* DEPRESSION

[I wrote this paper twenty years ago. I think I still agree with most of it. I'm posting it here for your interest. I will add a discussion space in the group for relevant comment and discussion]

DEPRESSION

by David Brazier

INTRODUCTION

The collection of symptoms which we call depression is very common. Everybody probably has at least some of them some of the time. They may be brief or of long duration. The following domestic dialogue illustrates the theme:

Jane: What's the matter?
Peter: It's nothing.
Jane: Something..
Peter: It's just the same old thing again, I'm tired of talking about it. I'm just a drag to you and everyone.
Jane: Tell me what you're feeling.
Peter. It's never any different. Flat. Black. Lifeless. I just can't see the point in anything.
Jane: You look so troubled.
Peter: I get resigned to it. I don't know where it comes from. Although I know from experience it probably isn't going to last forever, it feels as though it will.
Jane: I hate to see you so low.
Peter: If I'm honest, I really wish I was dead.
Jane: Please don't do that.
Peter: I don't feel any urge to do it. I don't feel any urge to do anything. I just would prefer that I was dead and it seems almost a kind of imposition that I still have to be alive.
Jane: What can I do to help?
Peter: It doesn't feel as though anything will help. Just be patient with me. I know I'm a trial when I am like this. There just does not seem to be anything I can do about it.

The "symptoms" exhibited by Peter here are typical: dejection, sadness, regret, resignation, anger, bitterness, withdrawal, pessimism, isolation, flatness, apathy, anguish, resentment, helplessness, morbid thinking, self-blame, blaming fate, hopelessness are all present in some degree. A person who is "depressed" may (or may not) have difficulty in sleeping, or may sleep more than other people. They may (or may not) lose their appetite, or eat insatiably. They may burst into tears unpredictably. They may hate their job, their family, their life. They may experience a loss of sexual interest. They may feel guilty. They may feel lonely or believe that nobody cares about them or that they do not deserve love or that they have no love to give. They may believe that they have no value or that life is pointless. They may take unnecessary risks, put themselves in danger or even seek self destruction.

Depression covers a wide range of phenomena. It is a composite term. To think that there is a single entity called depression is probably a mistake for the therapist since each client needs to be understood in terms of the singularity of their individual situation. Nonetheless, as a composite term, it does still have some use, allowing us to make generalizations about a range of distressing conditions. These states, it will be argued here, commonly have to do with the basic existential problem of coming to terms with change, transience and temporality.

It is not argued here that this is the only way of viewing depression. It is possible to view depression as a biochemical process. It is possible to see it as a social phenomenon. There is plenty of evidence that it is related to lifestyle, not least to lack of physical exercise. It is possible to see it as a sleep disorder. There are many ways of viewing it. The theory advanced here provides an attempt to understand human dejection as one stage in a process of growth which has an overall positive direction. It is based upon my experience of clients and, in no small measure, experience of myself. It is a departure from the conventional view of depression as a dead end state.

Both the term "depression" and the term "low" draw a picture of us of going down. We speak of "sinking feelings". There is a sense of going down or going back. Depression has an affinity with death, sleep, with returning to the earth, going back to the mother, the womb, hibernation. To return to the earth is to return to the timeless, the eternal. When the projects of our life, our experiments with time, have come apart or proven barren, we have to return to the eternal, to our beginnings, to the ground from which we grew, in order to start again. There is a kind of cycle here. Once the emptiness of depression has been accepted, it begins to fill itself again naturally, just as spring follows winter. Depression is a hard thing to accept. However, the traditional way of thinking in terms of cycles is probably more useful to us in understanding the tides of the spirit than the modern myths of linear progress and normality.

Depression is like the behaviour of a wounded animal who goes away and curls up "to nurse their wounds". My family once owned a cat which, while crossing the road, got hit by a motor-bike. A number of bones in the pelvis were broken. In the wild the animal would have died. The vet offered to destroy the cat but my mother would not hear of it and set her upon a cushion. There she sat for several weeks in a state of seeming indifference. Gradually the signs of life returned. She began to eat. One day she got up and walked a few steps. Eventually she returned to normal life. On this analogy we may see depression as a stage in a process of healing rather than a disease.

In many "primitive" mythologies we are pictured as composed of earth and spirit. When these two separate we die. In the meantime, the pull of the earth or of the spirit may be stronger. We may be in high spirits or low. We come from mother earth and we eventually return to her. In the space between birth and death our spirits rise or sink with our fortunes and we feel correspondingly more or less "full of life". We are all familiar with this pattern of imagery, of earth and spirit, even if intellectually we subscribe to some other belief system. We will see this theory resurface later in this paper in the more modern guise of Freud's dualistic theory of instincts.

It is worth, at this point, saying something about language. The term "depression" tends to be used to classify our topic as a disease entity. This may not be very helpful. There are alternatives. Depression may, for instance, as we have just seen, be called a "loss of spirit" and it may serve us much better to think of it in terms of a person's "spiritual journey" than to burden them further with medical labels which pathologize. Or we may use common language. To be depressed is to be "low", the opposite of being "high". Some people's lives swing back and forth between "highs" and "lows", a condition which the scientifically minded have called "bi-polar affective disorder" or "manic-depression". To say that a person suffers from uni-polar or bi-polar disorder may, however, be a form of labelling which one would prefer to avoid.

