We have all felt hopeless, helpless, and ineffectual in our day to day work with depressed persons struggling to survive the ravages inflicted on them by their own depressive objects. This may be especially true in our attempts to relate with those individuals who give the impression that they are surrounded by a fault, schism, dead space or some other type of barrier to being connected with, or touched by the analyst or the analytic process. These are, I believe, some of the most difficult times for both patient and therapist in the treatment of depression. The patient and therapist may be drawn toward disidentification, acting out, and action discharge defenses in an attempt to cope with the increasing tension and anxiety. Yet it is our identification with these same individuals that allows us to be empathic, while simultaneously opening the door to our experiencing something of their excruciating pain and misery. In the process we may be exposed to the same relentless and seemingly inescapable cruel and sadistic attacks that are inflicted internally by their own depressive objects. The challenge, it seems to me, is to not only understand the patient's depression in a helpful way, but to survive; to stay alive and available in the face of merciless attacks, or what may be experienced as inescapable deadness that may continue for prolonged periods of time. These attacks, as I will discuss in more detail later, are designed to kill off or poison the analyst's vitality, capacity to think creatively, and narcissistic supplies, by exerting a numbing and or deadening effect. What the patient needs most in the analyst may be nearly destroyed, and the analyst may be at risk for being thrown away as he or she has become, in the mind of the patient, and to some extent in reality, as useless, weak, and ineffectual as the patient feels. It is as if the person is saying “stay back” all the while desperately needing to form a “corrective” attachment or treatment alliance in order for the therapy to progress. This enactment in the transference may provide insight into the early situation out of which the patient's depression evolved, and may be an unavoidable development, especially in the early phase of treatment.
“I don't work with people I don't like” or “I don't work with people who don't like me” may sometimes be the therapist's manifest reaction to their own depressive objects, their own depression and despair, when confronted with such patients. The perversity in love is seen here as the patient's manifest drive to destroy the therapy, to defeat the therapist, and then upon killing him off, to add the corpse to the preexisting collection of trophies. During such times the person may only be able relate to these petrified trophies albeit with the same extreme ambivalence that characterizes all other relationships. Such individual's object relations are often similar to those described by Tauber (1981) in what he referred to as the necrophiliac phase of disordered affect, which is characterized by “a miserly investment in life experiences, a circumscribed sense of joy and other positive affect and self absorption”. In fact, at one point Tauber (1981) defined disordered affect as a “qualitative negation of life”. There is considerable energy devoted to mutilating or killing off any object that shows too much vitality, including the self, which may also be treated as an object (Bollas, 1987). This proclivity to engage in attacks of self-loathing and self-destructiveness highlights the disturbed self and object representations. The stopgap reaction on the part of the therapist may be to flee the treatment situation by only listening to manifest content. It is here I have noticed the greatest potential for our pulling away from the subjective experience of the moment to what may be described as “objective clinical detachment” in an effort to rescue our own sense of reality. This is especially tempting because the distinction between reality and fantasy may be so clouded and confused that reality is often used for defensive purposes. Because such persons are far from sure about the distinction between fantasy and reality they need to always be kept as far apart as possible. Fantasy must only be fantasy, and when fantasy and reality are telescoped together, intense anxiety appears. In addition, there is little sense of potency for confronting reality, so there is an unending stream of imagined dangers. The patient's self-representation includes impotency, weakness, inferiority, and an overarching sense of incompetence, so they are constantly tortured from within. From time to time nearly everything and everyone may appear to be threatening. There is an incessant anticipation of danger, frequently leading to a state of hypervigilance. All too often, life is lived on the brink of one paranoid crisis after another. Persecutory anxiety and fantasies inevitably increase, exerting enormous pressure and anxiety, only to fall off again, usually without resolution or insight, in an unending vicious cycle . Ordinary human concern or compassion are often squeezed out. The world is organized around opposites with little space between for curiosity or reflection. Therefore, order and control must be maintained at any price, by a structuring anal reference which allows splitting to continue to function, and above all keeps the patient and the therapist away from what can be learned from the unconscious.
Because such individuals often experience life as meaningless, the treatment may easily become only an extruded version of that same meaninglessness. Accordingly, there is little if any pleasure derived from self-understanding, and what precious little meaning is discovered is soon lost. In fact, any sense of shared mutual pleasure is alien; rather, it is a sense of shared mutual suffering that characterizes such person's attachments. Life becomes organized around ever present concerns with survival. Pleasure or joy are at best only ephemeral because they are not deeply trusted, therefore cannot be deeply experienced. It would seem that the patient's early joyful and pleasure states became associated with fear, pain and object loss. Thus, life becomes a trial and a burden for these people and some degree of anhedonia nearly always seems to be present. Frequently there is little room for play; instead there is a joyless and resentful dedication to a miserable, painful world that offers mostly fear and suffering. The characteristic response to the therapist's efforts to be helpful are pain, weariness, and worry; if not outright paranoid fears and fantasies, as the patient feels the sense of order and control slipping away and all too often blames the therapist and the therapy.
