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The Roots of Depression
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Seminar 5

THE ROOTS OF DEPRESSION

©Anne Baring

O the mind, mind has mountains; cliffs of fall
Frightful, sheer, no-man fathomed. Hold them cheap
May who ne'er hung there. Nor does long our small
Durance deal with that steep or deep…
                      Gerard Manley Hopkins 1844-1889

This seminar or paper is offered to people who suffer from depression but who are not under psychiatric care.

Gerard Manley Hopkins, as the words of his poem suggest, suffered from depression. Depression for him, as for so many others today, was a serious, life-destroying state of being, where one is not really living but existing from day to day in a miasma of misery, apathy, anxiety, guilt and despair. It may be compared to a living death. Some people spend their whole lives in this state, yet may never know the name of what they suffer from. Many forms of illness derive from it.
         The ramifications of depression extend far into the social fabric of society, causing profound and permanent disruption of family life and affecting the well-being of millions - perhaps 100 million worldwide. In the States depression affects some 19 million people (National Institute of Mental Health). In the UK prescriptions for anti-depressants have increased from 9 million in 1991 to 39 million in 2008 to 43 million in 2010. Prescriptions for sleeping pills rose to 10.2 million. There are currently (2011) 3 million people suffering from depression. "Some 25% of women and 12% of men suffer major depressive disorder during their lifetime…and depression affects up to 35% of the medically seriously ill." 1 (Powell 2002) Beneath the hidden and, until recently, neglected statistics of wife-beating and the sexual abuse of children; beneath chronic alcoholism and drug addiction, beneath the "modern" symptoms of anorexia nervosa and bulimia, beneath the restless, driven activity of so many people or the powerlessness, apathy and despair of many others, is depression. Finally, the omnipotent and aggressive behaviour of tyrants, bullies and oppressors of every shade and degree needs to be considered as a possible symptom of this underlying affliction.
        For the person experiencing it, depression feels like a perpetual punishment. There seems to be no end to it nor any possibility of respite from it. It is like slow, constant torture or the insidious "eating away" of leprosy. If, for a while, the depression lifts, there is the constant apprehension that it will return without warning, turning the bright day into night. Consequently, the most frequent compensatory mood or mode of life for the chronically depressed person when he or she is not transfixed by apathy, is manic activity or compulsive behaviour of one kind or another for, in these ritualistic patterns, there is some hope of warding off the fear of the return of the helplessness and black hole of depression. Behind depression lie one or more of four very powerful emotions: terror, grief, shame and guilt.
        For someone in the grip of a depression, the feeling is like being caught in the tentacles of an octopus, of being incarcerated or buried alive. The bodily appearance changes; hair and clothes are neglected or one simply puts on yesterday's clothes for months at a time. Deep, restful sleep eludes one. The voice has a different inflection and a lifeless, tone. The simplest daily routine tasks seem insurmountable. The most attractive surroundings take on a monotonous uniformity and pass unnoticed. Other people become threatening, irritating, even arousing paranoid feelings of distrust and dislike. If the depressed person speaks at all, it may be to criticise or attack other people - particularly partners or children. Alternatively, the attack may be internalised as a constant undermining, critical voice which has a devastating effect on the balance of the psyche, as well as the psycho-physical immune system. The memory of happy relationships or a happier mood, vanishes as if it had never been and will never return. It is as if the personality has been invaded and taken over by a destructive entity. One is left, as Dante describes it, in the midst of a dark wood, with no indication of a way out.

People may fall into a depression as a result of certain life situations, such as poverty, redundancy, bereavement or conditions of restriction or impotence which seem to offer no escape. But I believe that the incidence of depression increases in a culture which recognises no dimension of experience beyond sensory gratification, when the horizon of the human spirit is confined to this material world alone and there is no feeling of relationship with the "eternal" or with a transcendent entity or dimension. How many people commit suicide because there was no one to talk to about disturbing feelings that are difficult to articulate in a frenetically busy culture? Forty or so years ago, suicide was regarded as a crime and there is still a lingering stigma attached to it; this stigma may extend to depression whose symptoms are still not properly recognised and responded to in a society that has not yet developed emotional intelligence. 2 (Goleman 1996)

The Roots of Depression:
If you suffer from depression, it might be helpful to ask yourself these questions before you read any further:
As a child, did I lose one or both parents due to their death or disappearance through war, illness or divorce, particularly my mother?
Was I an adopted child or one brought up in an orphanage?
Was I ever separated for a long time from my mother when I was an infant or child under the age of seven?
Did I have to witness one parent physically or verbally abusing the other?
Did I suffer chronic abuse myself, either physical or emotional?
Did a parent or grandparent suffer from depression? (genetic inheritance can be one cause of depression)
Was I the victim of bullying (by parents, siblings, teachers or other children)

If the answer is yes to any of the above questions, it is possible, though not inevitable, that one or more of these life events could lie at the root of your depression. The following section will attempt to explain why.

