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.

This rage may itself be a defense against fears of disintegration, as I discussed in my post about hatred as glue.  Or it may be a kind of omnipotent, destructive reaction to feeling unbearably needy, small or frustrated.  In any event, it is a sign of progress (and an emotional challenge for the therapist) when such clients can experience and express rage within their sessions and yet not destroy their treatment in the process.  Helping the client to tolerate this kind of rage involves the patient work of years.

2.  The Fragmented Self:

Whatever our theoretical orientation, most of us understand that when mother-baby relationships go awry, for varying reasons, it affects the child’s developing sense of self.  The more unreliable those early experiences (i.e., the more unavailable or inconsistent the mother), the shakier the child’s sense of self.  In severe cases, the person may feel as if he or she is constantly in danger of falling into pieces under the pressure of intense emotion, as discussed in my earlier post on disintegration anxiety.  Anxiety may thus be one sign of a shaky core self, where the person feels terrifed of disintegration; depression may be another sign, where it may feel as if he or she already has fallen into pieces.  Such disintegration may be experienced as a kind of personal psychic death; the depressive feelings that result are akin to mourning, a mourning for the self, full of grief and hopeless despair that anything can be done to salvage the fragmented self.

This kind of client needs the safety of ongoing psychotherapy and a strong empathic connection with the right therapist.  I’m not sure I would go so far as to call it “re-parenting”, but given the insecurities of their early attachment, such clients need to regress and become emotionally dependent to a significant degree; they almost always need to come more than once a week.  Within the context of the client-therapist relationship, they learn to understand and tolerate unacknowledged feelings, helped by the safe holding environment the psychotherapist provides.  Again, such work takes years.

3.  The Rejected Self:

In especially toxic environments where parents may be abusive or projectile, evacuating their own feelings of unworthiness or confusion into their children, those children may grow up with intense feelings of basic shame.  Rather than experiencing their selves as if they were in pieces, these men and women feel dirty, damaged, ugly, smelly, disgusting, repulsive, contemptible, etc.  They may feel that their authentic self is so thoroughly damaged, in a state of such decay as to be beyond redemption.  In these cases, the individual may be highly defended against feelings of depression and unworthiness; they often inhabit a false self organized around the characteristic defenses against shame, evacuating their “depression” into others.  They may come across as superior and arrogant; they may feel contempt for others who they perceive as excessively needy or vulnerable.

At heart, they feel enormous contempt for their own authentic damaged selves and want nothing to do with them.  The work with such clients — if they even reach the point of seeking treatment — is to help them to become depressed.  In other words, it is a sign of progress when such clients can experience depressive feelings.  They usually don’t experience this depression as progress, however, and may break off treatment as a result. A particularly tricky variation is the superficially-devoted client who becomes a major fan of psychotherapy, possibly entering the profession.  Such individuals attempt to ward off depression and awareness of damage with a false, pseudo-therapeutic self that uses the language of insight and emotion with fluency but never gets near authentic shame. The challenge with such clients is to bring them into contact with their actual self in such a way that they don’t experience it as an unbearable narcissistic injury.

Years.  The work always takes years.

Finding Your Own Way:

Sadness, hopelessness, feelings of low self-worth — these are the familiar symptoms of depression.  Do any of the underlying dynamics I’ve described strike a familiar chord?  If you experience disintegration anxiety, it may be easier for you to identify with my description.  If unconscious rage is the issue, or if you’re heavily defended with a false self, you may have a harder time recognizing yourself in what I’ve written.

Think about times when you exploded or lost your temper (I discussed this approach in my post on hatred as glue).  Have there been islands of rage within the sea of your depression?  It’s not unusual.  How did you experience them?  As an awful “coming to life”?  As a kind of horrible salvation?  Or did it fill you with shame afterward?  Do you think there’s a relationship between your depression and those outbursts of rage?  If so, how would you describe it?

If you’re not depressed and have little patience, maybe even a feeling of contempt, for those who are, for their perceived weakness, that should give you pause.  We often feel contempt for disowned aspects of ourselves we recognize in other people.  If you envision yourself as feeling depressed, how does that fantasy make you feel?  Put yourself in the shoes of someone you know who suffers from depression, give yourself that person’s life and imagine how you’d feel about yourself.