Consequently, analytic work may have to traverse a mine field of potential resistance, disappointment, and narcissistic injury. Despite the greatest caution, during certain analytic hours, many depressed persons will alternately experience the analyst's attitude and interpretations as seductive promises, severe rejections, breaches of understanding, or sadistic punishments; all of which may increase the seemingly insatiable demands, frustrations, ambivalence, and ultimately the depression. I believe these are precarious times because the patient may temporarily need the analyst to come forward in the real relationship in a way that is almost palpable. In these critical moments the analyst may need to react either with a spontaneous gesture of kindness, or even with a brief expression of anger, to carry the person over these especially difficult hours. However, too much “reality” or too much “real relationship” brought into the analytic space may be experienced as a shocking and disorganizing intrusion.
There are also those who endeavor to avoid such painful encounters and stay hidden by ensconcing themselves in the shadows of the cast of characters they bring to the hour. Consequently, there may be inordinate effort devoted to understanding themselves through talking about others. This deflection of interest and attention away from themselves has as one of its effects the erosion of narcissistic pleasure gained from self-understanding and the accrual of self-knowledge. The insight gained during these times often tends not to be mutative or even useful. I have understood these ministrations as the individual's attempts at dealing with intolerable anxiety and vulnerability by continually shifting the focus away from themselves, as a means of communicating their own struggles, while simultaneously maintaining some degree of safety by remaining hidden.
On occasion the therapist may unconsciously seek to “turn the tables” on the patient, and consistent with the law of the talon, make the treatment into a trophy of sorts. Since the patient may have been so very dangerous to the therapist's self-esteem, the trophy would be highly prized. We've all heard therapist's talk boastfully about the borderline, severely regressed and chronically depressed persons whom they have been able to genuinely help after years of heroic effort. I have privately wondered whose self-esteem and sense of potency was being established with such proclamations. Perhaps the therapist is proclaiming his or her triumph over their own fear and anxiety, over failing and being a failure, over being made into a trophy of sorts by the patient.
The type of depression I am attempting to understand originates in early loss situations where the loss was overwhelming and wasn't compensated for by the capacity to provide adequate self comfort and solace to the young ego, so the little person was unable to negotiate the subsequent painful and disorganizing mourning process. There is no doubt, the touchstone of depression is loss; a state of anguished, incapacitating anxiety, dysphoria, and self-hatred is characteristic in adults. This wretched condition may be brought on by the loss of ideal aspects of the self, including positive valued traits such as confidence, esteem, competence, and reliance, as well as the loss of someone important and close to the self as an object of love or need, currently or in the past, as was first pointed out by Freud (1917) in his seminal paper Mourning and Melancholia. When this loss experience takes place at a very early age, it exists in the persons mind as an unmetabolizable, foreign percept that is endowed with meaning and defense. This miserable experience becomes a part of something which may be likened to a black hole or cold star (Grotstein, 1990) drawing into it all other similar experiences; shards of pain and suffering coalescing into what I am herein describing as a depressive object. The black hole or cold star is, in this instance, the distance, disconnection, and lack of concern written on the mother's face, and may be experienced as a “dead zone” that once internalized, becomes the “living hell” experienced by those caught between their need for relationship, and the terror of being annihilated by it. Here, the need for touch meets with the gut wrenching fear of being touched. It is as though being touched, in the way one may be during the analytic hour, precipitates a “malignant regression”, in the Michael Balint (1968) sense, to a time when the need for mother collided with mother's experience of her baby as overwhelming and a threat to her own survival. In a sense, a primal competition for existence, for the right to life itself, may be experienced by the object as it seems to translate in the mind of the child to, “if you want to live, stay back”. In other words, staying alive becomes associated with detaching and avoiding contact with the object during times of need.
I have observed with several such patients a broad spectrum of defenses; most notably, reaction-formation, splitting, turning against the self, and reversal or denial in the Dorpat (1985) sense. These persons were ardent environmentalists, nearly pacifists in their antimilitary stance, exceptionally sensitive to the correct social attitudes, and they highly valued their autonomy and their friends. Their values and attitudes initially seemed quite laudable. However, what soon became obvious was how over cathected they were. For example, one patient always took delight in doing anything he could to keep people from “poisoning everyone around themselves by smoking”, with absolutely no regard for other people's right to live their own lives differently than he did. Because he was on the right side, nothing else mattered except that he win the war against them, and that his will prevail over theirs. The underlying narcissism and hatefulness became obvious in the contemptuousness he reveled in whenever someone who dared to differ with him came up in our work together. His attitude toward those he felt competitive with was nearly homicidal, and as it turned out, pointed toward his unconscious identification with the allelopathic effects of the depressive object, while simultaneously withdrawing. Because his inner world was dominated by this arrangement, he could conduct his campaign with an attitude of self-righteousness and entitlement. It was as though he had refound his birth right to live and grow in a supportive environment without being constantly exposed to the poisonous effects of his depressive object. His self protective withdrawal constituted a major crime; murder by abandonment of the object, or rather the object's goodness and vitality, for which he deserved to be punished, and was in fact punished by having to live such an inescapably miserable life. In this way his suffering reinforced his sense of badness. He also needed to suffer to live with feelings of deadness and numbness. Thus, he had entrapped himself in his own pain filled life with little hope of escape.
