Background

You may also want to see the Qualifications page, which describes my academic and professional experience.

 

(From Undoing Depression) 

             When I was 15 I came home from school one day to find that my mother had committed suicide in the basement.  She had bolted the doors and taped a note to the window saying she was out shopping and I should wait at a neighbor’s.  I knew something was wrong and was climbing in a window when my father came driving in after work.  We discovered her body together.

            She had put a plastic bag over her head and sat down at the table where I played with my chemistry set.  She ran the gas line from my Bunsen burner into the plastic bag, and turned on the gas.  Later we learned that she had also taken a lethal dose of a sleeping pill that my father sold in his job as a pharmaceutical representative.  Her body was cold, so she must have started to set things up soon after we had left the house in the morning.  This was not any cry for help; she went to a great deal of trouble to make sure she would end her life.

            Until two years before, my mother had seemed happy, confident, and outgoing.  I remember her joy getting ready to go out to a party, or singing 40's songs with my father on evening car rides.  When I look back at the course of my life, I realize now how much it has been shaped by my need to understand what happened to her.

            To understand also what was happening to me, because I’ve had my own depression to contend with.  I didn’t recognize it for a long time, though I’m a reasonably well-trained and experienced psychotherapist.  I've been a patient myself several times, but I never put a label on my problems; I always told myself I sought help for personal growth.  This is despite the fact that there were long periods in my life when I drank too much, when I alienated everyone close to me, when I could just barely get to work, when I would wake up each morning hating the thought of facing the day and my life.  There were many times I thought of suicide, but if I couldn’t forgive my mother, I couldn’t forgive myself either.  And I have children and family, patients, and colleagues I couldn’t bear to do that to.  But for many long periods life seemed so miserable, hopeless, and joyless that I wished for a way out.  Everyone who has ever been depressed knows it's impossible to be sure, but I think those days are finally behind me now.  I don't hit the deepest depths, but I live with the after-effects.  I still struggle with the emotional habits of depression.  But accepting the fact that it's going to be a long struggle has made me more able to deal with the short-term ups and downs.

 

            I believe now that depression can never be fully grasped by mental health professionals who have not experienced it.  I've repeatedly seen "comprehensive" theories of depression develop, flourish and dominate the field for a time, then be rejected because new, contradictory evidence is found.  These are all theories that try to explain depression from a single point of reference--the unconscious, the brain and its chemistry, cognitive processes, family interaction.  Many psychologists and psychiatrists seem to have a fatal predilection for theory-building--for making their experiences fit with some pre-existing theory, or for destroying someone else's theory, or for developing a new theory that will explain it all--rather than trying to figure out practical ways to help their patients.  They get too far away from experience.  I realize now that no simple, single-factor theory of depression will ever work.  Depression is partly in our genes, partly in our childhood experience, partly in our way of thinking, partly in our brains, partly in our ways of handling emotions.  It affects our whole being.

            Every patient I’ve ever known who was depressed had a difficult childhood. Sometimes it was a very critical, demanding father, sometimes a cold, narcissistic mother, sometimes both, sometimes variations on these themes. The death of a parent at an early age or loss of the parental relationship through divorce or separation certainly seems to make people susceptible.

            On the other hand, I can’t find such evidence in my mother’s story. I remember her parents as warm and loving. She was the youngest of three daughters,  the baby of the family. My grandfather was a factory worker and they were not well off, but the family seemed happy and stable. Photographs show a happy child and adolescent. She was successful and popular in school.

            When we left West Virginia for Chicago, her troubles seemed to start. I was an only child. My growing up deprived her of what had been her major function in life—raising me. She had trouble making friends and she and my father fought bitterly. She tried working but didn’t stick with anything. She started to drink and abuse prescription drugs, and would spend hours watching television, dressed in her nightgown and slippers all day long.

            But I know my perception of my grandparents, who may have been warm, loving, and indulgent with a child who was not their primary responsibility, may have been vastly different from my mother’s. It may ultimately be that she experienced her childhood as difficult or depriving for reasons that other people may not be able to understand. It may be that she was genetically predisposed to be unable to respond effectively to stress and isolation.

