“Depression as a feature of mental illness is the misery of childhood translated into the present….” Charles Brenner MD
As we enter into the Thanksgiving holiday and remind ourselves of what we are grateful for, I am also reminded that relieving human suffering is the goal of my work as a clinician, and my work as a teacher. As such, understanding suffering is critical to a meaningful intervention. Children who suffer in childhood are likely to suffer as adults because those are the limited tools they are given to cope with a challenging and uncertain world. This understanding has multiple layers. One obvious layer is that we, as a society, need to do what we can to make sure that childhoods are supported by a rich infrastructure of nuturance, through schools, community clubs and religious organizations. Second, those who did suffer greatly as children, who grow to adulthood, need intensive intervention and understanding to create a new, more optimistic schema of their world. Third, mental health practitioners need to understand the connection from past to present in order to help the depressed adult. One cannot just look at the here and now, without thinking about what this current suffering hearkens back to.
Robyn, fifty-five, male, comes to mind. He dreads the Thanksgiving Holiday and so this time of year he retreats into his apartment and does not go out much, except for work. “What was Thanksgiving like as a kid?” I ask, trying to tie past with present. “Oh, I hated it. My family would get together and they would be mean to each other. My mother would tell my father that he was lazy and did not do any of the work. My brother and sister would fight, leading my brother to make holes in the wall, as that is how he discharged his anger. My mother would then praise my brother for hitting the wall and not a person. The more I think about those days, the more sad I am about the family I grew up in,” Robyn says, with deep feelings which make me feel both sad and interested in his past. “Do you think those memories have carried forward such that you are re-living them every year around this time?” I ask, wondering if he sees the connection between past and present. “Actually, I did not think about that, but as you say it, it sounds so obvious,” Robyn says with obvious excitement over this understanding. “Maybe you can layer over those memories by creating happy times for yourself around the holidays. Maybe you need to make an extra effort to do that, as a way of pushing down further the memories of your Thanksgiving table.” I say, not encouraging repression of memories, but layering over them, consciously, with times which create very different associations to the holiday. “Maybe you need to ask your friends for an invitation, so you won’t be alone?” I say, encouraging him to reach out to those who care about him. “Yes, of course that is what I should do, but I need to think about it, as I am afraid I will be a downer.” “Maybe if you are around people you care about, your mood will lift and people will enjoy your company,” I say, pushing him to interact over this sensitive time of year. “Maybe,” Robyn says, with extreme hesitation.