Depression, Mourning and Melancholia

An Explosion of Depression?

Google’s release in 2017 of the UK’s popular search terms led ITV News to claim, ‘Britain amongst the most depressed and anxious countries in the world.’

 

ITV Report on Depression

 

In an article based on figures from NHS Digital, also released in 2017, BBC News reported anti-depressants to be the most common treatment for depression and published a chart showing prescriptions have more than doubled in the last ten years.

 

BBC News reports on depression

 

However, for therapists there is no single depression as these news headlines may suggest. Therapy involves going beyond this catch-all idea in order to come to terms with the ways in which we respond to difficult experiences of being in the world.

 

What is Depression?

At Therapy in Manchester I invite clients to begin describing what ‘depressed’ or ‘depression’ means for them, recognising that speaking about difficult subjects may not be easy. As clients begin to talk, however, an individual life of complexity comes into view from behind this catch-all term.

For some clients, depression describes a feeling of discontent with society, a resignation and withdrawal, even isolation. For others, it describes powerful feelings of despair, grief, being disconsolate and mournful.

Depression can mean the loss of a sense of self, an experience of emptiness, or of a void that threatens to engulf. Depression might be marked by disgust with oneself, and a relentless self-criticism.

Depression can describe anxious, fearful and guilty states along with emotional flatness or blankness.

As clients talk, it becomes apparent that depression can be frequent, persistent or intermittent. It might be associated with a separation from, or loss of a person, relationship, career, or something less tangible or apparent: the loss of a belief, an ideal or a faith.

As this brief description may suggest, the idea of a single and uniform depression implied by news headlines is probably misleading. We can explore this further by focusing on a couple of examples involving separation and loss.

 

A Sense of Identity

Some of our strongest emotional ties come about from our identifying with a person, an object, a situation or an environment. Identification is powerful because it results in our forming a sense of self, an image of ourselves.

Advertisers understand this process very well. What often makes an advertising campaign successful is the degree to which it leads us to recognise ourselves in terms of the product being advertised: we become a Nero’s and not a Starbucks person, a Persil and not an Ariel person, a Tesco’s and not a Sainsbury’s person, etc.

 

Mourning

When we experience a loss, we loose an identification, a sense of who and what we are. Who am I without you? Grief is our response, and by mourning we work through our grief.

 

Munch's Death in the Sickroom

Munch, Death in the Sickroom, 1893

 

Mourning requires other people with whom we can acknowledge and commemorate our loss. In his 1893 painting Death in the Sickroom, the Norwegian artist, Edvard Munch, seems to point to the social as well as the individual nature of mourning. A death has just occurred, and family members seem isolated. They are shown turned away from one another and eye contact is avoided. A connection between them is nevertheless established by their mirroring and echoing one another through bodily posture and gesture.

We may feel there is no one to support our mourning, or that asking for support is not possible since we have to be ‘the strong one.’ Mourning can become protracted and the depressed feelings in our grief may become too much to bear. Working with a therapist can reduce the impact of depression by allowing us to continue mourning.

 

Melancholy

Some people describe depressed feelings that are long standing and for which it is difficult to attribute a cause. It is as if a shadow had fallen over them, as though the sun had become eclipsed. Another picture can help us explore this.

 

Durer's Melancholia

Durer, Melancholia, 1514

 

Melancholia is a 1514 art work by the German Renaissance artist, Albrecht Durer. The title appears within the work itself. In the foreground is the winged figure of Melancholia, hemmed in with darkened face.

The various elements in the picture reference the depressed feelings not of mourning but of melancholy, the most conspicuous being:

• The dog, a symbol in Western art and therapy of our identification with others, is shown shrivelled, half-starved and with eyes closed. Melancholia’s ties to others have almost dissolved.

• The tools of craft, art and science are strewn over the floor like rubbish, clearly no longer of use or meaning.

• Almost everything in the foreground scene is static, including the scales and bell. Nothing moves except for grains of sand in the hour glass whose chambers are shown with equal amounts of sand.

In Melancholia the distinction between life and death is no longer clear. Time passes and nothing happens. Some recognise the figure of Melancholia in a song by John Dowland, In Darkness Let Me Dwell:

Thus, wedded to my woes and bedded to my tomb,
O let me Living die, till death do come.

Melancholia is unable to separate from that which has been lost – as happens in the process of mourning – since they have identified with loss itself. This experience can be invasive and ravaging. Working with a therapist can help mediate this, perhaps enabling the tools of craft, art and science to take on meaning and be of use once more.

 

Depression and Therapy

I have suggested how depressed feelings form part of two very different processes, mourning and melancholia. There is no standard or uniform depression as news headlines may suggest. At Therapy in Manchester I invite clients to begin describing and exploring what depression means for them, recognising that speaking about difficult issues may not be easy.

 

Melancholia’s Dog?

I began with reports of an explosion of depression, during a period when there has also been an escalation in homelessness. Indeed, five-hundred years after Durer’s artwork, is Melancholia’s dog to be found with the homeless and beggars in our towns and cities? The similarities between artwork and photographs of the homeless invites reflection.