            My case is similar. It’s possible be that I’ve inherited some genetic predisposition to depression. I certainly worry about it in my children. I also know that my childhood experiences, and my mother’s death and its aftermath, left me angry at the world, suspicious and reserved, wanting very much to be loved but afraid to trust—a sure setup for depression.

 

For many years I was haunted by the belief that I wouldn’t live past my thirty-eighth birthday. That was my mother’s age when she took her life, and I was obsessed with the idea that I couldn’t outlive her, that whatever drove her over the edge would catch up with me. I’ve since learned that this is a common fear among the children of suicides.

            After my mother died, what I felt, consciously, was anger. I blamed her for being selfish, and I could not believe that she had ever really cared about me. My father and I grew apart; he quickly remarried and I had a new family before I was ready. Rather than let myself feel rejected by my parents, I rejected them. I developed an icy armor. I threw myself into the one thing I knew I could do well, school. I had terrific grades and SAT scores, and was editor of the yearbook. I won a scholarship to a college a thousand miles away from home. I told myself I’d never look back.

            But I was unprepared for the fact that there would be lots of people as bright as I at college. It turned out everything I’d accomplished in high school was easy; now that I didn’t stand out, things were tough. I got scared. I learned to drink. I became desperate to fit in. My grades were lousy. I wasted four years of college and a few years afterward, scared and depressed. I still had this self-image of a tragic hero who was going to write the great American novel, or accomplish something else earth-shaking. But I didn’t write or do anything else constructive. My idea of myself as a misunderstood genius was a pitiful attempt not to need anyone. I didn’t recognize my real fear, that if I let myself depend on someone again, I could lose them again—and of course it would be my fault, because deep down inside I was truly unlovable. I started mixing alcohol and pills, the same sleeping pills my mother had used. There were nights when I didn’t care if I woke up the next morning.

            Something motivated me to get help. I went to see a therapist a friend recommended. It turned out to be a husband-and-wife team, practicing some of the gimmicky Transactional Analysis–type stuff so popular in the seventies. They passed me back and forth between them and had me join a group they were running. It was pretty hokey, but very helpful. They helped me realize I needed to change my life—to stop hanging back and embrace living. During this time I changed careers and got married.

            I went to graduate school and did pretty well, but I had a problem with stage fright; I couldn’t speak up in class. I told one of my professors about it, and also a little about my background. She recommended that I see a colleague of hers, a psychoanalytically trained psychiatrist.

            What happened next wasn’t the psychiatrist’s fault. Just after our first appointment, he came down with a serious illness that laid him up for several months. When he came back, he seemed weak and frail. In his office on the twenty-third floor, he sat between me and the window. I had a full-blown anxiety attack in his office, feeling that something was drawing me out the window. It was devastating, the worst feeling that I ever remembered, and it happened every session after that for three years.  I was trying to mourn my mother’s death, but I didn’t feel safe; all I could feel was panic, not grief.

            This is what we call an iatrogenic problem—a problem induced by the treatment. Perhaps if the psychiatrist hadn’t been sick, or if he hadn’t presented himself as so gentle and tentative, I would have felt safe. As it was, I couldn’t feel comforted in his presence. This was despite the fact that I consciously liked and respected him, and still do. My life on the outside went along pretty well. We had children, and I discovered I was a good father. I did well in graduate school and began to enjoy my work. But every week I would be sweating bullets in his office, convinced I was doomed. My phobia generalized; soon I couldn’t go up in any tall buildings, or cross bridges.

            Perhaps this helped me by confining my depression, as it were, to this one symptom and letting me get on with my life. Even if this were true, though, it’s not how therapy is supposed to work. Besides, these weekly episodes of pure terror were eating away at my self-esteem, making me feel as if there were a demon inside me I couldn’t control. It seems incredible to me now that both the psychiatrist and I let this drag on for so long. I hope that if I were the therapist in this situation, I would say, Look, this is crazy. Let’s try something different. Let’s try some medication, or behavior therapy, or let me refer you to a colleague for a fresh start.

