In my earlier blogs I stated that there are many different causes, or pathways, that lead to depression. The goal of this brief commentary is to focus on the role anger and aggression play in keeping the depressed mental state alive. The emphasis will be on a few different ways that anger and aggression directly impact one’s mood.
What Causes Depression? Relationship Dissatisfaction
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. However, the emotional reality is not the pain of feeling alone and abandoned because the individual does not actually accept the loss. Unlike many people who suffer a devastating loss, the fact that something is over, or has permanently changed, is not mourned. Instead, the feeling (which may or may not be conscious) is that someone took something away from me, and therefore they, or someone, has to pay.
Having someone to attack, for one thing or another, is all that seems to matter. If there was a good and satisfying relationship the constant stimulation from the blaming and attacking would eventually melt away. This good relationship, or pleasure in life, is a problem because it would allow one to slow down. If one slows down, they may begin to feel sorrow, pain or loss. A healthy and good relationship poses a real threat, and therefore must be avoided at all costs. If there is a good relationship this model I am describing would begin to break down.
One way to ensure relationship dissatisfaction is to let those who are closest to you know that you are suffering. It is not enough, however, to just let them know you are in pain, you must remind them constantly and continuously. More importantly, it needs to be made clear that there is nothing they can say, no advice they can give, or support they can offer that can ameliorate the suffering. The goal, which is not consciously intended, is to upset or frustrate the other person in an attempt to make them feel responsible for your suffering.
Anger and its Link to an Empty Feeling
Another way to punish someone is to be critical, devalue, and diminish them. This can play out internally (in one’s mind) or one may behave overtly aggressive. When you criticize and devalue a loved one, or in many situations anything of value, such as a compliment, a promotion, or a piece of advice, the important people around you begin to lose their status and value. In fact, everything, the compliments, advice, promotion, etc. all begin to lose their value. These devaluations and attacks have very serious consequences on one’s self-esteem. For instance, if you devalue your job, or partner, your own self-representation as someone connected to a devalued job/other can leave you feeling like a failure and in turn this increases the depression.
When one attacks and devalues in this aggressive way, and denigrates anything of value, this ensures the destruction of any possibility for love and connection. If this vicious cycle of attack, denigration, judgement, and criticism is not broken you can be left with an inner world devoid of meaningful, valued, and loving emotions. It is not uncommon, in fact, that I hear many depressed patients complain of an incredibly painful and visceral feeling that something is missing, there is a void of some sort, they tell me, as they point to the empty space they feel in their chest or upper stomach.
A Basic Example:
In order to protect the identity and anonymity of my patients I will not talk about any one patient experience. The following example describes a composite of several patient’s issues.
Let’s say, for instance, a male patient of mine experiences a loss or defeat of some kind. Over the preceding months, and sometimes years in a prior psychotherapy treatment, he can’t seem to put this to rest. One may hear from this person that he is all alone, nobody is there for him, and he expresses this misery in many different ways as he becomes sullen, pouty, and withdrawn. Even though he is withdrawn and depressed, appearing to not want to engage, this person may actually not want to suffer alone and would love it if someone, preferably the person who he feels hurt him, would suffer alongside of him. If he is suffering, someone should be suffering too. The thought and intent are not conscious, but just below the surface he is saying to me, in his suffering, nobody can help me, why doesn’t someone make me feel better, what is wrong with you, or you are useless to me.
There are many different meanings and reasons one becomes depressed and goes on the attack, that is why talking to someone who is highly trained and has extensive experience working with these complicated inner dynamics is incredibly important to the healing process.
What is Causing my Depression – A Few More Dynamics
There is so much more that can be said about this prototypical patient, such as his unique way of feeling loved and not alone when he creates a fight, how he needs to fight in this way because it recreates an aspect of his childhood experience of an emotionally unavailable caregiver, and how the fight and suffering defends against the greater pain of loss. Space constraints will not allow us to go into each of these dynamics, but we can see how getting angry and critical prevents and distracts him from dealing with and thinking about that which was initially lost (and all of what it means to him that something is lost forever). These things get complicated BUT lasting change is possible when one can, over time, work through and put to rest each of these dynamics.
Wrapping it Up
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, for instance, some depressed patients will get angry and critical. It is far more complicated and requires more technical tact when the 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,” which means I have to help this kind of patient express his anger more directly. Once expressed, containing and detoxifying the anger has very valuable consequences. Containment does not mean sitting around passively listening to all of the complaints. This act of containment, an active way of working with these patients, is so important that it will require its own separate article, which will be coming soon.
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 criticisms may be just the manifest level of the problem. More genuine and true feelings that are too overwhelming and therefore difficult to see and process are pushed away with anger and judgements. Treatment, that will have a lasting impact, allows one to get to these more complicated and painful idiosyncratic feelings. If you have any questions about this commentary or if you or someone you know suffers with this kind of angry depression, feel free to reach out.