In this paper I would like to consider some of the ways of understanding depression, advance a more positive view on the subject and relate all this to the task of therapy. This last, I suggest, is to attend to the person as they pass through this process of healing, aiding the process which leads a person toward fullness of life. In keeping with my comments above upon language, I do not conceptualize therapy in this case as the rectifying of a fault nor the curing of a pathological condition. Depression is a phenomenon which has its place in the scheme of things and it is our task to inquire into and understand it, not condemn. I will argue here that depression is an opportunity, not merely a set-back. Out of an appreciation of suffering we may achieve a wider compassion and a steadier maturity. The therapist is a companion. Sometimes it is humbling to realise that the client one is with may, in the depth of their reflection upon "the dark night of the soul," be further along the road than oneself. Nonetheless, even inexperienced companionship can assist a traveller. And when the therapist has themselves passed "through the valley of the shadow of death", they may sometimes be able to achieve a remarkable communion with a client who is now journeying in similar parts.


ATTACHMENT AND LOSS

So what is the natural history of depression? Of what sequence of events is it typically a part? This is, to a large extent, common knowledge. We suffer a loss of spirit when we suffer a loss. Spirit, whatever one may conceive it to be, is clearly associated with our attachments and involvements. Whenever we are attached to something in particular, and we lose it, our spirits sink. Freud called spirit "libido". He talked of how we invest it in the world around us and how this results in a loss if the objects of our investment are taken away from us. The prototypical case of loss is the death of a loved one. We come into this world dependent upon others. We love, we lose and we suffer.

The relationship between depression and bereavement or other loss, in women at least, has been very carefully researched by Brown and Harris (1979). Their model of the phenomenon involves two stages in the setting up of the conditions which give rise to depression. The first stage, which may occur early in life, is the exposure of the person to "vulnerability factors". The second stage which actually triggers the onset of depression is exposure to a "provoking agent" (ibid., p.238). The most powerful vulnerability factors are early loss, most especially the death of one's mother before one reached puberty. Provoking agents may any one of a range of set backs or upsets, major or trivial in themselves perhaps, but sufficient to tip the person over into a deep rumination upon the pessimism about life which they had always, up to that point, kept at bay.

Loss brings home to us the transiency and unreliability of everything, our own frailty. We may ward this knowledge off for years. The feelings of grief may themselves be "buried" for a long time before they surface. It may sometimes be the task of the therapist to set the grief process in motion by helping the client toward an acceptance of the reality of the loss. It may also be the therapist's task to aid the process of learning by accepting the basic lessons which this condition has to teach us in a factual way.

Furthermore, we should not expect rapid changes. The sense of loss, just like the attachment which preceded it, can last a long time. Those who have studied the process of grief (see Brazier & Beech 1993) show how there is a fairly typical sequence through which people pass as they "recover" from a loss. Typically these stages follow a pattern of initial shock and disbelief, followed by anger, then dejection, which gradually gives way to a period of fluctuating moods as the person begins with gradually increasing consistency to re-engage with life.

We can see this pattern as an expression of the tasks a person generally has to carry out when their life is substantially reorganized for them by forces beyond their control. The first task is to try to maintain continuity with the past, which may initially mean simply discounting the reality or the importance of the change. If the change cannot be denied, then the urge to fight arises. By fighting back we may be able to restore the former state of affairs. If this does not work, we retire to lick our wounds and think of a new strategy. We go to ground. This is the depressive phase. It is a period when nothing much appears upon the surface but substantial reorganization goes on inside. Then, insofar as a new approach to life is evolved, the task becomes that of testing it out upon the world around us. This testing period brings successes and failures and since the new behaviour is not fully established, there may be many changes of tack. Finally the person does become more settled in a new pattern of attachments and activities. We may think of grief as a natural chain of events following loss, one of the links in the chain being depression. A person may get stuck in any of the different phases. The depressed person is stuck at the phase of dejection. This theory provides one useful way of looking at depression. It is not the only way of seeing it, however.

The description given above is structured by the common sense notion that grief is an entity which begins with loss and ends with a return to "normality". This is, however, an arbitrary choice of time frame. The chain of events in which grief occurs does not begin with loss, but with the formation of attachment to what was lost. Grief is simply the process that goes on when we are forced to give an attachment up. The grief is inherent in the attachment. Attachment and grief are simply two aspects of the same phenomenon, two different angles upon it, separated by a distance of time. If grief really is a "recovery", then it is a recovery, not from loss, but from attachment. Grief is, in this sense, "a return to reality" (Brazier & Beech 1993, p.8).


THE DUALISTIC THEORY OF HUMAN NATURE

The theory of attachment and loss provides one starting point for understanding some of the phenomena of depression. A second useful beginning is the theory originated by Freud, of a tension between life and death instincts or ego and sexuality. In Freud's concept, the sexual energy or "libido" is "the true life instinct" and is responsible for involving us with our surroundings. The range of different uses of the term "love" in the English language gives us a good idea of what Freud had in mind. We are "taken out of ourselves" by our love affairs, both those with other people and those with various life projects, base or sublime. Depression is sexual repression, the defeat of the life instinct. A diminution of libido might appear as depression. Or, we might say, depression is the ascendancy of the death instinct.

