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Depression

by Sheldon Litt, Ph.D.(more info)

listed in depression, originally published in issue 29 - June 1998

My dictionary defines depression as: "an emotional state of mind characterised by feelings of gloom and inadequacy, leading to withdrawal." This is the usual description of a pathological depression, and the practising psychologist sees a lot of patients with this symptom every week.

In a famous essay "On Mourning and Melancholia", Freud gave a good explanation for many types of depression. Life, as we all know, is ball of tragedies, and for most people, there is recovery after disaster. A loved one dies, there is a mourning period, and then after a while, life returns to normal. However, for some people, the mourning period never seems to come to an end – thus, a state of more or less permanent melancholia, or depression. Now sometimes this may be because there was no adequate mourning period; a person who doesn't really allow himself to go through mourning, who never completes this healthy though painful cleansing, will then tend to carry the mourning with him until it develops into long term depression. So, often the solution for a patient is to help him go deeper into mourning for a short time, to fully complete the mourning process, so that there is no long after-effect of depression.

For the gestalt therapist, this means helping the person stay close to his immediate experience, so that he is able to recognise his feelings in the Here and Now. Often what happens is that, to avoid painful feelings, the person blocks off such necessary suffering, and thus develops a chronic, longterm symptom. Often a depression of this type becomes self-perpetuating, especially if there is support from the environment. That is, other people feel sorry. for him and take care of him, so that the role of "the depressed" may become harder and harder to shake off.

Now, many people don't even want to come close to experiencing their bad feelings, so they choose to avoid them as long as possible.

And so the depression clings on. A visit to a psychiatrist will produce some pills which may have some effect. Psychopharmalogical treatment is quite common in Sweden and in the USA, where prozac is a best-seller. The problem is people react with individual differences to such medication. And there may be detrimental side-effects: physical complaints, zombie-like feelings, diminished sexual appetite, etc. Some people do achieve the desired result with prescription medicine, and for them, the depression is under control.

But most of us think that it is better to try some psychological treatment first. If this fails, then one can always try a pill. A combination of psychological and medical treatment is, of course, another possibility.

In Germany, instead of taking prozac or any of the other new pharmaceutical wonder-drugs, it is more likely that St. John's wort will be used. The advantage of this, of course, is that there are no side-effects, and many claim results that are equal to if not better than prozac. Again, there are always individual differences, and psychotherapy can also be a valuable adjunct here.

There is also a great deal of discussion now, especially in northern areas, such as Sweden, about many cases of depression being caused by the winter darkness (there are not many hours of sunlight in Sweden in the winter). Some hospitals here even have special "light treatment rooms", where patients come and sit for 3 – 4 hours per day in a room bathed in light. I have seen such a treatment room myself at the Karolinska Psychiatric Centre in Stockholm. It seems to work for some people, but I have always been sceptical of this approach. To me, it has always seemed that the weather or the amount of sunlight is merely a backdrop to life, and what is the difference if it is sunshine or rain outside if you are in bed with someone you love passionately. But perhaps the lack of sunlight affects some people differently.

In a book of English poetry I find support for my view:

"If the heart of man is depressed with cares,
The mist is dispelled when a woman appears."
- John Gay (1668-1732)

For those of my readers who like case studies, I offer the followings `two illustrative examples. The first was a young man who complained of intermittent depressions. After a few weeks of exploring the times and ways of his depressed outbreaks, it began to occur to him that there was a definite pattern to his depression – how they started and how they ended. He had had several relationships with young women, and he realised that his depression was a way of ending these liaisons. He was much too kind and nice to discuss such things directly with his partner, nor would he be "the bad guy" and leave them. What he did each time was to go into a depression. After a while, his put-upon partner couldn't take it any more and would leave him. Soon after, he would pull himself together, recover his energy, rise from bed, and begin life again. However, his last girlfriend was more stubborn. When the relationship was over, he became depressed as usual, but instead of leaving him, she hovered over him and tried to nurse him back to health.

Thereupon he became more and more depressed. The harder she tried to help, the further down he sank into moribund helplessness, staying in bed for weeks. Finally he was hospitalised in deep depression. This did not help either, because his faithful girlfriend visited him as often as possible to "try to cheer him up". He became only more and more depressed, until they placed him in a mental hospital. The persistent girl continued her visits, until at last the patient was placed in a closed, locked ward with no visitors. Freed from contact with her, he was able to feel better, left the hospital and moved to a new flat where she could not locate him.

This is a dear case of depression being used as aggression against another person. Not an unusual syndrome, I must add. Similarly, the next case again shows depression as a mask for getting out of a difficult situation.

A woman in her 40s married to a travelling salesman had frequent attacks of depression, which we learned after some "mapping" of the frequency, occurred in conjunction with her very irregular menstrual cycles. She had been to several doctors, gynaecologists and endocrinologists but they failed to discover any physical reason for her irregularity. I asked her to keep two calendars, one showing the days her husband was at home, and the other marking the days when she had had her period and was depressed. You can easily guess the result – when her husband was away, there was no menstruation or depression, but when he came home and she was forced to confront her (negative) feelings for him, then she began to menstruate and feel depressed.

Of course, not all cases have such dear and simple outlines, but these are illustrative and memorable.

In some cases, depression may result from holding back aggression. Instead of showing aggressive feelings towards others, the person holds them back, turns them against the self and becomes more and more depressed. In extreme cases, this may lead to suicide: "I'll show them," he says, as he is about to pull the trigger with himself as target.

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About Sheldon Litt, Ph.D.

Dr Sheldon Litt is an American psychologist who trains professionals in modern methods of psychotherapy. He has taught at many universities in northern Europe. He was trained by Fritz Perls at the New York Institute for Gestalt Therapy.S. Litt, Inedalsgatan 25, S-11233 Stockholm, Sweden. Tel: +468 651 2489 Email: sheldonlitt@hotmail.com.

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