Early attempts to repair the original object yielded only failure, but this time he was on the right side and had the “power of the mother-state” behind him in his attempts to wrench smokers out of their vile habit. He would not allow them to poison others by putting their toxic waste into the “innocent” people around them the way he had been poisoned. Freud's grand river of self-relatedness here is obvious; by saving other innocent victims he was also saving himself, or at least giving himself a chance to be saved. While he was reasonably successful in his campaigns against smokers, there was of course, little improvement in his depression.
The slavish devotion to asceticism was a reaction not only to destructive impulses, but also to a profound sense of deadness that centered around his genital sexuality. Melanie Klein's (1946) voice echoed, as it often seemed to me that he needed all the goodness he could muster to defend against annihilation. In fact, he once described himself as being dead below the waist. For many years he had slept with a crucifix above his bed to make sure he was good, and to remind himself what would happen if he wasn't. At one point he exclaimed, “after all, angels don't have sex”. However, it wasn't enough to be good, he had to be “more good” than those around him. The quest for others to recognize his
angelic character meant he did not have to recognize his homicidal murderous impulses, that he wasn't crazy, and that his sense of deadness wasn't so bad after all. What began as a defense against his own sense of deadness and corresponding self-hatred, ended in his contempt and hatred for so many others.
Michael Eigen (1996) begins his book Psychic Deadness with the following statement, “although feeling dead is a central complaint of many individuals, it is not clear where this deadness comes from or what can be done about it.” Contrary to Eigen, I believe that within the context of our understanding of our patients and the lives they live, such expressions often do make sense. These adaptations or defenses can be understood as attempts to cope with experience which threatens one's right to life itself, both psychically and somatically, by undermining or actually attacking what Stern (1985) and others have referred to as “vitality affects”. Such experience may be considered as allelopathic in its numbing or deadening effects on the child.
The clinical picture often involves oscillations between identifications with the depressive object's allelopathy, and its victim. Consequently, aggression, if not vicious aggression, directed internally or externally, is often a part of the person's struggle. The intimate relationship that exists between depression and aggression has been repeatedly emphasized in psychoanalytic studies of depression, and appears to fall along several main lines:
aggression is a universal condition and fundamental causal agent in every depression (Abraham, 1924; Klein, 1940);
aggression is an agent of depression, but forms part of the larger process that consists of frustration, rage, and hostile attempts to gain the desired gratification. This line of thinking states that when the ego is unable, for external or internal reasons, to attain goals, aggression is turned against the self with an ensuing loss of self-esteem (Jacobson, 1971);
aggression is present in certain cases but the central and universal cause is the decrease in the person's self-esteem caused by fixations to experiences of helplessness (Bibring, 1953);
aggression is a secondary phenomenon in response to the failure of the external object, which generates pain and narcissistic rage in the depressed individual (Kohut, 1977).
I have not found it helpful to elevate any one view of the role of aggression over the others because my patients do not always read psychoanalytic textbooks, and I have never had a person come to me for psychotherapy because they were internally inconsistent in their theoretical understanding of their misery. However, it does seem to be an oversimplification to always view aggression as the fundamental causal agent in every depression as Klein (1940) following Abraham (1924) would have us believe. Certainly, Abraham was correct in his assertion that aggression destroys the object; that fantasies of oral and anal attack may leave the person feeling that he has destroyed, ruined or annihilated the object; a crime which may leave behind unbearable anxiety and guilt. The destruction or denigration of the object leads to its loss as a stimulant object capable of underpinning the narcissism of the self. I believe this is the primary reason that we must do whatever we can to prevent the patient from totally destroying the analyst and the analytic process. Once the “analyst-depressive object” has been denigrated beyond a point of recovery, the treatment may be doomed because the therapist's ability to be used as a good object has been lost along with a measure of the patient's self-esteem.
Maintaining focus on the unfolding negative transference in such situations is one way to work against the development of a negative therapeutic reaction. However, even more important than this is the struggle with my own countertransference. In addition to sometimes tolerating the streams of vicious attacks, I must also sit with inertia, hollowness, deadness, and on occasion the toxicity that the patient brings in. The task then, is to establish a consensual space or frame before the therapy can progress. Here I have become aware of a pull toward contracting into numbness; deadening myself and stifling my ability to think, feel, and interact creatively. The repeated struggle with this life long conflict in my work, has I believe, benefited me enormously. Additionally, I have often noticed in others a desperate flight away from understanding their own conflicts in this region by drawing on several techniques. These techniques include: the free expression of their own aggression with some underlying sense of entitlement; the endless offering of a breast relationship and all the succor imaginable, unfortunately excluding any real understanding; the demand to be seen as the “good all powerful mother”; the retreat into detachment, intellectualization, and stultification in pursuit of being seen as competent; and the escape into states of reverie or sleep. Perhaps we all struggle with conflict in this region, which may help explain why it is so seldom openly discussed. Recently I said to someone who had nearly fallen asleep while his patient was berating him, that maybe sleeping was a way of dealing with all this “back and forth” hate and contempt. He looked at me, somewhat surprised, and rather thoughtfully said, “yes, I think so”. Then I said, “now you have to wonder what this is all about.” He then declared, “no I don't”! I believe he was genuinely shocked by his own reaction which I found to be refreshingly honest.