In my paper on Thanatos and Athanatos (1994), I developed from this idea a theory of spirituality, showing how, corresponding to the primitive tension of ego and sex, a tension subsequently develops between "super-ego" and "spirit" as the person matures. The development of the super-ego is part of the higher development of the conservative, ultimately death-ward, tendency in the person, the ego. The development of spirit is the higher development of our sensual involvement with the world around us. Through spirituality, we come to appreciate the world not simply as a series of gratifications for particular lusts, but as something all encompassing and sublime. We see "the universe in a grain of sand".

This then is also a developmental theory, a theory which suggests that a higher development of both sides of the personality is possible. This higher development does not come about automatically, however. It is won through struggle. From this extended version of the dualistic theory, therefore, we can derive the formula that depression is the sign of frustration of a person's sexual or spiritual aspirations. It is what happens when a person is confined within the death instinct (ego plus super-ego). This can happen at different stages or levels of maturity. It can simply be the consequence of the frustration of our lust or it can be due to the failure of our attempts to reach the most sublime states of union.

When the life instinct has been weakened by rejection or failure, the death instinct holds sway and the person sinks back into nursing the ego. In passing we can note that since the super-ego is ultimately also part of the death instinct, this idea provides an understanding of why it is counter-productive to simply tell depressed people to "pull themselves together". Such a direct appeal to the super-ego, if it has any effect at all, is, from this perspective, quite simply a reinforcement of the same tendency which is manifesting as depression. It reinforces the prison bars rather than effecting a release.

The dualistic theory suggests that life evolves as a dialectic between the two different tendencies in the person. It suggests that the sexual-spiritual energy is the energy of life and of love. That when this energy loses momentum we fall back upon a self-centred preoccupation which is essentially depressive. The need we feel at such times is to seek security. The life energy will not, however, simply go away. In the depression, therefore, there goes on a struggle to find a new adaptation to life, a new way of reaching out, appreciating and loving. When this struggle proves successful the person emerges eventually from their chrysalis with wings they did not have before, that is, they achieve a more mature form of loving.

In the polarity between ego and sex instincts, then, depression is to be seen as what happens when the life instinct is frustrated and the person relies upon their ego. The trigger for depressive moods is, thus, often a sexual rejection. On a wider scale, a depressed society is generally a sexually repressed one. We need love in our lives, both to be able to give and to receive. This involves us, however, in needing others. In this respect we are vulnerable. A loss of love object can plunge us into low spirits. Love, however, is not just love of other people. The libido which Freud talks of is the impetus for all our relations with "objects" of all kinds. It is that energy which takes us out of ourselves into engagement with a world. If we translate this into phenomenological terms, we are talking about shifts of attention. The ego "instinct" is the tendency to attend to "self" whereas the sex "instinct" is the tendency to attend to "other".

In the past ten years there has been a great deal of research upon the concomitants of depression. Much of this was stimulated by the theory that depression might be associated with a particular pattern of thinking. The works of Aaron Beck and of Dorothy Rowe (1983, 1989) are well known in this respect. A more recent hypothesis which I would like to pick up, however, is that of Pyszczynski and Greenberg (1987) which suggests that "depression is the result of an inability or unwillingness to exit a self-regulatory cycle after the loss of a significant source of self-worth and that it is maintained and exacerbated by a maladaptive deployment of self-focused attention" (ibid. p.307). What this somewhat technical formulation suggests is that depression may be more a function of attention than thought pattern, or that the characteristic thought patterns of depression may be explained by a surfeit of self-focused attention. Pyszczynski and Greenberg cite a variety of research evidence from which "it seems fairly clear that self-focused attention and depression are positively associated" (p.309). The interesting paradox is, then, that so called "self-esteem" may well be highest when attention to self is lowest and vice versa. The person who is "self confident" probably refers to self very little.

The construction of the ego and the activity of self attention seems to be an attempt to achieve a sense of security in an uncertain world: "as a number of theorists have suggested blaming the victim of misfortune may sometimes be preferred to the alternative of concluding that the world is a cruel and unjust place in which to live. Believing that one is deserving of his or her misfortune may thus shield the individual from the more threatening prospect of viewing the world as unjust and hostile. Given the aversive nature of the depressed individual's recent life experiences, buying into a negative self-image may, in some cases, be more endurable than accepting the possibility that tragic events can occur in an unpredictable and uncontrollable fashion" (Pyszczynski and Greenberg 1987, p.318). We take on responsibility for failure in an effort to stop looking at threatening surroundings. The ego is itself a "defense mechanism".

