Different Types of Depression

As I discussed in an earlier post, most people use the word “depression” to describe many separate and distinct experiences — grief, disappointment, mild forms of unhappiness, etc.  When I use the word here, I mean clinical depression, the sort of mental and emotional suffering that sends people into therapy or to their physician for prescription-based relief.  I’ve seen many depressed men and women over the years; from my experience, the roots of their suffering usually lie in three common areas.  I’d like to offer some thoughts about these types of depression and their origins.  I don’t view them as necessarily distinct; they often overlap and mingle in various ways.

1.  Post-Apocalyptic Rage:

Beginning with Freud, psychotherapists have noted the frequent connection between anger and depression; you may heard depression described as “anger turned inward.”  I’d take this a step further and say that explosive and violent rage often lies at the heart of certain severe forms of depression.  I use the phrase “post-apocalyptic” because, with many severely depressed clients, I have felt almost as if a nuclear bomb has gone off inside them, devastating their minds and laying them waste.  Such clients might make it to session but lie inert and mute on the couch; they might say they feel nothing, or describe their body as feeling numb, weighted down by a pressure that flattens all emotion.  In the room with these clients, I often feels as if meaning has been completely destroyed and the emotional realm is void.  Such clients might describe themselves as feeling no interest or motivation to do anything.  They often mention intense pressure around their eyes or face.

Re-creating the emotional events that led to this state of devastation takes time and patience.  The task is complicated by the fact that the rage is almost always unconscious:  the client has no idea that he or she has been raging.  Sometimes you might hear hints of it in the client’s material when he or she begins to speak; more often, you see it in dreams or simply feel it by intuition.  The landscape of the apocalypse often appears in the dreams of depressed people: bleak ghettoes, vast lifeless deserts or scorched terrain borrowed from movies such as The Terminator.  If you have a strong empathic link with your client, you may find feelings of rage rising inside you during the silence, for no reason you can understand.

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Defenses Against Shame

Over the years of my practice, I’ve found that most clients who come into treatment struggle on some level with issues of neediness and shame.  In other posts, I’ve discussed difficulties in bearing need; now I’d like to address in detail three core defenses against the experience of unbearable shame:  narcissistic flight, blaming and contempt.  Denial of internal damage lies at the heart of all three defenses.  Feelings of basic shame also form the core of what is commonly referred to as “low self-esteem”.

Narcissism is the primary defense against shame and often goes hand-in-hand with the other two defenses.  When people suffer from an unbearable sense of shame, they often seek to elicit admiration from the outside, as if to deny the internal damage.  Beautiful outside versus ugly inside.  We’ve all known such narcissistic types.  As friends or acquaintances, they tax our patience and drain us emotionally because of their constant need to draw attention to themselves; their narcissistic behavior makes social interactions dull and one-sided.  Recognizing that these people suffer from unbearable shame may help
us to feel some compassion but it doesn’t make the relationships any more satisfying.

The shame-driven client poses a major therapeutic challenge.  If the therapist tries to discuss narcissistic behavior as a defense, to go beneath the “beautiful” outside and get closer to the “ugly” inside, it can easily feel to the client like a narcissistic injury, unbearably painful; rather than feeling that the therapist wants to help them get closer to  something true but unrecognized, such clients often feel humiliated.  I discussed such a client in my post on ‘Avatar’ and toxic shame avoidance.  As we got closer to the core of shame in our work together, whenever I tried to put him in touch with the damaged David hiding behind his narcissistic Internet encounters, he’d often begin to scream, accusing me of misunderstanding or purposefully humiliating him.  It felt to me as if the shame were so excrutiating that he had to “scream it out,” to rid himself of that searing pain and project it into me.  As his therapist, I found the experience deeply painful but at the same time, it helped me understand the degree of his suffering, the intense pain he was constantly warding off.

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Narcissism vs. Authentic Self-Esteem

You may have seen or heard about these two new studies on self-esteem in college students.  A recent New York Times article reports that, when given the choice, most college students prefer to receive a boost to their self-esteem in the form of a compliment or good grade over eating a favorite food such as pizza or having sex.  The article begins with the following question:  “Are young people addicted to feeling good about themselves?”