For most severe types of depression, I believe you can’t really “find your own way.”  Severe depression calls for long-term psychotherapy.  Psychotropic medication is not the answer, despite its well-publicized placebo effect.  Self-affirmations aren’t the answer. Cognitive-behavioral therapy has been shown to relieve symptoms to a degree but it isn’t the answer, either.  Time-consuming work in individual psychotherapy, over a number of years, is the only way I know to achieve a significant change in the underlying dynamics of depression.

Joe is the author and the owner of AfterPsychotherapy.com, one of the leading online mental health resources on the internet. Be sure to connect with him on Google+ and Linkedin.

Diary of a Shame Attack

On Saturday, I made a short new video, making use of what I’d learned in media training. I felt very good about that video because I’d confronted some underlying shame and the related wish to…

Performance Anxiety and Shame

When artists use their medium as an attempt to escape from internal “ugliness”, performance anxiety may reflect the fear of being exposed, their true damaged self becoming visible to the audience.

Anxiety Symptoms, Mindfulness and the Enlargement of the Self

Mindfulness meditation techniques are a useful adjunct to psychotherapy, allowing you to see your defense mechanisms in action and to disengage from them, rather than a replacement for it.

28 comments

    I can identify my past self among your descriptions here. Having suffered from depression from very early childhood (so through all my formative years) and not realising it until it manifested itself through anxiety in my early twenties. Then rage set in as I began the long difficult process of self exploration. Unfortunately life often interrupted the healing process and because of other commitments I put my self needs on hold for many years- often screaming silently inside as a result. Eventually returning to therapy and self exploration in later years it is only now that I am bordering on peace and acceptance of myself. But it remains a constant evolving process which I regularly need to check and review to maintain well-being.

    I like the way you convey so much important information in a concise, clear way. An English professor of mine in college once told me that “clarity is everything” and I’d say you’ve mastered that and then some. I’m realizing there are some holes in my psychology education. For example, after reading about “disintegration anxiety” which is a new term/concept for me , I had some “aha” moments.

    In an earlier post, you talked about non-successful art lacking dimension and depth. I’m aware that some artists actually purposefully strive for that feeling. Edward Hopper would be a good example. In one piece, he depicted lonely, isolated diners in a fifties coffee shop. He managed to capture a flat, devoid-of-life existence where the air was dank with emptiness. In fact, one gets the feeling the very air and atmosphere in the piece was almost sucked out by a giant vaccuum. Another piece shows a single solitary soul reading in a chair. The viewpoint was thru small window of a giant, depersonalized apartment complex. Hopper was trying (and in my opinion succeeded) in conveying that flat, empty, stark feeling. Some would say the piece lacked dimension, depth and feeling. I maintain he produced some of the most important art in the 21st century.

    The other thing, is that I’m not convinced that there is a thing such as an unsuccessful piece of art. It’s all so subjective. And if the creator of the piece felt free, thoughtful and relaxed constructing the piece (but others hated the outcome) I think the art could still be considered a success because the artist felt wonderful while producting it.

    Thanks for your insights in your blog and making it available to others. Keep up the good work! Your are encouraging others to think deeply and contemplatively and that’s a good thing . . .

    Very interesting ideas. I know what you mean about Hopper; but at least to me, his paintings don’t feel flat or devoid of life. They feel desolate, bleak, lonely, sometimes desperate. I like your astute description of his work but I could also argue that those paintings contain and convey the feelings I mentioned. They vividly convey an experience of emotional desolation that’s quite powerful in its own way. I don’t have a “flat” response to his work, do you? As for unsuccessful art, I suppose we’d have to look at it from two different points of view, that of the artist and that of the audience. It may be a “success” for the artist, as you say, but unless the artist paints/writes/composes only for him- or herself, then surely audience response matters.

    Quite frankly I don´t feel no rage, I just feel numb still functioning going to work but hardley anything else. I had a psychotherapy in the 90ties for about 2.5 years it did not give me anything. Now I´m just taking pills but somehow I have the feeling they don´t realy help, but my experience with my therapy does not exactly make me feel like wanne go to another one

    Martin complains of gaining nothing from 2.5 years of therapy:
    If his therapist was properly qualified, (some are posers), and Martin had spoken of his feelings as he does in his post – the result may have been more constructive.

