Depression is a complicated phenomenon, with multiple ways of seeing and understanding it. There are perspectives that focus on an organic causality (an imbalance in brain chemistry, a disease). Other perspectives focus on problems in cognition (something wrong with one’s thinking). From a psychological perspective, the one that I endeavor with my clients to understand, I find it useful to remember what the British psychoanalyst Adam Phillips said about depression: he called it “sentences left unsaid.” From my years of experience working with people struggling with depression, in individual and group psychotherapy, I find that simple sentence to be immensely true.
In my understanding of depression, there are some words, some feelings, something about that person’s true self that he or she is not expressing. Depression serves as a lid keeping those things unexpressed. From another point of view, it is the result of such censorship. A person’s psychic energy goes into the suppression of those thoughts and feelings rather than towards their expression. The result is less energy to harness in living, less vitality. That is why I believe that the opposite of depression is not happiness: it is vitality.
There may be many factors contributing to this suppression of words. Often the thrust of psychotherapy is to discover these influences. A person may believe that his thoughts or feelings are not welcome by others, that they will be met by a negative, critical or dismissive response. There have no doubt been such experiences, perhaps those occurring during significant and formative years, which have created and then reinforced these beliefs. For another person, truly expressing oneself, one’s genuine self, may not have been properly reinforced or encouraged. In such cases, the person might have felt that what was asked of him or her was to present a false self. Another person may have great fears about experiencing and expressing all his or her feelings, including those that are very painful. Such a person may believe that doing so would be an overwhelming, unbearable experience.
The work of psychotherapy involves not only understanding the forces that conspire to silence, but also speaking these words, expressing oneself. In this way, the client can experience his or her true, authentic self. That’s the goal of psychotherapy: true speech and an experience of authenticity are the hallmarks of that experience. I encourage all my clients, especially those dealing with depression, to speak their minds, whatever is on their minds. There are no thoughts that are off limits, no emotions that can’t be expressed, and in the supportive environment that the client and I create, no feelings that can’t be felt. I encourage my clients to finish their sentences, all of them. Sometimes I add some words; often I provide an attentive ear. And when clients feel that they can truly express themselves – a process that takes time and is not something achieved overnight – often symptoms recede, vitality returns, and a person is more able to be present in his or her life.