At first, I found this question idiotic.  I am sick and tired of how our culture has adapted the language of addiction to describe everything.  The more I thought about it, however, it did make a (limited) kind of sense to me, especially if you consider addiction to actual drugs as a means to avoid some other experience or to seek an inappropriate remedy for a very real problem.  As I’ve written elsewhere, narcissistic people crave attention and admiration in order to ward off feelings of inferiority and to  bolster a fragile sense of self.  In other words, they have no authentic self-esteem and look to others to provide a substitute for it.  The problem with external sources of self-esteem, as with all drugs, is that they wear off and you have to secure more of it to feed your habit.  As a result, those individuals without genuine self-esteem have an insatiable need for their their egos to be bolstered by the people around them.  In this sense, I suppose it makes sense to talk about them as addicts, even if “addicted to self-esteem” sounds ridiculous.  Besides, receiving a compliment has nothing to do with authentic self-esteem.

In my experience, you can’t obtain real self-esteem from the outside.  Yes, it’s important that our parents praise and encourage us as we grow up.  We internalize that praise, along with their values and standards and those of our teachers, peers and social environment; then, once they’ve become a part of us, we must live up to those standards if we’re to feel good about ourselves.  I’m not referring to perfectionistic and overly harsh standards, impossible to meet.  I mean our own ideas and expectations, evolved from the disparate influences of family, peer group and culture, about what it means to be and behave like a person we would respect.

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A Portrait of Narcissistic Personality Disorder in ‘The Social Network’ (2010)

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Throughout The Social Network, Mark Zuckerberg demonstrates most of the traits associated with what the DSM-IV calls “Narcissistic Personality Disorder.”  If you’ve spent much time on my site, you’ll have gathered that I’m no fan of diagnosis.  I don’t want to end my discussion of the film before I’ve even begun by affixing a label to this character; instead, I’d like to use The Social Network as a way to approach a cluster of psychological traits that often go together.  Sometimes you see them in the bipolar disorders; or you might find them displayed by someone who’d receive a diagnosis of Borderline Personality Disorder instead.  In truth, the so-called personality disorders exist along a spectrum, nobody fitting neatly into any single diagnostic category, but I’ll use the DSM-IV criteria for Narcissistic Personality Disorder as a basis for my discussion.  I’ll invert the order of list and end with the earlier criteria since they raise some interesting and difficult questions.

According to the DSM-IV, you need to display at least five of these qualities to meet the diagnostic threshold.

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‘Avatar’, Toxic Shame and Avoidance of Authentic Relationships

At the opening of the movie Avatar, Jake Sully has suffered a severe spinal chord injury that leaves him a paraplegic.  No longer able to perform as a combat marine, and because the military won’t pay for an operation to restore the use of his legs — that is, to return him to his former self — Jake volunteers for a specialized military mission to the planet Pandora.  Through the miracle of medical technology, he learns to psychically link with and inhabit an “avatar” or alternative physical self on that planet.  In contrast to his paraplegic self, this avatar is healthy, fit and stands ten feet tall, with enormous physical prowess and sensory capabilities beyond those of humans. Embodying this avatar allows Jake not only to regain the functions he lost but also to surpass his human potential.  His experience on Pandora ultimately proves to be more real, more meaningful to him than his actual life; at the movie’s end, he finds a way to transcend his human physical damage and move permanently to the realm of his superior Na’vi self.

This story perfectly embodies a dynamic I’ve seen with many clients, where they feel themselves to be so damaged, so filled with basic shame (or toxic shame) that they long to escape into the world of fantasy and become another person entirely.

It’s a particular instance of the dynamic I discussed in my post about hopeless problems, perfect answers. In these cases, avoidance of authentic, realistic relationships is strong; instead, they wish for a perfect relationship with an idealized partner. The Internet has enabled many people to pursue and act out this fantasy — in virtual form, of course, and for a limited time only.

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