In this, again, we see a basis for the well known association between depression and anger. When the person looks toward the threat, anger arises. When the person looks away, depression sets in. These are the two poles of the fight-flight reaction to stress. There is also here a suggestion that the "common sense" admonition to the depressed person to "think about something else" may contain a germ of truth, even though the depressed person is generally too enmeshed to be able to carry out the suggestion by will power alone. Nonetheless, it is not uncommon for depression to lift when, through accident of circumstance, the "outside" world becomes more demanding of attention. Thus rates of depression generally fall markedly during war time, not something one would predict if depression were simply the result of adverse circumstance or pessimistic thinking. At the very time when the threat is greatest, the tendency to depression diminishes. I suggest that this is because it is at such times that the person feels much more compelled to shift their attention away from self and onto practical engagement with circumstance. There is thus some tendency for depression to be a "disease" of security. When there is prosperity and peace, for some people at least, there is more opportunity to ruminate upon self.


THE PARTICULAR AND THE UNIVERSAL

Certainly, the idea of maturity generally contains the idea of increasing stability. A mature person is less easily "knocked down" by life than an immature one. To develop this in terms of the dualistic theory we could say that with maturity the ego develops into the super-ego and comes to be governed more by principle and less by self-consciousness, while our more sensual desires give way to a more universal appreciation of our participation in a life process greater than ourselves, however this may be expressed. Both tendencies come to be informed by a wider perspective.

This idea of maturity as the attainment of a wider perspective provides us with a means of unifying the theory which relates depression to loss and change with the theory which sees it as part of a developmental crisis. The commonly held view is that grief is a departure from the mainstream of life, whereas what I wish to argue here is that it is actually an important part of that stream. Attachment is essentially a narrowing of perspective. It consists of a focusing of attention upon a narrow field. It is an attempt to create a safe niche for oneself, immune to the ravages of time. Of course this does not work indefinitely. Whatever we attach ourselves to comes undone eventually, simply because everything is impermanent. The path toward maturity is a path toward ever widening, rather than narrowing, perspectives. Attachment sets us up for a developmental crisis, the release from which involves us in dejection. The depressed person can thus be seen as one who stands on the threshold of an important existential (spiritual) realization, a point of truth.

This obviously is an unorthodox view. Interesting support for it comes, however, from a review by Taylor (1989) who, summarizing many research studies, comments that: "Normal people exaggerate how competent and well-liked they are. Depressed people do not. Normal people remember their past behavior with a rosy glow. Depressed people are more evenhanded in recalling their successes and failures. Normal people describe themselves primarily positively. Depressed people describe both their positive and negative qualities. Normal people take credit for successful outcomes and tend to deny responsibility for failure. Depressed people accept responsibility for both success and failure. Normal people exaggerate the control they have over what goes on around them. Depressed people are less vulnerable to the illusion of control" (p.214). Or, as Cain succinctly puts it, "Depression, Taylor argues, represents an absence or loss of illusion... Recent and accumulating evidence... supports the view that depressed persons may see the world more clearly than the normal person" (Cain 1990, p.264).

"Normal" people fear disillusion. Yet how is reality to be found except through that gateway? Taylor argues from her review that illusion must be healthy because it is the strategy which normal people use. It is perfectly possible to argue the other way, however, if we free ourselves from the axiom that "normal" means "healthy". Perhaps most people are not "healthy". Perhaps the depressed person is closer to a real understanding of life. Perhaps those who have not passed through this gateway simply exist in a dangerous fool's paradise. Perhaps the challenge to the depressed person is not the task of getting rid of a pathological state, but rather that of raising their condition from that of a "little grief" into that of a "great grief", one which holds the seeds of a more wide-ranging insight into life, time and liberation.

In our pleasure seeking mentality, we are inclined simply to see depression as something to be got rid of, a blight. If we drop the idea that pleasure is the goal of life, however, we can reassess darkness of the spirit and discover that it is something to be inquired into and learned from. We are talking here of a spiritual approach to the matter. Depression is a trial of the spirit by which we can become free. It is worth noting that the great spiritual innovators of history, Lao Tzu, Confucius, Buddha, Christ, and Mahommet all went through a period of total defeat and disillusion before they came upon the truths with which they were subsequently able to enlighten the world. On a lesser scale, many excellent therapists have had periods of serious depression in their lives and, I suggest, they are much better therapists as a result.

St. John of the Cross wrote:
    1.    In order to have pleasure in everything
    2.    Desire to have pleasure in nothing.
    3.    In order to arrive at possessing everything
    4.    Desire to possess nothing.
    5.    In order to arrive at being everything
    6.    Desire to be nothing.
    7.    (quoted in Merton 1976, p.39)
and Merton himself, summarizing what so many spiritual writers have said, writes: "The only way to true life is a kind of death" (p.38). Depression is not something to be ignored. It has something to teach us.

Depression, then, can be understood as part of a process of recovery from particular attachments. That is to say, it is a time when we are brought face to face with the fact that the things we have heretofore taken refuge in do not have the power to sustain us. The challenge at such a time is to discover the deep learning which is available in this crisis. Beyond the negative discovery that particular attachments lead to grief, there lies the positive possibility of discovering acceptance, peace and a love which is more nearly universal, one which provides "pleasure in everything". What I am suggesting here, therefore, is that, despite appearances to the contrary, depression is a sign that we have lost touch with the universal and become trapped in the particular. Not only that, but that it is often a sign that we are actually in the recovery phase from such an alienating move. And, even more, that the depressed state contains within it the ingredients necessary for the emergence of a genuine and solid maturity.

