Voicelessness: Depression

(The fifth in a series on the adult consequences of "voicelessness")

At 3:00 a.m., millions of mental alarm clocks go off all over the world, waking people in a panic:

"What's the point? Do I really matter to anyone? Do I exist in other people's lives? Who knows me? Who cares? Why do I feel so unimportant?"

Some get back to sleep after an hour or two of tossing and turning. Others start their day at this early hour filled with dread. They look forward to daytime activities that may distract them from their despair for a few moments.

Modern psychiatry defines people with such thoughts as having a biochemical disorder, as candidates for antidepressants. Indeed, early morning awakening is one hallmark of depression. Nevertheless, before we dismiss the problem with a simple prescription, it's worth taking a closer look.

It would be comforting to think depression is a simple biochemical problem. The solution would be easy and relatively inexpensive: prescribe the right pill. But mounting evidence suggests that the current antidepressants, while often helpful and occasionally life saving, are matched in their effectiveness by---placebos. Thomas J. Moore, in his article in the Boston Globe, "No prescription for happiness," (10/17/99) reports that both antidepressant and placebo regimens drop depression scale scores by 40%. While anti-depressants are obviously effective, so are placebos. If an inert substance has the same effect, it is unlikely the biochemical mechanism advertised (selective serotonin re-uptake inhibition) is the reason for improvement. The pills do have significant psychoactive consequences. Moore writes (and my clients confirm this) "Many patients report a lack of emotion or being more detached from problems and everyday events that otherwise might trouble them." In other words, rather than selectively addressing their depression, the pills are muting feelings about everything. (Evidently, this includes sex. Moore reports "Depending on definitions, from 10 to 70 percent find their sex lives diminished.") Apparently, Prozac, Paxil, etc. work as general emotional anesthetics, rather than specifically targeting depression. I do not want to minimize the importance of this effect: relief from pain and anguish can be a godsend for people with chronic, severe depression. Nevertheless, if a specific biochemical substrate for depression exists, it is yet to be found.

Where, in addition to the synapse, might we look for a cause and a solution to depression?

In Giving Your Child "Voice": The Three Rules of Parenting, I wrote: "One of the most important psychological factors in raising a family is giving children voice.' What is voice'? It is the sense of agency that resides in all of us that makes us confident that we will be heard, and that we will have impact on our environment. Exceptional parents grant a child a voice equal to theirs the day that child is born. And they respect that voice as much as they respect their own."Without "voice" people feel tiny and helpless. They have no "place" of their own; instead they struggle to find a place in other people's world. Some inflate themselves like a blowfish in order to feel secure and consequential ( see: Voicelessness: Narcissism). Others search endlessly for powerful partners who will validate their existence (see: Little Voices and Why Do Some People Choose One Bad Relationship After Another? At times these strategies succeed, but the satisfaction is rarely lasting. An event usually occurs (a loss, betrayal, rejection, etc.) which returns them to their previous state of despair.

Other people do not understand. "You have family/friends, a good job," they say. "People care about you. You have no reason to feel this way." But the depressed person often has good reason even if they can't verbalize it: an absence of "voice." Without "voice" they have no place in the world and are left without a reason to exist. Life consists of having to perpetually claw and scratch their way out of a dark, bottomless pit.

If depression is, in part, a disorder of "voice" then psychotherapy should help. And, in fact, it does (see, for example, The Effectiveness of Psychotherapy--The Consumer Reports Study by Martin E. P. Seligman) The first step in therapy is to help the client understand the historical reasons for the absence of "voice" (see Relationships: The Role of the Hidden Message) Following this, the difficult work of discovering and reinforcing the client's place in the world begins. First, the client has to find his or her "voice" with the therapist. In cases of serious depression, this may take months or even years of hard work. Then, the therapist must help the client establish his or her newfound "voice" with family and friends. (See Psychotherapy and the Restoration of Voice for more about the therapy process.)

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