Depression is the greatest health concern in the Western world today, after cardiac care. It has become a global epidemic, with political, economic, linguistic and cultural implications. The rapid rise in the diagnosis of Depression has further led to the ‘mental health deficit’ phenomenon – a ‘depressed’ economy caused by people who cannot go to work because of the way they feel. This is the modern symptom: ennui, disaffectedness, hopelessness. It seems that this word, this ‘depression’, has captured something of the spirit of our time.
Depression is frequently self-diagnosed: the patient arrives at the doctor’s surgery to say, ‘I’m depressed.‘ He or she may even self-prescribe, asking for a psychopharmacological solution to their misery. Increasingly, they are being offered a form of talking therapy as research has shown that what is needed is a relationship-based treatment.
Psychoanalysts have never accepted the term ‘depression’ as a sufficient diagnosis in itself. They do not run through a checklist of symptomatic behaviours: sleeplessness, withdrawal from social engagement, lethargy, etc.. Instead they ask the person to talk about how they feel, while listening for depression’s associative terms: ‘grief’, ‘stuck-ness’, ‘bereavement’, ‘guilt’, ‘anxiety’, ‘loss’.
Loss, in its many manifestations, is the core element of depression. Grief is a natural reaction to loss – of one’s partner, of one’s job, of some beloved part of oneself. In today’s consumer-driven society, however, this natural reaction has been progressively pathologised by the cultural intolerance of anything less than satisfaction. The modern myth demands a Hollywood ending, in which everyone lives ‘happily ever after’. The heroes and heroines of this modern myth are subjected to an unprecedented pressure to ‘have’ – jobs, cars, houses, children, money – rather than to ‘have not’. In the face of such a cultural imperative, Depression is one of the names for failure.
Freud, the father of psychoanalytic psychotherapy, understood the suffering of his depressed clients trying to cope with mourning and melancholy, with loneliness and heartbreak, with failure and impotence. He did not seek to fix them, he did not offer a set of ready-made solutions. Instead, he listened to their particular experience in a respectful, confidential space. He drew upon the elements of that unique narrative, to construct with them a new narrative, one that acknowledged the loss and facilitated a tolerable un-happiness.