When a person has been resistant to every form of depression treatment, is it possible that their illness stems from a different place? In a recent New York Times article Hillary Jacobs Hendel, a psychotherapist, writes about a patient who experienced what she calls “chronic shame.”
Hendel’s patient, Brian, had tried every type of treatment but electroconvulsive therapy, which he didn’t want to do. After meeting with him, she learned that he was neglected as a child.
During our initial sessions I developed a sense of what it was like to grow up in Brian’s home. Based on what he told me, I decided to treat him as a survivor of childhood neglect — a form of trauma. Even when two parents live under the same roof and provide the basics of care like food, shelter and physical safety, as Brian’s parents had, the child can be neglected if the parents do not bond emotionally with him … Brian had few memories of being held, comforted, played with or asked how he was doing.
Hendel says the “innate” response to this kind of environment is distress. Brian blamed himself for that distress, believing he was the reason why he felt so alone. He felt shame for being abnormal or wrong. “For the child, shaming himself is less terrifying than accepting that his caregivers can’t be counted on for comfort or connection.” This is called attachment trauma. It results from a child seeking safety and closeness from their parent — yet the parent is not close or safe.
Hendel also is a clinical supervisor with the AEDP Institute. She specializes in a treatment called accelerated experiential dynamic psychotherapy. Because Brian didn’t trust his own emotions, he was unable to use them as a compass for living, she explains. She aimed to use AEDP to bring this emotional life into awareness and allow Brian to experience his thoughts and emotions in an actively supportive environment.
Unlike traditional talk therapy, the therapist in AEDP is emotionally engaged and actively affirming. Hendel repeatedly grounded Brian into the present moment, as he still fought bouts of “wordless suffering.” When he was more stable they worked on validating his emotions and helping him to feel them fully. “When I noticed tears in his eyes, for example, I would encourage him to inhabit a stance of curiosity and openness to whatever he was feeling.” It sounds a lot like mindfulness — being in the moment and staying observant without judgment.
Over time Brian learned to express his feelings and practice self-compassion. In a way, he became the kind of parent he never had. Before treatment he had no template, no model for doing this.
What struck me the most about Brian’s story is how adversely affected we can be simply by having no model — not just having overtly bad ones. I didn’t have the caregiver who was distant, unfeeling, inaccessible, or uninvolved. I had the unsafe kind. My worth was very clearly communicated through physical violence and verbal abuse. But it’s no different. Depression is so inherent in childhood trauma it’s as natural to us as breathing.
What comes to mind for me is the feeling of being “unlovable,” and that is the seed of shame. The feelings of adults, whether expressly communicated or intuited by a child, become internalized and automatic. And the state of being alone and powerless is so pervasive we don’t even know how they shape our lives — even our treatment.
During my years in talk therapy, most of my sessions focused on my trauma history. Practical techniques from cognitive behavioral therapy were more often aimed at controlling my panic attacks and anxiety. Why didn’t we talk about depression? Why did I accept a prescription for anti-anxiety medication but not antidepressants? Because I had denied my depression for so long that I believed I was powerless.
When I had a panic attack, I knew something was wrong, but depression was different. A therapist wanting to talk about my depression felt like he or she were questioning my very existence. It was as if taking away sadness was pulling the rug out from under me. It was my way of life. When therapists asked how long I had experienced symptoms of depression, I didn’t understand the question. The answer was, “for as long as I can remember.”
It took a long time to face the fact that sadness wasn’t supposed to be something that lived in my shadow and took hours, weekends, weeks away from me while I sheltered in bed or in the bathtub wishing I could blink and no longer exist.
Trauma isolates, then depression keeps that person all to itself. If I could give anyone advice, it’s share. Talk to people about how you feel — especially your therapist. Join a Facebook group like Group Beyond Blue or the peer support forums on Psych Central. Don’t keep depression’s secrets.
Finding the roots of depression is illuminating, but it’s not enough. We’re all just looking for a model that helps us manage our emotions. If you see someone struggling, offer your support.
Rholes, W.S. & Simpson, J.A. (2004). Adult attachment: Theory, research, and clinical implications. New York: Guilford Press.
Freyd, J.J. (1996). Betrayal Trauma: The Logic of Forgetting Childhood Abuse. Cambridge, MA: Harvard University Press.
Bloom, S. L. & Farragher, B. (2010). Destroying Sanctuary: The Crisis in Human Service Delivery. New York: Oxford University Press.