refuse to let them contaminate other aspects of their life, the ones they so enjoy when well. The restless (and depressing!) search for a total “cure” is exchanged for a degree of grudging acceptance. With the help of wise counsel from someone who truly understands their private hell, they can develop ways of existing with, rather than raging against or totally surrendering to, this unwelcome visitor.
A one-off incident in a non-regular sufferer can sometimes be cleared up for good, once the antecedents are traced and come to terms with. Many episodes function like anaesthetic, numbing painful memories or traumas from the past that are threatening to re-emerge into consciousness. Often a marriage, a death, becoming a parent, divorcing, losing a job, triggers the mobilisation of long buried but unresolved historical issues. This delicate and deep work takes a professional skill that goes further than empathy and support. I will share true but anonymised stories about such therapeutic intervention in later chapters.
Counsellors and psychotherapists regard little ‘d’s and big ‘D’s as disordered mood states of the whole organism, not just some sequestered mental abnormality. Mind and body is one interrelated system. If you dissect a human corpse you’ll not find the mind anywhere. It’s an artifice, a construct that we deploy for the purposes of communicating with each other about our interior experiences. The body would be no more than a sophisticated robot without a mind, and the mind can’t come to life without the incorporated brain and its essential chemical, hormonal and electrical supplies. It’s for linguistic convenience only that we talk about the “mind” affecting the “body” and the “body” affecting the “mind”, for they are one and the same. We describe how these notionally separate units speak for one another, but really the whole organism is speaking for itself. The “mind” registers embarrassment, the physical face blushes. The student’s “mind” is saturated with anxiety as the exam paper is opened, but simultaneously their pulse races, their armpits stream with sweat, their heart thumps. The “physical” pain after the same surgical operation is experienced differently by different patients – requires more or less morphine – depending on their “mental” attitude to pain.
Whilst exploring quite other emotional or relationship matters with a client, the therapist is always on the look-out for signs that their client may be slowing down. Where there is persistent low mood, blood flow is sluggish, the skin pale; muscles don’t want to flex, there’s listlessness; digestion seems to stop and there are grumbles about constipation. The client reports that recently just lifting a kettle to make tea feels like carrying a boulder. Walking through the kitchen is wading through treacle. Lassitude makes the person crave their duvet, or alternatively dread and anxiety accompany all attempts at sleep. Recounting these changes as if they were oddities of little consequence, and preoccupied with other relationship worries, the client often fails to realise they are becoming Depressed. It falls to the therapist to remedy the situation.
Internal conflict in the Depressions
Internal conflict (opposing wishes and desires that are irreconcilable), both conscious and unconscious, is commonly associated with little ‘d’, and sometimes triggers a major Depressive episode in someone vulnerable to these. However conflict is not an absolute requirement for the diagnosis. As mentioned above, the loss of hope may come about through purely social causes, or multiple bereavements too overwhelming to absorb, or terminal illness that can’t be come to terms with. Some people are constitutionally susceptible to low mood, so that even small setbacks in their lives evaporate what little hope they normally entertain. The elements that make up a person’s constitution and how these might contribute toward the Depressions will be discussed in chapter two. Still, internal conflict demanding the anaesthesia of Depression is so frequent that it necessitates illustration.
Philip’s conflicts, conscious and hidden
Philip, fifty-six, unmarried, had always had a poor relationship with his Self. When he looked in the mirror he’d always seen a weedy sort of specimen, uninteresting, just about able to manage his lowly admin job and the house he shared with his widowed mother. A year ago she’d been diagnosed with Alzheimer’s and was going downhill quite quickly. There were no other surviving family members so his life appeared mapped out for the foreseeable future.
Then he met a lady chef in the canteen at work. She was also single, living alone in a bedsit. She had ailing parents in Ukraine, looked after by her bothers, to whom she was promised to return when her visa ran out in six months’ time. They both seized this last chance opportunity for happiness, shyly enjoying several months of courtship before Katya’s departure date loomed. She begged him to go home with her.
He couldn’t bear to put his mother in a nursing home though he longed to leave England and start a new, more optimistic life. He had for the first time encountered happiness, fulfilment, and he was already nearly sixty. He’d never in his life taken risks, put himself first. Surely he could allow himself this chance? Mum would need constant care soon in any case, so why not leave now? But she had looked after him all his lonely, under-confident life; how could he desert her now? The constant guilt and indecisiveness grew unbearable, and a few weeks before Katya was due to return home he suddenly sank into a torpor, uncommunicative, overcome with a sadness so immobilising and heavy he was unable to go to work. Despite her dementia, his mother in her more lucid periods, and Katya too, saw his decline and insisted he see someone.
It’s obvious why such a dilemma might make someone in Philip’s position very miserable, but did that warrant a complete shutdown? Why did he succumb to so dangerous an illness? The answer lies in an internal conflict of which Philip was completely ignorant until he commenced therapy and talked at length about his much loved mother.
Philip always emphasised his mother’s reliance on and need of him, as her only son; but in fact there had been another son, unexpectedly stillborn, whose name had already been chosen – Philip. The Philip described here was conceived very soon after and the dead infant never spoken of again. Philip learned of the baby by accident, overhearing his gran and a neighbour at the garden fence, so his questions had had to be answered. He couldn’t remember what his reaction had been at the time, but till now he’d assumed it was all forgotten, that life had just gone on as usual. He’d never introspected much and had always believed his childhood to have been rather dull, but happy enough. The only odd thing was that around each birthday he’d always felt unaccountably sad, never enjoyed his parties or presents much. He’d shrugged this off as “just one of those things”.
Over time in therapy we were able to reconstruct his forgotten childhood conflict, long buried but stirred up again by the new conflict over Katya and his mother. His young mind had decided that he must never enjoy life too much, never take centre stage and expect attention, never be too successful, or seek praise. For all these prizes would have been won at the expense of the child to whom they really belonged and who was denied any pleasure in them. His life had been purchased at the cost of his brother’s death. He could only justify his existence by comforting his mother for her terrible loss; that was his lifelong role if he was to avoid guilt and punishment for relishing life while his brother could not.
His late blooming love for Katya had dared him at last to defy brother and mother and for the first time live on his own terms in a new country (literally and metaphorically). He experienced a sense of wild liberation at the prospect, but in response to it an immediate guilt-soaked self-hatred that was so awful that both leaving and staying tortured him equally. He could live with neither option and sank into hopeless inertia.
Philip recognised at once – “like a light bulb going on” – this picture of himself standing in the shoes of his dead brother, taking on a massive responsibility that was never really his, with the result that he could never claim his life as his own. As the dead baby ceased to haunt him and he accepted he could not do his mother’s mourning for her, his mood lifted, along with his capacity to deal with the current conflict and its practical implications.
The couple decided they could not