Depression as the Symptom of a Wound to the Autonomic Nervous System:
Working with depression over many years, I have come to the conclusion that there is one very important primary cause which may be overlooked in the various approaches to treating depression: a trauma inflicted on the most fundamental, archaic and unconscious aspect of our psycho-physical organism - the autonomic nervous system or limbic brain. The limbic brain is the matrix of our primary instincts, our deepest feelings, and our capacity not only to respond to and survive difficult life challenges and situations, but also our ability to thrive, to make happy relationships, to fulfil our creative potential. If this fundamental aspect of our nature is injured, we may go through the whole of our lives carrying an unrecognised and untreated wound. Depression from this perspective is the symptom of a deeply unconscious psychic trauma which has injured or "frozen" the autonomic nervous system. More specifically, the optimum health and balance of the nervous system and the hormonal balance of the organism will have been affected. This in turn may ultimately manifest as physical or mental illness of some kind.
        How did this limbic brain system come into being? To answer this question, we have to look at the long evolution of the nervous system and the instinctive responses of reptiles and mammals learned over hundreds of millions of years. We, as humans, have inherited not only the fundamental structure of our nervous system but many of the instinctive reflexes and patterns of behaviour that are found in both reptiles and mammals. These reflexes are embedded in the neuronal pathways of our limbic brain system. Observations about the relationship between human beings and animals have been unpopular because they seem to conflict with the idea of human free-will and self-determination. So there is today a general lack of understanding about the relationship between animal and human behaviour and how we, living in the twenty-first century, may still be controlled by instinctive reflexes that belong to our primate ancestors and even to the dinosaurs.
        Of all the memories carried in our millions of years' old limbic brain system, those of being either predator or helpless prey are paramount. Palaeolithic man intensely lived these two patterns of life experience. In order to survive he had constantly to protect himself from becoming the prey of the great carnivores that roamed the plains and had their lair in the caves in which he sought shelter; at the same time he had to act as predator towards other animals in order to secure enough food to survive. We carry these ancient memories as part of our own biological inheritance: we are still deeply conditioned to act instinctively and instantaneously in certain situations as both predator and prey. These primary defensive and survival instincts are common to all of us, without exception. The predator behavioural pattern is a habit laid down over hundreds of millions of years in certain species which have learned to scent, track and kill their prey. Throughout this vast expanse of time preyed-on species have learnt instinctively to sense the approach of predators and to take evasive or defensive action in the face of the threat posed by them.

The Three Principal Responses to Danger:
Why are these instinctive responses related to depression?
There are three primary responses to danger/terror/life-threat that we have inherited from the reptilian and mammalian phases of evolution which are deeply embedded in our own survival reflexes. The first and second are widely recognised but the third has not received the attention I feel it deserves in our efforts to understand the roots of depression. All three are instinctive survival strategies.

The instinctive reflex to attack or to fight
The instinctive reflex to flee or to withdraw
Paralysis - the inability either to fight or to flee. One example of this is a rabbit's total paralysis when confronted by a stoat, a much tinier animal but a lethal predator.

Setting depression against this primordial background, I think it can be understood as a state of paralysis in the face of what is experienced as a threat to survival: a life-threatening situation. Depression is the mood or emotional state which reflects a situation in childhood (usually repressed or forgotten) where the fight/flight response was inhibited because there was no possibility of flight from a situation of overwhelming terror, pain, grief and suffering, nor any possibility of retaliation against an aggressor. This situation could have been a single event or a chronic one repeated over and over again in family life or school. Later in life the underlying state of paralysis may manifest as a chronic mood of apathy or inertia, an inability to speak or to act, or as an inhibiting block to creativity and also as self-destructive patterns of behaviour, including suicide.
        One approach to the treatment of depression may be to understand it as the final expression of a deeply repressed and unconscious memory of an early experience where the infant or child was transfixed by terror or anxiety in a situation from which there was no hope of help or escape. It had to endure unbearable emotional or physical pain - what one therapist has described as soul-murder. 3 (Shengold 1989) It is likely to emerge from this childhood situation imprinted with one of two convictions: that it has done something wrong, or bad, and that there is something fundamentally wrong with it/its nature for it to have been so punished/rejected/abandoned.

There are five major source-experiences which I believe give rise to the unconscious memories which later manifest as a chronic depressive mood:
1. the perinatal memory of a long and difficult birth, where the infant was trapped and compressed in the birth canal.
2. The separation from the mother in infancy and early childhood owing to bereavement or abandonment.
3. The emotional "absence" of the mother because of her own depression.
4. The child's helpless witnessing of a constant pattern of violence, whether physical or verbal, inflicted on one parent by the other. (this can be extended to the child witnessing the horrors and devastation of war).
5. The child's experience of being the helpless victim of a parent/adult's rage, violence, sexual abuse and cruelty, or of bullying by siblings or other children. To this must be added the suffering of a child who is exposed to an ambitious and bullying parent demanding high achievement through a unremitting barrage of negative criticism or failure to praise and encourage.

        Stanislav Grof has described in detail and with great brilliance and insight the effects of the birth experience. 4 (Grof 1995) John Bowlby has written the definitive work on the effects of early bereavement and maternal deprivation and I would refer people reading this to their work. 5 (Bowlby 1969,73) I am focussing here on the fourth and fifth of these primary causes which are often connected with each other and which are, I believe, far more widespread than realised. I would like to put forward the hypothesis that someone who is subject to serious and long-standing depression may carry in the unconscious one or both of the following memories:

the repressed memory of being the terrified and helpless victim of a parent or adult or other children who attacked or abused the child physically or emotionally. The child has no possibility of fight or flight.
The repressed memory of being the anguished witness of the violence of one parent towards another or of some other violent incident perceived as life-threatening to the child itself or to a beloved parent (such as the scenes witnessed by the children of cruel and abusive parents or by those in Bosnia, Kosovo, Chechnya, Rwanda or more recent theatres of conflict such as the Middle East where war and terrorism have replaced civilised society).

        Both these situations re-activate the memory, carried in the limbic brain, of the preyed-on animal being hunted down and attacked by a predator. In the work I have done with clients, the memory of a childhood trauma in either category may be expressed in the image of a wounded animal - often a horse or a dog, but sometimes a wild animal like a deer. Here is one such dream:

There was a movement behind me, to the left and I saw a horse, a lovely palomino/gold horse with a pale muzzle. I could see its jaw was somehow distorted, the muzzle enlarged - as if its lower lip jutted forward below the top. It was bleeding too, its skin hanging in ribbons. As it turned towards me, I saw the flesh of its right shoulder shredded and bunched together like a knot of ribbons. A woman said it was in a terrible way, and implied it should really be put down .

