Posted by Dr. Vollmer on November 12, 2015
Fall is here and I return to teaching psychoanalytic candidates about mood disorders. As per my style I open the class as a confession. “I do not understand depression,” I say, “after 25 years of practice, psychoanalytic training, psychiatry training, and life experience, I remain clueless as to what that word means.” The dye is cast. The students perceive my style immediately, mostly positively, with a visible sign of relief associated with validation. The discussion ensues. Nature vs. nurture. The role of trauma versus the role of mental constructs associated with the trauma. Does a person “make himself depressed” or is a victim of “depression.” Psychoanalysis, the study of the unconscious, argues that negativistic thinking is related to unconscious conflict, and when this becomes conscious, the person can resolve the conflict and take charge of their mental state. The is counter to the argument that depression comes on like a kidney stone attack, with mysterious forces, resulting in agony. The issue of agency, as to whether the person controls is mental state is key to the conception of depression, as on the one hand, this is the “blame the patient” approach, but on the other hand, if the patient is responsible for his mood, then he can fix it. The helplessness associated with depressed feelings could be a defense against dealing with even more difficult or agonizing issues, such that when the patient understands that although he feels helpless, he is not helpless, he can begin to consider how helplessness aids him in his avoidance of deeper conflicting feelings. Ada, thirty-seven, comes to mind. She has continual thoughts of wishing she were dead and she feels this is “just part of my life, I have always felt that way.” “That sounds how your mom feels as well,” I say, highlighting that those feelings may reflect a very strong identification with her mother’s state of mind. “You mean other people do not feel that way?” Ada says with genuine wonder. “It is interesting that you do not see wishing you were dead as a problem of your mental state,” I say, helping her to see that passive suicidal ideation is a sign of mental distress. Understanding how people think and feel about their lives is the key to understanding how they frame their world, and in so doing, how they have moods which change with both external and internal circumstances. At the end of the class I suspect that my students and I will share our confusion together, and in true psychoanalytic style, we will feel richer for it. Like studying philosophy, the more we learn the more confused we get. It is a fun class.