, it is a protective device to keep us unconscious, or rather, to keep the unconscious from becoming conscious. It holds down, via its handmaiden repression, all of the catastrophic feelings and sensations from womb-life, infancy and childhood that, if unleashed from their safe, subconscious stronghold, would threaten the integrity of our conscious awareness. It is the ultimate survival strategy.

Depression is a system-wide state of repression that blankets many feelings. It is the history of the body’s traumatic experience exerting its force. And ultimately, it is the state of repression elevated to a higher level. For this reason, the depressive is chronically awash in suffering because he/she cannot feel those specific, early feelings. The organism seems to say, "Better to feel numb than feel what lies below and go crazy." Thus, the labored movements, feeling flat and unemotional, the lack of energy, and so on; all the feelings adumbrated by my patients at the beginning of my discussion. Any expression – anger, for example – can temporarily ease depression because it lifts repression a bit. But depression is certainly not, as Freud believed, anger turned inward. (Freud, 2005)

A normal person is rarely depressed; he has no backlog of feelings lying unresolved inside. He is open to feel and does not repress unpleasantness. He will be sad when it is appropriate. But sadness is a “now” event, a real feeling related to real situations. Depression is a “then” feeling, unrelated to now. If the young child could feel each and every original imprint, he would not be depressed in his life. The depressive, on the other hand, is stuck in time. He is stuck back in his past whether he is conscious of it or not, so that everything he does is a symbolic portrayal of that past. This means that we are all open to sadness when our defenses give way. To suddenly be out of work, left alone or excluded by one’s friends is most distressing, but depression is quite another matter. We should feel distressed, despairing, unhappy, sad; these are normal reactions. Not so with depression, which has as its kernel a deep hopelessness and helplessness. This is a basic imprint from long ago that can be triggered when one of those adversities occur. This imprint is often set down either during gestation or at birth when there was no escape from the traumatic input, such as a massive dose of anesthetics given to the mother during delivery which, as we shall see, effectively shuts down the baby as well. It is often this hopelessness that is triggered when seemingly not-so-serious events happen and depression occurs.

Feeling down and discouraged in response to losing a job, or breaking up with a mate, or after the death of a loved one, is different from a chronic, interminable depression. The former may be what is commonly known as "grieving" or "bereavement" which lasts for some weeks or a few months. The person has a normal response: gloominess, sadness, crying, feeling terrible, which stops after a time. What happens is that the person is reacting with real feelings. "Sad," for example, is a feeling; depression is not. Depression happens when you don't feel the real feelings. Those feelings agitate the deep brain levels and activate the imprint. The depressive feels all that; the imprint on the move toward conscious/awareness. It never makes it, however, as repression intercedes. But a deep despair and resignation set in, and a feeling of defeat and wanting to give up; and above all, that gloom and doom that is the hallmark of so many depressions. That is the original, precise, imprinted feeling that is trying to push its way into consciousness; it colors and dominates the present. We see the depths of the imprint in a syndrome known as endogenous depression, something that appears without apparent warning, leaving us helplessly deep into its maw. It has been labeled endogenous because until now we did not know where it came from or why. It is so deep that it seems to come from nowhere, but that nowhere/somewhere is deep in the brain.
When external defenses fail or are under attack, what the depressive experiences is the repression, not the feelings themselves. He feels the pressure against those feelings pushing down into his system. That pressure produces effortful speech and movement and total exhaustion so that the depressive has little energy and moves about in slow motion; “my feet are stuck in cement,” as one patient put it. In short he feels the weight of the repression, the ineffable force of keeping feelings down. He does not feel the feelings themselves. Once he does, the depression can begin to lift.

In depression there is the feeling of "heaviness," a lack of energy, which can be so great that even getting out of bed seems like a monumental chore. It makes everything a Herculean job, so that normal tasks such as talking or raising one's arm can become a great effort, even chewing on solid food. There is little or no energy left for enjoyment, pleasure, sexual drive, or any drive, for that matter, other than the wish to find a way to end the suffering.

So the depressive goes to a therapist for help; he/she usually has to be coaxed into it. What he/she gets is encouragement and hope that the therapist will make it all better – someone who will perform magic. He/she wants to be “pulled out” of her state; a symbolic feeling that was there when the original event – birth trauma – was taking place. Someone literally pulling his/her out, breathing life into him/her. The patient’s passivity requires an active, assertive therapist. The therapist becomes his/ her “friend” because he/she has rarely ventured out to make friends. And he/she will willingly take orders and obey his directions. But he/she has to offer hope and encouragement to combat that loss of hope deep down.

Give a depressive a new outlet – a new job, a party or a chance to go shopping – and all of the inner-directed pressure now pours out in manic activity. He will literally “throw himself” into his work. He will be “happy” for those moments when his work will make him happy. What has really happened is that he has found an outlet to release the primal force. Here we see the basis for bipolar or manic-depression. Not a different disease but a different kind of template – hopeless depths followed by manic energy. When repression fails, manic activity sets in. The imprint reflects the same cyclic event that occurred at birth. The person was stuck in what I call the trough and was blocked, then with great effort made it out. The template – down and then up – is played out in the cycle of giving up and trying manically to finish. It is the same energy source but a different way of handling it. So we can see that some of us shut down early in life and, lacking outlets, we become “dead,” globally and emotionally shut down. Others shut down and “act” alive. If being the “happy clown” pleases one’s parents, then the act will continue. Among the professional comedians I have treated this was never truer. I am treating a depressive now whose mother was chronically ill; he became funny to try to cheer her up. Though it never worked for long, it became a habitual pattern. His need? A happy mother who could love him. Take away the chances to please and the lurking sadness will begin to ascend. If one was disliked, suppressed, and rejected at every turn, then deadness and depression will be reinforced. How we develop depends on later life circumstance: Were the parents loving? Were they not tyrannical? Could they allow free expression? If there were free expression and lots of touch, then the imprint will be kept at bay because it was not compounded, but it will never go away until relived and connected.