World Mental Health Day

It’s World Mental Health day next week, Feb the 20th. Here’s a short animated film on depression, which I found very warm and touching. The more we tackle the stigma of mental health problems, the easier life would be for all of us.

And here’s some of my writing on depression from an old paper – Mr Freud again, must be the winter!?

In the first paragraph of his paper on depression (1), Freud expresses his doubts about grouping aspects of depression in a unity, pointing also out that his observations ‘suggest somatic rather than psychogenic affections’ (p. 243). He starts his formulations by putting forward that both depression and mourning involve a gloomy mood with similar symptoms, however what is lost when one mourns appears clearer, as Freud argues: ‘mourning is regularly the reaction to a loss of a loved person, or to a loss of some abstraction…such as one’s country, liberty, an ideal, and so on’ (p. 243). While both involve a dejected mood with a loss of interest in living and loving and an inhibition of activity, what seem to distinguish melancholia from mourning according to Freud (1917), is one’s ‘disturbance of self-regard’ with senses of loss of self-value and respect which expresses itself in shameless self-rejection and self-hostility.

Following the above, and reading through Freud’s paper what has become evident are the overall elusive and complex processes involved in depression, especially in comparison to the process of mourning in which what feels lost is more in the light of consciousness. Freud seem to be open to the confusion and vagueness involved in depression, as he expresses his uncertainty whether melancholia was a single and well-defined entity. It is interesting that his uncertainty over what depression might be, corresponds in a way to the confusing, uncertain and vague thoughts and feelings of authors who have experienced depression themselves (Klein, 1935; Solomon, 2001; Wolpert, 1999).

Freud elaborates on psychogenic aspects of depression with openings to internal object relationships. His suggestions appear in line with contemporary theories, such as ‘endogenous depression’ (in McKenzie, 2000) which imply a depressive individual core. From an interpersonal viewpoint, McCranie (1971: 313-4) argues that melancholia may ‘arise from a depressive core to his [the patient’s] personality, but at the same time, the confusing response from the environment serves to validate these feelings’. Loss of such validation would mean potentially depressive loses of one’s ego or self as well as loss of the social “games” one is part of. (Szasz, 1961). In light of this, Becker suggests that ‘objects and games are inseparably joined’ with self and society constituting a single phenomenon. ‘People “create” objects by acting according to social rules… [t]hey “create” themselves as they create objects.’ (Becker, 1985: 369).

Depressed patients appeared to Freud realistic in what they described as lack of interest and incapacity to love and achieve; he writes that they ‘must surely be right in some way…’ (p. 246). Furthermore, he found it interesting that patients seemed in tune with reality in describing themselves as petty, egoistic, dishonest and deceitful towards self and other. Freud suggests that they appeared honest in acknowledging their dishonesty, having a ‘keener eye for the truth’. He also points out that the emphasis should not be whether the depressive expressions should agree with opinions of others, stating his concerns when scientists contradict self-accusing patients. Such attitudes are still predominant in cognitive/behavioural and medical paradigms of depression treatment, opposed to other therapeutic and analytical approaches that would attempt to understand depressive self-reproaches rather than treat them. Freud touches upon contemporary issues; what might be the impact of rejection and contradiction of one’s melancholic reality, by experts or others in general?
(1) Mourning and Melancholia