Sometimes aggression is directed against external objects as well as the self. Some depressed individuals, in addition to directing their aggression against the internal representations of their objects, also act out in the external world, thereby destroying friendships and family relationships, work relations, and real life opportunities. In fact, I have never worked with a depressed person who didn't experience some difficulty in this area of their life. Here, depression may be deepened because of the failure to create conditions that allow for the realization of fantasies that are central to the person. For example, the creation of a new and restorative family, or new objects to redress old injuries and heal the pain from the original ones. Unfortunately, the patient seems to inevitably find, in a way reminiscent of that described by Fairbairn (1943), what is most painful and frightening; the return of the depressive object. For example, one individual, highly educated and severely under employed, living on the fringe of society, the edge of the allelopathic killing field, was also tortured by his work situation. His employer, a seemingly well intentioned, supportive but somewhat detached person, was the source of enormous conflict. His initial reaction to this employer was one of respect and admiration. He wanted to be taken in, and although he wasn't conscious of it, loved and restored, but his fantasy was not to be fulfilled. As that became more and more obvious to him, his relationship began to change and was invaded with a near paranoid suspiciousness, and an excruciatingly painful sense of rejection. An internal situation was reconstituted, reminiscent of the one originally engendered by the depressive object's allelopathy, and from which he felt an urgent need to escape. At one point he described his depressive object: “mother didn't know how to raise boys…she didn't hold us and didn't even touch us…she pushed us away”. When she asked her mother what to do she was told “you made your bed”. She then went to her husband's mother in search of help and was told, “you have to push those boys away”. All this my patient told me in his usual detached manner. Thus he was forced to prematurely turn to father who was aloof and detached; a mental health professional.
From the beginning of our work together, I had the impression this person was surrounded by a sort of dead space that at times became a killing field that neither he nor I could bridge. My early attempts to reach him were unsuccessful and at one point I was left with the feeling that I was making one mistake after another in a rapid succession of attempts to find him. I became impressed with my continued efforts, and was reminded of something another patient once told me: “you know you're crazy when you just keep doing the same things over and over, expecting different results.” I had to “stay back” because feeling touched by me or the analytic process was absolutely terrifying to him. In other words, I had to be the depressive object who's allelopathy had been so damaging to him in the first place, at least in the transference, while containing my own guilt and feeling of inertia, which was extremely difficult. I was aware that sometime earlier he had made a suicide attempt and had lived on the brink of suicide-homicide since he was a little boy, which had intensified my desire to reach him. In the transference, I had become the young boy desperately trying to connect and he was the depressive object pushing me back, sometimes violently. The allelopathic effect of the object was acted out in the transference-countertransference. I became that part of himself he hated and condemned. About 41/2 months into treatment he began to achieve some success in his work situation which I was pleased by, but not too much for I had learned that my enthusiasm was experienced as dangerous. I think he felt supported by me and openly expressed gratitude. To my surprise, the hour ended with him extending his hand. This hand shake unfortunately concluded our work together.
For others, aggression against the self often takes the form of what has been described as “the sadism of the superego” or bad object. Here, the continuous self-criticism and hate lead to an inner war that deteriorates the representation and functioning of the self, resulting in the inability to maintain self-esteem. When such persons are able to realize how they have ravaged and mutilated themselves, along with guilt, there may be a process of mourning those aspects of the self which are experienced as lost or damaged as a result of their own aggression. Returning to Freud (1917), in Mourning and Melancholia, he correctly saw self-reproach and self-blame as the result of the introjection of aggression originally directed against the object; the self is reproached in the conscious, the object in the unconscious.
If one listens very carefully, they may hear in many of their depressed patients “I am not a monster,” as they plead for relief from the unbearable suffering that attends the fantasy they were so despicable, not even their own mothers could love them. There may be recurring thoughts that it was their murderous rage that drove mother away, making them a murderer whom no one would ever really love, especially if they became known. A life long struggle with guilt is a frequent consequence of this situation; guilt for having caused the object's rejection or absence; guilt over the reparative or restorative failure; guilt for all the hostility generated toward the object; and sometimes guilt for having ever been born. For example, one mildly schizoid young man; a bright, handsome, likable fellow who was severely depressed, believed his birth had killed off his mother's happiness, so her corpse like presence and unresponsiveness was his fault, his creation. Apparently she had developed a postpartum depression soon after he was born and thereafter became nearly inaccessible. I learned this as he told me the story of the Anduin, a mythical creature, a monster, whose huge body had split his mother apart and killed her during the birth process. This horrible crime had left him living on the fringes of society, filled with guilt and shame, unlovable and unloved. My patient identified with this mythical creature and believed himself to be a monster. Thus, he had tried to kill himself on numerous occasions, and nearly succeeded in hanging himself just prior to beginning therapy. From him I was reminded how horrible it is to feel like a monster, and I realized there was almost nothing I wouldn't do to escape such “god awful” feelings.