      Asked to relate this image to what might have happened to her as a child, my client's six year old self came back to her. She suddenly remembered that she had been given a wonderful Chinese painting of chrysanthemums by a friend of her parents - in the expectation that she would colour it. She had been thrilled and did indeed colour in the flowers but then, wanting to add something to the magic, she had cut pictures of fairies and flowers and other images she loved out of her books and pasted them onto the picture. When her parents saw what she had done, she was severely beaten (beatings were a regular occurrence in her family). Not understanding why her parents were so angry with her, she was deeply imprinted with the idea that her instinctive and joyous impulse to create was wrong or bad and would invite punishment. This was the primal wound to her limbic brain that lay behind the image of the bleeding and flayed palomino horse. The negative charge of that experience affected her life forty years after it happened, giving rise to severe episodes of depression whenever she tried to express her creativity (she was an artist). At the root of her psyche was the expectation of punishment if she dared to give expression to her delight in creating beauty.
      An account from the second category of experience (reported in The Sunday Times, 7/10/84) gives a vivid image of what it was like to be the helpless witness of one parent abusing another. I cut this article out of the paper several years before the woman who had written it came to me as a client. One day, I showed it to her, telling her that I had been deeply moved by it and had kept it in my files. To my amazement she told me that she had written it (under another name). An extract is reproduced here with her permission.

Going to bed, I would lie, back pressed against the wall, head half-lifted, taut as a cello string, craning my ears for the sounds I dreaded. Even silence was not reassuring, for sometimes the first signs of the storm to come would be a lull, a break in the conversation, More often, the voices simply rose and rose till the pleading started. No! NO! PLEASE! NO! NO! NO! Rising and rising in a harsh crescendo until the cries came, sharp and raw, an inhuman sound, leaving me trembling and impotent, weeping helplessly into my pillow.
      There were times when I intervened, tugged at his thudding arms, put my body between them. I was almost six when returning from school I found her, terrified, wedged in a corner, the bruises already rising on her face. Pushing between them, I begged him to stop. He did.
I'm aware there were times of remission. How long I don't recall: once such violence becomes currency, it dominates relationships and the frequency is almost irrelevant. They say that with torture it is not so much the pain itself which breaks people as the anticipation, the waiting. So it was in my home. The violence, the screaming, were not things which happened, ended and could be forgotten until they happened again. Each day of calm simply brought the next attack closer. Our lives hung suspended waiting for the next time…The physical violence was only part of it. There was no room in our house for normal conversation. Words were traps and weapons. Anything, anything at all, could make him rip into us, battering us with words, grabbing and holding us if we tried to go. And when we wept, he smiled.
      I learned not to speak without thinking carefully. Like the slum child, I became street wise: learnt to watch for the first sign of drink, to keep out of trouble, to lie, to evade, to bury my self respect: keep a bully at bay. I lived with the guilt and humiliation of being unable to protect the mother I loved.

      With this kind of sado-masochistic experience in the background, depression can become established as a steady-state mood from childhood onwards or it may be triggered by any subsequent life event which activates the unconscious memory of the original experience. A difficult or threatening later life experience instantaneously (probably via the amygdala reflex) triggers the childhood memory and the archaic memories of the predator/prey imprinting of the limbic brain. The actual memory of what happened may not be available to the conscious personality but the emotions that were once experienced still powerfully affect it. The conscious personality is then overwhelmed by those emotions (shame/guilt/anxiety/terror/rage) and these, still unconscious and repressed, manifest as the paralysis of depression. In relation to the immense and archaic power of an unconscious instinctive reflex, which acts in the manner of a predator towards the fragile conscious personality, the latter has little or no defence against it. It can neither resist, nor fight, nor control it until it has gained insight into what is happening and why. I have put that passage in italics because the conscious mind may think it preposterous that the traumatised instinct may be capable of overwhelming it with moods that may last for days, weeks, months and years, or with a perpetual state of anxiety..
      I find the discovery of the amygdala as the storehouse and transmitter of archaic genetic responses very helpful. 6 (Goleman 1996) The incredible speed with which messages received through the sensory perceptions of sight, hearing or smell travel to the thalamus and from there by a direct, instantaneous route to the amygdala, triggering the fight, flight or paralysis response of the sympathetic nervous system before the more recently developed conscious mind can inhibit it, explains why it has been so difficult for us to change atavistic patterns of behaviour and why consciousness in the sense of insight and the ability to reflect on our thoughts and actions is such a priceless evolutionary attainment.

      Yet, as we are increasingly realising, it is not enough. Unless we can learn how to respond to our emotional needs and heal our emotional suffering, we will remain condemned to repeat the predatory patterns of behaviour that now threaten the survival of our species, and to remain the victim of our unconscious traumas. When society is breaking down, people feel threatened and this feeling activates the buried traumas and responses of the limbic brain. What we call civilised behaviour is a very thin skin covering a substratum of instinctive survival responses to danger.

      There is undoubtedly a correlation between these emotionally charged experiences and the neuronal balance of the autonomic nervous system; between the chemical state of the body and specific states of mind or moods. Constant vigilance in the anticipation of violence and the absolute terror and anguish that accompany its re-enactment trigger the outpouring of adrenalin. This, coupled with the inhibition of the normal fight/flight response and the inability to act, move or escape from a frightening situation, affects the chemical balance of the bodymind, the neuronal pathways, hormonal and immune systems, which in turn give rise to physical conditions of illness or disease. Candace Pert's pioneering discoveries have shed great light on the relationship between mind and body. 7 (Pert 1998, see seminar 8) The metabolic effects of a chronic situation of childhood suffering may cause permanent lesions in the neuronal transmission pathways of the brain. We know that chemicals can alter a mood and lift a depression but we have not sufficiently explored what happens to the nervous system and the balance of chemicals in the body of a child or young adult who lives in a state of hyper-vigilance and anxiety for years at a time. The chemicals we use to treat depression can lift and alter the mood but they may not reach down to the trauma held in the limbic brain that underlies the mood, nor can they give the person insight into how this situation has arisen and how to transform its long-term effects on their lives and their relationships.

