Anger and Aggression: Another Cause of Depression
In my earlier articles, I state that there are many different causes of and pathways to depression. This commentary focuses on the role anger and aggression play in keeping the depressed mental state alive (i.e., allowing it to persist). It puts particular emphasis on a few ways anger and aggression directly impact one’s mood.
Relationship Dissatisfaction as a Cause of Anger and Aggression
Depression can sometimes be triggered by a traumatic event, such as the death of a loved one, a break-up or divorce, or any abrupt and unanticipated changed circumstance. For some, the pain associated with these changes is not actually the pain of loss. Unlike most who suffer devastating loss, some individuals do not accept the reality of the situation.
They do not mourn the loss because they do not accept the loss. Instead, such individuals feel–unconsciously or consciously––that someone took something from them and that this person (or someone) needs to pay. Oftentimes, this will present itself as conflict in a relationship.
In these instances, all that seems to matter is having someone to attack. These individuals do this as a means of avoiding the original loss. They seek constant stimulation by attacking and blaming their partners in order to destabilize the relationship. Stable, good relationships pose a threat to these individuals because such relationships allow them to slow down. In the process of slowing down, they may begin to feel sorrow, pain, or loss. Thus, a healthy relationship must be avoided at all costs! One way that these individuals can cause relationship dissatisfaction is by constantly letting those closest to them know that they are suffering and that others can do nothing about it. There is nothing they can say, no advice they can give, or support they can offer that can ameliorate the suffering. The unconscious goal is to upset or frustrate the other person in an attempt to make them feel responsible for their suffering.
Is Anger Filling or Creating a Void?
Depressed patients often describe an incredibly painful and visceral feeling that something is missing as they point to an “empty” space embodied in their chest and/or stomach. Similar to the creation of relationship dissatisfaction, criticism and devaluation are employed in an attempt to punish others and diminish feelings of emptiness. Such actions can play out internally in one’s mind or externally through overt aggression. Constant criticism of anything of value (e.g., compliments, promotions, advice) results in a loss of status for those who gave these valuable things (i.e., the important people in one’s life). Eventually, everything begins to lose their inherent value. These actions create a self-fulfilling prophecy: by devaluing the qualities of their life (e.g., job, partner), depressed patients feel a sense of failure and worsening depression simply because of their connection to the aspect they degrade. When one attacks, devalues, and denigrates anything of value, this ensures the destruction of any possibility for love and connection. If this vicious cycle of attack, denigration, judgment, and criticism is not broken, these individuals are left with an inner world devoid of meaningful, valued, and loving emotions (hence, the ‘empty’ space mentioned earlier).
The following is an example of a depressed patient enacting anger and aggression. In order to protect the anonymity of my patients,I present this case as a composite of many patients’ experiences.
In this example, a male patient experiences a loss or defeat that troubles him. Over the preceding months––and sometimes years in a prior psychotherapy treatment––he could not put this issue to rest. He tells me that he is all alone with nobody there for him, and he expresses this misery in many different ways by becoming sullen, pouty, and withdrawn. He expresses that he does not want to suffer. What he may actually be saying is that he does not want to suffer alone and would love nothing more than to have someone else suffer alongside him. In other words, if he is suffering, someone should be suffering too.
Without the experience of a highly trained professional, he may never become aware of these hidden meanings behind his anger and depression. Understanding these complicated inner dynamics are incredibly important to his healing process. Ultimately, his anger and criticism prevent him from dealing with and thinking about the original loss and what this means for him. While complicated, lasting and helpful change is possible over time when one is actively working through these dynamics.
How I treat the underlying anger
In my work with depressed patients, the main goal is to help them begin to examine and think about what they are feeling. The fact that one is depressed indicates that, while they know something is wrong, they are not yet able to deal with the feelings that are causing the depression. In other words, rather than deal with the feelings and solve the problem, they get angry and critical. A great deal of tact is required when this anger comes out indirectly in the form of pouting, whining, and complaining about how most things in life are of little value. With this in mind, the first treatment step is “containment,” in which I help this individual express their anger more directly. Once expressed, containing and detoxifying the anger has valuable consequences. Containment does not mean sitting around passively listening to all of the complaints; rather, the act of containment is an active way of working with these patients. While unable to describe in much detail here, the importance and concept of containment will be discussed in its own separate article.
Wrapping It up
If you or someone you know suffers with this kind of angry depression, it is important to keep in mind that the depression, anger, and criticism may be just the manifest level of the problem. Such anger and judgment serve to push away the more genuine and true feelings that are too overwhelming and difficult to see and process. Treatment, allows one to push past the superficial expressions of anger and get to these more complicated and painful idiosyncratic feelings.
If you or someone you know is struggling with anger and depression, it may be helpful to speak with a qualified mental health professional. If you have any questions about this commentary or if you would like to set up a consultation, please call my office at 212-591-0152 or fill out the form at this contact page. From there, I can review your case and offer you a treatment plan to meet your needs.