    I’m in my late 20’s. I had been incorrectly diagnosed with cardiomyopathy in the summer of ’09, because my pacemaker (for Mobitz II heartblock) was improperly programmed. I went through a really difficult emotional time, left to my own resources reading about the “LV Dysfunction” that according to the materials given to me, could kill me in a decade. This, along with insurance company dishonesty (they bailed; I apparently owe the hospital $53,000) threw me into a darker, depressed world for more than year. One which I have yet to full escape from. This past summer, I was having issues with alcohol abuse, having panic attacks, depression, hostility, instances of rage – followed always by intense regret (sometimes instant, as I realized what I had said/done) and almost a total unfamiliarity with myself. I was often shocked at what I was capable of saying, doing without realizing at the time.

    So, I took the drugs for several months (Celexa, Ativan), but eventually got tired of the odd emotional vacuity they put me in. The world was not the same. I quit them, along with the alcohol completely, months ago. Yet, even today, though it has been quite some time, I find myself again lashing out at people I care about. I’ll be fine for long periods of time – happy, “normal.” Then I’ll wake up one day, edgy, irritable. I’ll try to ignore an intensity in my mind all day. And then emotional turmoil washes in. And I have to speak, often in judgemental ways, to untie the knot. It just comes out. I don’t know what to do. I am exploring as much as I can, but my resources are so limited. I am a positive person, I can be very attentive and involved. All this emotional stuff feels like such a waste of my natural energy.

    I’m glad to hear you rejected the meds. It sounds to me like the difficulty has to do with reaching a point where you can no longer bear your emotional experience; it overwhelms you and you end up expelling it in some way — a temporary relief that makes you feel worse afterward. If you can’t afford to get into regular psychotherapy with someone who can help you to deal with these issues, it might help to explore mindfulness meditation. You referred to “an intensity” in your mind; that sounds to me like what I do when I work myself up over some issue by “thinking” about it all day. It’s an issue I discussed in an earlier post that you might find useful. What you need are some additional tools to help you take better care of yourself so you can muster your resources and manage your outbursts.

    I respect how you said that working on these issues takes years – not 6 visits as managed care prescribes with many insurance contracts. For people who’s insurance or financial circumstances don’t allow for years of psychotherapy, what do you recommend for them when they’re struggling with depression or anxiety?

    I personally have struggled with these issues and have had the benefit of 20 plus years of therapy. My therapist is in the process of retiring. Over the years I’ve realized how fortunate I’ve been to find a truly empathic, competent therapist who could re-parent me so that I now have more tools to deal with my underlying depression.

    My task now is to move beyond psychotherapy which is how I found your work. If you’ve written posts on how to transition from a long term therapy relationship to life without your therapist and could put the links in your blog, I’d love to read what your thoughts. I really appreciate your perspective and your work is helping me through this time.

    Thanks so much for sharing your wisdom.

    I haven’t written anything directly on the subject of transitioning. I’ll have to think it over and see if I have anything to add. For me, it was an adjustment that took years, not in any traumatic sense — it’s just that, like you, I’d be in treatment for so long it took me a quite a while to start doing the investigative work on my own, without my therapist to turn to. He always used to say to me that the goal of our work was to give me the tools so that I could continue the work alone; it sounds as if your therapist gave you those tools.

    Funny, I have depression and am unemployed post-college graduation, and in the past couple years I’ve referred to my view of the world as “apocalyptic”. I fear my generation is doomed, that there will be fewer and fewer jobs for us as time goes on. I am terrified of approaching potential employers. I shop compulsively. I cannot stay awake. And I sense that I want to bite the hand that feeds me. My problems are mine, and yet I want to rage at other people. I don’t want a therapist to see how phenomenally entitled, how spoilt, how rageful I really am; how I dwell on injuries from childhood and adolescence, how I travel a little hamster wheel of resentment and terror until it exhausts me and I have to sleep again.

    But I sense how correct you are: my depression is overwhelmingly rage, with no place to go.