Psycho-somatic Symptoms of Depression:
Many people suffer from depression without being able either to name it or recognise its symptoms. Apart from compulsive habits such as alcoholism and drug addiction, there are many physical symptoms which can be related to depression: abdominal pain, insomnia, apathy, constipation, headaches, muscular pain, backache. Each of these, when no specific cause can be discovered for them, may be symptoms of an underlying depression. Because the individual suffering these symptoms does not know how to relate them to depression or how to express deep feelings of psychic malaise to their GP, or feels ashamed of them, he or she goes on suffering. The GP may not be trained to recognise depression behind the symptoms the patient describes, or to "read" its presence in his or her body language. Because it is untreated, depression can destroy the happiness of countless families. The depressed person can do nothing about the mood which seems to hold him or her in its grip. There is usually, but not always, awareness of the oppressive mood but there is an inability to react to it, inability to take action which could bring release from its overwhelming power. Suicide is a risk because death may seem preferable to misery and despair. This state reflects the programming of the limbic brain memory of the preyed upon animal which has no possibility of defending itself against attack or of escape from a trap or from a predator. 8 A wound to the limbic brain system in childhood may manifest later on as:

a crippling, usually unconscious, predator-like inner voice or critic which continually attacks the individual and undermines his or her confidence. This voice is in essence an internalisation of the sado-masochistic pattern of childhood, where the child was the victim of the sadistic parent/adult or of the belief that he or she was not wanted (because abandoned, adopted or rejected). Memories of pain, grief and despair are carried in the muscles and nervous system and these surface as the critical, destructive voice that can lie at the root of the paralysis of depression.
an unconscious compulsion to criticise, attack and destroy others, so releasing the anger that had to be repressed as a child and off-loading the burden of shame/guilt and misery onto someone else.
A manic defence against the underlying depressed mood which can take many different forms of expression including the drive to achieve a position of pre-eminence or omnipotence in relation to others. On the other hand, depression may lead to a permanent state of dependency on others, financial or emotional.
An inability to relate to other people or to enjoy their company.
The seasonal affective disorder (SAD) which afflicts people living in northern climates during the winter months can (sometimes) be related to childhood memories. The apparently interminable greyness and cold of winter may activate unconscious memories of being trapped in earlier situations where there was no way out.

For the generation which is now reaching the end of their lives, who are in their late eighties or nineties, depression was never identified or mentioned. A cloud hung over the family of the depressed person, a cloud best described as an atmosphere of fear. Wives of depressed husbands (or husbands of depressed wives) would constantly be on their guard in case a careless word would precipitate a change of mood, or worsen an already existing one. The household was organised so that there was never a change of routine in case the dreaded anger was triggered and there was "a scene." If there was such an occurrence, the placating spouse would hasten to take the blame for having done something to irritate the depressed person, and assure him or her that it wouldn't happen again. Children were reduced to tears and lived in a constant state of fear that they would be humiliated, beaten, or punished. One particular child as well as the spouse might be singled out from an early age as the member of the family to receive verbal and/or physical abuse. The most frightening thing was not only the violence but the sudden and inexplicable shift of mood which transformed a loveable parent into a terrifying one. (The life of George Carman QC, written by his son, describes in vivid detail precisely this pattern). 9
      No-one ever dared to name the dreaded mood as depression or to suggest treatment for it, for treatment suggested mental illness and this subject was taboo. It was a carefully guarded secret, like having an alcoholic in the family. One of the most difficult aspects of their inheritance for children brought up in such an atmosphere was the pretence to the world at large that the home was happy when it palpably was not; and the confusion arising from the experience that they were both loved and at the same time rejected by the afflicted parent while the other parent, in collusion with the situation through fear or anxiety or a sense of misplaced loyalty, denied his or her own fear and suffering as well as the children's. The extended family may collectively have denied the existence of any kind of problem or unhappiness, perhaps through not wanting to intrude on what they felt was a private matter. There was therefore no-one to bear witness to the true situation and to validate and confirm the child's feelings of confusion and distress. This absence of a witness is of great importance. The only way to survive in such a situation is to develop a false personality in which true feelings are repressed and denied and the child conforms to what is demanded of it. The psychiatrist Winnicott wrote extensively about this 'false self'.
      Forced to be continually on the defensive, the conscious personality develops a rigid shell to offer some protection against these attacks and a hyper-vigilance to sense when an attack is imminent. Gradually, the shell and the hyper-vigilance become the "true" nature, one which is so essential for survival that it seems natural, even to other members of the family. But, in reality, it is a mask worn by the fragile child who can neither call attention to its pain, nor find a witness who can confirm and support its feelings of fear and distress. All instinctive response is repressed because protest or rebellion bring punishment or rejection. The continual denial of genuine and justifiable feelings of anger, confusion, outrage and anguish leads ultimately to a situation where life is seen and experienced, so to speak, through a glass wall, held at arm's length. It is too risky to feel, too painful, and anyway there is no point since any attempt to express feeling is punished, ridiculed or repressed. Feeling then becomes a matter for shame. One is ashamed to be oneself. One cannot risk being oneself.
      The collective expression of this kind of family situation is found in a totalitarian regime (such as the recent Taleban regime in Afghanistan) where a whole society lives in fear and subjection and no one dares to speak out against "the system" for fear of arrest and execution. The paralysis syndrome holds millions of people transfixed, unable (through fear) or collective conformity of reacting against a pattern of behaviour which is experienced as deeply oppressive and which may have long been accepted as tribal custom..
      For the next generation, things have improved, but only slightly. Because of the taboo on admitting the problem and seeking help for depression, many thousands of lives are still blighted by the tension and fear of living with a depressed member of the family. Whereas physical diseases and illnesses are for the most part accessible to treatment, depression somehow evades the definition of an illness. Its symptoms are not easy to detect unless there is some prior knowledge of the condition. The possibility that it may be helped both with drugs and with psychotherapy is not known to many people who avoid recognizing it as their main problem because "a bad mood" seems somehow to be part of life and therefore acceptable. Yet it is this mood or illness which destroys lives, through suicide first of all, but also in the blight which descends on those, both sufferers and victims of their suffering, who may not be driven to the point of suicide but who live their lives in a kind of psychic concentration camp (and impose it on others) from which there is no escape.