 

Photograph of homeless man with dog

Jon, Homeless Man and his Dog, 2013

 

Notes to article

The ITV News story is here (accessed 14/05/18),
http://www.itv.com/news/2017-05-10/britain-is-the-seventh-most-depressed-country-in-the-world-search-data-suggests/

The BBC chart is here (accessed 14/05/18),
http://www.bbc.co.uk/news/health-41125009

It is Harrison Birtwistle who references John Dowland’s song (accessed 15/05/18),
https://www.theguardian.com/artanddesign/2003/aug/30/art.proms2003

The photograph, ‘Homeless Man and his Dog’ (2013) by Jon, is taken from (accessed 15/05/18, pixelation added),
flickr.com/photos/jb-london/8729276154

The JRF Homeless Monitor: England 2018 can be found here,
https://www.jrf.org.uk/report/homelessness-monitor-england-2018

Darian Leader’s book, The New Black: Mourning, Melancholia and Depression (2008), is recommended reading.

Freeing Speech

Talking Therapy with Graham Norton and Orlando Bloom

At Therapy in Manchester, I invite clients to begin each session by speaking freely about what’s on their mind and what comes to mind. For some, this contrasts with their everyday speech in which emphasis is placed on being clear and sticking to the point – this can be counterproductive in therapy. So, I invite clients to resist the inclination to edit or censor what they say, and to speak as freely as they feel able, even giving voice to ‘stray thoughts’ that cross their mind no matter how irrelevant, insignificant or awkward.

Outside of our awareness, so much time and energy – more than we may realise – is spent routinely editing and censoring ourselves. For example, how often have we heard someone say, ‘I don’t wish to criticise you, but…’? We may well wonder why did they bother to bring that up only to deny it! However, as this example may also suggest, at times of difficulty it is through denials and other forms of negation that we seek to maintain and sustain our sense of who we are.

In therapy, that which we deny is telling. To speak freely, however, requires us to be not only relaxed, but also to have confidence that the intervention of our therapist will be respectful. Freeing your speech can take time, some practice and be hugely rewarding. It creates an opportunity to hear yourself speak. For example, to hear what you have wished for, but have not been able to admit, or to acknowledge home truths which seemed necessary to keep hidden or forgotten.

Of course, our speech sometimes frees itself anyway, despite our routine censorship and editing. For example, in the video clip below Orlando Bloom asserts something about his father, and then edits himself, only for Tamsin Greig to draw our attention to what he said originally! That Bloom then engages in an exaggeration – to great comic effect – suggests it may be necessary for him to disguise or to distract our attention away from what he had said originally.

Unlike the risks associated with freeing speech in public, at Therapy in Manchester I provide a respectful and confidential environment enabling clients to hear their freeing speech.

Therapy Words

Anxiety generally refers to both a state of mind (unease, apprehension, worry, fear) and bodily states (such as breathlessness, tension, nausea, dizziness). Anxiety can be free-floating and constant (generalised) or acute and temporary (panic).

Anxiety is something we seek to avoid at all costs. Outside of our awareness, we develop symptoms that serve to protect us from anxiety. A phobia, for example, transforms anxiety into fear by attaching anxiety to a very specific object: spiders, snowman, buttons, open spaces – almost any object or situation can be used to form a phobia. Anxiety appears first and a phobia is formed as protection. A phobia can enable us to get on with our life so long as it is organised so we do not come into contact with the phobic object.

This is why a quick removal of a phobia is rarely successful or desirable, it leaves you without the protection your phobia provides from anxiety. You are then likely to develop another phobia or symptom to compensate.

Obsessions and compulsions – also referred to as OCD – offer another protection from anxiety. Obsessions involve particular patterns of thought that can be absurd or unreasonable in nature, and which recur, often relentlessly. Compulsions require us to perform actions – sometimes against our will – that may be repetitive, ritualistic and trivial (having to check several times a door is locked, for instance). OCD may also be accompanied by a strong sense of guilt or perpetual hesitation that can lead to a state of limbo, confusion, meaninglessness or lack of direction in life. As with phobias, OCD serve as a protection from anxiety: anxiety appears first and OCD forms in response.

If OCD refers to troubling patterns of thought, then what are often referred to as psychosomatic illnesses are bodily sensations, pains or complaints for which a GP can find no organic cause. Some pains or illnesses may relate to a web of beliefs centred around food, weight, body shape, self-esteem, pleasure and sexuality – the most frequently mentioned being anorexia and bulimia.

Self-harm can involved injury to the physical self that may begin as a coping strategy to relieve the build up of anxiety or of feelings and beliefs that may otherwise be overwhelming. The frequency and severity of self harm may increase and give rise to other medical conditions. Therapy can reduce reliance on self-harm as a coping strategy.

Depression describes a range of experiences that can vary in duration, frequency and intensity – feelings of worthlessness, loss of confidence, loss of sex drive, loss of concentration and purpose, and thoughts about death. As this brief description may suggest depression often forms in response to a significant loss of an identification – with a person and a relationship, with a belief or an ideal, or with something that may not be so apparent or tangible.

For some, depression can alternate with feelings of elation or mania that may also involve delusions. Delusions can range from a single idea to beliefs which come together to form a pattern as in paranoia.

In therapy, there is no such thing as a ‘normal’ sexual orientation or gender identity. Your orientation and identity may not remain the same throughout your life. This can be both exciting and also a source of unsettling questions.

Therapy enables you to change your relationship to your symptom. Instead of emphasis placed on symptom removal, therapy invites you to address the underlying cause your symptom shields you from. Once therapy is working, the symptom then usually fades in importance. You, in turn, can experience a deeper level of self-acceptance, greater freedom to make decisions, and an increased ability to live life more fully in the present.

At Therapy in Manchester, we provide a professional, supportive and confidential environment to enable you to work things through.