    Andrea, a remarkably honest reply. You have a lot more understanding of yourself than most people with the same issues. I thought of you when I wrote today’s post about narcissistic rage and wondered what you’d think of it.

    I read this post and others on anxiety. Of course, this is an area of interest for someone like myself with ocd although I don’t like to read a lot on the subject. My desire to avoid any emotional pain that might surface through therapy or if someone were to something mean does not mean that I don’t think I could take it in the long run. However, I don’t know if I would fall to pieces and never make it back to where I am. When I was in so much emotional pain, I had to quit one job where symptoms first manifest and did not know if I would ever hold a job again. I did great in school but going everywhere was difficult and I had a lot of meltdowns.

    I don’t want to feel that kind of pain again nor do I want to feel pain with other emotions or hurt feelings. But if I didn’t have to work, I might be willing to try. But I have to be perky for my job and able to concentrate. I can’t fake it if I ‘m not feeling perky so I can’t have things to deal with like this.

    I think I am of greatest worth to my family if I work. I offered to help pick up leaves, which I have done a little in past years. My fears of contamination are about hurting others. So I can work in the yard. But sometimes I see things that make me nervous. If I could go through a decontamination shower before coming inside, then there wouldn’t be a problem. So after I am done, I have to concern myself with the porch, inside of the house, my clothes, etc. They didn’t want to deal with my meltdowns and paid someone. They said I might miss work also if my allergies were to act up.

    There are a lot of things that they don’t make me do as I am scared to even go in the kitchen and basement. When my mom and I had to leave home last Fall, we were with my sister and husband. They were very gracious. But my BIL had this philosophy of facing fears and made me do something that I was afraid of. It only made me more afraid. Things have been manageable within recent years and having to leave in the Fall was due to probably delusions from oxygen levels being off, which was temporary. However, we thought we were leaving for good. Next to ocd, I have never been through the kind of emotional pain that I went through thinking of how my dad would feel abandoned. My mom was able to get into a therapist pretty quick who accessed the situation and as my dad was stable after medical treatment for his health problem where he nearly died, we were able to return home. It hurt so much thinking of my dad being abandoned by my mom. I didn’t want him to think I rejected him either.

    So I just hope to be able to function like this and hold down my job, which I have had for years. I hope that my parents can take care of me and that I can help bring in income.

    I can’t stand to live with other people for a variety of reasons including my shyness and ocd. I did live with other people prior to ocd and in some cases that went quite well.

    It is hard to talk about abuse even with therapists and I never had therapy that was geared towards that. They might be nice sometimes but most of the time they have glazed over eyes. Or maybe they are just trying to be calm, which in some cases helps a lot. But when they verbally minimize my feelings saying that some have dealt with a lot worse, it makes me not want to share. That therapy was behavioral therapy and not geared towards my ocd even. A lot of money spent that was down the drain really. I didn’t go that long but it was leading nowhere. Ocd doesn’t exist sitting in a chair across from someone. Well, I felt contaminated there but talking about it did nothing long term. I was forced to quit seeing that therapist.

    When I told someone on the phone about abuse, they are like sometimes you need to talk about it. Then, I sent them a few emails. I was in a manic state so I went on at too much length. They never even acknowledged a single thing in my email. They ignored it 100 per cent.

    But I guess venting probably doesn’t do such much good when you tend intellectualize things like me and aren’t really getting in touch with your feelings. As I said, I can’t afford to do that as I have to hold it together. In many ways, I have a sense of well-being.

    As I was reading your article I realized that from the age of around 7 to 17 I was experiencing post-apocalyptic rage caused by a bi-polar step father and a mother who suffered from the “rejected self” form of depression. She dumped all of the side effects of that form of depression on me mostly, but also my 3 sibblings. Anyway, while probably not the norm for most people, I actually fought off my form of depression by myself. I never realized I was depressed, I always thought it was a temper issue, thus I never sought out any help. One day I just vowed to change. I didn’t want to live with the horrible rage and the lack of ever feeling anything any longer. It took a while to get into the routine of lowering my automatic defenses whenever an arguement came about but I did it. I’m now a happy 22 year old with no rage, numbness, or repressed feelings. The human body can do amaizing things when its determined.

