“Yeah I don’t think I can keep seeing you. I mean I shouldn’t have to teach you how to do your job,” she said with more than but of indignance.
“What makes you think I need you to teach me how to do my job?” I asked already fairly sure of the answer.
“You asked why I was here and I told you because of my depression. Then you asked me what depression means,” she answered triumphantly.
By the time most of my patients finally make it to my office they are in a fairly dark place. Most have suffered with whatever has brought them in for a very long time before they even decide to look for someone to talk to, let alone actually call to make an appointment. I had one patient tell me he had carried around my office phone number in his contacts for six months before actually making a call. Then he had not shown up for his first few scheduled appointments. Three appointments actually.
By the time a person finds themselves sitting on my couch they are likely to be only passively interacting with the outside world. As one of my younger patients once put it, she had been “phoning it in” (only participating at a minimum in her life) for years before she came to see me.
Mostly this type of tentative interaction style results in a person only sort of listening to what is said to them and then jumping to conclusions of understanding more often than not because rather than doing any sort of deeper thinking about what a person says or does, due to the absolute drain on psychic energy depressive states (all mood extremes really) can be, there simply is not enough energy left over after performance of the basics to do so. This patient was doing just that.
I began gently as I wanted to clarify with the patient, not start, or continue, an argument, “I know what depression is in my world and what the word means to me, but in order for me to help you (and I do want to be helpful to you) I need to understand what depression means in your world. I need to understand what depression means to you, and the only way I can get that information is if you tell me.”
The real problem with mood issues isn’t just that they are uncomfortable and suck the zest for life out of a person, it’s that they are highly isolative in nature. A person struggling with these emotional states may feel like they are alone and no one could possibly understand what they are going through. They may feel cut off from pleasure, not just lacking in pleasure but unable to experience pleasure.
At least that was part of the experience until the internet came alone. There is so much bad advise and personal experience being advertised as scientific fact it is really hard for a person in pain to fight the demons which are at work inside them. On the one hand the information can help a suffering person to know they are not a broken freak of some sort, that people do and are suffering along with them right now.
We all want to have a club to belong to.
The problem with that is much of the information out there serves to separate one from their emotions (“you have anxiety, you got depressed”) and end up making emotional pain sound something like catching a cold. I’ve had many patients in the past few years make statements like “everything was going great until I caught some feelings.”
Human beings have two functions: thinking and feeling. The only way to rid oneself of either of these functions is complete or nearly complete anesthesia. A person has to be unconscious, not asleep, but truly knocked out.
Another common misunderstanding about moods is that they are somehow external to the self. This is fueled by the current medical model of mental health treatment in the US. The medical model works great when there is a problem with the body (a great example is a broken bone) because the tests which exist are designed to look at the body for problems (x-rays or lab work), then apply the necessary treatment. As the saying goes , see a broken bone, set the broken bone, and in a few weeks the bone is no longer broken. The body is a truly miraculous self healing machine.
Where the medical model falls short is in issues of the mind and issues of the soul. if you go to a cardiologist because you got dumped and your heart is broken, there is nothing that doctor can do for you, but if your symptoms persist for two weeks they do have a pill for that…..(seriously don’t get me started)
When a person comes to see me for help with their depression I try to at first focus on just that, their depression. Their depression is likely much different than my last patient’s and with very different causes. Yes the symptoms are similar but you cannot cure by only focusing on the symptoms.
So I ask all these patients the same question, “what does your depression mean to you?” And then I wait for them to respond. Depending on their response I can tell how engaged they are with their world and in the present case I knew she was not very engaged because she heard me ask “what does depression mean?” Also she, by all outward appearances, did not present as depressed. She looked….chipper. She bounced into my office with a smile on her face and asked me how my day was going. She then proceeded to attempt to engage in a conversation with me about all manner of notwhyyoucametoseeme things. We might still be chatting now had in it interrupted her to ask why she set the appointment.
“I said I was depressed , that means I’m like depressed and I have no motivation to do things,” she stated. Her voice starting to become uneasy.
“So you’re tired?” I asked, “are you sleeping more than usual, or do you want to?”
“I don’t know,” she said voice suddenly steady and forming tears sucked back into their ducts, “I guess so. I don’t know what’s wrong with me, that’s why I’m here so you can tell me.” Her voice was edging on combative now, “So you need to do your job and tell me how I can fix this!”
My own anxiety starting to rise, I answered as gently as I could while focusing on breathing slow and deep, “I didn’t ask you what’s wrong with you and I will never do so, do you know why?
“Because you suck at your job?” She stated sarcastically.
It is commonplace for a person under great stress or in a heightened emotional state to “regress” psychologically. Essentially regression is when a person decides right now is too unsafe or confusing or painful and decides to go back to a time when life made more sense. As time travel only can occur at the level of the psyche (at least as far as I know) a person will psychologically return in time to a safer age. Unfortunately for everyone involved (the patient and everyone else they may come into contact with) in the process, regression does not literally move you back in time. It figuratively moves a person back in time and they start acting as they did at that younger age. Which can be difficult.
The person I was treating at this moment was no longer 27, from her tone and rebellious attitude, I would guess she was more like 15. Maybe 12…..
“I would never ask you what is wrong with you because I already know there is nothing wrong with you. You are not broken. You are a perfectly wonderful human being who is struggling with emotions which are at the present time too big for you to process.”