This idea, however, seems to present further difficulties. How can we possibly live and not be entrapped by particulars? Is our life not composed of a series of particulars? Do we not, in practice, go through each day dealing with one particular after another? And are not all the most significant things in our lives - our parents, our children, our spouse, our home, our work - all particulars? Does not "attachment to particulars" constitute "normality"? Is it not inevitable that we are going to be attached to things and so suffer?

In a simple way, all this is perfectly true and, in that same simple way, we may say that suffering is inevitable. The crucial point, however, would seem to be not whether we are in this moment dealing with this or that specific thing, as we must be, but whether we experience these specific things as part of the whole or whether we experience them as limited and particular. It is a question of where the horizons of our perception are fixed. If a person is in touch with the universal, they will experience the universal in every specific thing. If, on the other hand, they experience a fragmented world, there will be no life-line for them in their sorrow when adversity strikes.

The world is experienced as fragmented by the ego. The ego is our attempt to preserve ourselves as separate and important in our own right. Depression is a sign that our lives have become unduly tied to this attempt to be separate and independent, beyond what reality can sustain.

The therapeutic implications of this perception of depression as an opportunity rather than a failure are considerable. If we see depression as a departure from a more cheerful, "normal," optimistic state, we are likely to approach the task of therapy from the perspective of trying, one way or another, to "cheer the person up." This may, however, amount to no more than seducing the client out of their state of truth into our state of delusion. If depression is actually an opportunity and a necessary stage on an important personal journey, the therapist may actually be required to hear the truths which the person is revealing as simply so, rather than denying them by trying to get the client to achieve a "cognitive restructuring" more to our liking.

These truths may be such things as that nothing can be relied upon, that friends let you down, that loved ones die, that nothing one has achieved in life will endure, that one has wasted a great deal of one's life, that the things you did achieve turned out not to have been worth it and so on. The client is likely to relate much material of this kind. If the therapist's mentally classifies all this as "dysfunctional cognitive structures" and makes a response in the mode of "Yes, but...", an attempt to get the client to relinquish what they have discovered, I suggest that the therapeutic purpose will not be well served. For the therapist simply to accept that all these statements are true, not just for this client, but for all of us, is a better beginning.


POWER AND HATRED

In depression, the client is on the hook of unpalatable discoveries of this kind, on the point of disillusion. The whole process seems like a devastation of the ego, a demonstration of powerlessness, of lack of control of destiny. The universe does not answer to our will. The attempt to construct a secure ego may give us comfort for a time, and then the ship-wreck arrives.

Ego building is a matter of seeking security in a kind of separation. We take refuge in pleasures and circumstances, ignoring the fact that they do not last. By doing so we attach to particulars but we separate ourselves from the whole. We try to build a safe place for ourselves as if one twig could live independently of the tree. In doing so we set ourselves up for a collision with reality sooner or later.

In keeping with the dualistic theory, we may also say that ego building is the opposite of love, acceptance and surrender. The ego requires aggression. Hate is the separator, love the joiner.

Depression may seem like a loss of power. It is possible to consider, however, that it may be the opposite. Where there is a deficiency of love, there is likely to be a surfeit of the sense of power. This is not, however, an unmitigated blessing. The sense of having power can be oppressive to oneself because it brings responsibility or, at least, fear of consequences.

Judith is depressed. Her mood remains low most of the time. She is frightened to go out of her house. She does get to her sessions with her therapist and ventures to the corner shop, but anything more fills her with alarm. In one sense, she presents as a powerless person whose life does not amount to much and she will describe herself as powerless. As therapy progresses, however, it comes to light that she feels some responsibility for the death of her father who suffered a heart attack while at home alone. She wonders if she should not have been there with him when she might have been able to get an ambulance quicker and, quite likely, thereby save his life. Following this line of exploration a little further, it appears that more strong than her guilt, however, is her feeling of anger toward her step-mother who had walked out on the father just before the fatal incident. More than herself, she blames the step-mother. Then it is revealed that the father had had intentions of changing his will but died before doing so, with the result that the step-mother inherited all his wealth. Our client is now seen to have very strong pretexts for a desire for vengeance upon the step-mother who, in a sense, killed her father and cheated her of her inheritance. The therapist now has a picture of Judith, no longer as a passive, powerless person but as one consumed by a dangerous passion which must be kept under control, a task which can only be achieved with the utmost difficulty. It is not so much that Judith does not walk abroad for lack of power as for fear of what she may use her power to do. The murderous rage seethes within and must be kept imprisoned. Judith, as its carrier, must therefore imprison herself, both in order to protect the world from herself and to protect herself from the world's ultimate retribution were she ever to carry out her vengeful desire. In her self-imposed imprisonment she is powerless in one sense, but when we know more of the story this phenomenon presents itself in a different light.