    That’s wonderful, Allyssa. What you’re describing is the journey most of us need to make in lowering our “automatic defenses,” as you put it. Not an easy road but I’m sure you’d agree it’s well worth the effort.

    after sporadic depressions for as long as I can remember, I started therapy and experienced an acceptance of me – the whole me – previously unknown to me. I now try to feel my emotions, and – allthough I’ve always been able to rationalize any behavior and think my way out of everything – I find that I can no longer fool myself. When I’m stressed out before my perfectionistic mother comes to visit, I can no longer yell at my husbond for annoying things that he does. I know that I’m in the wrong. So I appologize for the attempted yelling, and am left with a tearing feeling of pain. It is a wordless sorrow, like my soul hurts – it’s the opposite of weltschmerz, it’s ichschmerz. I can see that yelling isn’t helping, but The pain confuses me. My map is no use in this terrain. I’m lost for words, it’s all feeling. Is this really me? Is this how bad I actually feel about myself?

    It’s so incredibly difficult to do what you’re describing … I really admire the effort. If it helps, from my own experience with the same battle, the longer you struggle and the better you are able to keep from inflicting those emotions on your loved ones, the better you will feel about yourself. It’s a topic I discussed in my post on the healing of shame.

    When I read this:

    “This kind of client needs the safety of ongoing psychotherapy and a strong empathic connection with the right therapist. I’m not sure I would go so far as to call it “re-parenting”, but given the insecurities of their early attachment, such clients need to regress and become emotionally dependent to a significant degree; they almost always need to come more than once a week.”

    it made me really jealous. I wanted that from therapy but I never found it. I don’t know if I’m just not the right candidate for this type of empathic, ‘re-parenting’ kind of therapy, or maybe I expected too much from the beginning, but it seems as though the therapists I’ve seen in the past do not see me as someone who suffers intensely, and it makes me jealous of other people who get more attention for their problems.

    Whenever I have feel rage it often has to do with the feeling of having my problems dismissed or ignored. This rage often intensified during therapy, particularly when I felt the therapist didn’t understand how difficult things were.

    It’s a kind of work most therapists don’t want or know how to do. It’s emotionally demanding and time-consuming. And because insurance companies have become less and less generous about covering long-term therapy, not many people can afford it, either.

    This column is most distressing. As one who is depressed and have in the past reading. this truly reinforces the hopeless feeling that treatment and help is a luxury out of my reach. “It takes years” is not financially possible for myself and a lot of people. Sadly what I can afford is a cheap prescription which is hazardous. It does seem hopeless.

    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.

    Such disintegration may be experienced as a kind of personal psychic death; the depressive feelings that result are…hopeless despair that anything can be done to salvage the fragmented self.

    Unfortunately, these describe me and my experience to a tee. The first quote is dead on…things that I once could experience as meaningful and evocative and moving or otherwise poignant have been stripped of all of that emotional content and replaced by this suffocating, omnipresent feeling state of despair and meaninglessness, but the despair has no apparent context…kind of like waking up once day with a stick jammed into your eye and having NO idea why it’s there or why it won’t go awaay. Four years later, I still can’t see what it’s got to do with…not on a clear, gut-level anyway.

    My therapist believes it’s a kind of unconscious self-punishment for attempting to move into adulthood (my symptoms were triggered when I attempted to have an real, adult relationship for once).

    But, it’s so hard to get to this place when the depression acts as a kind of sensory cotton or insulation between you and meaning. How does one cut through that?

    Also, the physical part. It feels like a heavy fog in the front part of my head, like wearing an old fashioned diving bell around all day. It’s truly horrifying.

    The second quote also described me perfectly. There’s this feeling lodged into my consciousness – and even when I’m dreaming – that this “broken-ness” is permanent and un-fixable, even if I don’t really know what exactly is broken. All I can experience most of the time are the symptoms, which make it hard to see or understand anything or to feel anything.

    But, one thing I do know. I’m very, very, very angry…and it comes out in various ways. It doesn’t have much focus. Mostly, I’m angry that I have to live with and deal with being in this God-awful place all the time.

