Nor do the feelings go away when a child reaches adulthood. Maintaining a sense of self and agency is necessary for our emotional well being. But for adults who grew up voiceless, this sense is very fragile. Without "voice" people are prone to feeling hopeless and helpless. Often, the voiceless have no "place" of their own; instead they struggle to anchor themselves in other people's worlds. Unconsciously, many try to use relationships to address old wounds and repair their "self." Some try to inflate themselves like blowfish in order to feel secure and consequential (see Voicelessness: Narcissism). Others search endlessly for powerful partners who will validate their existence (see Why Do Some People Choose One Bad Relationship After Another?) or twist themselves like a pretzel in order to fit into another person's world (see Little Voices). At times these (and other) unconscious strategies succeed, but the satisfaction is rarely lasting. In everyone's life, situations occur that threaten our sense of agency (facing death is a prime example). But the "voiceless" have no ground floor, nothing or no one to catch them--the thought: "yes, but I am a good and valuable person" provides no safety net. An event usually occurs (a loss, betrayal, rejection, etc.) which re-opens the childhood wound and sends them tumbling into a bottomless pit.

Aloneness contributes to the problem. Because the emotional injury is well concealed, 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 has good reason even if they can't verbalize it or see it themselves: a history of childhood "voicelessness."

If depression is, in part, a "voice disorder" 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). For some, correcting the faulty/pessimistic thoughts (e.g. I am a worthless person; I have no control over my life) is enough. Cognitive behavior therapy efficiently serves this purpose. Others find it important to understand the historical reasons for the absence of "voice" and the roots of their helplessness. They want to know why they struggle, and to understand how their voicelessness has affected their relationships. And, of course, they want to re-find their missing "voice." This is the realm of psychotherapy. The work of therapy does not occur in five sessions as the insurance companies would like consumers to believe. A client's voice emerges slowly in the context of a relationship with a caring therapist, often with the analgesic aid of medication. The therapist's job is to explain self-destructive thinking in the context of personal history, find the client's true voice, nurture it, and help it grow so that it can withstand the challenges of life. Once developed and applied to relationships and work, voice can be a powerful and lasting anti-depressant.

About the author: Dr. Grossman is a clinical psychologist and author of the Voicelessness and Emotional Survival web site.

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