What is Causing my Depression? A Psychodynamic Perspective on How we Don’t Think

In an earlier commentary I spoke about the important and often times unrecognized role loss plays in depression. I detailed and began to discuss why some of us suffer from depression while others have a capacity to better tolerate everyday feelings of disappointment and sadness. I mentioned that the symptoms typically associated with depression are designed to not think and/or experience painful feeling around loss. Not thinking is second factor that operates behind the depressive scene so it is important to understand the role it plays.

I would now like to say a little more about thinking, and how many people wrongly believe they have a capacity to think, and ‘analyze’ their problems. Many people have ‘thoughts,’ but thoughts are not thinking. Thoughts, more often than not, are persecutory in nature, obsessive, and leave one stuck and depressed. Thoughts are often critical, or judgmental, of oneself of others, and this only leads to further problems and provides no genuine relief.

Transformation of Thoughts to Thinking: Couples Therapy

In order to protect the identity and anonymity of my patients I will not talk about any one couple’s experience. The following example of a couple in psychotherapy treatment describes a composite of many couple’s issues.

A couple comes into session appearing defeated, hopeless, and depressed. Initially they can’t talk about that which put them in this state but can only use generalizations, accusations, and express an overwhelming sense that things are hopeless. Close exploration reveals that she made a simple request, such as he clean such and such a thing in the apartment, prepare a meal, or drive her to a certain venue. He agreed to this request, but when it came time to perform the act, he got busy with work, confused about what was asked of him, or just outright forgot that he made this commitment. Her initial response was one of rage, she went on the attack and accused him of being lazy and stupid.  He felt badly, and could see how she would think this of him, and in fact admitted that often times he forgets and gets confused when she asks him to do things.

As I helped them look at this example more closely, I had in mind my psychodynamic perspective, admittedly my own bias in listening to the material. If we are to come to a more meaningful understanding of what happened in these situations, and for this understanding to have any value, it must unite with prior experiences that are scattered and forgotten. The goal is to introduce order where the appearance of disorder reigns. I want to help this couple discover, much like I do with my individual patients who come to me in distress, a new fact in their story, a fact unknown, but one that will be sure to unite past and present.

Her Contribution:

As we talk about the incident it slowly becomes clear that the he is perceived as someone who is supposed to be there for her, who is supposed to soothe, comfort, mirror and take care of her when she has a need.  This, as I discussed in my first commentary, is quite common when someone lacks that inner maternal smile. When that internalized image of the comforting caregiver is missing there is a fragile sense of self, I explained. Since one’s inner self is fragile and does not have the resources to manage emotions IF she, in this example, can control his behavior she can also control the flow of sustenance and love. She will accuse him, and call him names (judgmental thoughts) in an attempt to self-justify her behavior BUT she will not THINK about her problems as arising from within.  This is what I call not-thinking. It is only when I can help her begin to think that she can locate and begin to talk about the problem as an intense feeling of having been abandoned. However, the abandonment is not just coming from him, any longer, it gets linked up with earlier more traumatic losses that have not yet been processed because of her inability to think.  

Once she recognizes that she cannot control him, completely, the wish and hope for love and nurturance is again lost. The inability to think negates the necessity of confronting these issues and weakens the capacity to mourn the loss (of him/her primary caregiver not being there for her). As these kinds of incidents get discussed, and a capacity for thinking grows strong, one can begin to see and articulate long forgotten wishes that someone should have and should be there for her.  The past is in the present and the present is a replay of the past

His Contribution:

Much more will need to be said about his contribution to this ongoing struggle in a later commentary but in short, the question for him to ‘think’ about is, how is it he ‘forgot’ or got too busy to fulfill her request. How did he suddenly get too tired, or busy with work? These are the questions I would help him begin to think about, especially since there is systematic repetition in the way he does not fulfill a need of hers. Why does he initially agree to go along with the request to only later frustrate her wish and need for him to be there for her, I would help him consider. We can slowly begin to see, as he started engaging his mind in the thinking process, that he too has an image in mind. His is one of a relationship between a scolding, controlling other (again, we needed to look back at his own history with his significant caregiver) and an incompetent, weak, impotent and depressed self.

Wrapping it Up:

The work of thinking is accomplished, in part, by a trained professional who can function, and provide for the patient, an apparatus for thinking. I help this couple, through my own capacity to think with them, begin to think about their own intolerable emotional experiences.

In this brief commentary I tried to share some of my thoughts on another factor that leads to and intensifies depression. My focus was on the incapacity to think and I tried to demonstrate how this inner limitation has interpersonal consequences. My goal is to transform unprocessed and undigested emotional thoughts into thinking. If you or someone you know is struggling to manage their emotions it may be helpful to contact and talk with a qualified mental health professional.  If you have any questions about this commentary or if you would like to set up a consultation to talk about your emotional state feel free to reach out. 

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