    At this point, I’m just hoping that somehow, some way, something will shift for me internally and I’ll get some clarity of some kind that will alleviate the symptoms and allow me to actually live my life.

    The anger is key. I can’t say for sure, but my guess would be that there’s a kind of unconscious raging that goes on inside; the depression you feel is the result, where in your rage you have laid waste to everything, including your own mind. Moving forward means becoming fully conscious of the degree of rage and its effects, then learning how to defuse it, quiet it, bring it under control. Often this work is part of the transference, where the rage enters into your relationship with your therapist; his or her ability to tolerate your rage and bear with you will help. But it’s a long process.

    Thanks for your insight. I wonder if you ascribe to the Freudian catharsis idea, where one “taps into” a kind of reservoir of repressed emotions and “gets it out” and then feels relief from their symptoms. Or if you feel that becoming aware of the feelings is more important than just feeling them.

    Thanks again.

    I don’t believe in the value of “catharsis”. In an earlier post, I talked about how therapy can easily become a kind of “dumping”, where clients bring up all sorts of painful feelings in session and feel better afterward, but mostly because they’ve unloaded on the therapist. I think becoming aware and learning to bear with intense feeling (and not be overwhelmed or ruled by it) is the goal.

    The “toilet” post is great. Early in my therapy, I had numerous dreams featuring toilets. My therapist and I had some interesting discussions about these.

    Thanks, Joe.

    Reading this makes me feel understood and helps me understand that myself. I am grateful that I have a therapist that is willing to help me despite my neediness. I berate myself constantly for being dependent ànd in my mind weak and just recently have given myself a break. My therapist has never made me feel like I was too much trouble and yet I fear that he wishes I would go away. I’m constantly arguing with myself over whether or not to reach out when the desire to hurt myself becomes too overwhelming.
    Feeling that I’m not worth anyone’s time or that I don’t deserve to be cared about kept me from asking for help. The harder I tried to be okay on my own the more self destructive I became. I not only punished myself, I stayed in an abusive relationship and turned to drugs. I have a hard time being angry at people that hurt me. When my therapist asked me to write an angry letter to my rapist, I struggled because I had never acknowledged any anger. Trying to accept how I feel without shame devouring me is a challenge.
    Thank you for sharing so much with all of us.

    You’re welcome. Sometimes we feel that the solution to our difficulties is to kill off or get rid of our needy, vulnerable side, as if that were possible. Sounds like you have a good therapist.

    I’m curious about the text, “Whatever our theoretical orientation, most of us understand that when mother-baby relationships go awry, for varying reasons, it affects the child’s developing sense of self. The more unreliable those early experiences (i.e., the more unavailable or inconsistent the mother), the shakier the child’s sense of self. ”

    In your writing I hear blame and assigned responsibility only to mothers for “child(rens) developing sense of self.” As a therapist I meet daily with adolescents and adults who experience depression and other issues based on their attachment (or lack of attachment) with their fathers. I also know gay (male) couples who have well adjusted children at all ages, and whose children had no female “parent figure” involved in their upbringing. I agree that attachment issues between an infant and mother can create problems, however, there are many adults in life whose relationship with their mother was less than perfect and even non-existent or abusive, but still manage to have a relatively healthy sense of self. There are people whose sense of self was devastatingly destroyed by their father. And, there are people who have grown up in incredibly functional homes who had great attachment with their parents (mother) who are immobilized by their dysfunction.

    I believe dysfunction does not alway beget dysfunction and health does not always beget health. Each individual story much be seen as just that, individual…both in it’s causation and healing. As a survivor of sexual abuse I have to remind myself (often) to remain vigilent in not transferring or countertransferring my issues unto the men and women who sit across from me, especially my wounded self that sometimes see all men as evil and all women as victims. Somedays it’s tough

    Having failed to connect with my psychotherapist and thus been moved to the care of a community psychiatric nurse I underwent nearly 2 years of CBT. I was discharged from her care about 18 months ago but have now found that the utter emptyiness and rage has returned. The overiding thing I ‘feel’ now is the want to just be gone and the sense of inner pain to step. I wish someone could actually help with this and understand what I mean.

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