There is another interesting permutation in these developments which incorporates the fantasy of being an exception. In Some Character-Types Met With in Psychoanalytic Work, Freud (1916) described “the exceptions” and highlighted the ubiquitousness of the desire to be an exception, “they say that they have renounced enough and suffered enough, and have a claim to be spared any further demands”. He then stated what we all know but only rarely admit, “it is no doubt true that everyone would like to consider himself an `exception' and claim privileges over others. But precisely because of this there must be a particular reason, and one not universally present, if someone actually proclaims himself an exception and behaves as such…there must be some experience or suffering to which they were subjected in their earliest childhood, one in respect of which they knew themselves to be guiltless, and which they looked upon as an unjust disadvantage imposed upon them.” The demand that treatment not repeat these early painful experiences with the depressive object, while simultaneously seeking relief from the suffering and disorganization caused by such experiences, sometimes resolves itself in the patient's painful yearning to be an exception in the context of their own therapy. The analyst's inevitable mistakes and errors may be experienced as attacks on the person's love fantasy, provoking the fury of “love made angry”. I no longer believe it is always possible or desirable to interpret the transference ahead of such enactment's. The attitude adopted by Winnicott (1971) in his paper, The Use Of An Object And Relating Through Identifications, is for me most useful here.
The essential characteristic of this depression is that it develops and takes place in the presence of the object which is itself absorbed by a bereavement. For example, the mother for one reason or another becomes depressed and self-absorbed. Her sorrow and lessening interest in the child create a brutal change in the youngster's maternal imago as mother experiences an internal tension when exposed to the little one's neediness. This in turn provokes her rejection, not only of the child's ministrations for attention, but also his or her vitality or aliveness itself. The space around the object becomes a sort of killing field which may be internalized as a dead zone and many years later repeated in the transference situation in a manner similar to the transference depression described by Andre Green (1972). Here the depressed person becomes prey to the repetition-compulsion in an attempt to master the early traumatic situation. But this attempt is doomed to fail. The feeling of impotence becomes ascendant. There is impotence to withdraw from conflictual situations, to love, to make the most of one's talents, to develop friendships, or when these do take place it is with a profound dissatisfaction with the results. The patient has the feeling that a malediction weighs upon him, that his suffering is interminable, and that he is trapped in failure, incapacity, and a miserable loveless world forever. In truth, the person encounters an inability to love because his love is still mortgaged to the depressive object. Accordingly, the patient can give little in spite of being generous and having much to offer, for there is no enjoyment reaped from it. True sharing remains forbidden and inaccessible. Arrested in their capacity to love, those under the empire of the depressive object can only aspire to real autonomy. Conversely, I have also observed in several depressed individuals, a fear of their attraction to withdrawal and disconnection from others. Such time out is not used for restorative or contemplative purposes but is instead a retreat from human contact and relationship. As such, it may be a last ditch effort at finding a safe haven in the external world, since none can be found internally. The obvious problem here is that such isolation often leads to more suspiciousness, estrangement, disorganization, and deeper depression.
The concept of allelopathy (Barbour,1987) has opened a kaleidoscope of images that have been helpful in conceptualizing and understanding these depressions. Allelopathy is a chemical process that a plant uses to keep other plants out of its space. There are several types of chemical allelopathy. In one kind, the plant in protecting its space, releases “growth-inhibiting compounds” from its roots into the ground. New plants trying to grow near the allelopathic plant absorb those chemicals from the soil and are unable to live. These “growth-inhibiting compounds” bring to mind Allan's Schore's (1996) recent assertion that “misattuned relational environments that generate high levels of negative affect act as `growth-inhibiting environments' for developing corticolimbic systems.”
Aerial photography of allelopathic trees and shrubs (Whittaker, 1975) show dead zones around each one; a chilling example of the effect of competition on the surrounding plant life. One is immediately struck by the fact that all plants, even those of the same species, including direct offspring, are killed off. The further back from the allelopathic plant, the more one is likely to encounter offspring existing in a stunted state, as though waiting for the death of the mature plant for their own chance to grow. If the dominant plant lives too long there is no hope for those seemingly waiting in the wings to have a chance at life.
Apparently, the dominant plant is reacting to ensure its own survival. I believe this is a profound example of the state some human mothers find themselves in when the demands of their own infants or toddlers seem overwhelming. As Mills and Conboy (1996) have pointed out, the “real child” may clash with mother's fantasies or idealizations of herself and her youngster in a way that telescopes the mother back to her own early maternal relationship. The result, deepening her depression and further depleting the inner resources necessary for good enough parenting.
