Depression
Depression’ is an broad term for a symptomatic picture that ranges from feeling of being ‘down’ and a general loss of motivation to so-called endogenous depression with its characteristic total apathy.
Alongside a total block on all activity and the depressed mood itself, we also tend to encounter in depression a whole range of accompanying physical symptoms, foremost among which are tiredness, sleep-disorders, loss of appetite, constipation, headaches, heart-palpitations, lumbago, disturbed periods in women and loss of body-tone.
Depressives are plagued with strong feelings of guilt and self-reproach, and constantly worry about making restitution. The word ‘depression’ derives from the Latin verb deprimo , which means ‘to press down’ or ‘to press under.
This immediately raises the question of what it is that depressives feel that they are being pressed down by, or indeed what they themselves are suppressing. By way of an answer, we find ourselves confronted with three subject areas:
1.Aggression
We said earlier that aggression which finds no outlet transforms itself into bodily pain. This observation needs to be extended to include the fact that aggression that is suppression of the psychological level leads to depression.
Aggression whose expression is blocked gets turned inwards to the point where the transmitter becomes the receiver. The repressed aggression is responsible not only for the guilt-feelings, but also for the numerous accompanying symptoms, with their various types of pain.
We have already pointed out elsewhere that aggression is merely a particular form of life-energy and activity.
Thus, those of us who anxiously repress their aggressive impulses simultaneously repress all their energy and activity too.
Eager though psychiatry is to involve depressives in some kind of activity again, the latter merely find this threatening. They compulsively. avoid anything that fails to meet with general approval, and attempt to hush up their aggressive, destructive urges by living a life that is beyond reproach.
Self-directed aggression finds its clearest expression in suicide. Suicidal tendencies should always prompt us to look into just who the murderous intentions are really aimed at.
2.Responsibility
Suicide apart, depression is the ultimate way of avoiding taking responsibility: Depressives no longer act, but simply vegetate, more dead than alive.
Yet despite their constant refusal to get to active grips with life, depressives merely go on to find them- selves confronted with the theme of responsibility via the back door of their own guilt-feelings.
This fear of taking responsibility is well to the fore in those depressions that strike at the moment when patients are faced with embarking on some new phase of life, as is exemplified particularly clearly in the case of puerperal depression.
3.Withdrawal – loneliness-old age – death
These closely related topics serve to sum up the final and (to our way of thinking) most important of our three subject areas. Depression has the effect of forcing patients to come to terms with life’s mortal pole.
Depressives are deprived of all that is truly alive, such as movement, change, companionship and communication, and in their place life’s opposite pole manifests itself: apathy, rigidity, loneliness, thoughts of death.
Indeed, this death-aspect of life which makes itself so vividly felt in depression is nothing more or less than the patient’s own shadow.
The conflict then, lies in the fact that the depressed person is just as afraid of living as of dying.
Active living inevitably brings with it guilt and responsibility – and it is these that the depressive is above all determined to avoid.
Accepting responsibility also means abandoning all projections and accepting one’s own all-one-ness. Depressive personalities, however, are a maid to do this, and therefore need other people to hang on to.
Separation from such intimates can, like their death, quite often be the external trigger for depression.
Those concerned, after all, are now left on their own and living alone and taking responsibility are just what they least want to do. Being afraid of death, they fail to grasp life’s conditionalities either. Depression makes us honest: it brings to light our incapacity both for living and for dying