The pattern of denial and estrangement from oneself starts in childhood, often in infancy, but what is often not understood is that the childhood pattern lives on in the adult who may have lost all memory of the initial pain which instigated the pattern of alienation and denial. Depression is the final symptom of repressed memories of the experience of unbearable anguish. At all costs, no hint of them must be allowed to return. The adult is treating the memory of the original experience with the same repressive violence which it initially experienced at the hands of others. Any situation which reminds him/her of that experience and the feelings associated with it will trigger the return of the depression.
      In the original situation, the adult was stronger than the child. In the depressed adult, the impulse to control and repress the memory of the original pain conflicts with the psyche's need to heal the wound it carries: the conflict between these two opposing needs creates enormous stress. The depression is a symptom of the conflict between the conscious and unconscious aspects of the psyche. But it is also an expression, one of many, of the original experience of childhood misery, grief and anguish. Until the afflicted person begins to recognise the trauma carried in the unconscious, the depression is always stronger than the conscious personality, just as in childhood, the parent or the oppressive situation was stronger than the child. This is why people who are depressed kill themselves so readily. The pain of living is so overwhelmingly acute that death is preferable to life. This is what the child felt ten, twenty or fifty years before but the child, although it longed to die, did not know how to escape, to end its life or to articulate its feelings. The adolescent or the adult, with the greater knowledge of different ways of putting an end to life but with the child's feeling that there will never be an end to its misery, has the power to commit suicide, but not, without help and insight, to stop the memory of trauma returning in the form of the depression. (see the case of the tragic suicide of Philippine Lambert. Sunday Telegraph October 28th, 2001)

The unrecognised chronic states of rage, grief and guilt which underlie depression come from forgotten memories of a situation where, perhaps as a child, one was unable to protect oneself or someone else through terror of punishment, unable to express vocally or physically the anger, grief or distress appropriate to the situation. What was experienced in the past is projected forward and anticipated in the present. Because one was helpless and terrified in the past, the control exercised by the unconscious memory says that one will be helpless and terrified in the present or future. Hence we become fixed in the past, prisoners of the terror we once experienced as victims, continually re-living these memories at the unconscious level.
      If a family can be destroyed by one depressed or psychopathic parent who has no insight into the causes of his or her moods and cannot therefore be released from their power, how much more is this true of people who have experienced the trauma of war and cannot free themselves from their memories of terror and powerlessness or from their desire for revenge?

The Damaged Core of the Personality:
There is a further dimension to understanding depression. In the Jungian sense, what is damaged in such a situation, is the core of the person's being. The natural, instinctive and healthy response to a situation of threat and danger, which an animal would react to by running away or attacking, is inhibited. The child, because it needs food and shelter, cannot, generally speaking, run away. It has to stay and bear the torture. It may develop mental or physical symptoms of distress or it may become silent and acquiescent, but it can no longer react as it would have been able to do in a healthy, unhostile environment. The child's psyche is imprinted with the memory of the parent's/adult's destructive rage against it. In this situation, it is the victim. Later on there are two modes of response to a situation which recalls the original one:

The response of continuing to enact the role of victim. The inhibiting or controlling factor in the psyche says that it is too dangerous to alter this victim pattern of response.
 The response of acting as predator towards others as prey, acting out with persecutory anger or cruelty the feelings that were originally repressed. This pattern is characteristic of the bully.

Paradoxically, the person who has had the experience of being someone's prey may later act as predator to someone else, often without any conscious awareness of what forgotten scenario he or she is re-enacting. When in a position of power in relation to a weaker human being, the former victimised child may become the bully or aggressor, inflicting on its victim in turn the same kind of brutal or sadistic behaviour that it once experienced itself. The collective memory of having been a victim may force a specific group into the position of predator in response to a threat from another group.

The Bully and the Tyrant
We may also recognise the second pattern in many different kinds of cruelty in society, from the cruelty of the tyrant in the totalitarian state, to the cruelty of a teacher towards pupils in schools, or of the bully towards other children, the ability of people to feel justified in torturing and killing others who have been demonised as "enemies", or to inflict pain on animals in the belief that they can't feel pain like human beings. There is also the cruelty meted out to prisoners by their warders. 10 (Gilligan 2000)
      The one characteristic that these "predators" have in common is that they are in a position of power in relation to those who are weaker or more vulnerable than themselves and are therefore able to "punish" or "destroy" them with impunity. The impotence of the child becomes the omnipotence of the adult. 11 (Fromm 1987) The desire to punish takes on the character of a compulsion but a compulsive element in human behaviour suggests that it is a re-enactment of something experienced in the past which has caused great suffering. The inability to feel for the person one is attacking, terrorising or victimising arises from the denial of the child's feelings in the original experience. The baffling thing about this pattern of re-enactment is that there may be no memory of the original situation. But the ferocity of the attack, whether verbal or physical is a clue to the degree of suffering once endured by the child.
      People simply do not realise that the dissociated or split-off rage of a single depressed individual that is directed at "enemies" can destroy the lives of millions (Milosevic, Karadic, Osama bin Laden, Saddam Hussein, Pol Pot, Stalin etc. but also leaders who exhibit the desire to punish or destroy an "enemy"). This fact should be borne in mind wherever national leaders activate the process of projection and demonisation. The compensation to the experience of being a victim as a child is to acquire a position of great power as an adult. Hence the symptoms of inflation and grandiosity which so often conceal an underlying depression or sense of worthlessness.
       Alice Miller has pointed out that the pathology of the bully and the tyrant (she brings Adolf Hitler as one of her examples) reveals unbearable childhood suffering which is later inflicted on his victims. Saddam Hussein, treated with excruciating cruelty by his step-father in his childhood, is a recent example of this pathology. There are many degrees of tyranny between the school or office bully, the controlling parent who holds a family in terror, and the psychopaths whose unconscious complexes cause havoc in the world. This is a pattern of human behaviour which is still insufficiently identified and therefore cannot be addressed and healed. 12 (Miller 1983, 1985)

