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What is the cause of the experience of depression itself? Essentially the experience of depression is caused by the turning of a great intensity of energy upon the ego. This energy is usually destructive in nature.
In simplified terms, depression is oftentimes experienced when the energy of anger is turned toward the self instead of being expressed toward some object or the symbol of some object in the environment.
This destructive energy is turned toward the self rather than externalized because somewhere along the way the patient has learned that such expression could lead to the destruction of some other person, feared retribution, loss of love and security, abandonment or the loss of a highly invested idealized image.
Mrs. Jones was referred to me because of her depression and recurring headaches. The physician who referred her could discover no organic cause for her condition. She had previously been a nurse, but for the last five years, since her children were born, she had been home with them.
She hated being home with the children not only because she preferred to be working in order to gratify strong masculine achievement strivings but also because her children were very boisterous and very hard to control. She admitted that she could not control her children because for a number of reasons she could not permit herself to get angry with them.
She had a great need to be needed and was very fearful that if she got angry with her children they might not love her. Most of all she feared the loss of control of her anger. This fear related to an event that had occurred early in her life. She was a very tall and powerful girl and one day she lost control of her temper and nearly killed another girl.
For many years she had repressed her hostility toward her mother who was extremely controlling. Her mother selected what clothes the patient was to wear and later on in life even told her what career to select. All the other siblings in the family were boys.
She noticed that her mother disliked aggressiveness in her boys, so the patient competed for attention by becoming the “good little girl.” She never got angry, and never did anything naughty.
Her husband, who seasonally was out of work, would take out his frustrations on her and she would rationalize it away by saying that she knew he really did not mean it but that he just naturally had to get it off his chest.
She had come to see that she had adopted the role, for the world, of the
“human punching bag.”
Her consistent and intense repression of her anger eventually caused her to become depressed. At first she tried to escape from her depression by compulsively becoming involved in civic and social affairs in an almost manic fashion, but soon she withdrew and seemed to lose interest in all of her affairs.
This need to block hostility from being expressed, which is so frequently the case in depressions, leads the body to assist the mind in holding the angry feelings in check, producing all kinds of physical complaints (for example, the headaches here).
It is also typical that in this kind of depression, due to the severe over-control which these patients impose upon themselves, they are also unable to achieve sexual release, for all “letting go” is experienced as dangerous.
The blame for this sexual frustration is usually projected onto the husband and may lead to sexual fantasies about other men, aggravating the depression by the guilt that it engenders. This was also true for Mrs. Jones. In addition, her masculine identification made it almost impossible for her to cry, which would be a sign of weakness, femininity, vulnerability, etcetera.
Thus she had no outlet for the release of her tension which had built up due to the repressed hostility and ungratified sexuality. As a consequence, her enormous tension, without an opportunity for release, was being turned in toward the self, resulting in the depression and the headaches.
Therapy with this kind of patient should aim at helping her to learn to express negative affect, at least verbally, without feeling guilty. Sometimes the establishment of a negative transference toward the therapist may be necessary in order for the patient to learn that her hostility is not destructive and that people will not necessarily reject or abandon her just because she expresses herself honestly.
For therapy with this kind of patient to be successful, of course, it is necessary that the therapist be secure about his own worth, so that he will not have to hurt her in any way when she starts to express her pent-up angry feelings onto the therapist.
Helping the husband to accept negative expressions from his wife is also helpful in the same way. It is not unusual, as was the case with Mr. Jones, that the husband is actually quite pleased with his wife becoming more assertive because her “good girl” role made it very difficult for them to communicate honestly and have a close relationship.
Many times his anger toward her was a baiting of her in the hope that she would express the hostile feelings that he sensed were within her. He recognized that she was also making him feel very guilty by not responding to his anger.