The representative aspect of the depressive object derives from the absent, dead, deformed or in some primary way, defective mothering experience. A mother who is psychically somewhere else, displays by her attitude and behavior but primarily by her face, a configuration of absence, of horrifying inescapable absence. This quality of absence is often at the core of the depressive object. It seems to me that it is the perception of absence about the face that is so often at the center of so much human suffering and what is so often erroneously referred to as endogenous depression. There appear to be certain depressions that include, along with the quality of absence, a communication to the youngster to “stay back”. Therefore, the sense of maternal absence, with all the attendant pain and suffering, is still better than being killed off emotionally, in a sickening encounter with the object's allelopathy. However, the patient is left paralyzed developmentally, and unable to “connect” with others, yet equally unable to disconnect, which may equate with suicide. Often these people seem to be living on the fringe of society, much the same as they lived on the border of the object's allelopathic killing field. They are waiting for something to magically change their miserable lives. Stunted in their development, they are at risk for spending their entire life waiting for the object to either die or loose its power so they will have a chance to live; an unconscious or sometimes even conscious fantasy that represents one side of their ambivalence. This tragedy is repeated over and over again without insight or understanding in countless human lives, often leading to addictions, suicide and almost incomprehensible suffering.
Building on the work of Freud, Bowlby, Spitz, Bibring, Krystal, Jacobson, and others, in an attempt at understanding the relentlessness of these depressions, perhaps we could say that in a paradoxical and convoluted way, some individuals may experience despair, detachment, and the agony of loss as a means of maintaining a connection to the object. I have observed on numerous occasions in my work with depressed adults, that the feelings of loss and pain are ways of preserving a certain representation of the object; in a sense a depressive object. The loss of the object is at one and the same time acknowledged and disavowed. The consequences of the loss are denied and in fact it seems that often, an idol takes the place of the original object. The depressed person often seems to establish an idolatrous relationship, in the Henry Krystal sense, with the lost object. In so doing, a decree of external reality is refused, and all too often it's messengers are systematically eliminated. I believe this contributes much to the analysts countertransference experience of being killed off, rendered impotent or ineffectual, and the destruction of meaning or links in meaning. An extreme example of the destruction of links in meaning may be the kind of “blank mourning” that we see in patients whose minds seem to empty of any contents for relatively long periods of time. It is as though the loss was so destructive, so painful, so disorganizing that any sign of it had to be expunged from consciousness. The blank, in blank mourning, may signify the patient's attempt to not experience the horror of the dead zone surrounding the object. I have seen otherwise highly intelligent and verbal individuals regress to a sort of blank torpor as they struggled with this experience. During these times I have felt as though I was witnessing a nearly incomprehensible catastrophe; not just the loss of meaning, but the obliteration of everything that gives life definition and purpose. At times the room has seemed to me to become so empty it almost physically hurt, as I began to feel invaded by the same emptiness that invaded my patient. It is the identification with the depressive object on the level of oral relation that seems to be most conspicuous here. In understanding both my reaction and my patient's, I cannot help but hear Richard Sterba's (1957) footsteps as I am reminded of his excellent paper, Oral Invasion and Self Defense. In the conclusion to this paper he presents an hypothesis about an early defense reaction of the self. “the earlier the defense reaction is established the more totalitarian is it in its character….The defense against oral surrender and invasion is not localized ….it comprises much wider parts of the personality and spreads out over all kinds of experiences which are only loosely connected with the oral area and activity.” Instead of the “fear of being penetrated by the breast or nipple and filled with the mother substance, so it replaces the self” as Sterba insightfully described, there was the actual invasion of mothers psychical absence and emotional detachment along with the breast experience. Perhaps this contributes to the depressions we often see underlying so many people's struggles with drug and alcohol addictions, the life long search for colostrum. In any event, the “blank mourning” some depressed individuals struggle with as a defense against experiencing the nightmare of the depressive object, is in itself a downward spiral into the horrible emptiness that is being defended against; so an unending vicious cycle is constantly revivified.
As one author (Hugo Bleichmar, 1996), from a slightly different perspective, recently stated, “it is the sense of helplessness and hopelessness for wish fulfillment that constitutes the common nucleus of every depression”. It is as though the early repeated disappoint-ments and failures with the depressive object left the person void of any hope for fulfillment in either work or love. Consequently, even the slightest movement toward the possibility of their wishes being fulfilled is followed by anxiety, and sometimes overt actions that derail any opportunity for success. It has seemed to me that the depressed person is often afraid to consciously wish for anything and that my hopefulness may be experienced as frightening and indicative of my ignorance and lack of understanding. Yet not being hopeful is even more terrifying because it translates into total absolute futility which may even be received as a communication or invitation to commit suicide; something the patient, in identification with the depressive object, may on occasion yearn for. It is here that we may observe the toll taken on the individual's sense of healthy entitlement; a belief in the legitimacy of one's needs, and a right to pursue their gratification, which is necessary for a sense of efficacy and initiative. Thus, we are caught between the patient's fearful attitude toward wish fulfillment on the one hand, and the horror of absolute futility, which may incorporate an early suicidal/homicidal commun-ication, on the other. The conflict here can be nearly as vexing for the therapist as for the patient. On occasion, I have caught myself being over identified with the patient's hopeless attitude toward even the remote possibility of their wishes being fulfilled, as a defense against the anxiety and acting out that seems to be provoked if I show too much hope or enthusiasm. Yet I believe these persons will not prosper unless I am capable of enjoying them. Didactic interpretations of conflict or need will not suffice without the right music.
