Being Good at Depression

Considerable research has shown that people with depression differ from others in how they perceive the world and themselves, how they interpret and express their feelings, and how they communicate with other people, particularly loved ones and people in authority. They tend to think of themselves as unable to live up to their own standards, they see the world as hostile or withholding, and are pessimistic about things ever getting better.

In relationships with others, they have unrealistic expectations, are unable to communicate their own needs, misinterpret disagreement as rejection, and are self-defeating in their presentation. They are in the dark about human emotions. They don't know what it's like to feel normal. They fear that honest feelings will tear a relationship apart or cause others to reject them. They need to learn to live with real feelings.

The effects of depression can be divided into five main areas.

1. Feelings - how we deal with our emotional lives
2. Behavior - how we conduct ourselves, our use of time and energy, our habits
3. Thinking - the assumptions we make about how the world works
4. Relationships - how we act with other people, what we want and expect of them
5. The self - our self-image and self-esteem

Why Depression is Self-Defeating

Depressed people work harder at living than anyone else, although there is little payoff for their effort. But in the course of their hard work, they become very good at certain skills. They are like weight lifters who concentrate exclusively on upper-body strength-massive muscles in the arms and trunk but little scrawny legs underneath-easy to knock down. Depression permeates every aspect of a person, but they can free themselves by consciously deciding to do things differently. People get good at depression-they over adapt and develop skills that, at best, just keep them going, and often make things worse.

To recover, sufferers can apply their energy, talents, and dedication in more appropriate directions. With practice, they can undo the effects of depression by replacing them with healthier, more adaptive skills.

Many people who have had severe depression report that they suffered for years, sometimes for decades, before they told anyone. They felt so isolated and so self-blaming that they assumed there was nothing to be done, nothing that anyone else would understand. Meanwhile they "passed"-they went right ahead with life, putting on a happy face and achieving success in school, in careers, in the family. Often the meaning of a suicide attempt, a "nervous" breakdown," or a psychiatric hospitalization is "Look, I can't keep up this charade. I'm sick and I need help." It becomes a transforming experience, an adoption of the sick role, a clear message to the self and others that there is terrible distress below the appearance of competence and good cheer.

Depressed people tend to be overly dependent on external factors-continual feedback from others and/or a relentless quest for accomplishment-for a good feeling about the self. Because there is really little we can do in life to influence the behavior of others or to change events, the depressive's self-esteem is always in danger. Self psychology uses the term "self-object" to describe relationships that help us sustain our sense of ourselves as doing well and deserving love.

Parents and spouses are self-objects for us, but so are our friends, coworkers, neighbors, and other people we interact with regularly. Our work, our recreation, and our daily routines serve self-object functions for us. Everyone needs self-object relationships throughout life; they are like water to a fish. We swim in a sea of self-objects that invisibly holds us up and provides us with nutrients. But the depressive's need for self-objects is more desperate, sometimes more distorted or disguised. It is as if the depressive has lead weights on his ankles, dragging him under; or as if the depressive has never learned to swim effectively or float effortlessly. Instead, all he can manage is an exhausting, desperate flailing and gasping. The sea of self-objects that provides others with nurture and support doesn't give the depressive any buoyancy.

In self psychology theory, the depressive is understood as relying on others in his life in order to make up for deficits in the self. These deficits may come about as a result of a number of causes, but the best understood is the absence or inability of parents to provide the child with functions he or she needs in order to grow. A maturing child needs certain qualities in the parents to acquire and maintain a healthy sense of self-esteem.

The idealizing aspect of the self means that part that needs to look up to parental figures as powerful, confident sources of comfort and models for identification. It lays the groundwork for mature forms of idealization, such as identification with values or religion-a sense that in being part of something larger or more important than ourselves, we are enriched and our lives are given meaning.

As the child's immature grandiosity-his fantasy of being invulnerable and omnipotent-diminishes in response to his growing ability to perceive reality, idealization partly replaces it. The child may no longer feel that he alone is omnipotent, but through merger with a strong, comforting parent or other adult is protected from feelings of helplessness and loss. Failure of parents to provide a sense of strength and support-often because of their own depression-leaves the child feeling alone and vulnerable. He may grow into an adult who sees himself as weak, seeks others to model himself after, and remains dependent on a connection with other people for a sense of self-esteem.

The grandiose aspect of the self refers to the need of the young child to feel himself as powerful, supreme, the center of the world, the object of unquestioned love and adoration. Failure of the parents to respond empathically to these feelings of the child and to respond with some delight as they get in touch with these childish aspects of themselves, can lead to a sense of worthlessness, rejection, and a hunger for response. Such people are described as "mirror-hungry"-they constantly look to others for affirmation of themselves as potent, worthwhile, and worthy of love.

Depression is loss of parts of the self, the gradual numbing of feelings and experiences that the child learns are unacceptable and banishes from experience. Cure comes from recovery of the missing pieces. Depressive moods in everyday life come from suppression of impulses or unwanted emotions.

"The true opposite of depression is not gaiety or absence of pain, but vitality: the freedom to experience spontaneous feelings," says Alice Miller, author of The Drama of the Gifted Child. As patients learn from their experience in therapy that the breakthrough of suppressed emotions, however painful or upsetting, can be counted on to lift depression, they begin to change how they handle feelings. Specifically, painful or upsetting feelings are no longer avoided, but experienced. This leads to a reconnection with the lost parts of the self.

Case Study:

Mark, 43, went to his therapist complaining of obsessive thoughts and difficulties with his family. He desperately wanted to be a good father, but the harder he tried to connect with his children, the worse he made things.

Mark's childhood appeared to be cold and frightening. His mother constantly worried about everything, from thunderstorms to the bills, and Mark's health. His father rarely ever spoke. With a mother who could not insulate a child from the normal anxieties of childhood because of her own terrors, and a father who seemed to withdraw actively if not cower from other people, the young Mark was completely on his own in learning how to live. Somehow, though, he did a very good job.

Coming from a working-class family, Mark put himself through college and eventually rose to a very high position in his profession. Although he felt confident about his skills at work, he felt completely inadequate to the task of being a father and a husband.

The therapist talked to Mark about being a self-made man who had learned the rules in the working world, but didn't know the rules about family life. Together, they set about assembling a manual, a metaphorical how-to book for a father's role in a family. Mark's idealization of the therapist was obvious from speculative comments he made about how well the therapist's family must function. The therapist did not challenge this, but let Mark feel that he had a strong, capable friend to rely on. Whenever they would discover one of the rules of family life, Mark was very pleased. He felt a sense of shared accomplishment which he was then able to use as his children grew and mastered their developmental tasks. Instead of constantly trying to control his children-a response which was, in essence, a reaction to his anxieties about fatherhood-he developed empathy for them. Seeing the world from their point of view, he was much better able to respond to their needs.

Mark's need to control his children was what set him up for failure. Though children always need limits, Mark could not get in touch with their joy and exuberance and help them redirect their energy when they went too far. He couldn't tell the difference between high spirits and out-of-control behavior, so he was always trying to control. Helping Mark feel that he understood the "manual" enabled him to get out from under the horrible anxiety that his children's normal behavior caused him. Without the anxiety, he became a much more effective parent-able to enter into his children's play and then step out of it into a parental role when it was time. As he developed the capacity to experience joy, his depression-which was never the focus of treatment-was greatly relieved.

On the next page we will talk about Addressing The Problem.