Before I began taking on new clients for online counseling in November, it had been quite a while since I’d started therapy with someone new; for the most part, my practice had involved ongoing work with long-term clients who were no longer struggling with depression. A number of people have recently come to me with depression symptoms and I’ve been struck once again by how important it is to understand the role that anger and rage play in so many depressive conditions.
In an earlier post about different types of depression, I discussed severe cases that result from intensely destructive but unconscious rage; I believe unconscious anger plays a major role in less severe conditions, as well. You’ve probably heard depression described as “aggression turned inward”; accordingly to this view, depression symptoms are the result of unresolved and unexpressed anger that is turned inward upon the self instead of being directed outside, at other people. This might account for the apparently unjustified feelings of guilt that often accompany depression symptoms: while the depressed person has no real reason to feel guilty — that is, they haven’t actually done anything in the external world about which they might legitimately feel guilty — their (unconscious) enraged fantasies of wanting to hurt people around them nonetheless inspire feelings of guilt. As therapists, instead of treating the feelings of guilt as irrational and unjustified, we might instead wonder what the person has done (in unconscious fantasy) to justify those feelings.
I’ve also heard many clients with depression symptoms describe themselves as being “a good person”; one such client felt that this was the only thing she had going for her. When being “good” matters so deeply, it’s often because the person is afraid of unconscious “bad” feelings. They want to see themselves as kind, generous, compassionate, etc. because unconsciously, they feel just the opposite. Many years ago, one extremely depressed teenage client told me this story from her childhood: some of her schoolmates had found an injured bird on the playground and were torturing it; my client felt horrified at their cruelty and pleaded with them to stop. As she told me this story, she became tearful, insisting that she could never do such a horrible thing to a helpless creature. Although she didn’t actually say the words “I am a good person,” her story carried that message. She was the kind, compassionate girl who came to the rescue, attempting to save the injured bird from the cruelty of her evil classmates.
As the work progressed, we came to understand that this young woman was carrying a huge amount of unacknowledged rage. In addition to having depression symptoms, she was also a “cutter”; one day she had the following spontaneous fantasy while slicing open the skin of her arm with a razor blade: a mechanical hand with metallic fingers emerged from the opening she had made into her flesh; at that moment, these words came into her thoughts, as if someone were speaking them aloud: “It will take whatever it wants.” Over time, we came to understand the enormous sense of entitlement she felt, her angry desire to be taken care of, to be given whatever she wanted, and the urge to savage those people who didn’t comply with her wishes. The mechanical hand became a metaphor for the ruthless, unfeeling side of her. In the transference, she eventually came to direct this rage and sense of entitlement at me; over time, as she became more able to bear and contain the rage, her depression symptoms abated.
I started my own therapy during college, largely because I was so depressed; over time, my therapist introduced me to a very angry and destructive side of me, the very antithesis of how I viewed myself. Sometimes when I went to a session feeling deeply depressed, my therapist would put me in touch with my unconscious rage and the depression would immediately lift. With many of my own clients, I’ve had the same experience, again and again. Bringing unconscious rage or anger into awareness leads to a lifting of the depression symptoms. It’s not true for all types of depression, of course, but I find it to be an
enormously important tool for the treatment of depression.
Here’s an example of how it might come up early in treatment. One new client — a young woman who struggles with depression symptoms and thoughts of suicide — told me she felt guilty about something she had done. She’d been in conflict with someone else and had tried repeatedly and reasonably to resolve that conflict, all to no avail. She finally took her complaints to a higher authority, which led to the other party receiving a rather harsh punishment. She felt guilty, that she was in some sense responsible for what had happened, even though she rationally believed the other party had been in the wrong and brought it upon himself. On a hunch, I suggested to her that it wasn’t her actions that made
her feel guilty so much as the way she felt about the other person. She said yes, that she’d had repeated fantasies of strangling him, literally. This opened up a whole new field for discussion — the issue of her frightening anger, how to acknowledge and express it.
Although clients at first may resist interpretations about unconscious anger because it challenges their view of themselves as “a good person,” in the end, they find it a relief. Rage may be painful to acknowledge, but splitting it off and denying its presence demands a huge expenditure of psychic energy; many defense mechanisms ultimately weaken the self and sap our power. As I discussed in my post about the film Black Swan, the recovery of the split-off and disowned shadow self can be enormously empowering. Not only does it lead to the lifting of depression symptoms, but it helps people access the aggressive side of themselves — a side they need in order to function and make their way through the world, to defend themselves when necessary, and to go after what they want from life. We may be afraid of our shadow selves, but owning our rage can be a very good thing.