One patient, whom I will refer to as Jane, struggling with a lifetime of misery, found to her amazement after being out with friends for an evening, that she was feeling joyful and enthusiastic; the realization of which so confused and frightened her that she immediately set upon making herself feel as bad as possible. Jane began the subsequent hour remembering how she wasn't even allowed to feel bad. She went on to say, “I am trying to understand how I feel, this isn't like depression, I don't feel panicky or anxious…I feel profoundly sad like I have lost something.” She then informed me that two of her friends had recently told her to “just let it go…forget the past.” I said “you have never been able to be what you feel.” She responded, “I feel like I am on a wave and I am just going to have to ride this out.” After a long pause, speaking for the projective side of her ambivalence, I said, “you sometimes wish you could just let go of this sadness and with it everything in your life that has hurt so much.” Without hesitation, Jane said, “maybe, but then I would loose everything I have worked so hard for”. After a long silence, Jane told me about a friend who spoke several languages she didn't understand, and about a beautiful opera her friend had recommended with the following caveat, “I think you will like it, but not like you would if you could speak the language.” There was a long sad empty silence, then I said, “feeling pleasure is like a language you never learned and so is telling your friend she hurt you.” Jane immediately said, “yes, my friend called; she said, `I love you Jane'. I said, `I love you'…I thought, whatever the hell that means.” During the course of our work together, she would sometimes leave feeling good and soon after call me in a panic, fearing she had done something wrong, while at the same time being hateful and contemptuous toward both of us. Of course, there were feelings of longing and sexual arousal that she felt compelled to immediately choked off, but it took me some time to realize she was also reacting to a sense of excitement and enthusiasm which in her own words made her “visible”, and carried a haunting sense of danger. It became apparent that whenever she felt touched by me or our work together she had to destroy it in order to preserve her own life; and return to the object world she had been condemned to for over fifty years.
This cocooning seemed to represent an attempt at forming an impenetrable barrier against the allelopathic effects of the depressive object. Later real life experiences reinforced her fear that she couldn't trust anyone, and that she was surrounded by people that turn into vicious monsters without warning. Jane believed she would be eaten alive if she dared to be seen, yet at the same time she nearly pleaded for attention. Her hunger was both dangerous and insatiable, so she clung to the magical fantasy that in time a transformation would take place, and she would be able to emerge a new person, both lovable and loved. This magical fantasy provided the thread of hope that made life bearable.
The sense of deadness or numbness may have also been a defense against invasion by the depressive object and it's allelopathic effects, while simultaneously squelching her need for positive maternal contact or holding. Jane once exclaimed, “I am just a bottomless, empty, needy pit,”. I however, did not experience her neediness but rather her detachment. I pointed this out and said, “it may have been dangerous to feel needy around mother so you had to keep it all inside; even your body became a part of your cocoon (she had until recently been one hundred plus pounds over-weight).” Her associations led to being around mother and how mother hated her “open mouth”. Jane said, “I used to have my mouth open all the time…she (mother) would tell me, if I didn't shut my mouth she would slap it shut.” Thus her natural human need, one expression of aliveness, became associated with disgust and self-hatred; in a way, poisoned by repeated exposure to the object's allelopathy.
The repeated complaint of being stuck may also represent another form of connection to the depressive object. The lamentation, “I feel stuck” may be like saying I need different objects, I feel trapped with these. It may be a memory of the childhood wish to have a different parent, which surfaces in the treatment along with all the frustration and helplessness experienced originally; perhaps even more intensely, because some people may feel free for the first time in their lives to frankly experience and express themselves. Jane began an hour telling me that over the weekend she was feeling “stuck” in her depression, and when she told a friend how she was feeling her friend said, “what's wrong with you that you can't just let go of this depression.” After a short pain filled silence she went on with a litany of all the things she couldn't do right, and sounding like a young girl she said, “I can't even breath right.” Her ex-husband had told her repeatedly, “you make too much noise when you breath!” Obviously, she had “refound” in her x-husband the allelopathic effects of her original object. There was a sickening sense of sadness in the room as she went on through a stream of tears to say, “I feel my whole life has been an annoyance to everybody around me… she told me over and over I ruined her life…she and dad were happy until I was born.” Then after a long silence she said, “I know I have told you this before but I can feel it now.” This remarkable woman was actively struggling with what she had always felt to be insurmountable grief.