Shame and Guilt
The continual criticism, ridiculing, or persecution of a child leads to a deep sense of shame and guilt. 13 (Gilligan 2000) Without the support of the other parent, there will be nothing to mitigate the child's feeling that it is to blame for the parent's inexplicable rage, contempt and rejection. It will blame itself and unconsciously take upon itself the burden of the family's unacknowledged suffering. Guilt and shame in later life is one of the main characteristics of depression. (It is, I believe, the main reason why depressives are so reluctant to discuss their symptoms with their doctor who may sometimes behave like the critical, ridiculing, dismissive parent.) So often one hears the words "I know it's all my fault." Or, "If only I could have done this, or said that, everything would have been or would be all right." Guilt and shame lie like a layer of mud in the psyche, vitiating all attempts to discover something which would bring delight into one's life, swallowing all positive initiatives, denying the value of any real achievement. It is expressed primarily as negativity, a defensive "no" to everything, or a heavy, sodden inertia and despair that inhibits a creative impulse by killing it stone dead before it can get started. "What's the point?" "It's all hopeless," are the often repeated words.
      A parent is like a god to a child and if that god-like power is reinforced by the image of a powerful deity, the two may become identified in the child's mind. An angry punishing father can, to a child, take on the aspect of an angry God and vice versa. The depressed parent will be very controlling of the family. Everything must be exactly as he or she wants it because absolute control is the only way that the threat of depression may be controlled. There are many parents who terrify their children into obedience and who reinforce their authority by enacting the role of the punishing, vengeful aspects of the deity they believe in, just as there are others who, sensitive to their power to distort and damage their child's life, act with the utmost consideration for his or her feelings. If, in addition to the terrifying or omnipotent parent, the child finds a similar image of the deity in whatever religious instruction it is given, the fear of and compulsive need to serve and obey an overwhelming power is amplified.

Healing Depression:
What can break the spell - because it is like a spell - and heal this state of suffering? The primary agent of healing is the establishment of a relationship of trust and affection between the afflicted person and another human being, preferably a therapist, since the burden of the traumatised individual may be too great for a partner, relative or friend to carry.
      Because fear disrupts the hormonal and neuronal well being of the body, attention should be paid to restoring the optimum equilibrium in both. An unvarying low morning temperature is a symptom of thyroid deficiency that may not be discerned in routine blood tests. Iodine supplementation (under medical supervision) can help this deficiency. 14 Magnesium levels should also be tested since magnesium deficiency can exacerbate depression and magnesium can alleviate anxiety. (A study in the United Sates has found that a of 451 patients with chronic depression one test found that 60% were magnesium deficient and another 100%). 15 Regular exercise is an essential part of the treatment of depression.
      Diet also plays a role in depression. The depressed person may become addicted to certain foods. Sugar, wheat, coffee, tea, chocolate and alcohol can each contribute to a disturbance of the nervous system, heightening anxiety. It is helpful to eliminate one of these at a time for at least a week, preferably longer, and observe whether there is a diminution of anxiety and alleviation of the depressed state.
      Recent research has found a link between depression and a lack of essential fish oils. Studies and trials have shown that patients with the symptoms of depression show marked improvement and even remission after a few months when given ethyl-EPA.( see The Natural way to Beat Depression, by Dr. Basant Puri and Hilary Boyd, Hodder Mobius 2004)

Attending to the physical needs is one aspect of the treatment of depression. For a therapist treating a client suffering from depression, it is essential to take a minutely detailed case history of what the atmosphere in the childhood home was like and the specific memories associated with the relationships between the child and parents, siblings and teachers.
      I have found that learning how to activate and use the healing power of the imagination is one of the most powerful therapeutic tools. The biggest problem is how to reach below the defence system of the conscious mind to the instinctual intelligence of the older limbic brain system. It is in this region, so unconscious and so difficult to access, that the memories of the traumas or wounds experienced in childhood are held and it is here that the programming of earlier phases of our evolutionary development are also held, incorporated into our genetic memory. Without communication with this deep level of the soul, we can only continue to function unconsciously, following the pathways laid down over millions of years. See the article "Animals in Dreams" on this website.
      What is absolutely clear to me from my work is that emotional trauma activates the neuronal memory pathways of the older brain which maintain the sympathetic nervous system in a state of perpetual arousal. No matter what the achievements and brilliance of the mind, the instinctual brain can remain transfixed in a state of anxiety and tension for years - perhaps for a whole lifetime. Sometimes the very brilliance of the intellect is developed and relied on as a counterbalance to the anxiety, anger, fear or grief that is hidden beneath the surface of consciousness. The effort and control required to keep these feelings away from consciousness is an indication of the extent of the wound that is carried in the instinctual ground of the psyche. Such a person may be extremely manipulative and controlling of others.

