Shirah Vollmer MD

The Musings of Dr. Vollmer

Can Depression Be Taught?

Posted by Dr. Vollmer on December 10, 2015

Depression Class: check! I just had a wonderful and stimulating time teaching depression at the psychoanalytic institute and yet I am left feeling that this is a class which should not be taught. The word is simply meaningless. Psychic pain is my replacement. Pain is a symptom. Depression is a diagnosis. We need to be clear about the distinction. Symptoms trigger deep inquiry into the origin, the pathophysiology and the underlying issue. A diagnosis closes the discussion, as if there is nothing more to be said. “He is depressed,” the physician says, as if the next step is clear, when in fact, so much more needs to be done to investigate what that means. So, maybe I do need to teach this class to convey this point of view, spread the word, as they say. Yet, I am left feeling part of the problem and not part of the solution. I will lobby to rename this class “Psychic Pain” because this gets at the issue of how people suffer, and as with all of psychiatry, there are more differences than similarities between patients, making this the most interesting field in medicine from my point of view. Pattern recognition, the job of a good internist, to determine how symptoms present the clue to disease processes, gets old and routine, whereas the individuality of psychiatry, the unique stories of the patient, create an atmosphere of intense curiosity and openness to new perspectives. Looking at suffering as the end-product of years of life experience helps the patient understand how the past influences the present. It is not that the patient is “depressed,” but rather that the patient has hit a time in his life, both because of current and historical issues, along with their biology, making the patient lose the joy, the happiness, the fulfillment, in his life. There are contributing factors, but never a “good explanation” for why the patient is suffering. The quest of understanding is infinite and hence digging into suffering is a deep and moving experience. “Thank you for making me think about something I did not want to think about,” my patient expressed today, causing me to laugh and feel her gratitude, at the same time. That is what I want to teach. The way in which suffering has a language, which, when shared, creates an intimacy, a healing feeling, which cannot be quantified or predicted, and yet, is very meaningful when it happens. Psychic pain, that is what I am going to propose. That sounds right.

11 Responses to “Can Depression Be Taught?”

  1. Jon said

    I can understand how “Depression” is a possible diagnosis of “Psychic Pain;” however, I could see many other possible diagnosis of the system of “Psychic Pain.” I do not know if you care to open up the possible “design space” of your class to discuss other diagnoses. You may, or you may not. That said, I still think this is a good way of addressing the problem, going from symptom to diagnosis. What might be some other diagnoses of “Psychic Pain?”

    If I remember correctly, you once said that depression was caused by ungratified desire. Is this the case? Are there other ways that one might become depressed?

    • Thanks for your comments Jon. I feel like I live in confusion land when the word depression lands in a conversation. Depression, says who, is my first question. The patient, the doctor, the family member? Who gets to decide? I know I am not addressing your question, but my tangential response points to my lack of clarity on this word and the surrounding meanings. Thanks again.

  2. mimi said

    beautifully said Shirah!

  3. Shelly said

    Does your ‘definition’ of depression resound with your colleagues as well? Do they also have trouble defining it? What you write and believe surely sounds right to me but I want to know if it is a collective view as well.

    • Hi Shel,
      It is very hard to know if it is a collective view. One way of seeing people in my field is that there are the lumpers and the splitters and the splitters agree with me. I am not aware of any consensus, only people who want to speak their minds about these issues. Thanks.

  4. Ashana M said

    I always disagree with you about this. I think that depression is very specific. It is not a generalized psychic pain. It is distinct and different from other kinds of psychic pain. It comes from an instinctive perception that this cannot be done–whatever “this” is. The “digging” ought to be in the direction of what it is that cannot be done, is it really that it cannot be done? It’s difficult in Western culture, because it is a “doing” culture. It does not allow for impossibility. Everything is supposed to be possible, and so there is this additional problem that depression creates isolation. Frequently, no one else will acknowledge that it cannot be done. So there is this secondary problem of a lack of social support and connection, because one is alone with the experience of futility.

    • I do not think that it is inevitable in Western culture that the person is alone in the feeling of futility. However, I do think that the nature of this futile feeling is unique and needs to explored, and hence cannot be clumped into one pot. You are right that I talk about this a lot, and with the completion of this class, the topic has regained importance to me. Thanks.

      • Ashana M said

        I am not saying it is inevitable, just that it happens. So then there are often two problems: the perception of futility and an aloneness with that perception. And aloneness causes other problems.

  5. Laura said

    I guess I would be considered a splitter. It is hard to define a construct of depression that would fit along the lifespan, for both sexes etc. Currently my niece is “depressed” and in an inpt adolescent unit. As a clinician myself I have never seen her majorly depressed but dysthymic, moody,oppositional yes. It is her experience of depression that got her admitted. I think it is as much a learned behavior as even as a young child when she did not get her way she would become sullen and hide. Her parents would cajole, bribe to bring her out of her shell. Her dad now has full custody as mom due to addiction is little involved. I know she has issues and probably feels emotionally neglected. She can be very bright,sweet, funny but she has yet to develop core strength. i think the materialistic culture we live in, adds to deficient self esteem as kids feel you need the newest phone or what have you to be cool. Kids use to have more parental time,church time, scout time, neighborhood time where there was so much more involvement and connections to others. Now they tend to isolate, and keep in those dark thoughts with fewer instances to express, share them. I don’t think its healthy. Now she is going on week two at the inpt unit. Her therapist has not been there most days, my brother only met with him once, it is more of a holding tank then any really therapy being done. They also had her on 60mg Prozac which I think is high for 13 yo., not like she is adult with severe OCD or resistant depression. i pray this all works out well for her.

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