It is obvious to all clinicians that there is a close association between depression and anger. Often the "treatment" of depression consists of providing opportunities for a person to give expression to the hate in safety. In psychodrama, for instance, it is possible for a protagonist to inflict the most gruesome or cruel retribution upon those who have abused them, without any harm being done "in the real world". Learning to face the murderous rages which we harbour within us can be an important step on the path to reintegrating our lives. If we cannot do this, we are liable to remain our own gaolers, keeping the monster within under lock and key by giving up all those arenas of life in which the beast might get loose.


SELF HARM

To keep ourselves imprisoned is a form of self-harm. Yet, who is not engaged in some degree of self-harm? Self harm can take many different forms: suicide attempts and self-mutilation at the extreme, but short of that most people are engaged in some forms of activity - smoking, alcohol, drugs, over-work, under-exercising, over eating, junk diet - which they know are not "healthy".

Generally, we are talking about infliction of some damage upon the body, but there is also a great deal of harm which can be inflicted upon the mind. Thus much of what we read and choose to watch in the media is hardly conducive to inner peace, security and self improvement.

Also, it is sometimes difficult to say where use stops and abuse begins. One way or another our lives are used up. We give our lives, our health, our energy, our time, in the service of something. There is, therefore, the question of motive. Are we to speak of self harm in the case of people who sacrifice themselves to save others?

When we begin to think in this way, we can also see depression either as self-harm or as a form of self-sacrifice. A person who becomes unproductive, who does not engage with others, who restricts their activity by fearing to leave the house and so on, is sacrificing life just as much as the person who mutilates themselves with a knife.

If, like Judith, a person sees no other way of controlling the wild and destructive passions within than to amputate a large part of their life, is this different in principle from other forms of self-sacrifice in the service of others?

What I am suggesting is that it does not really make sense to regard self harm, and depression with it, purely in terms of individual pathologies, as though there were a non-self-harming state which was common and normal. A genuinely non-self-harming life is rare. The reality seems to be rather that most people have some struggles to control the negative forces, the hate, which in certain circumstances takes root in them and this struggle manifests as actions which seem destructive. Furthermore, while the most saintly individual may be able to rise above some of the passions of the world, nobody is immune to their immediate impact. The people who become depressed are, in a very real sense, carrying the pain for the rest of us. We are all involved in the same pain and we may well consider that it is largely a matter of chance that at such and such a time it is a particular individual who is manifestly afflicted.


TIME AND LIMITATION

The essence of much of what I have said so far is that depression is a natural phase in a person's attempt to come to terms with the reality of transience and that it remains a painful condition so long as the battle with this existential reality continues. The black mood may be lifted temporarily by new attachments and distraction, but in essence these only buy time. real release only comes with capitulation. Maturity involves not so much a coming to terms with transience as its complete acceptance.

Let me quote from Jessie Taft: "Time represents more vividly than any other category the necessity of accepting limitation as well as the inability to do so, and symbolizes therefore the whole problem of living.... I remember... deep depression in adolescence over the realization of this flow of time. Why go to a party since tomorrow it will be over and done with? Why experience at all, since nothing can be held? On the other hand, there is equal fear of being permanently caught in any state or process. Fear of being bored.... As living beings we are geared to movement and growth, to achieving something new, leaving the outworn behind and going on to a next stage. Hence we do not like a goal that can never be reached nor yet a goal that is final, a goal beyond which we cannot go. In terms of this primary double fear of the static and the endlessly moving, the individual is always trying to maintain a balance and frequently fails" (Taft 1932).

In depression the experience of time tends to be one of endless unchangingness. The person may be preoccupied with the past and may have no particular vision of the future except the idea of "nothing ever being any different". This is a picture of futility. It is also a picture of time without limitation. The prototypical limit in life is death. Fighting against accepting the reality of death, we lose touch with the reality of all limits and so time becomes worthless and life with it.

The suicidal gesture of the depressed person is, perhaps, an attempt to reintroduce a limit, without which life is meaningless. The suicidal or self-harming action creates an event that the person cannot ignore. It punctuates empty time. Such gestures are most likely to occur just at the point when depression is beginning to lift. They are, in a sense, a way in which the person tries to get time to "hurry up" once again.

When a person is "full of life" they can turn their attention to the past or the future, but for the most part are engaged in activities which keep their attention fully in the present. Interestingly in this context, the dying person who has genuinely accepted that death is at hand, is also in this position. To such a person each moment may seem immensely meaningful even though they are not engaged in activity. It is not the activity as such which makes life meaningful, but the attitude to time to which it gives evidence. In this moment, I am alive. The acceptance of limited time may thus be a therapeutic influence in depression. Time which stretches out endlessly, like anything else which is in unlimited supply, is accorded no value. We only begin to value what is limited.

How is it possible to reconcile the fact that depression seems very commonly to follow a loss (change) with the fact that the experience of depression is one of unchangingness? I think here we have to consider the possibility that depression is an attempt to escape from change. The fact of change is one of the basic existential characteristics of being. Everything is in a process of change. The depressed person wants at least to slow this process up. If we consider depression as a form of healing rather than a form of disease, we can get a sense of how the person needs the time and space to convalesce. The shock of loss has constituted an over dose of change. Now the person needs to stagnate, to slow time down. Depression is a warding off of the impact of too much change.