The Imagination and Empathic Dialogue with the Limbic Brain
So what can we do? I think we can find ways of entering into an empathic and imaginative relationship with our instinctual soul. The imagination has extraordinary power to heal. Amazingly, the imaginative relationship we can create with the limbic brain has the power to alter the neuronal pathways, replacing negative messages with positive ones, re-structuring the responses of the sympathetic nervous system, releasing the creative impulse of life to flow in the direction it seeks.
      Through the image, we can enter into a dialogue with the most archaic part of ourselves - the limbic brain - as an actual entity that has consciousness, intelligence, feelings, and the possibility of communicating with us. Many of you who read this will be familiar with the image of the inner child that has been the focus of therapy in the past few years. But what about the inner animal? There are many animals, as well as birds and fish that may carry specific meaning for us. Stop a moment as you read this. What animal image presents itself to you, flitting across the screen of the mind? Through this image, you can enter into a dialogue with your instinct not as a something, but as a someone - as an actual entity that has consciousness and feelings and the ability to communicate with you. In the dream of the palomino horse mentioned above, it would be helpful to engage in a dialogue with that horse, to paint it perhaps, to encourage it to speak and emerge from the prison of neglect in which it has lived for decades.
      The creation of an empathic relationship with this instinctive part of ourselves is essential to the healing process. The crucial point I want to make here is that this part of our nature does not have the power to release itself from the programming it has received and in which it is imprisoned. It can only signal its plight to us through emotional or physical symptoms of distress and certain patterns of behaviour which reveal this distress. It is dependent on our conscious mind to become aware of its suffering and to find ways of releasing it from its prison and healing its pain. It will, to begin with, be deeply resistant to any attempt to enter into contact with it. But once the relationship is established, it has extraordinary power to heal itself. This is as true for society as a whole as it is for the individual.
      What was the image that came to mind as you read this? Was it a caged or wounded animal, a fire-breathing dragon, a mammoth, wild boar, lion or panther or other wild animal. Was it a smaller animal, like a deer, or one closer to human relationships like a horse or a dog or cat or a bird? Was it a fish, a dolphin or a goldfish? What state was that animal in: healthy, or sick and wounded? What emotion does its behaviour reflect? Can you ask it to show you what kind of wound it carries or what has triggered that emotion? Perhaps it was caught in a trap with an injured or broken leg; perhaps it has been imprisoned or caged or has fallen into a pit dug for it by hunters. Did it charge you like a rhinoceros or did it approach you trustingly as if it wanted to communicate with you? How did you react to this creature emerging from the depths of yourself? With fear and dislike, or with sympathy and interest? It may be helpful to reread some fairy tale you remember in which an animal played a part. Again, see what story first comes to mind.
      Once a relationship is established with this part of yourself, ask it to tell you its story. Write that story down, exactly as if you were listening to and recording a fairy tale. You will be amazed and fascinated to read what this hitherto unknown part of yourself has to say about its plight and its feelings.
      The second stage is to ask this animal how you can help it.
      As it becomes aware of your interest and your empathy, this part of yourself may speak to you, tell you what has happened to it, explain how it feels, offer suggestions as to how it can be helped. When this happens, the flow of life, the flow of a creative relationship with life that has been blocked by neglect or trauma begins to be released. Something begins to awaken in you that has been held paralysed, turned to stone, something that has, as it were, been buried alive.
      If we treat this part of ourselves in a mechanical way - with drugs for example, doing something to it that we think needs doing in order to achieve a superficial result - we will not heal the soul although we may temporarily alleviate the symptoms of its distress. But with the creation of an empathic relationship with the deep animal psyche, toxic emotions and the toxic neuronal chemistry in the body/mind organism that accompany them begin to change. Other pathways in the brain are activated. Where fear and anger were the primary response to life, trust and love begin to replace them.
      We need to create a space for this part of ourselves to speak to us and for us to listen to it. We need to enchant it by telling it myths and fairy tales. We can ask it to dance, paint, act out its story, releasing the unconscious memories held in the muscular system of the body. We can respond to its longings, notice the signals it sends us, taking care to write down the words we hear. By our empathic attention, we free it from the black hole of our neglect. We restore to it the hope it had lost, the happiness it never thought to experience. By doing this, we transform its sorrow into joy, its fear into hope. Treating this "unconscious" part of us as if it were a person, aligns our different brain systems so they begin to function with less conflict and tension. With this encouragement, the life of the soul begins to develop and flower in some form of creative expression. We release the authentic voice of the soul that has been held prisoner by the behaviour patterns and belief systems imposed on it.

Recognising the destructive voice of the inner critic:
Apart from the building of a relationship of trust between therapist and patient, one of the principal tools in the psychotherapeutic treatment of depression is helping the sufferer to become aware of the continuous attack by a internalised negative, critical voice. 16 (Kalsched 1996) At times, this voice can take on a murderous intensity and power. To begin with, this voice is deeply unconscious. Many depressed people are completely unaware that their high level of anxiety is caused by an inner critic, or worse, an inner murderer. The childhood situation where the child was the helpless victim of an abandoning, critical, depressed, or sadistic parent/adult has been internalised. The depressed person has to endure the constant attack of an inner destructive voice which will use whatever pegs it can find to hang the "coat" of its attack on. If the person has no confidence in her/himself as a parent, or in creative or professional work, or in his/her personal appearance or in the field of relationships, that is the place where the critical voice will attack. It has been named variously as parasite, predator or negative animus (Jung). It may have a demonic intensity to it and it is this unconscious voice which drives the depressed person into a state of inertia or manic activity or self-destructive and compulsive patterns of behaviour which may lead to suicide on the one hand or to verbal or physical attacks on other people on the other.
      Techniques can be learned which greatly help in the management of this internalised destructive voice. Cognitive therapy may be of help to some by making conscious negative patterns of thought and their expression in language. Contacting the child within, learning to love the child who is crippled with guilt, grief and self-hatred, learning to recognise its symptoms of terror and despair and to stand by it against the attacking voice – engaging the limbic brain through the technique of active imagination – all these can be taught to the depressed person. The mind can be trained to recognise the first physical symptoms of an attack — such as the tensing of muscles or protective stiffening or "freezing" of the body, in addition to knowing the situations which are likely to trigger them.
      Secondly, positive affirmations are a great help, repeated daily or hourly as a kind of protective ritual. Even stroking the hand or arm and tried and proven methods of relaxation can, with practice, allay the anxiety that can swiftly become a depression. Lives can be transformed with the assistance of these simple techniques. But a therapist is necessary to give the constant background support, to help the depressed person recognise his/her negative inner voice and to give encouragement. It is most important that the therapist helps the depressed person to realise that he/she is no longer the impotent victim of aggression but is an adult with an adult's powers of self-defence and that there is something that can be done. Whereas the child had no witness to its suffering since the parents/adults were largely unconscious of the destructive effect of what they were doing, or did not care about the effect of their words/actions on their child, the therapist takes the role of witness to the patient's response to the attacks of the internalised aggressor and can therefore reinforce the client's stand against them.
      Thirdly, the recognition and letting go of compulsive patterns of behaviour is essential if the chronic state of anxiety and stress is to be relieved. The person needs to be helped to see where he/she is driving him/herself too hard for the nervous system and the body to bear without symptoms of distress. Once this situation has been acknowledged, steps may be taken to cut back on the amount of work engaged in, to ensure periods of recreation and relaxation, to develop interests which express a different part of the personality.
        Many doctors and therapists do not realise that they may be drawn in their choice of a career to help other people precisely because the wounded child within their psyche is projected onto those they try to help. The high suicide rate among the medical profession together with the prevalence of alcoholism may suggest not only prolonged stress but also an underlying depression which has never been addressed. But there is another aspect to the doctor/patient relationship: the doctor may re-enact with the patient the same parent/child scenario of his own childhood. The patient is in the doctor's power in the very act of asking for help and the patient's attempts to express his pain may be treated with the same dismissal, irritation or disinterest that the doctor (or psychiatrist) experienced as a child at the hands of his/her parents. Equally, the patient may find it impossible to speak clearly and confidently about symptoms to the authority figure on whom he/she is projecting the fearful and feared parent. Or he/she may be flooded with inexplicable feelings of rage and frustration in the course of the consultation.

