Shirah Vollmer MD

The Musings of Dr. Vollmer

Depression As Conflict

Posted by Dr. Vollmer on December 3, 2014

“Whatever diagnostic label one chooses in classifying mentally ill patients in whom depressive affect is prominent, the important thing is to understand clearly the nature and origins of ech patient’s compromise formation and underlying conflicts.” Charles Brenner MD

Depression should not be a diagnosis, but a point of inquiry into the nature of the patient’s mental interior. This statement does not relate to the issue as to whether the patient should be put on psychotropic medications. That is a different, unrelated, matter. We, as mental health providers, should not label patients as “depressed,” and nor should we encourage patients to label themselves in that fashion. Rather, we should encourage a curiosity as to what is stopping the patient from having more joy and/or satisfaction in one’s life. Freud defined mental health as the ability to love and work, and as such, issues inhibiting loving relationships and work satisfactions need to be explored, but not labeled. This has been my thesis for my previous posts and this will continue as I teach my class on mood disorders. It is radical, my students tell me, for a psychiatrist, such as myself, to want to ban depression from the DSM 5. This is the most common reason patients come to see us, but that does not mean that one size fits all. Like a headache, depression, is a symptom of an underlying problem, and like a headache, most of the time we are mystified as to what causes it, and most of the time, like a headache, it eventually goes away. I do not advocate the waiting and seeing approach to depression, but I am aware that no intervention, will, often, lead to improvement. At the same time, psychotherapeutic intervention, the journey of understanding, will also help with a depressed mood, and will likely prevent, or shorten depressed moods in the future.

Allison, from the show ‘The Affair’ comes to mind. She lost a child, we are told, not immediately but over time. She has an intensely emotional reaction when she sees a child customer in her restaurant almost choke. She runs to the bathrooms in tears. She has a complicated relationship with her husband and she has a wandering eye for other men. Sure, she is not my patient, but as a character in a drama she illustrates that for her, her low mood results in, what appears to others, as rapid mood swings, and abusive relationships. In drilling down, which the show does slowly, one becomes more understanding of why Allison makes the choices she does. Her obviously low mood is persistent, but she continues to function in her job as a waitress. She manifests her despair by trying desperately to reach out to others who might distract her from her pain. Allison appears depressed, which she may be, but she is also grieving and struggling to find inner peace. Then again, aren’t we all?

2 Responses to “Depression As Conflict”

  1. Shelly said

    I just love your empathy with people, and I don’t know if that comes from being a psychiatrist or just your nature. Shirah, your humanity is showing. Our life experiences may make us empathize with television characters, but I am sure that the producers/writers of the show didn’t have your insight when they wrote the story line. I do wonder, though, of something you wrote, “…most of the time, like a headache, it (depression) eventually goes away.” Do you mean that the depression goes away or the depressive mood (this time)? Because I thought that depression is a life-long disorder that someone has to battle, and it can wax and wane?

    • Depression can be a life-long disorder that waxes and wanes, but it can also be episodic where it heals itself with time, sometimes returning, sometimes not. As I draw the parallel to headaches, some suffer often, whereas for others it is a rare event.

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