I've blogged previously about the advantages of treating suicide as a form of homicide, in which the killer and the victim occupy the same body. Now I want to extend the metaphor to the conceptualization of depression. Although I believe that every depression is unique, because every depiction of the defective self and every depiction of the oppressive self is unique, I also think that a general consideration of a defective self and an oppressive self can clarify what’s going on.
I hope to especially shed some light on the way the form of depression affects the interpretation of other people’s reactions in a way that maintains the depression.
Let’s consider four broad categories of depression, somewhat following Edith Jacobson’s approach. In each case, the self is despised for one reason or another that varies from person to person and usually or always smacks of hidden perfectionism. For example, you might hate yourself for not being smart, attractive, free, charitable, or special enough. The current categories have to do with the experienced locus of the conflict between the hating self and the hated self.
In neurotic depression, the conflict is experienced as internal. You look in the mirror and think you're a slob, fat or pimply or balding. You say something incorrect in class and think how stupid you are. You move through life as if you are a short-tempered nanny with an ugly or annoying baby. Your depressive lens for interpreting the reactions of other people makes you want them to agree with you that the baby is an intolerable burden.
When others treat you well, you resent it, like a nanny watching the usually inconsolable baby cooing in someone else’s arms. If a therapist suggests you treat yourself better, it enrages you, because it implies that this is your fault and not a natural reaction to the little brat you happen to be saddled with. You want the therapist to give the baby a sedative.
In pointlessness, the conflict is not experienced at all. The world seems bleak and hopeless at best, a cesspool at worst. Old reinforcers are ineffective and no new ones take their place. The oppressive self has abandoned the real self, much as the economy has abandoned the slum or the aristocracy has abandoned the poor. The oppressive self is glimpsed only in occasional fantasies of nobility or triumph, especially in fantasies of the nobility of suffering.
Just as slum life cannot be understood without considering the economic abandonment by the larger culture, pointless depression cannot be understood without considering the oppressive, glorified self that is carrying on outside of awareness.
An important childhood memory of mine was watching a homeless man digging through a garbage can looking for food in a New York winter while I was eating a hot dog in a restaurant. I pointed out to my mom that the restaurant provided free sauerkraut and pickles and so on. My mom said the homeless man was living in a different world from us, and the free condiments didn’t exist in his world. I asked my mom if that was why he was in New York.
It seemed to me that the homeless people in the South were generally more comfortable in the winter. Pointless depressives react to others as poor people do to advice. If a therapist suggests you confront the glorified self, you look the way poor Washingtonians would if someone told them to go talk to the President. If a therapist suggests exertion, you act like you’re being blamed for your predicament. If a therapist expresses curiosity, you resent it the way poor people resent anthropologists. You want uppers for excitement, or opioids for relief, not ideas.
In narcissism, the conflict is also not experienced, but here, it’s the despised self that is out of awareness. Life is like a Hollywood party ignoring the homeless people watching the red carpet. Hollywood parties, I assume, are crucibles of face-losing disappointments, where you feel like crap because you haven’t won an Oscar recently or because you only made $10 million in your last film, but the distraction from the homelessness is well worth the blows to self-esteem.
When others point out the emptiness of your life, you resent it the way the rich do when told that they could not have made their money except on the backs of the poor. You avoid any conversation about the less fortunate aspects of yourself, personifying the glorified self to the extent you can get away with it.
In despair, the conflict is externalized. You feel rotten and you are aware that others despise you. At the extreme, you hear voices telling you that you are worthless, but short of that, you are constantly fighting the unfair expectations of others. You attack their yardsticks and demand special consideration.
You are miserable and you know it’s someone’s fault, but you have no idea that it’s you who oppresses you. Therapists are enraging because they talk about conflict resolution when you think what’s needed is a revolution. When therapists tell you to modulate the anger that is wrecking your life, you hear an aristocrat telling the poor to be patient.
My overarching point here is to emphasize how the psychology of the problem—in this case, depression—is also typically the psychology of reacting to solutions. Self-blamers insist on total acceptance and experience any effort to change them as a kind of blame. People who find relief in being told that depression is not their fault, that it’s a disease or a function of chemistry, experience any effort to help them change as an unrealistic expectation.
Narcissists experience empathy with the real self as an affront to their glory, and people adrift in pointlessness find any breath of hope to be unbearable (like Midwesterners who learn to hate the weather by visiting better climates). Kierkegaard said that one solution to the existential dilemma of integrating an infinite mind with a finite body is to deny the body, a solution he called schizophrenia (when the word meant something else); he called the solution of denying infinitude depression.
It is characteristic of all forms of depression to be too much a physical creature and not enough of a spiritual, emotional, or psychological one, so physical framings of the problem are preferred, and chemistry is a more appealing source of treatment for many depressives than psychology. But chemical solutions maintain the depressive frame, whereas philosophical solutions challenge it.