How could depression become more generally recognised and therefore helped? First of all by diagnosing it in children at school and treating the whole family as a unit, thereby helping to bring to an end what may have been a destructive pattern going back several generations. I am convinced that while depression may be inherited as a genetic disposition, it is reinforced and fixed by the behaviour patterns in a family. Secondly, by helping adolescents to recognise symptoms of depression, perhaps in the sixth form of school, so that they go for help before a self-destructive pattern or suicidal tendency has taken a firm hold. Thirdly, by helping young mothers (who may experience post-natal depression) to trust and value themselves and by giving them far more help and support in the first few months of learning how to relate to and handle their baby. (This support can often be achieved in a group situation where young mothers can share their experiences and concerns).17 Fourthly, realising that symptoms of stress, particularly in the high-achieving, driven personality or the bully, may mask an underlying depression. Most important of all, helping people to understand before they have their own children, that if they repress and ignore their own symptoms of depression, they may destroy the lives of their children or partners without being aware of what they are doing.

Since writing this paper, two very helpful techniques for healing Post-Traumatic Stress Disorder and Depression have come to my attention. These are Thought Field Therapy (TFT) and EMDR (Eye Movement Desentization and Reprocessing). The first has been successfully used in the treatment of survivors of the Bosnian/Kosovan war. Developed by Dr. Roger Callahan in California, the website address (for the uk) is www.thoughtfieldtherapy.co.uk and there is now a Global Institute (mentioned on that website). The second technique, EMDR, is presented in a book by Francine Shapiro and Margaret Silk Forrest (Basic Books, USA 2006) and has been used to treat traumatised soldiers and nurses who served in Iraq and Afghanistan.

I have recently (2011) had a book recommended to me by Dr. Andrew Powell FRCP called Induced After Death Communication by Dr. Allan Botkin (Hampton Roads 2005). Using the EMDR technique, he has developed a method of treating the trauma of bereavement by taking this method to a further stage which results in the actual appearance of the individual who has died or been killed. The traumatised individual finds that he or she can see the "dead" person and often, talk to him or her. At first hesitant to tell colleagues about this new development and its enormous potential for healing trauma, Dr. Botkin shows how his growing experience brought confidence in it. He brings many case histories to show the effectiveness of this ground-breaking new method of treating bereavement and also the ongoing guilt of veterans who have seen comrades killed or who have killed others in combat and carried deep guilt because of this.

References:
1. from a paper given by Dr. Andrew Powell FRCP at the conference 'The Place of Spirituality in Psychiatry' held jointly by the Spirituality and Psychiatry Special Interest Group, Royal College of Psychiatrists UK and the Psychiatry Section of the Royal Society of Medicine, London, 14th May 2002 (see also www.rcpsych.ac.uk/college/sig/spirit)
2. Goleman, Daniel, Emotional Intelligence, Bloomsbury Publishing Plc, 1996.
3. Shengold, Leonard, Soul Murder: The Effects of Childhood Abuse and Deprivation, Fawcett Columbine, New York 1989.
4. Grof, Stanislav, The Holotropic Mind, HarperSanFrancisco 1993; Beyond the Brain, State University of New York, 1995.
5. Bowlby, John, Attachment and Loss, Volumes 1 & 2, Hogarth Press, 1969, 1973.
6. Goleman, Daniel, Emotional Intelligence see also the website heartmath.com
7. Pert, Candace, Molecules of Emotion, Simon & Schuster, London 1998.
8. Burkert, Walter, Creation of the Sacred, Harvard University 1996.
9. Carman, Life of George Carman QC, 2001.
10. Gilligan, James, Violence: Reflections on Our Deadliest Epidemic, Jessica Kingsley, London, 2000.
11. Fromm, Erich, The Anatomy of Human Destructiveness, Penguin Books, 1977.
12. Miller, Alice, For Your Own Good: Hidden Cruelty in Child-Rearing and the Roots of Violence, Faber & Faber, London, 1983 and Thou Shalt Not Be Aware, Pluto Press Ltd., London, 1985.
also de Zulueta, Felicity, From Pain to Violence, The Traumatic Roots of Destructiveness. Whurr Publishers, London, 1993.
13. Gilligan, James, Violence: Reflections on Our Deadliest Epidemic, Jessica Kingsley, London, 2000.
14. C. Norman Shealy M.D. Ph.D. et al, Correction of Low Body Temperature with Iodine Supplementation, in Frontier Perspectives, Vol. 11, Number 1, Spring 2002.
15. C. Norman Shealy M.D., Ph.D. et al, Intra-cellular Magnesium Deficiency in Chronic Disease, in Frontier Perspectives, Vol. 11, Number 2, Fall 2002, page 6.
16. Kalsched, Donald, The Inner World of Trauma, Routledge, 1996.
17. A charity called Home-Start is achieving excellent results.

I would also recommend a book published in 2010 by Paul Gilbert whose work I find impressive and effective in the treatment of depression, called "The Compassionate Mind" available on amazon.com.

©Anne Baring

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