She softened her posture in the chair a bit and her frown retreated a bit, she was likely trying to decide, on a very deep level, if I was trying to manipulate her or was full of bologna or both. “Yeah I’m going through some shit right now.”
“I can see that you are,” I replied still focusing as much of my attention as I could spare on my breathing (I too am only human and my patient’s emotions deeply impact my own), “why don’t you take a couple of slow deep breaths with me and then when you’re ready you can tell me about what you are experiencing and how long it’s been like this.”
We sat in silence, breathing slow and deep until the anxiety had drained from both of us. She looked up at me suddenly and said the only truth she was capable of accepting at the time, “I don’t know where to start. I think I have always felt like this.”
I sat in silence to see if her thoughts would connect and she would continue speaking. It is an amazing thing to witness, when a patient is in a place when they start to actually feel safe enough to explore their pain and to communicate what they discover with another person.
“It’s like nothing I ever did was good enough for my dad. He never said anything nice to me growing up. It was always you can do better or why didn’t you do more. I think he wished I was a boy because when my little brother was born he basically ignored me completely.”
Unfortunately it is difficult for some men to relate to women. There is a fear of the feminine at work in all men and if this is not approached properly and at a young age what ends up happening is instead of the masculine integrating the feminine the masculine instead can get corrupted. This sort of thing happens, or can, when a mother doesn’t properly nurture her son’s masculinity. Instead of encouraging the son to find and tame the beast of masculinity within him she dominates him, makes him dependent on her. In a word she emasculates him. Of course she does this because she was raised by a father who abused her in some way as well, didn’t allow her femininity to grow and incorporate itself into her unconscious masculinity.
Sometimes I envision a chain of improperly individuated children being raised by improperly individuated parents who were in turn raised by improperly individuated parents and on and on and on backward through time. I imagine in a way all my patients, indeed all people, are trying to reach back through their lineage to find that original person and help them to heal. The patient zero of unindividuated people.
By growing up in a household where nothing she did was ever good enough for her father (her original opposite sex love object) she developed a deep sense of rejection and because her mother, who was equally suppressed by not only her husband but her own father (which lead to a toxic version of the old fashioned view of femininity to develop) she had no allies at home and worse still no healthy role models to immolate. As a result my patients sense of rejection was compounded and reinforced at every turn leading her to conclude that not only was she being rejected because of something wrong with her but it was “trying,” that naturally developing urge to do things on her own, that was the cause of her suffering. To use her word, it was motivation (the emotion to get things started) which was the problem and therefor must be repressed.
Of course one cannot remain a child forever, one must learn to act on one’s own behalf. But for my patient to do so, to act on her own behalf was not safe and therefore could not be allowed lest we face the repeated rejection of the parents. So even though she wanted to, she couldn’t, which is a rather simple way of saying she developed an internal conflict which had grown to overwhelm her.
The result of this of this conflict was misery for her. She wanted to go out and do things, to make something of herself but she would not allow herself to do so. Wanting something that you know you can never have causes a specific emotion to emerge.
“Growing up like that sounds like it doesn’t feel very good, ” I stated.
“It doesn’t,” she replied, “it makes me so sad to think I could been doing more but I won’t let me do it.”
“There’s a name for that emotion, but it isn’t sadness,” I paused to see if she would fill in the blank but she was struggling so I decided to throw her a lifeline, “It’s called frustration.”
I have treated many people who are struggling with depression and the two biggest misconceptions I have seen is the belief depression is an emotion and it is something akin to sadness. I think that is mostly due to the word depression becoming a part of the common lexicon of language over the past forty years or so. People don’t say they are sad anymore, they say they are depressed.
The problem with that is that depression isn’t an emotion in and of itself, it’s a construct. That is the state of clinical depression is a combination of several different emotional states which persist for extended periods of time. Most of the patients I have treated for depression are angry not sad but they are angry at someone or something which they feel at a very deep level they either cannot be angry at (like a parent or god) or something they know they could never do anything about (the system, the government, people). The result of this kind of anger is that either a person tends to give up, in which case the anger turns to failure or resentment, or they attempt to change the way they feel inside by changing things outside, which causes the anger to turn to frustration or disappointment or worse unending longing.
None of these emotions are sadness but they sure can feel like sadness and when a person is using almost all of their psychological resources fighting an internal battle like this they tend to not have a whole lot of resources for the rest of the world, which certainly looks like what we are all shown depression looks like.
The cure, so to speak, of such a condition is to first identify what emotions are actually present, which is not always that easy to do, and then figure out why that emotion was necessary in the first place. You have many different emotions yet your psyche chose anger or frustration or whatever, if you can figure out why that emotion was chosen (and you can) and then actually allow yourself to feel the emotion, you will be able to more completely process it. Once an emotion is processed it goes away because its job is done.
Depending on where a patient is psychologically in their journey when the step into my office for the first time I may start with a discussion of emotions if they are far enough along, or if they are really just beginning their journey I start with what I sometimes think of as empowerment training.
Realizing you have created the world you are struggling in can be quite the kick in the guts but it also comes with a realization of power. If you have created this world that you suffer in, you could create a world in which you are not suffering. You have the power, you just need to learn how to use it. Part of that process is learning and accepting your emotions as a part of you. It isn’t always easy but given enough time we all can do it.
Sometimes it happens in a single session. Many people just need to be told they aren’t broken. That life is hard and it hurts sometimes but you can get through this.
Sometimes it takes a long time and yes sometimes medications can help (again don’t get me started) but with enough practice and a helpful guide along the way. You got this.