            I was thirty-five and still believed time was running out for me, and that I wasn’t getting the help I needed. I extricated myself from the situation by getting accepted as an analytic subject at the Chicago Institute for Psychoanalysis—I knew this was something my psychiatrist couldn’t argue with. We parted company.

            When I met my analyst, I was somewhat disappointed that he wasn’t much older than I was—how much could he know? But he was a respected psychologist who had already published with some high-powered thinkers in analysis. I rather liked him—he was pretty unstuffy for an analyst, had a quirky sense of humor, and seemed to respect me. I stayed with him for another five years, getting through my thirty-eighth birthday unscathed, with a real sense of relief. We worked on my phobia together, and I felt comforted and supported. I enjoyed the analytic process, and recommend it highly as a growth experience.

            I was finally able to talk about the bind I was in regarding my mother.  It seemed to me that either she had correctly perceived the futility and meaninglessness of life, or she didn’t love me.  Neither alternative was acceptable to me.  But somewhere along the line I learned to understand her better and to forgive her a little. She knew what her choices were. She had seen her older sister impoverished by divorce, finally forced into another abusive marriage as an economic necessity. Isolated from her family, stuck in a loveless marriage, my mother could see no alternatives. Her suicide was both a result of despair and a gesture of defiance. She was so far down in the well, her vision so distorted, that her choice made sense at the time. 

            I’m not symptom-free, but I haven’t felt the need for regular treatment. I still have periods of depression. I have a psychiatrist I trust to help me with medication when I need it, and a therapist I know who I can turn to when I need to. I’m still working on all this; in discussing this book with my father before his death, he gave me still another perspective on my mother. He reminded me of how guilty she felt about being depressed, the horrible debt that the cost of her treatment had placed upon the family. In a sad, twisted way, her suicide was also a self-sacrifice. She saw herself as a burden on us; removing that burden was, in her mind, a gift to us. This point of view certainly helps me feel less anger toward her, but I can’t help feeling a little guilty now, and the terrible implicit sadness is something I can take only in small doses.

            A while ago my analyst sent me a copy of a paper he was writing.  He used an incident in my analysis to illustrate a point he wanted to make. In doing so, he had to summarize my background and treatment. I was knocked for a loop. There was much in the analysis that I had repressed. I had repressed all the times I spent on his couch, writhing in terror and anxiety, trying not to hear what he had to say. We had gotten past my height phobia; there were times when I felt very safe with him and times when I didn’t feel safe at all. And seeing my case history laid out in objective clinical terms, I was overwhelmed with feeling for my self: pity, but not self-pity in the usual sense; more the kind of objective empathy we might feel for a stranger. Some of that compassionate curiosity. Also, I could see that, while my analyst had a particular theoretical point of view about my problems, I had a different one. This wasn’t news. During the analysis we had often disagreed on this subject, but both felt we were in good agreement as far as the practical implications for me. It got me thinking about how doctrinaire I used to be, and how I seem to have gotten away from that.

            What all this has made me realize is that therapy—and probably medication—doesn’t really work for the reasons professionals think it does. My first therapists, with their naïve enthusiasm, helped me greatly using methods that no one takes seriously now. My second, with all his expertise, did me more harm than good. My analyst helped me a great deal—but I think he did it by acting like a caring, respectful friend I could lean on, and he thinks he did it by helping me get in touch with repressed impulses. Most psychopharmacologists believe sincerely in their pills, even though they can’t explain how they're supposed to work..  The therapists at the clinic I directed—from a variety of training, backgrounds, and disciplines—were usually quite helpful with their clients, but all had different explanations for how therapy works.

            So it doesn’t matter how you get better, as long as you get better. The wiser, warmer, more experienced therapists can probably help you more reliably, but I think it’s like teaching a child how to ride a bicycle. You can explain how to steer and how the pedals work, but you can’t explain balance and momentum. You have to hold the bicycle up while the child learns these things for himself.

            A good psychotherapy is in essence a creation, a change in the patient’s way of being, crafted by the patient and the therapist in a mutual process. For many patients it may be their first creative effort since kindergarten.

 

 

 

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