Winnicott's work underscores an important dimension of the early mother-infant relationship that may lead to a stasis in mourning or depression. He emphasized an area of heightened vulnerability to the loss of mother as a source of base feelings of effectance and positive self esteem . In particular, his conception of the grandiose-omnipotent stage of development and its normality in infancy has proved most helpful. In his discussion of this phase Winnicott (1971) states, “the good enough mother is able to meet the needs of her infant so well that the infant, as emergence from the matrix of the infant-mother relationship takes place, is able to have a brief experience of omnipotence…the mother at the beginning, by an almost 100 percent adaptation affords the infant the opportunity for the illusion that her breast is part of the infant. It is, as it were, under the baby's magical control. The same can be said in terms of infant care in general, in quite times between excitements. Omnipotence is nearly a fact of experience.” In other words, the mother gradually introduces reality to the infant in a way that is manageable bit by bit, so the baby is not shocked and the omnipotent experience is not shattered. This is of course accomplished by her empathic attunement or resonance with the infant. Too much failure and disillusionment during this time may have the effect of shattering the developmentally essential child fantasy of omnipotence, leaving the youngster alone, empty, and disconnected with a disorganizing and intolerable sense of smallness, powerlessness, and despair. This situation is sometimes compensated for by the type of tyrannical, coercive omnipotence described by the Novicks (1996). However, it may also contribute to the development of a depressive object and a life of nearly inescapable suffering.
I began working with a man in his early fifties about two years ago, shortly after he attempted suicide by shooting himself in the head. He evoked compassion and concern from almost everyone he came into contact with, but felt mostly hatred and contempt for himself. An alcoholic, he was chronically depressed, and obsessed since childhood with killing himself. I have only occasionally sensed the slightest hint of confidence or efficacy in this person. I have had the fantasy that he was writhing in pain waiting for some magical transformation to take place. Hopelessly caught between his depressed, schizophrenic, suicidal mother “upstairs”, and his half dead, drunken father hypnotically transfixed on the television set “downstairs”, he was unable to connect with his mother or wake up his father. This was his memory of being home when he was a boy. Here, the depressive object included not only the allelopathic effects of the maternal-depressive object, but also much of the experience with father as well. “I have nothing behind me, nothing in front of me…I don't want anyone to love me…I am an empty shell,” was his plaint. He lived in the shadow of the depressive object with little hope of escape aside from alcohol. On one occasion, he nearly screamed out, “you can only take the pain so long then you need morphine (alcohol).”
At about this same time in our work together, he began an hour unusually enlivened stating, “I want you to see `Leaving Las Vegas'…I have probably watched it twelve times.” We worked over his request and at the close of the hour he said, “will I ever break out of this…I really want to.” This trace of hope had all but disappeared several days later when I next saw him. I mention my work with this person to illustrate the sense of powerlessness, hopelessness, and misery that awaits those who survive having the developmentally essential sense of infantile omnipotence crushed in early childhood, along with their emerging selves. Hence, any thought of connection, even love, becomes associated with futility, emptiness, and a numbing sense of deadness. Paradoxically, he was able to derive some degree of potency knowing he could kill himself whenever he wanted. To this end, he always kept a large catch of lethal weapons at hand, which of course had the effect of keeping my concern and anxiety at a heightened level, and gave me a taste of what he had endured with mother's frequent suicide attempts. An act of suicide, homicide, and genocide all in one, from which he could draw strength. He not only introjected the object's allelopathy, he also identified with it.
Lastly, I would like to briefly mention a women who was tortured by sexual and physical abuse from early childhood; depressed, suicidal, and dissociated throughout most of her life. No one could witness her struggles without feeling enormous respect for her courage and tenacity of spirit. She was, from the beginning of our work together, exquisitely sensitive to the quality of my presence. In fact, I never really felt like I was carrying her, rather from the beginning, over eight years ago, much of the time I felt more like she was carrying me. I have seen her depressed, and dissociated self transform. She has become wiser, deeper, more creative, more alive, and more connected to those she loves. She has blossomed as a gifted writer and poet. Recently she ended an hour saying, “I feel free…not like I have stepped away from myself, more like a butterfly leaving her dead cocoon behind…I feel free and my life isn't so flat.” As we approach termination and our time together draws to an end, I think how much this person has given to me from the first hours when she was curled into a fetal position in the corner of my office, terrified and unable to speak. She and others like her have given me the vision and the belief necessary to work with those who hour after hour fill the room with hopelessness and despair.
In conclusion, I want to point out that this paper is obviously not a comprehensive study of depression or a case study. Nor is it a review paper, for, with the exception of a few references to Freud, Winnicott, Klein, and several others, there is little reference made to all that has been written on the subject. As to how the various depressions are best understood or treated, it seems likely there are still more questions then answers. Still, this work we do provides for many people, the only opportunity to redress the chance happenings of childhood, and transform pain and suffering into creative living.
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This paper was given May 18, 1997 in East Lansing,, Michigan for the Michigan Psychoanalytic Council.