We saw above how grief, and depression with it, is an end of a process which began with attachment, loss being, as it were, the mid-point of this process rather than the beginning of it. Attachment is, in a sense, a denial of temporality. When we attach ourselves psychologically to things we act toward them as if they were immortal. From this we see that it is not just depression, one link in the chain, which constitutes a denial of time and change, but that the whole chain of events in which depression occurs began as an attempt to ward of realization of temporality.

The therapy of depression thus needs to manage the issue of time very carefully. If the worker is available completely "on tap" this may be too much, reinforcing the idea of endless unbounded meaningless space. This kind of relationship lacks value. On the other hand, if the worker is not available enough, or if the contact is curtailed too early, the client may be retraumatized by the further experience of loss. Taft believed, and I agree, that the way that the time availability and limits are managed is a very significant part of the therapy process. It constitutes a real dialogue between worker and client: one in which the worker's needs and willingness are clearly displayed as well as those of the client.

It is possible to think of the path out of depression as one upon which time comes gradually to be valued once again. At the beginning, with the most depressed client, time may be valued very little by the client, and the client may seem to want unlimited amounts of worker attention. The client's insatiability in this respect may be felt by the therapist who may feel a variety of personal responses to it. Perhaps there is a desire to be unlimitedly available. Perhaps there is a resentment at such an invasive expectation. The worker has to carefully examine where their own ego is becoming ensnared. This will be a function of the extent to which the worker has themselves come to terms with the question of time and its limitations in their own life or failed to do so.

The therapy may involve a series of incidents in which the question of time, limits and availability come to a head and these may seem like make of break points in the therapeutic relationship. If all goes well the client will learn from these incidents both that the worker is careful of the client's needs and also that limitation is not disastrous. The discovery that the worker's non-availability at a particular time does not mean that the client has been rejected tout court can be a crucial step forward which can give rise to a renewed valuing of and trust in the therapy relationship.

Further, in the detail of the contact between worker and client, the client is likely to exhibit a strong tendency to deny the reality of any change. The worker, on the other hand, simply through the process of empathic reflection and phenomenological observation and description is constantly drawing attention to every little change in the client's demeanour and mood, attention and thought. The responses by the worker highlight each shift, be it ever so small, in the client's flow of experiencing. The more accurate, detailed and careful the empathy is, the more true this will be. The worker's genuineness and immediacy make these changes very difficult for the client to continue to deny. Furthermore, the therapist's apparent prizing of the client provides an atmosphere in which it becomes possible for the client to begin to think of each of these changes as no longer threatening to the whole stability of their precarious position, but rather part of an acceptable and supportive process.

We could rephrase this by saying that it is the worker's unconditional positive regard for the client which provides the continuity and stability which the client craves while the empathy reintroduces to the client the realization that flow and change are not necessarily devastating nor disastrous. Thus the worker provides the psychological conditions within which the client can reestablish a positive attitude toward temporality. Without the worker's presence, the client has to undertake their reorganization deep within their own shell. With the worker, it is possible for the process to, as it were, rise to the surface, because the worker provides a new protective shell and, temporarily, inhabits it with the client.


THE ARGUMENT IN ESSENCE

In this paper I have brought together some of the underlying theory of grief and loss with the dualistic theory of human nature previously developed in the Thanatos and Athanatos essay to suggest that depression is the product of a crisis in the development of our life instinct brought about by the confrontation with changeableness. The fact that all things are transient presents a significant difficulty for our impulse to love, since whatever particular thing we love will, in due course, pass away.

Our life thus tends to be structured as a series of experiments in loving and losing. When we initially invest our love in an object we close our minds to any knowledge of the object's inherent transient nature. Later, when loss ensues, we are forced to face the reality. We go through a painful travail of dejection and self reproach. It is at these times that we seek to construct a defensive wall around ourselves, the ego. Within this wall, however, the life energy restores itself and looks for ways to reach out once again. The cycle of love, loss, dejection, reorganization, renewed love, thus continues.

If we learned nothing from experience, this would be a circular pattern. However, generally there is a development toward maturity, which is to say, toward a wider perspective upon life. Our loving becomes less narrow. By stages it approaches the universal. As it does the term "spirituality" becomes more fitting than "sexuality". Spirituality is a form of loving which is universal, unconditional and non-possessive. It is a great love rather than a small love.

As we go round this cycle again and again we may pass through the depressive phase numerous times. However "highly developed" a person may be, they may still be afflicted by the "great grief" as they seek to go on. What is suggested here, therefore, is a reevaluation of depression. The common view of it as a disease, an abberation and a departure from a desirable normality is here replaced by a concept of depression as a necessary stage on the path of anyone who aspires to go beyond the "fool's paradise" of ordinary consumer oriented existence.

The role of the therapist is similarly reconstructed as being that of a companion upon a journey of great significance, a journey upon which the client may well be better travelled than the therapist, and one upon which there are crucially important existential realizations to be attained. If depression is a necessary stage in our higher evolution, the therapist must be alive to the possibilities it holds and not deceived by pathologizing concepts. Above all, the therapist needs the courage to venture with the client into the darkest parts of the journey, to hear the most frightening discoveries, to confront the most fearsome obstacles. Such courage can come from the therapist's own faith in or knowledge of the possibilities of this path of liberation. This work is also, therefore, like all therapy, a challenge to the workers themselves to face the facts of their own transience and to find the courage to work with reality rather than resort to comforting illusions.



