Shirah Vollmer MD

The Musings of Dr. Vollmer

Depression as a Whole in the “Self”

Posted by Dr. Vollmer on December 11, 2013

I struggle with this concept of depression, as I struggle to define it, to treat it, and to clump it into a category, as it means such different things to different people. As per my last post, there is no certainty in “knowing”. A disease versus a symptom, a subject of a previous post, puts me in the symptom camp, where depression is a state of mind, indicating deeper issues and conflicts. As a symptom, it is a window into a deficiency of one’s identity and hope for oneself.

Gaby, fifty-one, jumps to mind. Her daughter, Sari did not get into her first choice law school, throwing Gaby into a mental state of despair. Gaby was angry at her estimation of injustice, and she was sad that Sari had to cope with disappointment, given how hard Sari has worked her entire life. “Yes, but this rejection has gotten to you in such a deep way. I would like to understand that better,” I say, hoping to clarify why this rejection letter has sent Gaby into a very dark place. “Sari deserves better,” she insists, with a tone of bitterness, making me wonder if Gaby had disappointments in her life, which this letter has now triggered. “When I was her age, I did not get the job I wanted, even though I deserved it, and I do not think I have gotten past that,”

Gaby spontaneously reads my mind, as she brings up her previous disappointments. “So Sari’s news is bringing up a very sensitive, and raw part of your past,” I say, thinking, once again, how the past lives in the present. “The fact that you did not get the job promotion seems to have been your symbol of unfairness, and it seems like you have focused on that event as the pivotal experience which caused you to be less successful than you imagined you would be and now you project that experience on to Sari’s future.” I say, outlining how Gaby has organized her life around not getting this promotion, such that experiences which smell of unfairness, brings her back to this bitter and angry place. “Yes, I know Sari will have her own experience and I also know that getting passed over for a promotion did not define my entire professional life, but it did feel to me, at the time, that I was very limited in my career and I felt painfully stuck and angry.” Gaby says, with frankness, and understandable frustration. “I could not move for a better job because I had a family. My kids were in school and my husband liked his job.” She says, anticipating my question that she could have searched for a new job by casting a wider net. “Accepting that limitation has been very hard for you, ” I say, thinking about her necessary journey of acceptance and self-love. “Yes, indeed. I guess I am not over it,” she says, as she looks at me with a sense of knowing that she has work to do.

6 Responses to “Depression as a Whole in the “Self””

  1. Jon said

    Wow. All I can think of when I read the story of Gaby is what a wonderfully cushy world she lives in. Actually my first thought was, “Welcome to the Real World, Gaby.” Then I considered that if her major disappointments in life are a) not having gotten the job or promotion she wanted long ago, and b) her daughter not getting her FIRST choice law school (I assume there is an acceptance at a lesser choice), her life is much better off than most of us on this planet.

    All this leads back to the discussion of depression as a disease verses a symptom. Clearly, something is wrong with Gaby’s internal mental state – she is depressed. I would also say, with you, that this is a symptom of her world view, not a disease in itself. The task then becomes allowing Gaby to alter her world view in a productive and self affirming manner. Much easier said than done.

    • One of my goals in these posts is to emphasize that content is secondary to feeling, and so Gaby’s free-fall after her daughter did not get into her first choice law school, is to some a “good problem” but to others, in this case Gaby, a substrate on which she can re-experience previous difficulties in her life.So much of life is how we view it, and so the circumstances are woven into our mental state which determines our world view. For example, a person can go to the store, excited to buy heirloom tomatoes, only to discover that the market sold out of them, and this disappointment to some, might be irrelevant, whereas to others, this might set off numerous feelings of being “let down”. The tomatoes are not important, but the feelings triggered by the tomatoes are important, So, with Gaby, her daughter’s disappointment at face value is trivial, but her subjectivity around that is not trivial. Yes, her mental state is both a symptom of deeper issues, and historically relevant, in that we now have a window into how she experienced her previous upsets. Listening with curiosity allows the listener to think about meaning, or as Freud would say, the latent content versus the manifest content. The multiple layers of meaning is what makes listening so complicated, so time-consuming, and so interesting. If we do not think in layers, we miss the literary aspect of the human mind. This, as you know, is my fear in our climate of needing metrics to determine utility. Thanks.

      • Eleanor said

        Oh Shirah, I’ve been busy lately so honestly the only thing I took time to read here is your reply. Totally brilliant and so moving and insightful. Over the years I’ve seen issues like this happen…just seemingly inconsequential things happen and result in major or at the very least significant reactions…sometimes bordering on near devastation. If only folks could realize the layered meanings in things and be willing to “think about” issues more deeply. I know….most people would rather not, but knowledge and understanding and insight can lead to healing and ultimately better ways to handle lives vicissitudes for all of us. It is so much about “feelings”. Thank you for your brilliant explanatory response.

  2. Shelly said

    Whoa, Shirah, on so many levels, this post makes alot of sense to me. I get it, I really do! But then I get confused when I think of depression, the disease, as opposed to “feeling low.” What you describe here is not clinical depression. I think we use the term “depression” far too loosely and we need to define it better. Similarly, we describe someone as behaving “manic” as someone with alot of energy, but again, we are not describing someone in the clinical sense. Can we go back to using the word depressed for depressed people and low mood for people who are feeling a little bit low?

    • Yes, we need to have a more meticulous language to convey a clinical picture. Depression is just too vague. My preference would be to stay away from one word explanations, and push for a narrative which puts the mood in context, thereby conveying the severity and longevity of the experience. Of course, medicine is moving away from narratives, and hence this is a minority point of view, but one that keeps my blog going and going. Thanks.

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