REFERENCES:

Beck A. (1980) Cognitive Therapy of Depression. Chichester: Wiley.
Brazier D.J. (1994) Thanatos and Athanatos. Newcastle: Eigenwelt.
Brazier D.J. & Beech C.B. (1993) Unspeakable Losses. Newcastle: Eigenwelt.
Brown G.W. & Harris T. (1979) Social Origins of Depression: A study of psychiatric disorder in women. London: Tavistock*
Cain D. (1990) Reality, illusion and mental health. Person-Centered Review, 5, (3), pp.259-267
Merton T. (1976) The Ascent to Truth. Tunbridge Wells: Burns & Oates*
Pyszczynski T. & Greenberg J. (1987) The role of self-focused attention in the development, maintenance and exacerbation of depression. In K. Yardley & T. Honess, Self and Identity: Psychosocial perspectives (pp.307-322). Chichester: Wiley*
Rowe D. (1983) Depression: The way out of your prison. London: Routledge
Rowe D. (1989) The Construction of Life and Death: Discovering meaning in a world of uncertainty. London: Fontana*
Taft J. (1932) The Time Element in Therapy. Paper read at the American National Conference of Social Work, Philadelphia, May 1932.
Taylor S.E. (1989) Positive Illusions: Creative self-deception and the healthy mind. New York: Basic Books.






SUMMARY

1. Depression has a place in the natural order of things.
1.1 Depressive symptoms are various. We all have "low spirits" from time to time.
1.2 This paper relates depression to the task of coming to an acceptance of transience.
1.3 Depression is part of a cycle, a healing process rather than a disease.
1.4 Mythologies suggest a conflict between "earth" and "spirit," death and life, in our nature.
1.5 Labelling depression negatively with medical language does not help.
1.6 The therapy of depression is a journey through suffering toward maturity and compassion

2. The theory of loss and grief provides one understanding of depression
2.1 Loss of spirit ("libido") corresponds to loss of love objects.
2.2 Depression is one phase in the grief process.
2.3 Loss is a lesson in transience.
2.4 The chain of events in grief starts before loss. It starts at the point of attachment.

3. A second basis for understanding is Freud's dualistic theory.
3.1 Life is a dialectic between ego and libido.
3.2 Depression is sexual repression, the ascendancy of the death instinct.
3.3 The ego develops the super-ego, the higher development of libido is spirituality
3.4 Depression is a crisis in the development of the life instinct. The ego is a defense.
3.5 The work of depression is to find a more mature form of loving.
3.6 Self-focused attention and depression are positively correlated.
3.7 Depression may lift spontaneously when other-directed attention becomes compelling.

4. Maturity is the stability which comes with appreciation of wider perspectives.
4.1 Depression and grief flow from attachment to "particulars", i.e. narrowing of perception.
4.2 Attachment thus sows the seed for a later developmental crisis.
4.3 Depression is the opportunity to break through to wider perception of life (time).
4.4 Research suggests that depressed people are more realistic than "normal" people.
4.5 Disillusion is the key to insight.
4.6 The "dark night of the soul" is documented in all major spiritual traditions.
4.7 Depression can thus be a necessary step on the road to maturity.
4.8 A universal perspective imbues all particular perceptions with deeper significance.
4.9 Therapy involves acceptance of the truths to which the client has obtained access.

5. A separated ego cannot be sustained.
5.1 Hate, the opposite of love, separates a person from others.
5.2 Depression may be not so much a loss of power as a fear of the power one has.
5.3 Hate may need to be heard before it can be relinquished.

6. Almost everyone harms themselves, one way or another.
6.1 Self-harm includes the damage we inflict on our minds as well as our bodies.
6.2 The difference between self-harm and self-sacrifice is one of motive.
6.3 Depression may be regarded as self-harm or self-sacrifice.
6.4 The struggle to control destructive impulses is something experienced by everybody.

7. Consciousness of time presents a fundamental existential challenge.
7.1 We fear anything final. We also fear unbounded time.
7.2 Depression involves a sense of unchangingness, a denial of temporality.
7.3 Self-harming gestures may serve to punctuate empty time, to speed it up.
7.4 We only value what is limited. Time limits can therefore be therapeutic.
7.5 Attachment is a denial of temporality, a taking refuge in transient objects.
7.6 Negotiations over therapy time reveal the client's dilemma and the therapists maturity.
7.7 Workers need to be at ease with time limits and genuine in their offers of availability.
7.8 The therapy dialogue highlights the signs of temporality.

8. Depression is the struggle of our urge to love with our perception of changeableness.
8.1 Our life is a series of experiments in loving, losing and learning.
8.2 The ego is our defense against the pain of this process.
8.3 As we do learn we move toward a more mature, spiritual and universal love.
8.4 Depressive phases can occur at every level.
8.5 Depression is a recurring attempt reach the sublime.
8.6 The therapist can give courage and faith.

D.J. Brazier
1995

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